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A new book critiques medicine

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Re: A new book critiques medicine

#61

Post by maximente »

SiempreViernes wrote: post #50
mistermann wrote: post #30

Earlier quoted context omitted.

Would it be possible for you to be more specific about the ways in which the commenter is wrong?

Have tech solved the issues of a client changing their minds about what they want? Well, all the interesting bits of medicine are built on social interactions. You ask the patient where it hurts and they lie about where.

are those the same social interactions that explain why surgeons resisted using things like checklist because it was "beneath them", "they never make mistakes", etc.?

because if so i agree, there's some real low hanging fruit there.

Re: A new book critiques medicine

#62

Post by dkarl »

astura wrote: post #60
dkarl wrote: post #52

Earlier quoted context omitted.

My brother-in-law, who has a mental disability, saw a gastroenterologist for abdominal pain. They found worms and prescribed him a drug to get rid of the worms. The doctor said the worms could cause abdominal pain, but then again in most cases they don't, so he also put him on a drug for irritable bowel syndrome. After a couple of weeks, the stomach pain went away, but meanwhile my brother-in-law was having issues wi…

I actually suspect a fairly large amount of those prescriptions were for off label use. But... Seems like the sort of side effects these medicines have should give us a pause when using them on vulnerable populations. Especially when the benefits are not especially clear.

You're exactly right. IBS is a legit off-label use for the antidepressant my brother-in-law was prescribed. I suspect doctors hear about these off-label uses and don't weigh the psychoactive effects because they're writing the prescription for a physical problem.

Re: A new book critiques medicine

#63

Post by chronic7382 »

pixelmonkey wrote: post #20
codingslave wrote: post #9

I've long believed that once startups and tech companies get their hands on medical data (patient outcomes, medication treatment outcomes, mal practice rates, surgery outcomes) that a reckoning will take place on the medical industry. The level of legitimacy and respect that doctors and hospitals currently have is far too high, and hinges on branding and the exclusivity of becoming a doctor. Once all of this data bec…

"The level of legitimacy and respect that doctors and hospitals currently have is far too high, and hinges on branding and the exclusivity of becoming a doctor. Once all of this data becomes available, it will be obvious how worthless and expensive most medical treatments really are." I'm the spouse/partner of a recently-trained doctor, and I'm a programmer and startup founder with 2 decades of experience. With all r…

> I'm the spouse/partner of a recently-trained doctor, and I'm a programmer and startup founder with 2 decades of experience. With all respect, you have no friggen clue what you're talking about.

Then you should know very well that the entire MD education pipeline optimizes for rote memorization and regurgitation of facts (from undergrad pre-med all the way through post-residency fellowships). Any patient with even the slightest deviation from what the physician searched on WebMD is given generic advice similar to how fortune tellers recite generic phrases. If you have a non-standard question or health problem, go to 3 doctors (or even specialists) and you'll get 3 different answers.

I work closely with clinicians at Tier 1 urban medical institutions daily, both at the in-patient and outpatient settings. Most doctors are dumb as a rock.

Note: Physicians with a MD/PhD are much better at critical thinking and make more of an effort to solve your problem.

Re: A new book critiques medicine

#64

Post by RandomBacon »

julienreszka wrote: post #32
RandomBacon wrote: post #7

The anti-vaxxers think it is. We need to be careful how we say this, because then you get generalities like the title and people who shun the basic of medicines such as neccessary vacinations.

> "We need to be careful how we say this" Who is "we" ?

People who don't want to further misinformation.

Re: A new book critiques medicine

#65

Post by slfnflctd »

astura wrote: post #11

>The New York Times reported that in 2014 physicians wrote 83,000 prescriptions for antidepressants and almost 20,000 prescriptions for antipsychotic medications for infants two years old and younger Wow... This seems very obviously inappropriate. I listened to the EconoTalk interview referenced in TFA after hearing about it on another HN thread. Highly recommended. I have to say that I have become skeptical of medic…

The only way I can think of where that would make sense is if they're using them for off-label reasons (i.e. harnessing side effects to treat other classes of problems). Regardless, major red flags. We need to better understand what's happening here.

Re: A new book critiques medicine

#66

Post by [deleted] »

alyx wrote: post #36
RandomBacon wrote: post #7

The anti-vaxxers think it is. We need to be careful how we say this, because then you get generalities like the title and people who shun the basic of medicines such as neccessary vacinations.

