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The Rise and Fall of Evidence Based Medicine (1998) [pdf]

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Re: The Rise and Fall of Evidence Based Medicine (1998) [pdf]

#71

Post by rgbgraph »

haldujai wrote: post #61
rgbgraph wrote: post #58

Earlier quoted context omitted.

I had an inkling I should have ended one of the points with that line of thought. However, I haven't seen any research that shows more than minor absolute risk changes, regardless of statin -- they're the wrong drugs for the job.

Do you have a single citation to back this claim up? Unless you’re talking about prophylactic statins in patients with no known risk factors (I.e. primary prevention which is not standard of care) this is complete misinformation.

Taylor, Fiona, et al. “Statins for the Primary Prevention of Cardiovascular Disease.” Cochrane Database of Systematic Reviews, vol. 2021, no. 9, 2013, https://doi.org/10.1002/14651858.cd004816.pub5.

Page 11.

If you have an account at Cochrane: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD...

If not, just get it from LibGen with: 10.1002/14651858.CD004816.pub5

Re: The Rise and Fall of Evidence Based Medicine (1998) [pdf]

#72

Post by DoreenMichele »

dekhn wrote: post #64
DoreenMichele wrote: post #62

Ah, the human as a specimen in a petri dish approach to so-called health care. Flies directly in the face of study after study after study that says: diet and lifestyle are major factors in all deadly diseases. Probably driven by modern tech, completely inadvertently, because x-ray machines and MRIs and such demand that the patient go to the clinic or hospital rather than the doctor going to the patient's home. Star…

I think this is a pretty thoughtless statement. Ashkenazi women often have genetic mutations that cause them to get breast cancer and the cancer prognosis is much worse than average. This cannot be addressed by diet or lifestyle. However, genomic sequencing detected common patterns that can be tested for, and with that information, women can make informed choices about treatment or other actions, ideally well before…

That's a wild misreading of my comment.

Re: The Rise and Fall of Evidence Based Medicine (1998) [pdf]

#73

Post by smegsicle »

msla wrote: post #67
smegsicle wrote: post #16

Earlier quoted context omitted.

curious how combative some people seem to get about homeopathics when placebo has been shown to have consistent positive effect, without side effects, for almost every illness

Yes, it's 'curious' how people with a sense of basic decency get 'combative' when the Alternative Medicine Industry lies to them to sell useless treatments for diseases that could actually be improved by real medicine. It really is odd how that works, isn't it?

homeopathic medicine is clearly marked as such, do you disagree on this point?

anyone who complains about it who doesn't have at least as strong a crusade against crap like phenylephrine is a hypocrite

Re: The Rise and Fall of Evidence Based Medicine (1998) [pdf]

#74

Post by lazide »

DoreenMichele wrote: post #62

Ah, the human as a specimen in a petri dish approach to so-called health care. Flies directly in the face of study after study after study that says: diet and lifestyle are major factors in all deadly diseases. Probably driven by modern tech, completely inadvertently, because x-ray machines and MRIs and such demand that the patient go to the clinic or hospital rather than the doctor going to the patient's home. Star…

All interventions that don’t require a patient being in a coma first requires patient compliance.

Diet and lifestyle are nearly impossible to address from the perspective of the Dr, as they require the patient to want to and be willing to change foundational elements of their life. Unless the patient comes to you requesting that, good luck.

Many will get actively angry if you mention even obvious and severe issues like obesity, to the point of slandering Dr’s or avoiding going in for serious issues later.

Taking a pill, patients will often be able to do that (but definitely not always!).

Getting a surgery, similar.

Is it any wonder that Dr’s use the tools that people will let them use, instead of the ones people won’t?

Re: The Rise and Fall of Evidence Based Medicine (1998) [pdf]

#75

Post by DoreenMichele »

lazide wrote: post #74
DoreenMichele wrote: post #62

Ah, the human as a specimen in a petri dish approach to so-called health care. Flies directly in the face of study after study after study that says: diet and lifestyle are major factors in all deadly diseases. Probably driven by modern tech, completely inadvertently, because x-ray machines and MRIs and such demand that the patient go to the clinic or hospital rather than the doctor going to the patient's home. Star…

All interventions that don’t require a patient being in a coma first requires patient compliance . Diet and lifestyle are nearly impossible to address from the perspective of the Dr, as they require the patient to want to and be willing to change foundational elements of their life . Unless the patient comes to you requesting that, good luck. Many will get actively angry if you mention even obvious and severe issues…

I have no idea why both of these comments assume that I am talking about treating people with only diet and lifestyle. Other than possibly prejudice and people know more about me than they are willing to admit.

I'm talking about doctors having a tradition of being some of the wisest and most knowledgeable people in a community and going to someone's home allowing them to know things about their lifestyle by seeing it with their own eyes instead of taking a history and hoping the patient didn't lie or leave out something important.

And we've lost a lot of medical wisdom that will not be available should some version of the tricorder ever empower doctors to take MRIs, x-rays and similar diagnostics to the patient's home in their little black bag. Those traditions are gone, possibly forever, as an unintended side effect of placing tech on a pedestal above human wisdom.

