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Comment by blhack | Hacker News Reader

Good.

I spent a few years working in a medical IoT startup, and the current state of the "mainstream" medical monitoring technology is not inspiring.

During a brainstorming meeting, I asked one of our cofounders, a physician, to tell me about some of the problems he had seen in health. Don't try and solve it, just lets talk about problems.

He said that by far one of the most common causes for re-hospitalization is congestive heart failure. It's a super common problem, and it's actually really easy to catch (it has strong indicators). When your heart begins to fail, depending on what side of it fails, your body will retain fluid (in the form of blood) in either your heart or your organs. Regardless, you will bloat up, and gain weight quickly.

So if a patient is at risk for CHF, a nurse will monitor their weight every day (or multiple times a day) and watch for spikes. If their weight spikes, a doctor will intervene in whatever way is necessary.

Can you imagine my frustration at hearing this? It's this massive problem with an obvious (CHEAP!! SO FUCKING CHEAP!!) solution.

I spend $30 on a scale from amazon immediately, and about an hour after it arrived I had it connected to an android tablet and broadcasting its readings to a webservice.

We never went to market with that (long story). Please, if you have the means to take something like that and scale it, do so. You could save lives. I'm currently trying. More people should be trying. This stuff is so easy, and the impact that you could have is massive.

Also: please call your grandparents and just talk to them. Ask them how they are feeling. Social isolation (full disclosure: this is what my current project is trying to solve) is probably the area where we as software people could have the biggest impact.

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Interesting you bring up heart failure readmissions. Not saying they aren't a problem, but here is a fascinating study in JAMA that argues that places with lower readmissions have higher (worse) mortality. https://jamanetwork.com/journals/jamacardiology/article-abst...

Not sure we (I'm a physician) understand even what the problems we need technology to solve are. But yes, we need technology to help (find and) solve some major problems that will improve lives.

Are there other examples of things you wish existed? Again, forget about if they could exist, just stuff you wish you had?

Loads. A functional EHR (UX). An easy way to keep track of what medications a patient is one and has been on (?blockchain). Better quality and cost measures (big data).

Couldn't this finding be explained by the fact that the hospitals with lower readmissions tend to be poorer (since poorer patients are less likely to be able to afford care)? I only took a quick look, but I didn't see how the paper accounts for this and other possible causality issues. On the other hand, it's certainly plausible to me that lower readmissions can cause higher mortality.

Sure. Or those hospitals gamed the system and didn't admit patients who should have been admitted. Or plenty of other explanations...

We call readmissions rate a Surrogate Marker. Something that isn't a hard outcome that we care about (that much), but rather an indicator of quality. We need surrogates to assess quality because hard outcomes are rarer. But this paper makes us think that maybe we need better markers.

Do you have recommendations for any books or other resources that cover topics on healthcare quality measures? This is the first time I’ve heard of surrogate markers. I’ve been searching around for more info on the concept you’ve described but didn’t have a term for it.

Why do we need technology to help improve lives when so many diseases (type 2 diabetes, Crohn's, IBS, high blood pressure, arthritis, and dozens of others) can already be reversed and prevented by simply changing a person's diet and lifestyle habits? It's really quite insane that people would rather take pills for the rest of their lives to treat symptoms of a disease than actually getting rid of it altogether by giving up food habits.

Part of it is also due to traditional physicians being so dismissive of the role nutrition plays in a person's well being.

You broke the site guidelines by taking this thread into a flamewar and grossly overposting. We're trying for quality, not quantity, in discussion here—you went far in the other direction. You also broke the HN guidelines in other ways, like personal attacks and going on about comment voting.

All of this is really bad. Please don't abuse the site like this again.

https://news.ycombinator.com/newsguidelines.html

Before you become "so dismissive" of traditional physicians, you try getting someone to radically alter their lifestyle for the promise of potential benefit in 10-20 years. Even if you can point to a few people that have done it, I can point you to plenty of data that says it's really hard and most people can't. Even technology may not help: https://jamanetwork.com/journals/jama/fullarticle/2553448.

