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A new book critiques medicine

blogs.scientificamerican.com

81–90 of 198 posts

Re: A new book critiques medicine

#81

> 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) Agreed, but then to some degree could this same argument not be made about vaccines?

No. It's pretty clear, even if the anti-vaxxer lunatics were not wrong (which they are, they are wrong, they are perniciously wrong, in the face of all evidence they are wrong), that vaccines would be a net benefit.

In other words, even if vaccines did cause autism (which they do not) it would still be imperative to use them. The alternative to widespread vaccination is much worse.

Re: A new book critiques medicine

#82

> 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) Agreed, but then to some degree could this same argument not be made about vaccines?

I place vaccines in the "absolutely necessary" category where the known benefit far outweighs the known risk. In the case of aspirin and Tylenol, I think they are most often used in unnecessary ways such as lowering fever and addressing minor aches and pains. Fever is actually a physiological defense against pathogens, which should almost never be countered. Minor aches and pains are typically useful for encouraging us to follow beneficial behavior (e.g. rest, sleep, don't move in certain ways).

Re: A new book critiques medicine

#83
post #36

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…

From your [0]:

> Whereas between 1978 and 1981 only nine product-liability suits were filed against DTP manufactur-ers, by the mid-1980’s the suits numbered more than 200 each year.6 This destabilized the DTP vaccine market, causing two of the three domestic manufacturers to with-draw; and the remaining manufacturer, Lederle Laborato-ries, estimated that its potential tort liability exceeded itsannual sales by a factor of 200.

So did vaccines suddenly become dangerous after 1980? Or did people develop irrational fear?

If you read further it plainly says that the "National Vaccine Injury Compensation Program" was started to mollify these anti-vaxxers to try to get them to vaccinate:

> significant number of parents were already declining vaccination for their children,10 and concerns about compensation threatened to depress vaccination rates even further.11 This was a source of concern to public health officials, since vaccines are effective in preventing out-breaks of disease only if a large percentage of the population is vaccinated.12

> To stabilize the vaccine market and facilitate compensa-tion, Congress enacted the NCVIA in 1986.

Re: A new book critiques medicine

#84
post #36

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…

I think you're misreading the supreme court ruling because you're misinterpreting the term unavoidably unsafe.

"In short, “unavoidably unsafe” is simply a legal term that means the manufacture is not liable because they cannot do anything to make the product safer. It does not mean that the product is dangerous and should be avoided."

This could apply to peanut butter because of peanut butter allergies. The manufacture is not liable for someone who dies of a peanut butter allergy when they eat peanut butter because this is not due to manufacturing defects but is due to the inherent nature of peanut butter being "unavoidable unsafe".

This does't mean peanut butter or vaccines are dangerous.

Re: A new book critiques medicine

#85

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…

> you have no friggen clue what you're talking about

Please do better than this, regardless of how wrong or ignorant another comment is. Your post gives us no information other than about yourself.

If you know more, please share some of what you know so the rest of us can learn. Please don't just name-call. This is in the site guidelines: https://news.ycombinator.com/newsguidelines.html.

Re: A new book critiques medicine

#86
post #18

Earlier quoted context omitted.

How would a startup make money by showing that treatments are worthless? Startups are going to have the same incentives as other pharmaceutical companies.

Well, the hope I have (and OP probably as well) is that machine learning techniques properly applied to the raw data could uncover a lot of statistical errors in the historical literature, which could be both profitable and disruptive. ... Unfortunately, this may happen first in countries with poor human rights records (i.e. China) because there is likely a greater availability of patient data under those circumstanc…

ML will simply be used to find all sorts of new spurious correlations that will spawn a whole new flood of unnecessary medications and treatments. After all, statistics puts a whole lot more care into avoiding those sorts of errors than ML and, well, here we are anyway. Technology doesn't solve societal problems.

Re: A new book critiques medicine

#87

I've always looked at western medicine as if it was the best car mechanic you can hire, just for your body. If your problem is mechanical, they can solve it. Surgical techniques are amazing. Breakdowns in known processes can be fixed. But if the problem doesn't fit those known processes, isn't mechanical, and you are relying on doctor for real troubleshooting of problems, that is where it falls short. You can fall in…

'Western' medicine though as opposed to what? Nostalgic prescientific systems such as Chinese, ayurvedic, etc don't do anything at all.

So yes, scientific medicine definitely has huge lacunae. Given the relative slowness of progress in understanding complex systems science has had in general, they'll be there for a long to come. But it's not as if there's some other candidate 'system' that has a better understanding.

Re: A new book critiques medicine

#88

Earlier quoted context omitted.

"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 t…

I can second this! I studied medicine for two years in a SE Asian country. My late dad was a doctor. Both of my host family parents are doctors in the US. My gf is a doctor.

The main reason I left med school and decided to study math and comp sci. is because of the need of rote memorization necessary in medical training. This is especially worse in the US because the system here requires 4 yrs (undergrad) + 4 yrs (med school) + 3 yrs (residency) = 11 years of training to become a doctor. In contrast, it takes 5 yrs (med school) + 2-3 yrs (residency) of training to become a doctor in my home country.

The journey to become a doctor in the US is unnecessarily lengthy and it makes doctors feel more entitled (because they have spent a lot of time and money as investment) to charge exorbitant fees despite what most of them are doing is simply prescribing antibiotics; analgesic; insulin; and garden-variety stuff (or read up "Up-to-date" [https://www.uptodate.com/home] to refresh on what they learned or what the current consensus treatment is).

Most of them do the same thing day-in-day-out. Sure, there may be some specialists that are top notch, but they are like the minority and even their work is mostly about being able to keep steady hand and cool head during emergency situations.

Re: A new book critiques medicine

#89

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…

>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.

Startups have been going at this problem for years and years already and have had the data. I've worked at them. You know what the goal of most of those startups was? To make money. Patients were a means to an end. If they helped people, it was a thing that happened but not the actual goal.

See, actually trying to help patients and do so responsibly and not just cause a bigger mess is hard. Medicine is complicated, people are complicated, the health system is complicated. Easier to just ignore all that, make some money and sell out before people realize all you did was funnel some money around.

>Once all of this data becomes available, it will be obvious how worthless and expensive most medical treatments really are.

There's plenty of existing literature that notes various medical treatments are worthless. Yet they still happen and are still prescribed and are still paid for. Knowledge doesn't change behavior.

>HIPAA laws are hiding patient outcomes and holding this whole sham afloat.

You can easily get medical billing data for a massive percentage of the US population which includes doctors, dates, procedures, diagnoses and aggregated costs. De-identified but that doesn't matter for these sorts of things.

edit: Also, what is probably the biggest hurdle for health care startups isn't data. It's the fact that AB testing, the cornerstone of how every tech company iterates, is considered unethical except in very constrained forms. Something about there being a difference between crashing the web page of 1% of your customers versus literally killing 1% of your customers.

Re: A new book critiques medicine

#90

> 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) Agreed, but then to some degree could this same argument not be made about vaccines?

Vaccines prevent disease and keep it from spreading. Preventing a problem from happening in the first place is and will always be the best solution.

Unfortunately they're a victim of their own success. They've done such a phenomenal job people scarcely remember why we use them at all.

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