Many "anti-vaxxers" are simply concerned parents. Considering that vaccines (in general) have been deemed "unavoidably unsafe" at the Supreme Court level, they are not completely unjustified in their fears. [0] Vaccine manufactures cannot be held liable. Thus there is a "National Vaccine Injury Compensation Program" put in place to compensate those that have been damaged by vaccinations. To date, over $4 billion doll…

[deleted]

Re: A new book critiques medicine

#67

Post by RandomBacon »

alyx wrote: post #36
RandomBacon wrote: post #7

The anti-vaxxers think it is. We need to be careful how we say this, because then you get generalities like the title and people who shun the basic of medicines such as neccessary vacinations.

Many "anti-vaxxers" are simply concerned parents. Considering that vaccines (in general) have been deemed "unavoidably unsafe" at the Supreme Court level, they are not completely unjustified in their fears. [0] Vaccine manufactures cannot be held liable. Thus there is a "National Vaccine Injury Compensation Program" put in place to compensate those that have been damaged by vaccinations. To date, over $4 billion doll…

The Supreme Court consists of zero medical doctors.

Do not take a legal opinion and present it as medical fact.

Re: A new book critiques medicine

#68

Post by agumonkey »

Reedx wrote: post #44
agumonkey wrote: post #29

Let me extend the query, is "modern medicine" overrated. Modern technology + western like urban lifestyle changed how we live.. and how much medicine we think we need. Walking in the woods is probably as effective as the average anti depressant. Good physical activity too. But we sell that modern life is great and that ailments are normal and that thanks to the medical field we have all these solutions.. that we prob…

Regular exercise, good diet and quality sleep prevent/solve most health problems. If exercise were in pill form, it'd be the most valuable pill.

Too bad gravity is free

Re: A new book critiques medicine

#69

Post by rjf72 »

sica07 wrote: post #13
codingslave wrote: post #9

I've long believed that once startups and tech companies get their hands on medical data (patient outcomes, medication treatment outcomes, mal practice rates, surgery outcomes) that a reckoning will take place on the medical industry. The level of legitimacy and respect that doctors and hospitals currently have is far too high, and hinges on branding and the exclusivity of becoming a doctor. Once all of this data bec…

There were and are a lot of articles about the fact that many prescription drugs and many treatments are overrated and I totally belive that. But saying that "most" medical treatments & prescription drugs are worthless it's quite a radical view based on... pure speculation.

I think your statement sounds perfectly reasonable, but it actually holds a pretty interesting corollary! If he is wrong that "most" medical treatments and prescriptions are worthless then that would necessarily mean that "most" are valuable. The reason this is interesting is because the exponentially increasing rate of both the amount of medication out there and the amount people are using. For instance from 1997 to 2016 the number of prescriptions filled grew from 2.4 billion to 4.5 billion [1]. And an exponentially increasing number of people, across all ages and demographics, are also being medicated with all sorts of drugs for various reasons.

So, if we assume that most medical treatments and prescriptions are not worthless we should see increases in healthfulness that are at least somewhat comparable with our increases in pharmaceutical usage. In reality we saw sharply diminishing returns on life expectancy that have now gradually shifted towards an ongoing decline in life expectancy over the past few years. By any standard of effectiveness, this is not looking good for pharmaceuticals.

So I suppose I'd turn it around. I think the view that medicines (and especially their recent exponential growth) are providing a substantial social benefit could be true, but it would seem to be the statement that needs to be explained. E.g. perhaps our own increasingly unhealthy lifestyles are contravening the gains from the medical technology? No idea there, but I do think occam's razor would tend to simply suggest that the reason we're not seeing improvements is because we're not improving.

[1] - https://www.webmd.com/drug-medication/news/20170803/american...

Re: A new book critiques medicine

#70

Post by 1e-9 »

Medications are a particular problem. It took decades of massive use for us to even realize that some of our most common over-the-counter drugs were being used in dangerous ways (e.g. aspirin can cause Reye's syndrome in children, Tylenol with alcohol can damage the liver). On top of that, I think drug interactions are a much larger problem than most people realize and that we have little idea of what we are doing to ourselves when we take multiple medications. A recent study [1] on just prescription drugs counted 220 million unique drug combinations experienced by a subset of the US population over intervals of about 3 years. How many of those combinations have been studied for safety? I'll make a wild guess that it's probably far less than 1%. I think it prudent to minimize one's medication exposure to the bare minimum that is absolutely necessary.

[1] https://www.nature.com/articles/sdata2017167

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