Edit: Also reversed is a pretty strong word. I haven't seen any compelling evidence that Crohn's can be cured with lifestyle change.

> try getting someone to radically alter their lifestyle for the promise of potential benefit in 10-20 years.

There is an incredible amount of confusion with regard to appropriate lifestyle interventions. Part of the problem is that your predecessors' predecessors (doctors in the 1950's and 1960's) came up with some simplistic and wrong advice that never got properly withdrawn: the hazard of butter and the superiority of refined vegetable oil, the hazard of salt (farmers and veterinarians give animals salt licks), estrogen as "the female hormone" -> DES babies && prescription horse urine (PREMARIN is PREgnant MARes' urIN), etc.

The American Heart Association still warns about saturated fat [0]. If science advances one funeral at a time, what can be done about organizations that insist on being wrong?

[0] https://recipes.heart.org/Articles/1013/Healthy-Cooking-Oils

Modern medicine does have some good advice, but it's very tough to separate the wheat from the chaff. I think medical professionals are just as confused as everyone else. On Christmas I heard someone (a physician's assistant) recommend an erection-killing intervention to help stop her sister's boyfriend's hair loss [1].

[1] https://www.webmd.com/sexual-conditions/news/20120413/propec... - this side effect might not be not universal, but is devastating to the men who suffer it.

"Palliative" drugs are commonly used. This is essentially Elisabeth Rosenthal M.D.'s rule #2 for American medicine: "A lifetime of treatment is preferable to a cure." [2]

[2] How Economic Incentives have Created our Dysfunctional US Medical Market - https://medium.com/@RosenthalHealth/how-economic-incentives-...

Dr. Brewer's pregnancy diet is supposedly quite helpful for dealing with common pregnancy problems. Iirc, the core pillars of this diet are adequate protein and "salt to taste". But conventional medicine never figured this out for itself - I've met lots of women who suffered from dangerously-high blood pressure during their pregnancies. One's diet consisted of saltine crackers - she was nauseous, and had to have labor induced before the baby killed her.

Appropriate lifestyle interventions start to benefit people right away. Coconut oil rapidly helps with alcohol cravings, for example. People can lose most of their excess weight over a period of 2-4 years. Pregnant women immediately benefit from adequate salt intake. Etc.

Doctors are doing much better today than 50 or 100 years ago. I think the industry would greatly benefit from a critical examination of common practices.

You haven't seen it because your traditional world of medicine does not include that group of people.

I have. About a dozen of them. In fact, each Crohn's patient that I've seen undergo a fast 2 weeks or longer has not had any flare ups since. And completely stopped taking all medications and undergoing their usual treatments.

(they do watch their diet after, mostly fruits and veggies).

Lifestyle change alone will not cure it. It must be preceded by a proper water fast.

Reversed IS a strong word, and very appropriate here.

Sad that you get down voted when you make so many valid and useful points. Galileo was in the same boat at one time!

I don't think you can blame traditional physicians. Most of them really didn't go to school for a decade to tell fat people to eat less. They want to solve medical problems, not play life coach.

Maybe there is a role for technology here. People accept statements from a machine that they'd take great offense to in person. Maybe Siri would be a better entity to tell you you're fat and need to lose weight.

Is this a new thing? When I was a kid, we still had what was called a "family doctor." I'm not sure these really exist anymore. He never hesitated to tell my mom she needed to lose weight or my dad he needed to stop smoking. Maybe the fact that he wasn't a specialist allowed him to be more practical with his advice.

From what I've seen, family doctors have been replaced by primary care physicians. There's still a place for generalists in the medical profession.

You've mixed up two separate concepts. Primary care physician is a role, not a specialty. Most PCPs specialize in family medicine, internal medicine, or pediatrics. The PCP acts as the patient's primary point of contact, leads the patient's care team, and makes referrals to specialists when necessary.

