We’re a Lot Better at Fighting Cancer Than We Realized • Hacker News Board

Re: We’re a Lot Better at Fighting Cancer Than We Realized

#121

Post by whatshisface » Sat, Aug 01, 2020, 10:11 PM UTC

arcticbull wrote: post #108

libraryatnight wrote: post #92

Earlier quoted context omitted.

In some ways I do practice my own medicine and doctors are just QA. I know when I need antibiotics, or I have a strong hunch, I just need them to confirm and write the script (They do this over apps now). My GP wasn't much help with a problem I was having, so I had to track down a specialist who would listen, eventually I was found to be RIGHT, and again just needed the doctor to write the script. Not saying they don…

> I know when I need antibiotics, or I have a strong hunch, I just need them to confirm and write the script (They do this over apps now). Frequently people do not know when or if they need antibiotics. People often end up taking antibiotics for viral infections (which do nothing). The CDC points out that taking antibiotics for viral infections can do more harm than good [1] and this leads to antibiotic resistance [2…

You are overlooking the role of intelligence in the success rates of anything you try to do yourself. Fixing your car, running a business, investing and researching your own disease are all tasks that some people are far more likely to succeed at than others.

Re: We’re a Lot Better at Fighting Cancer Than We Realized

#122

Post by Gatsky » Sat, Aug 01, 2020, 10:11 PM UTC

Cancer is the most difficult health problem humans face. It will still be there long after we conquer neurodegeneration, atherosclerosis and diabetes. It is a major failure mode of all multicellular life. Dinosaurs got cancer. Every animal from mice to elephants gets cancer. It is startlingly common in humans. The cellular pathways altered in cancer existed before animals existed. It is an inescapable hangover from our evolutionary origins as unicellular organisms.

The only way to beat cancer is to upgrade the human organism to design out anachronistic evolutionary trade offs and prevent cancer development. The way we treat cancer now - the slash, burn, poison, hunt paradigm - is inhumane, expensive, and of limited effectiveness.

Re: We’re a Lot Better at Fighting Cancer Than We Realized

#123

Post by codecamper » Sat, Aug 01, 2020, 10:13 PM UTC

arcticbull wrote: post #41

callmeal wrote: post #27

Earlier quoted context omitted.

>I'm curious about what kind of cancer masquerades as iron deficiency, an infection, and a benign tumor? The kind of cancer where the patient can be easily dismissed by the doctor because of course they know best.

"...doctor because of course they know best" is a really strange thing to say. I don't mean to invoke paternalism here -- but between a patient with Google and a doctor with years of medical training, residency and practice, they more than likely do know best. At least, better than the patient. They won't always be right, and you can ask for a second opinion, but they do know better. If they didn't, you could practic…

How old are you? How much experience with medical doctors have you had or the people you love had?

I've had nothing but bad experience. Complete crap on every count.

Re: We’re a Lot Better at Fighting Cancer Than We Realized

#124

Post by danieltillett » Sat, Aug 01, 2020, 10:19 PM UTC

vharuck wrote: post #71

DanBC wrote: post #31

Earlier quoted context omitted.

> Specifically, the U.S. has the best cancer survival rates in the world. This is a misunderstanding of what "5 year survival rate" means. You're missing "lead time bias", and "over diagnosis bias". From Risk Savvy by Gerd Gigerenzer --begin quote While running for president of the United States, former New York City mayor Rudy Giuliani said in a 2007 campaign advertisement:1 "I had prostate cancer, 5, 6 years ago. M…

Funny thing: in my job, I've calculated the relative survival rate of prostate cancer (the difference in mortality risk between people diagnosed and a similar population in age, sex, and race). Cause of death is not considered, only that there was a diagnosis (avoids complicate deaths and captures indirect influence). It'll often be that men diagnosed with prostate cancer have a better 5-year survival rate than men w…

Does this correlation still hold if you look at men below a certain age? Since prostate cancer increases with age then you could get a bias towards the more healthy as the non-prostate cancer peers die earlier of some others cause.

