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A new book critiques medicine

blogs.scientificamerican.com

181–190 of 198 posts

Re: A new book critiques medicine

#181
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 doesn't fix bad statistics. ML is really just a sexier way of saying real-time statistics with lots of data.

I would agree that ML is just statistics, but I also kind of think that a median approach to statistics in medicine are currently at an even poorer level of quality than the low bar set by typical ML, so there could be an improvement nonetheless.

Re: A new book critiques medicine

#182
post #69
post #13

Earlier quoted context omitted.

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…

I agree with you but in a different way :) (what follows its a long text written in bad English but I hope I'll manage to make my idea clear)

Regarding your idea that "By any standard of effectiveness, this is not looking good for pharmaceuticals": This is a very complex topic and I don't think anyone has a clear and objective view/explanation about this.

For example, we have a big problem with the antibiotics. We eat a lot of meat from animals that where treated with antibiotics. We "overuse" antibiotics. Etc. Because of this, new antibiotics-resistant bacteria appeared and classical antibiotics became less and less effective in fighting against them. How should we categorize this issue? Should we see it as a proof of the fact that medicines are not as effective as advertised? It's not a problem with antibiotics per se. Or as a proof that modern medicine is overrated? Medicine correctly identified the problem(bacteria) and the treatment(antibiotics). In reality it is a problem generated by mostly by the rising popularity of automedication, lack of basic medical/pharmaceutical education and urban myths (antibiotics are good for anything), medicines used on animals (which is not a problem of human medicine), and, I would say, only a tiny part of the problem is the treatments that unnecessarily include antibiotics and are prescribed by medicine doctors. But, let's say that we don't know anything about the above mentioned facts and we study some statistics. What would we think when seeing a clear correlation between the increase in the number of antibiotics and decrease of the effectiveness of the treatments? We could see it as a proof that "the quality of medicine drugs has decreased resulting in an increase of ineffective treatment".

The point I'm trying to make is that the reason why the effectiveness of many treatments decreased and now we have a decline in life expectancy it's a very complex issue and it's not fair to see it as simple as a fact failure of pharmaceutics or/and medicine.

Regarding your last statement, I think that we are not seeing improvements because our modern environment and life style has changed and is changing in such a rapid and unpredictable way that medicine can keep the pace. Medicine it's improving, but it's improving too slow. It is as out environment and lifestyle is traveling by plane while medicine and pharmaceutics are traveling by bus...

Re: A new book critiques medicine

#184

Earlier quoted context omitted.

> 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 il…

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

Given that different 'western' nations structure and pay for their health care systems entirely differently, there must be, mustn't there?

Or are you conflating "Western medicine" with "US medicine"?

Indeed you are:

> Medicine is an example of a huge market failure.

Re: A new book critiques medicine

#185

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 . 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 f…

> 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".

You've found one person who is wrong about one thing. Is it logical/prudent to then assume all "anti-vaxxers" are wrong, about everything that they believe?

Rather than assuming your ideological opponents are enemies, it might be worthwhile to put some effort into discovering their actual nature, and what their actual arguments are. As far as I can tell, your current perception is quite flawed (based on the reading I have done of conversations within the anti-vaxx community).

>> 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.

No, we don't. An absence of evidence is not evidence of absence.

https://www.cdc.gov/vaccinesafety/concerns/autism.html

Correct, epistemically sound statement: "studies have shown that there is no link between receiving vaccines and developing ASD"

Possibly correct, but epistemically flawed statement: "There is no link between receiving vaccines and developing ASD"

There is a difference between these two statements. Are you able to you see it?

> Pick your goddamned battles wisely friend.

I do. Thanks for your advice though.

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

I say the same to you in return. Based on recent news articles, the amount of vaccine cautious people, as a percentage of overall society, seems to be growing. Who is more responsible for this phenomenon - me, who recommends scientific honesty, or you, who opposes scientific honesty?

> One epidemic and the anti-vaxxers will be up against the wall.

I would argue that authoritarian thinking like this does not work in your favor.

