“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.”

#41

Post by kingkongrevenge » Fri, Jun 20, 2008, 3:02 AM UTC

arn wrote: post #40

kingkongrevenge wrote: post #38

Earlier quoted context omitted.

Semantics. I change my odds by 1.8% in the naive assumption that these numbers are applicable to myself at face value. If you like these odds I would like to sell you some lottery tickets. Your thinking is fundamentally flawed. 1.8 people out of 100 are prevented from dying, and not for free: there are side effects and financial costs. How many died in year six as opposed to year five is also unclear. We're talking a…

I agree that the cost is not free. The point being is that these medications do do something. They aren't sugar pills. You're first assertion was that these medications don't actually do anything. I simply am pointing out they do do something. It comes at a cost of $$, possible side effects, sure. But if you are arguing that point, then you have to concede that if the price is low enough or the side effects are low e…

> I simply am pointing out they do do something.

Personally, I'd say 1.8% over five years is nothing, and as I mentioned I've seen the abstract read closer to 0% or -X%. Think of it as 0.36% per year. Expect big lawsuits next decade about the side effects.

> you have to concede that if the price is low enough or the side effects are low enough, then it's worth it.

Not quite so simple, because there are lifestyle treatments that do work and are generally not pursued. The drug options are pursued at the opportunity cost of much more efficacious, much simpler, much less profitable options.

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

#42

Post by arn » Fri, Jun 20, 2008, 3:10 AM UTC

kingkongrevenge wrote: post #41

arn wrote: post #40

Earlier quoted context omitted.

I agree that the cost is not free. The point being is that these medications do do something. They aren't sugar pills. You're first assertion was that these medications don't actually do anything. I simply am pointing out they do do something. It comes at a cost of $$, possible side effects, sure. But if you are arguing that point, then you have to concede that if the price is low enough or the side effects are low e…

> I simply am pointing out they do do something. Personally, I'd say 1.8% over five years is nothing, and as I mentioned I've seen the abstract read closer to 0% or -X%. Think of it as 0.36% per year. Expect big lawsuits next decade about the side effects. > you have to concede that if the price is low enough or the side effects are low enough, then it's worth it. Not quite so simple, because there are lifestyle trea…

Again, I believe you simply don't understand percentages, or statistics.

The numbers were statistically significant, which means the differences were not likely related to random chance.

The statin prevented 1079 people from having a stroke, dying, or having a heart attack. It helped 10% of the people in a non-trivial way in this study.

(and lifestyle changes are typically pursued alongside these medical treatments. Certainly in these studies, of course your individual doctor's mileage may vary.)

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

#43

Post by kingkongrevenge » Fri, Jun 20, 2008, 3:39 AM UTC

arn wrote: post #42

kingkongrevenge wrote: post #41

Earlier quoted context omitted.

> I simply am pointing out they do do something. Personally, I'd say 1.8% over five years is nothing, and as I mentioned I've seen the abstract read closer to 0% or -X%. Think of it as 0.36% per year. Expect big lawsuits next decade about the side effects. > you have to concede that if the price is low enough or the side effects are low enough, then it's worth it. Not quite so simple, because there are lifestyle trea…

Again, I believe you simply don't understand percentages, or statistics. The numbers were statistically significant, which means the differences were not likely related to random chance. The statin prevented 1079 people from having a stroke, dying, or having a heart attack. It helped 10% of the people in a non-trivial way in this study. (and lifestyle changes are typically pursued alongside these medical treatments.…

I understand statistics just fine, asshole. You're saying I should bank with XYZ Bank because their savings account interest rate is 100% higher than my current bank! Or, .5% vs 1%. I'm saying the interest rates are .5% and 1% respectively.

As for the 10 out of 100 total winners claim, it looks fudged up to me on quickly scanning the abstract. I'd have to use a calculator and read the study. That cute little bit about a compliance adjustment smells like fudge. And, as I've said, there are other studies with other conclusions.

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

#44

Post by TheWama » Fri, Jun 20, 2008, 5:08 AM UTC

There are some young approaches to solving this problem. One I just discovered today is Qliance, a low-cost version of boutique care, dubbed "direct primary care."

No insurance needed or accepted (thus no coding or paperwork), ~$50 a month, same or next-day appointments, 24hr access to care, they take their own xrays for free and dispense their own medicine at cost, &c.

Aside from making workloads managable (800 patients instead of 2-3000), the really interesting part is how this does away with the perverse incentives of insurance payments (which reward procedures rather than health, and which turns primary care into 10 minute referral-fests, rather than actual care), as well as sets up other good incentives, which reward the doctors for keeping the patient healthy (healthy patients don't need to spend a bunch of time in your office) and so on. His talk is really interesting: http://health.scribemedia.org/2008/01/21/garrison-bliss-pion...