Re: We’re a Lot Better at Fighting Cancer Than We Realized

#125

Post by sangfroid_bio » Sat, Aug 01, 2020, 10:40 PM UTC

bserge wrote: post #67

trynewideas wrote: post #5

From a science and pharmaceutical perspective, maybe. As the partner of someone in the US dealing with stage 4 cancer in their 40s, who has two hospitals fighting with each other over whether to keep using a chemo drug that's sent them into anaphylactic shock twice in two rounds of chemo because it's _more convenient_ for the infusion clinic to administer, and all of that currently held up by pre-approval from a rela…

> a cancer that had been misdiagnosed as an infection, an iron deficiency, and a benign tumor for four months prior It's absolutely maddening that this is not even uncommon. Doctors think they know best, definitely better than you , and will stand by their sometimes quite obviously idiotic conclusions, leaving you helpless. And in some countries with universal healthcare, it's a lot harder to just go find a better do…

I have mentioned this before, this is a supply problem. If you do not gatekeep medical degrees with irrelevant non-academic barriers (volunteering, portfolios, admission letters) and mandate medical schools budgets to keep up with new demand, then there would be plenty of doctors and diversity of thought. Let the MCAT standardized test be the only signal for admissions and force the acceptance of medical accreditation based solely on technical competence. Medicine has a scale problem and nobody is trying to tackle it. The American Medical Association recently pulled their collaboration with Khan Academy to further keep up the barriers. At the end of the day, regardless of the complaints of big companies trying to seek "cheaper workers", software engineering as a field is still much more meritocratic than others. Attempts at unionisation and accreditation instead of leetcoding (kicking the ladder hmm?) has all gone absolutely nowhere. Be vigilant about attempts to gatekeep. For too long MBA and public policy institutions spewed the drivel that non-free-access accreditation is the end-all be-all, of the idea that if you do not genuflect before various admissions committees of expensive professional degree schools you do not have the right to take the accreditation exam, that you are a threat to public safety. Imagine where the world would be if the average admissions rate for computer science was 7%.

Re: We’re a Lot Better at Fighting Cancer Than We Realized

#126

Post by alecthomas » Sat, Aug 01, 2020, 10:43 PM UTC

bluedevil2k wrote: post #113

romanoderoma wrote: post #95

Earlier quoted context omitted.

the state of healthcare in US is absolutely horrifyng How is that even possible that there's a place on earth where middle level engineers are paid 6 figures salaries but as a society they don't care if someone dies in a hospital bed over insurance legalities is completely maddening to me it's one of those things that I will never understand and accept as normal

That’s a really harsh and unfair statement. The doctors and nurses care tremendously and want to help everyone, hospitals do their best to cure everyone. Yes, insurance sucks, but that doesn’t diminish the quality of the workers and how they’re trying to help you.

It is neither harsh nor unfair, it's reality. Your response is a generalisation. Perhaps you've had a great experience in the past that leads you to believe it to be universally true.

But not all doctors do care. I lived in the US for four years and we had a child while we were there. During that process we encountered both an obstetrician and a paediatrician who cared very little. The latter in particular.

Different people are motivated by different things. Some are motivated by wealth, some by prestige, some by compassion, some just by having a stable job. Doctors are people. Particularly in an industry where you can earn a great deal of money, motivations get skewed.

All that said, the parent comment is also a generalisation. People do care, there are some fantastic, compassionate people working in medicine in the US.

