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A new book critiques medicine

blogs.scientificamerican.com

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Re: A new book critiques medicine

#171

Post by alkonaut »

kirrent wrote: post #134
alkonaut wrote: post #117

Earlier quoted context omitted.

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. Aft…

> 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”. What are you talking about? Referred pain is well known and any doctor and especially any specialist will have studied and be familiar with common and likely referred pain…

> what more do you want from them than ruling out a gastrological cause?

I just want to get rid of the abdominal pain - I really don’t care about whether the cause is actually gastrointestinal. I want to rule out illness, that they are good at.

If the referred pain isn’t a known condition such as a herniated disc or anything else that shows up on a test o image - then they are usually not concerned at all (no illness - job done). And even if it is a known/visible cause outside their specialization, they are extremely bad in my experience at both recognizing and “referring sideways” to another specialist.

I live under a single payer system so the economics probably don’t factor into it, but I think the siloed thinking at specialists requires that the generalists take a holistic perspective, but in reality they cure tonsillitis and point to specialists. Somewhere I feel there is a gap.

Re: A new book critiques medicine

#172

Post by Aloha »

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…

I consider myself lucky when I find a doctor who acts as a people mechanic rather than a clinician.

Re: A new book critiques medicine

#173

Post by arpa »

rscho wrote: post #130

I would like to make a personal statement to the tech community in view of this thread's comments: A vast majority of you drastically overestimate the information processing and retrieval of the healthcare system. We MDs can all see your superb AI/ML results in journals, and yes you can improve things with technology. What we can't see is how we're going to use it. In my day-to-day job, there are a myriad of new-supe…

Yes! healthcare informatics is so much more than just dispensing magical vitamins, when MDs and patients need painkillers. We have had terms like PHR and EHR for thirty years now, we have HL7, together with FHIR, and we have PACS, but these terms are still not ubiquitous. There has been major developments in developing classifiers like SNOMED, AHCI and ICD, yet MDs mostly still type the diagnosis up, and consider themselves lucky if the HIS has some templating capability. And very few HISes are capable of getting the personal health records to the patient - i mean, it is more likely you get a xerox of your case than something in a portable format that other HISes can understand if you change your healtcare provider...

However, it is somewhat strange that personal health projects keep dying - google health discontinued in 2011, microsoft healthvault to be closed in 2019 - and these are by major players - maybe somebody has some insight why they fail?

Re: A new book critiques medicine

#174

Post by darawk »

rscho wrote: post #126
jcims wrote: post #123

Earlier quoted context omitted.

How do I pay a doc for their time? I just sent emails to 35 different PIs this morning trying to find the most suitable clinical trial for my wife. I’ve learned a bit in the process but I’m still funtionally illiterate. Both of the oncologists we are working with just look for trials out of their location. When i ask what else is out there they point me to clinicaltrials.gov and say Godspeed.

First, let me say that I'm sorry that harm seems to have come your way. Second, unless you are extremely rich and can privately employ a doctor like a saudi prince would do, I do not know of any (non-forbidden) way to directly pay your doc for his time. Hopefully I'll stand corrected. Third, and that's the most important, primarily allocate your money to proven treatment. Clinical trials are not designed to help part…

There are a lot of doctors now that don't take insurance, and that you pay on retainer. The phrase you want to google here is "concierge medicine". It's definitely expensive, but not Saudi prince expensive.

Re: A new book critiques medicine

#175

Post by kolinko »

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 holistic. Western medicine is excellent when you can diagnose a specific single issue and fix it.

For issues that don't have a single-specific cause, the western medicine won't help much - it can cover specific symptoms, and tell you to do more sport, fix your diet and go to a therapist.

Example - all kinds of chronic pain (IBS etc), chronic tiredness, etc. Doctors will order all kinds of tests, and if there is no clear single issue, they won't help you.

Eastern/holistic medicine may not be perfect, but if science-backed options are exhausted, it's all there is.

Also, with all my respect and sympathy towards strict science, it has it's limitations - especially when it comes to complicated systems. That's why nobody argues for using science-based methods of running startups :)

Finally, fun fact, if we use current medical criteria, parachutes were never proven to work. No double-blind placebo-controlled human trials. :)

Re: A new book critiques medicine

#176

Post by Elrac »

rscho wrote: post #126
jcims wrote: post #123

Earlier quoted context omitted.

How do I pay a doc for their time? I just sent emails to 35 different PIs this morning trying to find the most suitable clinical trial for my wife. I’ve learned a bit in the process but I’m still funtionally illiterate. Both of the oncologists we are working with just look for trials out of their location. When i ask what else is out there they point me to clinicaltrials.gov and say Godspeed.

First, let me say that I'm sorry that harm seems to have come your way. Second, unless you are extremely rich and can privately employ a doctor like a saudi prince would do, I do not know of any (non-forbidden) way to directly pay your doc for his time. Hopefully I'll stand corrected. Third, and that's the most important, primarily allocate your money to proven treatment. Clinical trials are not designed to help part…

I'm guessing that what you're saying implicitly applies to the USA. Just for a bit of perspective, I'd like to describe what this experience looks like for me as a resident of Germany, a developed and prosperous country that isn't the US!

