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A new book critiques medicine

blogs.scientificamerican.com

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Re: A new book critiques medicine

#111

Post by chronic7382 »

rscho wrote: post #104
chronic7382 wrote: post #63

Earlier quoted context omitted.

> 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.

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

No, medical education does not have to be this way. It is purely gatekeeping.

It's similar to how "You need a PhD" to land top AI/ML jobs. That's gatekeeping as well, though it is slowly changing.

Not many doctors or AI researchers will openly state this gatekeeping because they benefit, at the expense of those not in their field.

Re: A new book critiques medicine

#112

Post by coldtea »

rscho wrote: post #107
coldtea wrote: post #106

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. 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.

>and often even identical but in a far less controlled form

I dunno, I'd trust something used for centuries (given it doesn't kill its users) over something hastily discovered, sorta understood, and rushed to market (after being extracted and distilled in the most potent chemical form) for profit...

At least traditional remedies/drugs don't have the "let's rush this to make a buck" nor the profit motive involved (well, people selling them today want to make a profit, but I'm talking about actual traditional drugs, used for millennia, and which anybody could e.g. just grow/distill/whatever in their country, so there was no exclusivity thing)...

Re: A new book critiques medicine

#113

Post by wolco »

neural_thing wrote: post #57
wolco wrote: post #33

Earlier quoted context omitted.

We've started with ubiome/23andme providing customers data previously not available. Another area is improving existing processes. We see techniques where photos are being read more accurately and quickly compared to manual processes. Medicine now resolves around tests. Those can be improved and automated. We will see tools that will empower personal medicine and shift the power balance away from the family clinics.

To be fair, ubiome is a fraud, and (anecdote) 23andme made a mistake in reading my genome and their data showed that I had an incredibly deadly cancer predisposition (Li-Fraumeni), which a reputable medical lab showed to be false.

ubiome is a ycombinator company.

Why would you call them a fraud. I've done a number of tests over a period after antiobiotics and I definately saw the change into diversity correlate with the foods I introduced.

Re: A new book critiques medicine

#114

Post by rscho »

chronic7382 wrote: post #111
rscho wrote: post #104

Earlier quoted context omitted.

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.

> What you don't perceive is why medical education has to be that way in the current state of affairs. Yes, has to. No, medical education does not have to be this way. It is purely gatekeeping. It's similar to how "You need a PhD" to land top AI/ML jobs. That's gatekeeping as well, though it is slowly changing. Not many doctors or AI researchers will openly state this gatekeeping because they benefit, at the expense…

Nope, not gatekeeping. I know I won't convince you, but just think about that:

Most parts of the country are approximately medical deserts. So once you're educated, you are dispatched to said desert. Your hospital has standard pathways where nursing teams operate. Problem is, everything that escapes the standard pathway comes your way with no one to help you.

"Yeah, but there's UpToDate, MEDLINE, etc.". Well, no. NO! You simply don't have the time. Your job is to operate as a well-oiled machine to handle all the impromptu shit 70+ hours/week. That's why you did all this rote memorization.

A doctor is not an engineer. He is trained for a hostile environment where you have no time to think or search. As long as automation can't help (and it currently can't), docs are bound to memorization training.

Re: A new book critiques medicine

#115

Post by detaro »

wolco wrote: post #113
neural_thing wrote: post #57

Earlier quoted context omitted.

To be fair, ubiome is a fraud, and (anecdote) 23andme made a mistake in reading my genome and their data showed that I had an incredibly deadly cancer predisposition (Li-Fraumeni), which a reputable medical lab showed to be false.

ubiome is a ycombinator company. Why would you call them a fraud. I've done a number of tests over a period after antiobiotics and I definately saw the change into diversity correlate with the foods I introduced.

They've been raided by the FBI for insurance fraud, they reportedly conducted "tests" using samples that hadn't been stored properly, their CEOs/founders have resigned, they've let half their staff go recently and currently are not capable of actually doing testing ...

That's not saying that they never produced useful data, but ...

Re: A new book critiques medicine

#117

Post by alkonaut »

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.

As opposed to something holistic but still scientific. By “holistic” I mean that western medicine divides specializations too much and anything that doesn’t fit one box just falls outside everyone’s field. Generalist doctors aren’t very holistic either - they tend to just treat very common things or refer to a specialist.

Example: if you have abdominal pains, you will be referred to a gastrointestinal specialist. After some tests and maybe a gastroscopy they will diagnose or rule out the common things: ulcers, celiac disease etc. This is what modern western medicine excels at. They find and cure the likely things quickly. They can often rule out the dangerous things like cancer.

But now imagine for a second that the abdominal pain actually was a manifestation of a back disc issue. Few gastrointestinal specialists would find that and say “I think your back is the real problem and the gut pain is just a secondary symptom”. And you have already been referred as far “down” in the specialist chain as you can. This is when people start fumbling after alternatives.

Note that there is nothing “non western” about having a more more holistic (less narrowly specialized) perspective on medicine, it’s just something that is hard so doesn’t get much attention. Perhaps the traditional specializations should be restructured? We are now seeing some headway such as the connection between gut bacteria and mental health for example.

Re: A new book critiques medicine

#118

Post by lonelappde »

dkarl wrote: post #62
astura wrote: post #60

Earlier quoted context omitted.

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.

How is that an acceptable side effect for approving an off label use?

Re: A new book critiques medicine

#119

Post by lonelappde »

bdamm wrote: post #47
klenwell wrote: post #37

Earlier quoted context omitted.

> Once all of this data becomes available, it will be obvious how worthless and expensive most medical treatments really are. Most prescription drugs do nothing, and the ones that do something are more so just covering the symptoms. I've read Bad Pharma (and will recommend it to anyone interested in this subject). And one way to summarize (perhaps oversimplify) it is: pharmaceutical corporations manipulate data to ju…

I briefly worked for a startup back in 2005 that was doing data analysis on prescriptions to reverse analyze a patient's conditions. The customers were the insurance companies.

How does that work? Insurance companies have access to all the prescription purchase and tests ordered,but not the diagnoses?

Re: A new book critiques medicine

#120

Post by jcims »

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.

You touched on something there that has been a pet peeve of mine for ages. People dismissing treatments like accupunture wholesale because there’s no scientific evidence for Qi. So what? It’s the effect we’re interested in, not the explanation.
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