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

#45

Post by msg » Fri, Jun 20, 2008, 5:59 AM UTC

kingkongrevenge wrote: post #32

arn wrote: post #29

Earlier quoted context omitted.

"[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…

This study supports my position. 12.9 vs 14.7. From taking my statins I get a measly 1.8% lower chance of dying over a five year period, and that's a shaky assertion. It costs a fortune, I'm impotent, and my short term memory is screwed up, but hey, the doc says to take it for that 1.8%. And I suspect the 1.8% is misleading. The profile of the people who died in both groups was probably distinctly identifiable, so in…

You have some time now to find those opposing drug study citations. Your claims interest me and I'd like to subscribe to your newsletter, but the rubber will start hitting the road for me if this conversation progresses from accusations to evidence.

Here's an example of the kind of thing that interests me: a recent meta-study of FDA trials of SSRIs (antidepressants) showed little to no benefit over placebo, below statistical significance in some important cases. So there's a fair chance that most people shouldn't get SSRIs because they just don't work.

"Drug–placebo differences in antidepressant efficacy increase as a function of baseline severity, but are relatively small even for severely depressed patients. The relationship between initial severity and antidepressant efficacy is attributable to decreased responsiveness to placebo among very severely depressed patients, rather than to increased responsiveness to medication."

Read it here.

http://medicine.plosjournals.org/perlserv/?request=get-docum...

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

#46

Post by demallien » Fri, Jun 20, 2008, 9:11 AM UTC

kingkongrevenge wrote: post #43

arn wrote: post #42

Earlier quoted context omitted.

Again, I believe you simply don't understand percentages, or statistics. The numbers were statistically significant, which means the differences were not likely related to random chance. The statin prevented 1079 people from having a stroke, dying, or having a heart attack. It helped 10% of the people in a non-trivial way in this study. (and lifestyle changes are typically pursued alongside these medical treatments.…

I understand statistics just fine, asshole. You're saying I should bank with XYZ Bank because their savings account interest rate is 100% higher than my current bank! Or, .5% vs 1%. I'm saying the interest rates are .5% and 1% respectively. As for the 10 out of 100 total winners claim, it looks fudged up to me on quickly scanning the abstract. I'd have to use a calculator and read the study. That cute little bit abou…

1) Your continued comments are way off topic. In what way do they relate to doctors being overworked? None that I can see.

2) You really don't seem to have a good grasp of what the statistics are telling you. Take the statins example. As others have tried to explain to you quite politely, the statistical improvement of statins vs placebo are both significant, and even impressive. Your response? 'Asshole'. Nice work.

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

#47

Post by rms » Fri, Jun 20, 2008, 9:16 AM UTC

kingkongrevenge wrote: post #43

arn wrote: post #42

Earlier quoted context omitted.

Again, I believe you simply don't understand percentages, or statistics. The numbers were statistically significant, which means the differences were not likely related to random chance. The statin prevented 1079 people from having a stroke, dying, or having a heart attack. It helped 10% of the people in a non-trivial way in this study. (and lifestyle changes are typically pursued alongside these medical treatments.…

I understand statistics just fine, asshole. You're saying I should bank with XYZ Bank because their savings account interest rate is 100% higher than my current bank! Or, .5% vs 1%. I'm saying the interest rates are .5% and 1% respectively. As for the 10 out of 100 total winners claim, it looks fudged up to me on quickly scanning the abstract. I'd have to use a calculator and read the study. That cute little bit abou…

Nice try, but your argument doesn't hold up for society at large.

It doesn't matter to you as an individual if you are prescribed heart medicine when you need it. However, it truly does save lives in society. How do you propose we scale back the system of medicine? Should doctors no longer prescribe statins?

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

#48

Post by iamelgringo » Sun, Jun 22, 2008, 8:14 AM UTC

kingkongrevenge wrote: post #39

iamelgringo wrote: post #36

Earlier quoted context omitted.

Dude, I've worked as an ER/Critical care nurse for years. I push a drug, a person's heart rate changes. I tweak a drug on an IV pump, a person's blood pressure comes out of shock and normalizes. The idea that pharmacology doesn't help people is quite simply wrong. Sure, the protocol for Advanced Cardiac Life support changes every 2 years, because some therapies that we use to thing were very effective, are proven to…

Key words are ER and Critical Care. That stuff works great and makes progress all the time. It's also somewhat irrelevant to the bulk of medical practice and health care costs, which pertain to chronic conditions and lifestyle disease.

If people don't manage their chronic diseases with medication, where do they end up? The ER.

