“Ninety percent of doctors I know are fed up with medicine.” • Hacker News Board

Re: “Ninety percent of doctors I know are fed up with medicine.”

#21

Post by arn » Thu, Jun 19, 2008, 6:11 PM UTC

kingkongrevenge wrote: post #17

msg wrote: post #16

Earlier quoted context omitted.

I downvoted because there are a lot of assertions here without sources or context. My anecdotal experience, where my wife is in the doctor's office routinely due to Hashimoto's disease, is that your mileage may vary. We went to an immunologist who sat on his hands and waited for several months for her thyroid to get enough out of whack before he ordered more testing. We've had several incompetent doctors who failed t…

> there are a lot of assertions here without sources or context. I don't have time to build the full case. The nutshell version is that modern medicine is dominated by pharmaceuticals. Doctors are largely in the pill dispensing business. Problem is, the pills don't work. Spend more than fifteen minutes reading about the cholesterol and statin racket for just one example, and this is a huge billion dollar thing. It's…

"Doctors are largely in the pill dispensing business."

You do realize that doctors don't make any more money based on medications they prescribe.

"Problem is, the pills don't work. ..... and the treatments are empirically known to do nothing."

I don't really want to get into a big discussion about it because I know I won't be able to convince you. But this is just wrong. Many pills do work. Modern medicine is based on the scientific method and millions on dollars are spent on studies to prove that therapies work. Strnagely enough, insurance companies are part of the gatekeepers for this, since they don't want to pay out of their pockets to provide expensive care for things that don't work.

On the other hand, much of "natural" medicine and homeopathic medicine are based in anectodal evidence and not on any large scale scientific evidence.

Re: “Ninety percent of doctors I know are fed up with medicine.”

#22

Post by nradov » Thu, Jun 19, 2008, 6:21 PM UTC

kingkongrevenge wrote: post #17

msg wrote: post #16

Earlier quoted context omitted.

I downvoted because there are a lot of assertions here without sources or context. My anecdotal experience, where my wife is in the doctor's office routinely due to Hashimoto's disease, is that your mileage may vary. We went to an immunologist who sat on his hands and waited for several months for her thyroid to get enough out of whack before he ordered more testing. We've had several incompetent doctors who failed t…

> there are a lot of assertions here without sources or context. I don't have time to build the full case. The nutshell version is that modern medicine is dominated by pharmaceuticals. Doctors are largely in the pill dispensing business. Problem is, the pills don't work. Spend more than fifteen minutes reading about the cholesterol and statin racket for just one example, and this is a huge billion dollar thing. It's…

You have mischaracterized modern medicine. However, preventable medical errors were recently estimated to cause somewhere between 44K - 98K deaths per year in the US. For anyone interested in the details I highly recommend reading the Institute of Medicine report "To Err is Human". http://www.nap.edu/openbook.php?record_id=9728&page=1

There are good potential business opportunities in building automation to reduce errors, however it's still tough to get funding and find customers since the reimbursement system generally isn't structured to pay for error prevention. There was one positive step recently when CMS set a new policy to not pay for fixing preventable care problems. http://www.cms.hhs.gov/apps/media/press/release.asp?Counter=...

Re: “Ninety percent of doctors I know are fed up with medicine.”

#23

Post by hobbs » Thu, Jun 19, 2008, 6:23 PM UTC

iamelgringo wrote: post #13

I've worked as an ER nurse for 15 years. I make it a habit to ask MD's that I know whether they would become a doctor if they had to do it all over again, and the vast majority tell me, "No". Adjusted for inflation, MD's salaries haven't gone up for over 20 years, in fact, they've decreased over the past 10 years: http://www.hhnmag.com/hhnmag_app/jsp/articledisplay.jsp?dcrp... And, if Bush's medicare cuts go through…

I've heard the same from the lawyers I know as well.

Suddenly, being an IT professional doesn't seem that bad...

Re: “Ninety percent of doctors I know are fed up with medicine.”

#24

Post by kingkongrevenge » Thu, Jun 19, 2008, 6:28 PM UTC

arn wrote: post #21

kingkongrevenge wrote: post #17

Earlier quoted context omitted.

