Hacker News Reader

Comment by taxicabjesus | Hacker News Reader

You must have missed this ProPublica piece:

When Evidence Says No, but Doctors Say Yes - https://www.propublica.org/article/when-evidence-says-no-but...

There's a slander against "alternative medicine" that goes something like, "What do you call alternative medicine that works? Medicine. " The inference is that Medicine adopts what's useful. If a herb is actually useful, the pharmaceutical industry will figure out what the active ingredient is and figure out how to synthesize it, etc.

My corollary to the slander is the truism: "What do you call medicine that doesn't work? Medicine. " The ProPublica story linked above says that heart stents [are now known to not be] helpful for anyone that's not actively experiencing a heart attack, but thousands get inserted every year anyways.

[edit - clarification [] above]

View on HN

Why do you care about what doesn't work? If the things that work are in the set "Medicine", that's the only set we need to be concerned with.

Sure, it's worthwhile to try and figure out which medicine doesn't work, but we know for sure that anything non-medicine does, by definition, not work.

Except the range of possibilities isn't ['works', 'doesn't work']. Rather, it's ['works', 'no effect', 'harmful', 'works and is harmful at the same time'].

A banal example: proton pump inhibitor drugs used to treat acid reflux will, over very long timeframes, cause nutrient malabsorption resulting in more brittle bones. They also have what's called a rebound effect, where dropping them cold turkey leads to a huge jump in stomach acid production and worsening of symptoms. So while effective to reduce stomach acidity, they also have long-term negative effects and a sort of withdrawal that makes the original problem worse. It's a weird and complicated situation, and certainly not the most intense example.

Okay, sure, but again, the things that have "no effect" are not worth even mentioning at all. That is what the debate is about, not whether medicine that works is also harmful.

They are worth mentioning, because they are often expensive and take a lot of time. They are often uncomfortable or painful. It is not neutral.

> we know for sure that anything non-medicine does, by definition, not work.

We don't actually know that. That something is proven to work to the satisfaction of the FDA and the doctor's lobbies is too high a bar to say that anything failing to meet it does not work.

Many treatments that "work" either can't adequately be double-blind tested or have a status such that the current US regulatory climate makes it too hard to get them approved as treatments. For instance, treatments that are "medicine" in other countries (China, Japan, Russia...) but not yet accepted here. Treatments that can't be patented so it doesn't make economic sense to get them approved here. Treatments that probably work but are legally or ethically problematic for other reasons (eg, ketamine for depression, alcohol for social anxiety, or cigarettes for weight loss).

That doesn't change my point.

If new evidence comes to light that now says a treatment is ineffective, and doctors are still applying that treatment, that isn't medicine either. At best it's, again, placebo. At worst it's fraud and/or profiteering.

Reply on news.ycombinator.com