If a diabetic doesn't take insulin or their anti-high-blood-sugar pills, where do they end up? The ER in a diabetic coma. A daily dose of insulin is like $1 a day. An ER visit/ICU hospitalization for a diabetic coma is around $20-50k depending on the severity.

If an asthmatic doesn't manage their chronic condition with the appropriate inhalers, where do they end up? The ER. IF they let it go too long, they end up on life support in the ICU.

Pneumonia used to be a leading cause of death, now it's not. Why? Antibiotics and oxygen therapy. People used to get polio all the time. I haven't seen an active case of polio every in my 15 year nursing career. Why? The polio vaccine.

The incidence of tetanus has dropped from 600,000 deaths in '92 to less than 150,000 deaths world wide. Why? The tetanus vaccine. Ref: http://www.emedicine.com/emerg/topic574.htm

Please, stop saying the pharmacology doesn't work. It does. It saves lives. Are there problems with the system? Sure. But please stop spreading FUD about "Big Pharma".

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

#49

Post by Alex3917 » Sun, Jun 22, 2008, 8:45 PM UTC

iamelgringo wrote: post #48

kingkongrevenge wrote: post #39

Earlier quoted context omitted.

Key words are ER and Critical Care. That stuff works great and makes progress all the time. It's also somewhat irrelevant to the bulk of medical practice and health care costs, which pertain to chronic conditions and lifestyle disease.

If people don't manage their chronic diseases with medication, where do they end up? The ER. If a diabetic doesn't take insulin or their anti-high-blood-sugar pills, where do they end up? The ER in a diabetic coma. A daily dose of insulin is like $1 a day. An ER visit/ICU hospitalization for a diabetic coma is around $20-50k depending on the severity. If an asthmatic doesn't manage their chronic condition with the ap…

@iamelgringo/arn

What do you think of this paper on iatrogenic deaths?

http://www.ourcivilisation.com/medicine/usamed.htm

I ask as a genuine question, I haven't done enough research to evaluate the truthfulness of it.

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

#50

Post by iamelgringo » Mon, Jun 23, 2008, 9:53 AM UTC

Alex3917 wrote: post #49

iamelgringo wrote: post #48

Earlier quoted context omitted.

If people don't manage their chronic diseases with medication, where do they end up? The ER. If a diabetic doesn't take insulin or their anti-high-blood-sugar pills, where do they end up? The ER in a diabetic coma. A daily dose of insulin is like $1 a day. An ER visit/ICU hospitalization for a diabetic coma is around $20-50k depending on the severity. If an asthmatic doesn't manage their chronic condition with the ap…

@iamelgringo/arn What do you think of this paper on iatrogenic deaths? http://www.ourcivilisation.com/medicine/usamed.htm I ask as a genuine question, I haven't done enough research to evaluate the truthfulness of it.

I have zero doubt that this is true. I have been around a lot of those medical errors, and I have seen people who have been killed by medical errors and malpractice. It's tragic.

But, just because there are problems, that doesn't mean that the system doesn't work.

In the article that you posted, they mentioned 10's of millions of unnecessary antibiotics. The reason that antibiotics are prescribed for viral infections is twofold. And, it's primarily because people want them. If I take my child who has been sick for 1 week to the ER, spend 3 hours waiting in line for a 5-10 minute visit with an ER doc. I want to go home with a prescription in hand. If not, I'm going to be very angry. So, it's easier for the MD to prescribe an antibiotic than deal with the 5-10 minute conversation convincing the parents that it's only 2008 and we haven't found a cure for the common cold yet.

As for unnecessary medical procedures... That pretty much speaks to 95% of plastic surgery cases and 80% of dermatology practices.

Our society also has very high expectations of the medical community. We used to go to a shaman, priest or pastor when our family was dying and looked for answers or expected miracles. Now, we take then in a ambulance to the hospital and expect answers and miracles from our doctors and medical systems.

Doctors feel those expectations and generally work very hard in very difficult circumstances. They also are trying to make a decent living to pay for the 12-15 years of schooling they suffered through. So, the average MD will work 70-110 hours a week. When you work that much, you're bound to make mistakes.

There's no doubt about it, there are a lot of problems with the system, but that doesn't mean that we should throw the baby out with the bath water.

Tips to getting better health care:

#1 Bar none, go to the rich people's hospital. Go to the neighborhood with the most expensive homes, and find a doctor in that neighborhood. You get much better medical care in those areas because that's where the good doctors go to practice. After working in 35 different hospitals in 15 years, I settled on working at an upper class/upper middle class hospital in Silicon Valley. That was deliberate. I can give better care here than any where else I've ever worked.