> there are a lot of assertions here without sources or context. I don't have time to build the full case. The nutshell version is that modern medicine is dominated by pharmaceuticals. Doctors are largely in the pill dispensing business. Problem is, the pills don't work. Spend more than fifteen minutes reading about the cholesterol and statin racket for just one example, and this is a huge billion dollar thing. It's…

"Doctors are largely in the pill dispensing business." You do realize that doctors don't make any more money based on medications they prescribe. "Problem is, the pills don't work. ..... and the treatments are empirically known to do nothing." I don't really want to get into a big discussion about it because I know I won't be able to convince you. But this is just wrong. Many pills do work. Modern medicine is based o…

> Modern medicine is based on the scientific method and millions on dollars are spent on studies to prove that therapies work.

Sure. Take Ambien, for example. The studies show it works! People who take it fall asleep a whole 15 minutes sooner than placebo! For thousands of dollars and unquantified long term consequences you can have something pathetically less effective than lifestyle changes or some cognitive therapy sessions, so ask your doctor about Ambien.

Same for the cholesterol statins. They work! They really do lower serum cholesterol, just as advertised. However, they have absolutely no affect on mortality rates in the typically prescribed case, and are implicated in serious neurological disease...

This kind of nonsense is pervasive in the medical industrial complex. Doctors, for the most part, dispense treatments pushed on them. But the stuff is largely a waste of money.

With a whole lot of these cancer therapies you statistically buy an extra year of life. But the person who took the therapies felt like shit for four years and blew all their savings. The person who just let it be died a year earlier but spent a lot more time feeling ok and saved a lot of money. You can just go on and on with stuff like this. The medical industrial complex is deeply dysfunctional, and at the end of the day there are way too many doctors and they do too much. This is why health care spending and number of doctors per capita is uncorrelated to lifespan and health across regions of the US.

Re: “Ninety percent of doctors I know are fed up with medicine.”

#25

Post by dcurtis » Thu, Jun 19, 2008, 7:33 PM UTC

patrickg-zill wrote: post #14

I know of no other field where you intensively train someone for years, then make them do routine paperwork that takes up 25% or more of their time. Do commercial jet pilots have to sign the purchase order for the jet fuel? That is the equivalent kind of paperwork that doctors have to do.

The purchase of jet fuel can very rarely directly kill someone. A prescription, on the other hand....

Re: “Ninety percent of doctors I know are fed up with medicine.”

#26

Post by noonespecial » Thu, Jun 19, 2008, 9:42 PM UTC

ovi256 wrote: post #19

patrickg-zill wrote: post #14

I know of no other field where you intensively train someone for years, then make them do routine paperwork that takes up 25% or more of their time. Do commercial jet pilots have to sign the purchase order for the jet fuel? That is the equivalent kind of paperwork that doctors have to do.

They have a problem, we have an opportunity guys. Help automatise their paperwork and procedures! Nice big market, and clients with deep pockets. Do it right, and it'll spread virally, as they'll recommend your product to their collegues. Now, I could not tell you in what form and how this automatisation would work. Some standardizing (of data sharing etc) would help too. And furthermore, you would help them HELP peo…

We've traveled this road fairly extensively as well. You will almost certainly find that you will have countless ideas on how to improve things. The better the idea, and the more it will help, the less likely it is that you will be allowed to do it.

Implementing good ideas requires change. I can't think of many fields where change is more resisted than medicine.

Re: “Ninety percent of doctors I know are fed up with medicine.”

#27

Post by dividendium » Thu, Jun 19, 2008, 9:44 PM UTC

arn wrote: post #21

kingkongrevenge wrote: post #17

Earlier quoted context omitted.

> there are a lot of assertions here without sources or context. I don't have time to build the full case. The nutshell version is that modern medicine is dominated by pharmaceuticals. Doctors are largely in the pill dispensing business. Problem is, the pills don't work. Spend more than fifteen minutes reading about the cholesterol and statin racket for just one example, and this is a huge billion dollar thing. It's…

"Doctors are largely in the pill dispensing business." You do realize that doctors don't make any more money based on medications they prescribe. "Problem is, the pills don't work. ..... and the treatments are empirically known to do nothing." I don't really want to get into a big discussion about it because I know I won't be able to convince you. But this is just wrong. Many pills do work. Modern medicine is based o…

"Strnagely enough, insurance companies are part of the gatekeepers for this, since they don't want to pay out of their pockets to provide expensive care for things that don't work."

