A new book critiques medicine • Hacker News Board

Re: A new book critiques medicine

#161

Post by geofft » Mon, Jul 15, 2019, 6:02 AM UTC

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…

Aren't there a growing number of doctors who don't take insurance (under names like "cash-only" or "direct primary care")?

Would you be able to buy a day of one of those doctors' time? It sounds like it won't run afoul of insurance but also sounds cheaper than having a personal physician.

Re: A new book critiques medicine

#162

Post by [deleted] » Mon, Jul 15, 2019, 6:05 AM UTC

meruru wrote: post #153

cheesymuffin wrote: post #146

Earlier quoted context omitted.

And yet, in every 100 bullshit tech-bro commenters, there are 10 who are actually getting really interested in the subject and taking the time to check their old Bio notes, research opposing viewpoints, or maybe even bring something new to the table. Hating is easy. All you have to do is point fingers at people and tell them they know nothing. 100% of the time you'll be right.

I've always seem this kind of criticism of the "tech bubble" as a great endorsement of the tech community. Where else do you see people so interested in so many subjects that they have to be constantly reminded they are speaking outside their expertise? Am I just not aware of the HN equivalent for medical doctors?

[deleted]

Re: A new book critiques medicine

#163

Post by zby » Mon, Jul 15, 2019, 7:04 AM UTC

Update: If trials by manufacturers are biased - then how about some framework that would push trials made by competition.

There are two things: One is bad science, and we have a lot of it (https://en.wikipedia.org/wiki/Replication_crisis, https://library.mpib-berlin.mpg.de/ft/gg/GG_Null_2004.pdf) - but it should be improving and most of it is probably harmless (I have some hopes on better statistics education and https://www.google.com/search?q=causality+revolution). The other is bad application - and this is more complex. When I go to doctors (with my and my family issues) I, more often than not, have the feeling that they have no chance to give any good diagnosis as it would require too much time to test etc. (one simple case is when to use antibiotics and when the disease is virus based - but I have noticed that this is probably improving with strep and CPR tests) and they mostly just shoot first thing plausible, proscribe some medication and then in most cases the organism just cures itself - so the treatment is never tested. There is probably also 'medicine as signaling' (the theory by Richard Hanson: http://www.overcomingbias.com/tag/medicine), but my intuition is that it is not verly important, and other stuff.

Re: A new book critiques medicine

#164

Post by bedobi » Mon, Jul 15, 2019, 7:34 AM UTC

jcims wrote: post #120

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.

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.

If acupuncture had an easily and consistently replicable effect it would have been incorporated into medicine, even if we didn't understand how or why it worked. (just like paracetamol and any number of other widely used drugs and treatments we don't really know how or why they work)

Re: A new book critiques medicine

#165

Post by disqard » Mon, Jul 15, 2019, 7:35 AM UTC

I'm surprised that even antibiotics are considered one of two "magic bullets" (the other being insulin, which does seem close to a perfect solution).

I encourage those interested in the pernicious aspegts of humanity's overuse of antibiotics to read this interview with Stephen Buhner [0]

[0] https://www.thesunmagazine.org/issues/468/living-medicine

Re: A new book critiques medicine

#166

Post by afthonos » Mon, Jul 15, 2019, 7:45 AM UTC

disqard wrote: post #165

I'm surprised that even antibiotics are considered one of two "magic bullets" (the other being insulin, which does seem close to a perfect solution). I encourage those interested in the pernicious aspegts of humanity's overuse of antibiotics to read this interview with Stephen Buhner [0] [0] https://www.thesunmagazine.org/issues/468/living-medicine

Overuse happens precisely because they are so good at what they do. Moreover, at a first approximation, overuse results simply in a return to a previous state of no good defense against newly-resistant bugs. So in the worst case scenario, antibiotics bought us a century of better health; that’s pretty magical.

Re: A new book critiques medicine

#167

Post by disqard » Mon, Jul 15, 2019, 7:45 AM UTC

marcinzm wrote: post #89

codingslave wrote: post #9

I've long believed that once startups and tech companies get their hands on medical data (patient outcomes, medication treatment outcomes, mal practice rates, surgery outcomes) that a reckoning will take place on the medical industry. The level of legitimacy and respect that doctors and hospitals currently have is far too high, and hinges on branding and the exclusivity of becoming a doctor. Once all of this data bec…

>I've long believed that once startups and tech companies get their hands on medical data (patient outcomes, medication treatment outcomes, mal practice rates, surgery outcomes) that a reckoning will take place on the medical industry. Startups have been going at this problem for years and years already and have had the data. I've worked at them. You know what the goal of most of those startups was? To make money. Pa…

Thank you for articulating these points so well. Possibly preaching to the choir here, but you should check out "Geek Heresy" by Kentaro Toyama.

Re: A new book critiques medicine

#168

Post by Jallal » Mon, Jul 15, 2019, 8:12 AM UTC

The article starts with "Given medicine’s poor record, physicians should prescribe and patients consume far fewer medications, a new book argues." : on the contrary, I think the current state of medicine is outstanding, regarding what is was only two centuries ago. Thousands of illnesses have a cure, and for many others, we know what we can do to minimize their effects, infant mortality is very low in most of the western world, etc. And paradoxically, although most of the "alternative medicines" zealots criticize conventional medicine for insufficient results and/or side effects, none of them keep track of some indicators such as the cure rate. ANd this is one of the only relevant metric that can assess the efficiency of a cure.

I'm not saying that the conventional medicine is far from any criticism, but one has first to understand the difference between the current knowledge available, and the way it is used : some drugs/treatments are promoted by some countries, while not in others. I'm also convinced he drugs prices (which are going crazy) should be regulated for the benefit of everyone. And of course, modern medicine should be used wisely. People should not take drugs each time they have a cold.

That being said, of course, there are still room for improvement, there are a load of illnesses that cannot be cured by modern medicine, and yes, some doctors think themselves as Gods. But this should not question the many successes of conventional medicine.

Re: A new book critiques medicine

#169

Post by simiones » Mon, Jul 15, 2019, 8:19 AM UTC

coldtea wrote: post #112

rscho wrote: post #107

Earlier quoted context omitted.

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 (we…

The problem is that many "traditional" remedies/drugs such as those found in Ayurvedic and traditional Chinese medicine have the "this must work based on a priori magical/philosophical knowledge, so no amount of evidence that it kills patients / does nothing at all will convince us to stop" problem.

There very likely are traditional remedies that absolutely do work, but those lie more in folk remedies (especially use of native plants in teas), which tend to be slow trial-and-error over generations, rather than formal systems based on magical principles.

Re: A new book critiques medicine

#170

Post by pvaldes » Mon, Jul 15, 2019, 8:28 AM UTC

yourMadness wrote: post #27

Modern medicine has some aspects that are miraculously good and it is easy to fall into the trap of thinking that those are representative for all of medicine. It's a kind of halo effect bias. In my opinion the most amazing thing still is antibiotics (and vaccination). Treatmeant of war/vehicle/sports injuries taking the second place (including anesthetics). Both can take people from a path of sure death within hours…

> Modern medicine has some aspects that are miraculously good... like antibiothics and injuries treatment

Not to mention having all valuable poisons in the planet in a nice packed, chemically pure, split in comfortable monodose capsules, accurately measured and checked for 10 years before enter in your body, packed guaranteeing non posterior adulteration as long as the plastic seal is not broken, extensively documented in several languages and available at less than ten minutes away from your home. This is probably the biggest bonus from the real medicine.