I'm talking about diagnosing things effectively, not denying people drugs and surgeries. And I don't intend to reply further because from where I sit, it looks to me like HN is going out of its way to intentionally misunderstand me here lately.

Re: The Rise and Fall of Evidence Based Medicine (1998) [pdf]

#76

Post by lazide »

DoreenMichele wrote: post #75
lazide wrote: post #74

Earlier quoted context omitted.

All interventions that don’t require a patient being in a coma first requires patient compliance . Diet and lifestyle are nearly impossible to address from the perspective of the Dr, as they require the patient to want to and be willing to change foundational elements of their life . Unless the patient comes to you requesting that, good luck. Many will get actively angry if you mention even obvious and severe issues…

I have no idea why both of these comments assume that I am talking about treating people with only diet and lifestyle. Other than possibly prejudice and people know more about me than they are willing to admit. I'm talking about doctors having a tradition of being some of the wisest and most knowledgeable people in a community and going to someone's home allowing them to know things about their lifestyle by seeing it…

I don’t know why you think I was saying only diet and lifestyle, because I definitely wasn’t?

You seem to be imagining that this scenario where the Dr. Goes to your home and gives you something useful was ever a mainstream phenomenon, which as far as I’m aware is just not true.

So maybe the issue is not HN?

Re: The Rise and Fall of Evidence Based Medicine (1998) [pdf]

#77

Post by dekhn »

DoreenMichele wrote: post #72
dekhn wrote: post #64

Earlier quoted context omitted.

I think this is a pretty thoughtless statement. Ashkenazi women often have genetic mutations that cause them to get breast cancer and the cancer prognosis is much worse than average. This cannot be addressed by diet or lifestyle. However, genomic sequencing detected common patterns that can be tested for, and with that information, women can make informed choices about treatment or other actions, ideally well before…

That's a wild misreading of my comment.

All the comments I make on Hacker News are done in good faith and assume good will on the part of the person I'm replying to. If you really think I misread, please rewrite what you wrote; as far as I can tell, I read and interpreted it clearly. It's best if you come out and say things directly, while your statement's thesis isn't entirely clear, but I read it as:

Flies directly in the face of study after study after study that says: diet and lifestyle are major factors in all deadly diseases. Probably driven by modern tech, completely inadvertently, because x-ray machines and MRIs and such demand that the patient go to the clinic or hospital rather than the doctor going to the patient's home. Star Trek's Dr. McCoy and his tricorder was a dream of tech that you could carry in the proverbial little black bag. We aren't there and have forgotten a lot of important principles in the process of pursuing shiny tech. But it's generally a bad idea to critique any of that. Gets one nothing but hatred. <- I explicitly wrote my comment to be friendly, fact-based, and make my thesis as clear as possible. If you're going around pointing out that "medical basics that we've known for a while matter", nobody is going to agree with you. But if you attack doctors/medical researchers the way you do, you instance cause people to interpret you as somebody to argue with.

Re: The Rise and Fall of Evidence Based Medicine (1998) [pdf]

#78

Post by bedobi »

dekhn wrote: post #68
bedobi wrote: post #32

Earlier quoted context omitted.

In my case, I've been suffering from disc herniation induced sciatica for 5 months When I say suffering, I mean it - I haven't been able to stand, sit, lie down, walk, do anything without constant and extreme pain. For months on end now. There is a gold standard study called SPORT that proves more or less beyond all doubt that, in the long run, there is no difference in outcomes for patients who get disc herniations…

To add to that studies findings: in general, many people who have back surgery end up worse-off than before, because back surgery is risky.

Uh, no. That study is literally the source of truth on that topic. There's no "to add to".

I hope you never have to experience what me and others who have the same problem have experienced, but I guarantee you you'd want to do the surgery too if you ever did.

In any case, I was happy to share my story but I have zero interest in debating it, so I'll check out here.

Re: The Rise and Fall of Evidence Based Medicine (1998) [pdf]

#79

Post by nradov »

rgbgraph wrote: post #58
nradov wrote: post #56

Earlier quoted context omitted.

There are multiple different statins. The latest research indicates that some are more effective than you indicate, with a lower rate of serious side effects. https://peterattiamd.com/johnkastelein/

I had an inkling I should have ended one of the points with that line of thought. However, I haven't seen any research that shows more than minor absolute risk changes, regardless of statin -- they're the wrong drugs for the job.

Which specific studies are you referring to? I think you might be looking at outdated research, or studies that didn't run long enough.

Seriously, if you're interested in this area then listen to the entire podcast that I linked above. It's packed with information from one of the leading researchers in the field and might change your mind about a few things.

Re: The Rise and Fall of Evidence Based Medicine (1998) [pdf]

#80

Post by ls612 »

jbandela1 wrote: post #15

Evidence Based Medicine is one of those things that is a good thing, but was pushed so hard by its proponents that it ended up overemphasizing a particular kind of study as the only real way to know things in medicine. Yes, absolutely, medicine should be evidence based. Yes, large randomized, double blind, placebo controlled studies provide a lot of information. However, there are limitations with these kinds of stud…

Yeah and the other thing is that with an advanced enough understanding of statistics you can make a study say almost anything and many physicians won’t be able to tell.

Source: My dad is a physician and I am an economics PhD who knows a lot of statistics and talks with him about these things.

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