Could you clarify the distinction in the context of my parent's question? I think the same thing could be said of family doctor, but I'm not sure I understand what you're getting at. For what it's worth, my dictionary refers me to "general practitioner" when looking up "family doctor".

Effectively a PCP is a load balancer for the pharmaceutical industry, directing consumers to the appropriate pill pusher.

At this point you are trolling. Would you please stop?

Which part of my statement is inaccurate?

Family doctors (and specialists) still give their patients practical advice lose weight, drink less, eat better, exercise more, and stop smoking every day. Most patients ignore the advice. What more do you expect the doctors to do? If we want people to make better lifestyle choices it's going to take a new system of incentives separate from doctors.

I agree though, by the time a patient makes it to a traditional physician for advice it's pretty much too late in the game. What do you expect from doctors that accumulated a total ~20 hours of nutritional education in their many years in school?

And it stops there after a short suggestion. Maybe it's time for "behavioral medicine" a la behavioral finance. We already know people aren't going to listen (they statistically don't) so how else can we tell them in ways that they will listen.

Make it like life or car insurance. I don't pay as high of a premium as a person with DUI history. Why is my health insurance premium the same as a person with an unhealthy lifestyle that frequents the doctor far more than I do for ailments resulting from their poor dietary choices?

For many people the premium isn't the same. Under US law, medical insurance companies are allowed to offer premium discounts for members who meet certain wellness goals such as maintaining a normal weight or blood glucose level.

You know how in technology we like to say "no one got fired for buying Cisco?".

Well, for them it's no one got fired for selling Lipitor.

Exactly, and it's not an irrational decision either. There's a gap in the medical system. It's really really difficult to get people to change their behavior. It requires a completely different skill set from curing, preventing, or ameliorating clinical disease. Trying to get doctors do it is quite frankly a waste of everyone's time.

This dude posted up thread that Crohn’s can be cured by a 2 week water fast, so I don’t think he’s on the same page as you.

His views sound a little more extreme (and seem to ascribe malicious intent to what I would label as systemic biases), but I think there's a lot of truth in the principles behind what he says. It's accepted today to dismiss anything that hasn't been scientifically proven, which ironically does a disservice to science. I think if you asked most true experts in the field doing cutting edge research, they'd be the first to admit that they don't know if fasting could cure some cases of Crohn's.

You are being naive.

Who do you expect to do the "cutting edge" research to confirm fasting can cure Crohn's? Do you honestly not realize this is career suicide? There is zero benefit to researchers funded by the government or pharma to find out not eating for 10-30 days is the cure to something they are selling $200K/year treatment for. This is not a conspiracy theory - this is modern life facts 101.

http://www.crohnscolitisfoundation.org/about/sponsors/

Yeah - sure, every corporate sponsor on this list just wishes for the day that it is finally known that Crohn's is not actually a lifelong incurable disease - and not only there is a cure - it literally costs nothing. In fact, you SAVE money by not eating too! LOL. It's astonishing how otherwise very smart people (especially on HN) cannot see beyond what's in front of them. I actually think the more conventionally-educated someone is, the harder it is for them to admit solutions are far simpler than they "should" be.

I'm actually not disagreeing with you. Except that I think there is room to say that there are people working in this area who, like you say, are incentivized to research in other directions, not necessarily the one that most helps us. That doesn't make them evil or bad people. They're doing more to help than any of us trolling around on the internet.

I could see a computer calculated life expectency with weight loss as an option to increase it.

Being told you are fat is not a good reason to loose wight. People probably already know they are fat. Maybe there are other reasons that could be communicated...

Seems like one of those things where reason didn't get you to where you are, so reason won't get you out of it. People tend to have an emotional reaction to a person telling them to do something they already should be doing. Maybe tech can help. Here an example of what I'm talking about.

https://mobile.nytimes.com/2014/10/19/fashion/how-apples-sir...