Re: A new book critiques medicine

#186

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 . 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…

>> even if vaccines did cause autism (which they do not) > These sorts of comment lack epistemic humility/awareness. We do not know that vaccines do not cause autism. Science does not say this. This is technically correct, but it's very difficult to discuss against FUD. Let's try another example: Do vaccines cause earthquakes? Nah. Is it 100% scientifically proved that vaccines don't cause earthquakes? It looks very…

> So the conclusion is that scientist say that perhaps vaccines cause earthquakes? [What is a good answer here?]

Is this a similar comparison to what I've said (or implied), in the slightest? Might your imagination have added a bit of extra color to your reading of the actual words I wrote?

It may be enjoyable to mock lesser intelligent people, but if the intent of pro-vaxxers was purely concern about the prevalence and risk of vaccine misunderstanding throughout society, I would expect more willingness to understand what is really happening within the community you're worried about, and less (apparent) glee at simply telling people they're stupid.

At the end of the day, you will reap what you sow.

Re: A new book critiques medicine

#187
post #44

Earlier quoted context omitted.

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.

That leSs down the dangerous road that many who are against universal healthcare go down (not saying you were implying it). That most health problems are caused by poor decisions. These are the top 10 causes of death. https://www.cdc.gov/nchs/fastats/leading-causes-of-death.htm How many of those could be prevented by good diet, quality sleep and exercise?

You can't prevent death, only prolong life.

Most of those causes are accelerated by poor diet, poor sleep and lack of exercise.

Re: A new book critiques medicine

#188
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…

To add to this profane, yet important point: When you talk with NICU docs, their biggest complaint is the wires and tubes.

Often in a NICU there are wires and tubes everywhere. Operating or trying to help a babe invariably ends up with some person standing on some line and pinching it or ripping it out of the many many machines.

I'm super not kidding here. There are a TON of machines trying to keep the kiddo alive. Imagine a 5m sized cube filled with machines all trying to keep a kid the size of a breadbox breathing and the heart beating (or not, sometimes). It's a lot of carts, wires, amps, and waste heat in these rooms.

Wireless is not possible as a lot of the machines aren't sheilded properly or are activley trying to jam some frequency band for a medical purpose (MRIs). Wires are the only solution. Tubes filled with some form of fluid are also, obviously, not able to be wireless. Especailly when things get desperate, there are liquids, fluids, blood, tissues, urine, and saline everywhere as frantic nurses and docs trip over the tubes and pull them out of their machines.

You want to help the victims? Get rid of the wires. Stop dicking about with matrices.

Re: A new book critiques medicine

#189

Earlier quoted context omitted.

>> even if vaccines did cause autism (which they do not) > These sorts of comment lack epistemic humility/awareness. We do not know that vaccines do not cause autism. Science does not say this. This is technically correct, but it's very difficult to discuss against FUD. Let's try another example: Do vaccines cause earthquakes? Nah. Is it 100% scientifically proved that vaccines don't cause earthquakes? It looks very…

> So the conclusion is that scientist say that perhaps vaccines cause earthquakes? [What is a good answer here?] Is this a similar comparison to what I've said (or implied), in the slightest? Might your imagination have added a bit of extra color to your reading of the actual words I wrote? It may be enjoyable to mock lesser intelligent people, but if the intent of pro-vaxxers was purely concern about the prevalence…

We can't prove that vaccines don't cause autism. We can't prove that vaccines don't cause earthquakes. So they are similar. In both cases we only can show that the correlation is so small that we can't reject the null hypothesis. So the correct answer is an informal "Nah" instead of a formal "No".

> It may be enjoyable to mock lesser intelligent people,

No. But if you want to discuss epistemology, let's start with an easy example were we all agree that is false in spite there is no hard evidence. Sorry if it looked as a mock, but it was not my intention.

There are zealots and ridiculous claims in both sides, but at the end of the day smallpox is eradicated, polio is cornered (I hope to see the eradication day), meleases is reduced to very small levels (eradication looks more difficult). All of them used to kill a lot of people.

Re: A new book critiques medicine

#190

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.

Don't worry. (Almost?) All the traditional drugs that are effective have been stolen by Big Pharma and are now produced in mass and distributed in a more pure form (or perhaps with some chemical tweak to make it more safe, reduce the side effects, make it cheaper or easier to produce, or as part of an evil trick to get the patent).

So the effective ancient drugs are now part of medicine. Only the leftover are still classified as "traditional" medicine, so don't expect to find too much useful things there.

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