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Comment by low_battery | Hacker News Reader

Yeah, but that was in 1982.

Are you implying that doctors have become more accepting of theories which challenge the status quo? Do you have any reason to believe things have gotten better?

Doctors still seem to prescribe blood pressure medication and low-salt diets to people with hypertension, depite the overwhelming number of studies which show that neither prescription has any impact on mortality rates. It doesn't look like they are particularly evidence-driven or self-aware as a profession.

Doctors are selected and trained to memorize insane amounts of facts, and how to match symptoms to facts. Updating those facts is hard since they're stored when the brain is young and still great at learning (there are refresher courses doctors are required to attend to keep their accreditation, but they lean heavily towards learning new facts, not changing existing ones).

Most doctors are constantly learning new information. It's not just refresher courses, you have to pass frequent and comprehensive examinations to stay board-certified.

I have no idea why HN has this bias against physicians.

Frequent = a test every ten years in internal medicine and some continuing education/maintenance of certification. Even that is under attack (http://knowledgeplus.nejm.org/abim-moc-petition-reveals-deba...).

Doctors are human and some are constantly learning new information while others aren't. There are a lot of pressures on them that are perhaps orthogonal to "learning new things" and "keeping up with the best evidence."

Personal experience with physicians has been my primary way to gain this bias against physicians.

You could also do research on, say, Lister or checklists and get the bias that way.

You are probably right, but it is not clear which category this finding of a fungus-Alzheimer's correlation would be in. Most theories could retroactively be put in to either category (new facts or changed facts), so I am not sure whether this framework gets you anywhere.

In any case, the relative difficulty of updating previous beliefs does not excuse the failures of doctors which cause a great deal of death and suffering. When engineers fail to update their beliefs, and people die, it is called negligence.

This doesn't apply as cleanly to research, however, where the whole point is to discover new facts.

Well, medical researchers aren't doctors (they can't proscribe medication or perform medical procedures).

No impact? What about the SPRINT study ("Will lower blood pressure reduce the risk of heart and kidney diseases, stroke, or age-related declines in memory and thinking?" - 'largest study ever') was discontinued when it 'produced significant results' with the risk of death down by almost a quarter? I presume that blood pressure lowering was effected by drugs. Please clarify your comment because on the face of it (I have no expert knowledge, you may have) it seems to be quite wrong.

You are mistaken. There is very compelling evidence that controlling hypertension reduces mortality.

Hypertension is correlated with mortality, but reducing blood pressure does not seem to improve patient outcomes.

Most evidence does not suggest this.

2015: "[...] the NIH made the bold announcement that intensive intervention with a combo of three drugs to reach a new target systolic blood pressure of under 120 mm Hg reduced the rate of heart attacks, heart failure and stroke by 30% and cardiovascular deaths by 25%, "

http://www.healthnewsreview.org/2015/09/nih-sprint-study-spa...

http://www.cochrane.org/CD000028/HTN_blood-pressure-lowering...

http://eurheartj.oxfordjournals.org/content/early/2012/04/16...

http://www.escardio.org/The-ESC/Press-Office/Press-releases/...

There's more evidence available.

Contrary evidence is available, and there is no clear reason for the confusion.[1]. I have not read any of the studies you cite, though I will take a look as soon as I have the time. From what I have read, blood pressure reducing medication has been shown to reduce blood pressure (at the cost of severe side effects), but not reduce mortality.

[1] http://m.openheart.bmj.com/content/1/1/e000048.full

Your single link talks about mild hypertension, and says that interventions may not make any difference to health outcomes.

But you can look at what guidance for doctors is to compare what happens. Here's UK guidance.

https://www.nice.org.uk/guidance/cg127/chapter/Key-prioritie...

Offer drugs to people with stage one but only if there are other symptoms; offer drugs to anyone with stage two (but do careful measuring to ensure they actually have stage two); investigate causes and provide support.

It's pretty frustrating that you misrepresent the research, and what doctors do with that research, to push some anti-doctor spin.

There's plenty of bad stuff that doctors actually do.

No not Doctors, I am not dismissing the possibility of an oversight, but there are many things that got orders of magnitude better in 35 years (So, yes I have reason to believe things got better). We have much better imaging and analysis technology, much faster spread of information, 10000x faster computers etc. Considering all these, and many teams working on this problem for years, I am a bit skeptical.

what is the blood pressure data you are using to say that?

That seems to be the case as far back as medical history goes. New discoveries are sometimes dismissed or even laughed at by the establishment. Perhaps the skepticism is for good reason because there's so much quackery out there. But it seems that new medical ideas take a huge amount of effort to gain acceptance - even today.

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