Well as a physician, you can't really force your patient to exercise and eat better. The best you can do is prescribe a medication to treat the symptoms, tell your patient to exercise and eat better, and send them off.

Do you have an alternative to prescribing medication for type 2 diabetes and Crohn's? Do you think doctors should simply withhold care since it's their patients' faults that they have those conditions?

AFAIK, as a patient with Crohn’s, there is no evidence that any specific diet causes or cures Crohn’s disease. If you know of dietary restrictions which reduce risk of Crohn’s in the same manner as type 2 diabetes, please share it, as I know many people (both patients and physicians) that would be happy to help make lifestyle changes to cure their disease.

There is some evidence that the low FODMAP diet that has proven very effective for managing IBS can also be effective for managing IBD such as Crohn's. Personally, it has been much more effective for me than any of the half dozen medications I have tried.

Of course, this is not actually a cure for Crohn's, just a treatment.

I agree, I was merely entertaining the parent's claim that Crohn's could be solved in that way. I'm sure he thinks Crohn's can be simply solved by going gluten/dairy free or by fasting.

Did you even see my reply? I don't "think" or speculate. I've seen it. 2 of them still take me out to lunch when I'm in town because I've changed their life with a simple suggestion which they took upon themselves to research further. It's all about a person's state of mind. If you want to be a slave to the systemic misinformation that's out there - sure, go ahead. If you want to explore alternative options that take away a physician's job security, all the power to you.

It's AFAYK because that's what you are being told currently.

Who do you expect to show you the evidence that a 2-week water fast will cure your Crohn's? The company that makes Remicade which brings them up to $200K a year per patient? A university that gets funded by the government that is lobbied heavily by the pharma companies?

Come on. Think about it.

I already shared it - now it's up to you to pick it up from here and do your own research if you are interested. I've seen many who have stopped and reversed diseases including Crohn's using water fasting followed by a diet of mostly fruits and veggies.

I’ve fasted for more than two weeks while suffering from a blockage large enough to prevent eating solid food. I still have Crohn’s. It’s possible and certainly important to manage inflammatory symptoms with diet, but unfortunately curing the disease through diet is just impossible. I’m glad it’s worked out for your friends. I just hope you aren’t preventing those with serious disease who need proper medical treatment from following through.

I don't, funny thing is I see it exactly the opposite, the traditional medical treatment and attitude towards alternative options is preventing those with serious disease from following through.

2 weeks is the minimum I've seen. Some need up to 30 and in rare, advanced cases even 40 days of fasting.

You come across very badly. Just based on how you engage, I was ready to shoot you down and I have pursued dietary and lifestyle changes for many years to manage my incurable condition. I also have recently concluded that fasting is beneficial for my condition, which flies in the face of everything I ever understood to be true.

A few thoughts:

1) Try to not overgeneralise. Even if you really know of people who were cured, that doesn't mean it is guaranteed to work every time for every case.

2) Try to develop a hypothesis as to why and how it works rather than merely asserting that it does.

3) Drop the conspiracy theory language and stance. It only hurts your case here.

I hope you really do know something useful. It might even benefit me if you do. But your presentation really needs work if you are going to get anywhere.

Best.

Thanks for your feedback. As I said elsewhere in this thread, my presentation does appear a bit harsh when done in a comment section such as this one vs. how I am in real life.

I don't know if it makes sense to change it. It may seem counter intuitive, however it's been my experience that the harsh tone and somewhat trolling-like language IS what sparks some people to PM me and make initial contact, or at least open a new tab and start googling.

I used to not be like this online, and I definitely see better response from my current style. (better in the sense that I think it results in more people taking it upon themselves to research this further). Yes, it has its drawbacks and my responses are usually at the bottom of any health-related thread on HN, but even this thread already got a few people to find my email (it's not hard) and send a quick note.

