A new book critiques medicine • Hacker News Board

Re: A new book critiques medicine

#101

Post by arkades » Sun, Jul 14, 2019, 9:58 PM UTC

tptacek wrote: post #92

dang wrote: post #85

Earlier quoted context omitted.

> 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 .

I winced at this comment too, because of that line, but have to point out that the "other side" of this argument could stand to be a lot more respectful as well. The "most doctors are dumb" sentiment on this thread fits the caricature lots of people have in their heads about how "HN people" think.

I don't really think it's a caricature.

"Doctors are idiots following algorithms and don't actually have any knowledge or information and just scam everyone for money all the time until their eventual replacement by the first person who thinks of feeding electronic medical records to machine learning algos" would cover about 95% of HN comments in these sorts of threads. You might cover another 2% with variants of "there's no point in going to a doctor for your problem, any decent engineer can just spend a few dozen hours reading up on their problem and figure it out just as well."

It's gotten to the point where I only chime in once in a while when the thread has gone deeply, deeply, off the deep end. But then, HN seems to have variants of that attitude towards pretty much every profession that doesn't have an engineering degree.

Re: A new book critiques medicine

#102

Post by arkades » Sun, Jul 14, 2019, 9:59 PM UTC

chronic7382 wrote: post #63

pixelmonkey wrote: post #20

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…

And there's no Dunning-Kruger effect at play here, at all. You're entirely equipped to evaluate highly-trained technical specialists in a field not your own.

Re: A new book critiques medicine

#103

Post by rscho » Sun, Jul 14, 2019, 10:00 PM UTC

drcode wrote: post #18

lukeschlather wrote: post #14

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…

Yeah you see that's the problem. The raw data is not there, because we don't have the necessary information retrieval capability yet.

Data is really sparse and of the worst quality. It is interesting that the hype is exactly the opposite: big bad hospitals keep essential info for themselves.

Re: A new book critiques medicine

#104

Post by rscho » Sun, Jul 14, 2019, 10:06 PM UTC

chronic7382 wrote: post #63

pixelmonkey wrote: post #20

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…

What you don't perceive is why medical education has to be that way in the current state of affairs. Yes, has to.

You may be brilliant at other things, but your analysis of this particular problem is no better than the doctors you describe.

Re: A new book critiques medicine

#105

Post by rscho » Sun, Jul 14, 2019, 10:14 PM UTC

arkades wrote: post #95

codingdave wrote: post #42

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…

> 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. I mean, you're not wrong, but... No one pays docs to do this. The overpriced insurance that's squeezing you dry pays the doc peanuts for his time on your case. Most docs get allotted something like 15 minutes, all-in, per patient: see you, talk to…

Spoken from true experience! I, as most MDs will, totally agree.

Re: A new book critiques medicine

#106

Post by coldtea » Sun, Jul 14, 2019, 10:15 PM UTC

crispinb wrote: post #87

codingdave wrote: post #42

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.

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

That's not really true. Their explanations can be hocus pocus, but their mechanics/drugs/techniques can be as effective as western versions, simply come around by tradition/trial and error/Lindy effect and so on for millennia.

Re: A new book critiques medicine

#107

Post by rscho » Sun, Jul 14, 2019, 10:18 PM UTC

coldtea wrote: post #106

crispinb wrote: post #87

Earlier quoted context omitted.

'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.

> 'Western' medicine though as opposed to what? Nostalgic prescientific systems such as Chinese, ayurvedic, etc don't do anything at all. That's not really true. Their explanations can be hocus pocus, but their mechanics/drugs/techniques can be as effective as western versions, simply come around by tradition/trial and error/Lindy effect and so on for millennia.

As effective as western versions, and often even identical but in a far less controlled form. Also often just as toxic.

Re: A new book critiques medicine

#108

Post by rscho » Sun, Jul 14, 2019, 10:24 PM UTC

rhinoceraptor wrote: post #51

pixelmonkey wrote: post #20

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…

Yes, doctors are very smart and well trained. But medicine as a whole has a lot of completely insane practices. For example, have you ever tried to sleep in a hospital? They generally run very cool, daylight temperature lights 24/7, with tons of noisy machines, and the nurses wake patients every hour. And it's not just the patients who are getting their circadian rhythms destroyed, the residents themselves are doing…

Because money. You may become sick and have to deal with a sleep-deprived doc someday. But you have to pay said doc every month as sure as the sun rises. Plus, being sick only happens to others, right?

Re: A new book critiques medicine

#109

Post by carapace » Sun, Jul 14, 2019, 10:26 PM UTC

mistermann wrote: post #99

carapace wrote: post #81

Earlier quoted context omitted.

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 .

> 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 . Are the "anti-vaxxer lunatics" arguing that vaccines are not a net benefit? When you refer to "anti-vaxxer lunatics", who is it, exactly , are you referring to? Are you referring to specific people ( e…

> When you refer to "anti-vaxxer lunatics", who is it, exactly, are you referring to?

I'm referring to the old lady I met in the park while I was walking the dog who insisted that her homeopathic "doctor" had the authority to tell her that "vaccines cause autism".

> We do not know that vaccines do not cause autism.

I get what you're trying to say, but no. In this case yes, we do.

Pick your goddamned battles wisely friend.

Don't play Russian Roulette with other people's children.

(One epidemic and the anti-vaxxers will be up against the wall. Or we can shame the ever-loving-shit out of them and maybe prevent the suffering entirely. It's gaoddamned insane that we even have this problem. Image search polio, image search measles. Lord have mercy.)

Re: A new book critiques medicine

#110

Post by 1e-9 » Sun, Jul 14, 2019, 10:29 PM UTC

IggleSniggle wrote: post #91

1e-9 wrote: post #82

Earlier quoted context omitted.

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…

Reducing fevers is a mixed bag. Yes, the higher temperature may help fight the disease (or might do nothing, totally dependent on the diseases suitability for reproduction at higher temperature). Yes, it can also damage your body if it gets out of control. And yes, sleep is also good for fighting off illness, and a fever can get in the way of that. Just because it is your bodies natural response doesn’t mean it’s goi…

True, but cases of fever harming the body are extremely rare. The fact that mammals, reptiles, and even insects, increase their body temperature to fight pathogens suggests that fever confers significant survival advantage and that our null hypothesis should always be that it is helping us unless we have strong evidence to the contrary. I agree that sometimes (rarely) our immune system does get it wrong in a serious way such that medication is crucial (for example, anaphylaxis); however, most immune system misfires are minor and do not justify the risk of medications with poorly understood side effects and interactions. Oftentimes, there is a good alternative to medication. For example, when I have sinus congestion, I can almost always find a head orientation that allows me to breath and sleep.