Re: We’re a Lot Better at Fighting Cancer Than We Realized

#127

Post by MrLeap » Sat, Aug 01, 2020, 10:51 PM UTC

drocer88 wrote: post #12

trynewideas wrote: post #5

From a science and pharmaceutical perspective, maybe. As the partner of someone in the US dealing with stage 4 cancer in their 40s, who has two hospitals fighting with each other over whether to keep using a chemo drug that's sent them into anaphylactic shock twice in two rounds of chemo because it's _more convenient_ for the infusion clinic to administer, and all of that currently held up by pre-approval from a rela…

U.S. cancer treatment is the best in the world. The greatest research, innovation and results[1] happen in America. These are products of American Society. American Society is actually pretty good at fighting this disease. We devote huge resources to preventing, diagnosing and treating and have made great progress. The CAR T-Cell innovations are very promising and American research is making it work. Families often f…

It sounds like a lot of his issues arise from human factors. For you to talk about the qualities of how good cancer treatments in the US are -- when I'd call the OP's experiences a result of gross negligence -- is the most tone deaf thing I can remember ever reading.

Re: We’re a Lot Better at Fighting Cancer Than We Realized

#128

Post by tazjin » Sat, Aug 01, 2020, 10:55 PM UTC

raffraffraff wrote: post #99

xenospn wrote: post #69

Earlier quoted context omitted.

What do you mean? I'm from a country with universal healthcare, and you can just go see another doctor.

It's not that simple. Sometimes you go to two or even three doctors and they don't take your symptoms seriously. "A mild cough is nothing to worry about, lots of people have mild asthma and don't realise it, have an inhaler", "Everybody gets headaches, it's not abnormal", "Your blood results are perfect", "The X-Ray came up clear". You end up feeling like a hypochondriac. Most of the time the doctors are right. Twice…

> Your blood results are perfect

This is if you can even get prophylactic blood tests done, which is not a guarantee in some European countries

I had an awful experience with Sweden's health care system when I lived there ~6 years ago, and didn't get actual help until I went to a private doctor via private insurance.

Since then, while I still support access to universal healthcare, I personally have stuck entirely to private healthcare instead.

Re: We’re a Lot Better at Fighting Cancer Than We Realized

#129

Post by ivalm » Sat, Aug 01, 2020, 11:27 PM UTC

twunde wrote: post #91

petra wrote: post #61

Earlier quoted context omitted.

This begs the question: Why are for-profits winning over Kaiser, Why isn't the Kaiser model everywhere ?

This is actually two questions: Why do we have for-profit vs non-profit healthcare providers in the US and does that affect how they're run? The main difference is that non-profits tend to be more profitable since they don't pay taxes, but otherwise they're pretty much the same including the high bills. They are required provide some threshold of charity care, but the forms you need to fill out differ from provider t…

Note only the KP Foundation Health Plan and Hospitals are non profit. The med groups (which employ drs and a lot of other personnel) are for profit.

I think both a strength and weakness of KP is that it is not really one organization, but more like 20+ related legal entities. Each region has their own med group/health plan with some regions having their own hospital foundation (some like Georgia do not own hospitals). This means that a lot of work/decision making is extremely siloed and KP National has limited ability to lay down the law. Different Regions and even just medgroup vs health plan within one region often don’t want to share data. Also, KP’s ehr is not cross-region compatible.

Re: We’re a Lot Better at Fighting Cancer Than We Realized

#130

Post by vharuck » Sat, Aug 01, 2020, 11:45 PM UTC

danieltillett wrote: post #124

vharuck wrote: post #71

Earlier quoted context omitted.

Funny thing: in my job, I've calculated the relative survival rate of prostate cancer (the difference in mortality risk between people diagnosed and a similar population in age, sex, and race). Cause of death is not considered, only that there was a diagnosis (avoids complicate deaths and captures indirect influence). It'll often be that men diagnosed with prostate cancer have a better 5-year survival rate than men w…

Does this correlation still hold if you look at men below a certain age? Since prostate cancer increases with age then you could get a bias towards the more healthy as the non-prostate cancer peers die earlier of some others cause.

I can't answer that until tomorrow (vacation). We try to reduce bias from competing causes of death by using the Pohar Perme method [0].

Though I now wonder if there is a larger difference for prostate cancer than other cancer types. It's commonly believed by cancer researchers that, if they autopsied everyone, they would find a prostate tumor in most men over 65.

[0] https://onlinelibrary.wiley.com/doi/10.1111/j.1541-0420.2011...