The downvotes here and general negativity towards fasting does not paint the real picture. There are many silent voices out there who will not engage here fearing backlash from other users or even employers or potential customers.

I'm always happy to and offer to jump on the phone with anyone who wants to talk and hear from a live anecdote or just be pointed in the right direction research-wise.

Getting rate limited or banned may not serve your goal too well.

And one would do well to set their ego aside and try to first do no harm. Getting converts to your fasting religion may feel like a rush, but you may wind up harming someone. It does not sound to me like you really want to look at the possibility that your cure may not be all that and a bag of chips, which just sets off alarm bells for me.

I am a potential ally. I have done similar things. You choose to not engage those facts while justifying your admittedly trollish behavior. I don't think this speaks well of your motives.

If you want to make the world a better place, the best place to start is with the man in the mirror.

Your last statement makes no sense. I already started with the man in the mirror. That man is arthritis-free since day 20 of a water fast 6 years ago. That man plays soccer every weekend, after not being able to for many years.

I made my own world a better place. Friends and loved ones who listened to my real-life non-troll opinion are better off today. Every single one. A coworker who dismissed it 2 years ago came around a few months ago and said he's no longer diabetic. Nope - the doctors did not find a special pill just for him. No new injection discovered. He checked himself in to a fasting clinic and walked out a new man.

I'll consider toning it down in the future. It will still be downvoted and the only difference will be less discussion, which will result in less attention from those who need it most. Me? I don't actually enjoy this. I spent a couple hours refreshing HN today just for this when I could have been doing something else. I choose what threads to comment on very carefully because I know HN is very science-oriented, but people will die waiting for the pharma companies to admit this.

Me? I don't actually enjoy this

Then you are free to stop, no?

I have one and only one person listening to what I have to say about my condition and getting better.

I was you a few years ago. I have been doing this 17 years, not 6.

Anyway. Probably just wasting your time and mine both.

Ciao.

I'm curious if you don't mind sharing, how long was your longest water fast?

I do mind sharing. You clearly have an agenda. You are desperate for validation. You found a thing that works for you, you want to think it will work for everyone and ... Sigh. I have barely engaged you and I feel tired.

Think on this: I am a potential ally, doing similar things. You are actively picking a fight with me and driving me away.

Ask yourself: Why is that?

It's not about getting converts. That's the first problem here - that getting someone interested in a water fast as remedy to a disease is considered "cultish", some crazy conspiracy or religion. Seriously, have the pharmaceutical companies infected our minds this badly? That radiation seems normal and applauded as a great suggestion, but a water fast, simply the act of just resting and not eating.. is.. dangerous or some wild crazy tinfoil hat idea?

No, the first problem here is you are certain you have a cure. You will listen to nothing to the contrary. Anyone who has evidence or experience that contradicts yours is dismissed as not having fasted long enough.

Your behavior is egomaniacal and casually callous.

I have cystic fibrosis. I am getting well when doctors claim it cannot be done. I have been in your shoes in arguments. I am trying to give you the benefit of the doubt and be constructive.

But, sorry I engaged. Carry on with your knowingly and intentionally trollish goal of getting converts to your totally not a cult.

Also - why shouldn't I be certain that water fasting IS helpful and likely to cure many diseases? All the evidence I have and been exposed to shows precisely that. I'm not saying people should start it tomorrow. All I say is - research it, you will be introduced to an entirely different world of medicine.

Yet you have no issue with people who have never even heard of this concept coming here and making definitive statements that this is all non-sense?

I have not seen or heard today of any evidence that says water fasting is either (a) harmful or (b) not useful. Do you have any sources?

It is well known that fasts need to be from a few days to 40 days. I'm sure you've come across that 40-day number before if you're not entirely new to fasting.

I am pretty new to fasting. I don't know of the evidence you are pressing me for. The request tells me you don't actually understand what I am saying.

So maybe take some time to digest it and if you ever want to really talk, my contact info is easy to find.