Consider the economics here. If something is not expensive, you don't need insurance. So it's in the insurance companies' interests to inflate the prices so more people will need health insurance and can't pay for procedures out of pocket. The insurance companies just have to raise their premiums to compensate, and the larger the amounts of money passing through their hands, the easier it is for them to keep some of it.

I'm not attacking insurance companies, just pointing out that it's not entirely logical to assume that their interests are aligned with yours.

Re: “Ninety percent of doctors I know are fed up with medicine.”

#28

Post by dividendium » Thu, Jun 19, 2008, 9:53 PM UTC

Maybe we need to redefine the problem. Some of the suggestions below were about automating the paperwork. Why not automate the treatment? I mean consider how unscalable it is to have a doctor, an actual person, see each patient. At most they can get through one patient every 15 minutes.

A doctor normally looks at a patient, asks them a few questions to rule out certain conditions and then prescribes a pill or requests a test for more information.

Sounds like the perfect kind of job that software can do if it knew the parameters.

The hard part is training the software, so you'd need doctors to perform treatments in a way that a computer can understand it (codified in some way) and then you need patients to report back on whether or not that treatment worked.

There's your business opportunity and a real opportunity to help people, both the doctors and the patients.

Re: “Ninety percent of doctors I know are fed up with medicine.”

#29

Post by arn » Thu, Jun 19, 2008, 11:06 PM UTC

kingkongrevenge wrote: post #24

arn wrote: post #21

Earlier quoted context omitted.

"Doctors are largely in the pill dispensing business." You do realize that doctors don't make any more money based on medications they prescribe. "Problem is, the pills don't work. ..... and the treatments are empirically known to do nothing." I don't really want to get into a big discussion about it because I know I won't be able to convince you. But this is just wrong. Many pills do work. Modern medicine is based o…

> Modern medicine is based on the scientific method and millions on dollars are spent on studies to prove that therapies work. Sure. Take Ambien, for example. The studies show it works! People who take it fall asleep a whole 15 minutes sooner than placebo! For thousands of dollars and unquantified long term consequences you can have something pathetically less effective than lifestyle changes or some cognitive therap…

"[statins] have absolutely no affect on mortality rates in the typically prescribed case"

http://www.ncbi.nlm.nih.gov/pubmed/12114036

The Heart Protection Study (HPS) randomly assigned 20,536 subjects to simvastatin (40 mg/day) or placebo

After an average follow-up of 5.5 years, the following significant benefits with simvastatin were observed:

- A 13 percent reduction in all-cause mortality (12.9 versus 14.7 percent for placebo).

- An 18 percent reduction in deaths from heart disease or related blood vessel disease (5.7 versus 6.9 percent).

- A 24 percent reduction in major cardiovascular events (19.8 versus 25.2 percent)

- A 25 percent reduction in the first event rate for stroke (4.3 versus 5.7 percent) reflecting a 28 percent decrease in ischemic strokes and no reduction in hemorrhagic strokes

- Among 3982 diabetics without prior cardiovascular disease, a 28 percent reduction in the incidence of MI and stroke (14 versus 18.7 percent).

Re: “Ninety percent of doctors I know are fed up with medicine.”

#30

Post by arn » Thu, Jun 19, 2008, 11:18 PM UTC

dividendium wrote: post #27

arn wrote: post #21

Earlier quoted context omitted.

"Doctors are largely in the pill dispensing business." You do realize that doctors don't make any more money based on medications they prescribe. "Problem is, the pills don't work. ..... and the treatments are empirically known to do nothing." I don't really want to get into a big discussion about it because I know I won't be able to convince you. But this is just wrong. Many pills do work. Modern medicine is based o…

"Strnagely enough, insurance companies are part of the gatekeepers for this, since they don't want to pay out of their pockets to provide expensive care for things that don't work." Consider the economics here. If something is not expensive, you don't need insurance. So it's in the insurance companies' interests to inflate the prices so more people will need health insurance and can't pay for procedures out of pocket…

I'm not saying they are the only gatekeeper. But point is, pharmaceudical companies can't just create a medication and claim it "does xyz" and expect that people will pay for it. These medications are reviewed before being "covered" by insurance companies or medicare (goverenment), so it's not a free for all, as implied in the original poster's comment.