The German government mandates making public-option insurance available for everybody, and exercises some of control on drug and treatment prices. That means everybody is eligible for "standard" run-of-the-mill treatment for any illness. Referral to specialists is doled out by GPs, and there may be inconvenient wait time for non-emergency treatments. Prescribed drugs may be generic rather than top-tier. Various forms of quackery, i.e. drugs and treatments without good evidence of efficacy, are not covered by public-option insurance; examples include acupuncture and applications of chiropractic not directly applicable to skeletal motion, i.e. Palmer-esque "subluxation" treatment. Placebos are non-reimbursable here, but homeopathy is still covered in Germany so it's available for placebo use, though it's being excluded in other countries. Patients can opt for non-standard products, though, if they're willing to foot the bill personally.

Anyone with, I'll say, "upper middle class income," though, can opt out of public health insurance and sign up with a private insurance of their choice. For employees, half of the cost of private medical insurance is paid by the employer. Private insurers must cover at least the same drugs and treatments as public insurance but both commodities can be invoiced at much higher rates; 2x and more is common. This makes private patients like myself very attractive to doctors and hospitals, of course, and we get all kinds of preferential treatment. Yes, this results in a 2 class society with regard to medical treatment and I enjoy the opportunity to be in the upper class in exchange for paying higher premiums. I can access any doctor of my choice, including specialists, and those doctors can recommend any product. Private insurers also won't pay for just anything but there's more leeway and of course there's always the option of paying out of pocket for anything that's not reimbursed. While medical services will typically carry a steep (usually reimbursed) surcharge, drugs mostly cost the same for everybody and will be reimbursed if they pass muster as medically necessary and effective.

I've heard of clinical trials advertising for volunteers, but I think policy on those is similar to what you describe: a trial isn't a treatment option for just anyone who wants it.

Re: A new book critiques medicine

#177

Post by crispinb »

kolinko wrote: post #175
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.

As opposed to holistic. Western medicine is excellent when you can diagnose a specific single issue and fix it. For issues that don't have a single-specific cause, the western medicine won't help much - it can cover specific symptoms, and tell you to do more sport, fix your diet and go to a therapist. Example - all kinds of chronic pain (IBS etc), chronic tiredness, etc. Doctors will order all kinds of tests, and if…

it has it's limitations - especially when it comes to complicated systems.

I agree - the science of complexity is in its infancy (as I mentioned in the parent).

But your conclusion doesn't remotely follow. That there are conditions scientific medicine isn't yet much help with (truly!) does not connote that non-scientific systems must therefore do better.

Eastern/holistic medicine may not be perfect, but if science-backed options are exhausted, it's all there is.

But the treatments promoted by the major medival 'Eastern' systems don't work. You don't need a new understanding of complexity to demonstrate this - you give sick people the treatments, and see if they get better. They don't. So 'all there is' in this case is nothing.

Hardly surprising from a prior plausibility angle: the 'whole' their so-called 'holistic' rubrics work with (chakras, qi, etc) are old metaphysical fictions.

Re: A new book critiques medicine

#178

Post by kowdermeister »

rscho wrote: post #130

I would like to make a personal statement to the tech community in view of this thread's comments: A vast majority of you drastically overestimate the information processing and retrieval of the healthcare system. We MDs can all see your superb AI/ML results in journals, and yes you can improve things with technology. What we can't see is how we're going to use it. In my day-to-day job, there are a myriad of new-supe…

You are shooting at one sector of tech (researchers) and expecting innovation from another market focused segment (startups to bio tech firms), not really fair :)

Probably the huge amount of bureaucracy and regulation keeps medical focused IT in its shit pool of separate islands.

Maybe you should campaign for state regulation mandating to create a HMTL / W3 like standard for data sharing that's mandatory to use.

Re: A new book critiques medicine

#179

Post by TheOtherHobbes »

kirrent wrote: post #134
alkonaut wrote: post #117

Earlier quoted context omitted.

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. Aft…

> 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”. What are you talking about? Referred pain is well known and any doctor and especially any specialist will have studied and be familiar with common and likely referred pain…

I'm not sure there's a huge distinction between "how we structure and pay for our healthcare systems" and "western medicine."

As for the holistic view - there's a difference between check-list diagnosis (left arm pain -> possible heart attack) and what is effectively personal medical research, which may require knowledge of everything from diet to sleeping habits to emotional stressors to historical infections and illnesses. (That's a very short list, and not in any way exhaustive.)

There are limited professional incentives for doctors to dig into patient history with that level of detail. It's not a matter of specialist referrals, because some problems can be caused by multiple minor factors interacting with each other. Or they may have very generic symptoms, like fatigue, with a ridiculously huge number of possible causes. Or the causes still aren't understood.

Medicine is an example of a huge market failure. Not only is it the single biggest cause of personal bankruptcy in the US, but most people have had personal experience of obvious delayed diagnosis or outright misdiagnosis.

An effective market - rather than a "rational" one - could easily support a much larger number of doctors and supporting medical professionals, including non-corporate researchers. The effect on "western medicine" would be a dramatic increase in effectiveness.

Re: A new book critiques medicine

#180

Post by drcode »

sidlls wrote: post #53
drcode wrote: post #18

Earlier quoted context omitted.

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 is not in a state to be of much use in this context. Source: me, I work as a data scientist to apply ML and other techniques, with claims, EHR, and a bunch of other data, specifically for the purpose of identification of conditions, effectiveness of treatments and non-medical intervention. The tech world is very much in a condition of being unjustifiably arrogant about its ability to solve problems in this space.…

I kind of agree- A rigorous solution to this problem would probably involve running large numbers of (human?) cell cultures with deep analysis fed through ML systems. i.e. we first need to have a full understanding of cell chemistry/physiology and then scale it up to larger organs and the whole human organism.
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