If you want anyone to believe you then I would expect to see evidence from a large scale, double-blind clinical study published in a respectable medical journal. Find some researchers yourself and help put it together. Since there's no expense for medicine or food it ought to be fairly cheap to run. Despite your ridiculous conspiracy theory, hospitals and universities frequently conduct studies that aren't funded by pharma companies. Just pick up some medical journals and start reading to see how totally off base you are.

Look into research and patient treatment results by the likes of Dr Herbert Shelton. There is quite a bit of literature to support caloric restriction and in particular water fasting as ideal treatment option for many diseases once you filter out MSM sources that tell you it's a lie (and in the same page push you ads by Pfizer.. yep, clearly unbiased!)

It's not about who funds the research - there is literally no benefit to confirming that water fasting cures diseases. Nobody in the medical industrial complex would benefit from this. Not even food companies! (because you won't be eating for up to 30 days and then change your consumption habits drastically against mass produced factory food).

Are you referring to this one?

Shelton, Herbert M. Fasting Can Save Your Life: How Christians Can Change World Events Through the Simple, Yet Powerful Tools of Prayer and Fasting. Natural Hygiene Press, 1964.

Please.

Seriously - why would someone like you be so opposed to water fasting?

Think about it for one minute - patients go through extreme treatments like chemo, radiation, Remicade, whatever - anything to get better, right? Why is exposing your body to crazy treatments so accepted, but this isn't? Nobody is telling you to expose yourself to chemicals, eat crazy things, drink concoctions.. really. What's your issue with water fasting? Such a pure process.

So why not give this a shot? Type 2 diabetes people in fact see results in a matter of few days. What do they have to lose? I'm sure you're intelligent enough to realize water fasting for extended but still short enough of timeframe is not starvation, right?

If you could make an effort for 5 days for the chance of never having to suffer from Type 2 diabetes - why the heck not give the patient the information? This is sick, truly sick, and people like you are keeping it so.

On the contrary. I am not at all opposed to fasting, although extended fasts do carry certain health risks. You have presented a plausible hypothesis. Now do the hard work to validate your hypothesis by following the scientific method instead of wasting our time with unverifiable anecdotes.

Can you please point to the study that shows extended water fasts carry certain health risks?

Posted some more links for you in another comment.

Please what?

Do you have proof that you know of someone who water fasted for extended period of time and was not cured or was harmed?

Because I DO have the opposite proof.

So your empty statements and insinuations is just trolling.

Agree. My dad, also a physician, blames himself for being overweight. But if "everyone" is overweight, can it really be their fault? Surely "the system" has as much or more blame to share.

Your dad, Big Food, Big Pharma, MSM, his parents. The blame is in that order.

Sure, most physicians nowadays will mention to the patient that diet and exercise are beneficial, but at the same time will outright dismiss the critical role that diet specifically plays in curing the disease.

Yes, the alternative is a 10 to 30 day water fast for both of those. I know several people that successfully cured both. Especially Crohn's, the amount of misinformation given by physicians is stunning and borderline criminal. $200K a year Remicade treatments GONE after 2 weeks of water fasting. Why would Big Pharma have any incentive to get this message out there?

High blood pressure for example can be reversed entirely after 5 days of water fasting. Completely gone. I don't know how else to say it. I have first hand knowledge of many successful water fasts, but the medical world has brainwashed everyone to the point that I get shut down immediately in any social setting by even mentioning this. But that's okay. Not forcing anyone to do anything they don't believe in. All I can do is share my knowledge and point people in the right direction when they're ready.

Prove it. In a randomized, placebo-controlled, double-blinded trial.

There are plenty of quality and health savings organizations that would fund such a trial if there were any hint of benefit. But there isn't.

I'm glad to hear that pseudo-science still gets shut down in social circumstances.

It is slowly trickling in.

http://www.telegraph.co.uk/science/2016/03/12/fasting-for-th...

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4684131/

I personally know multiple people that did listen to me and others who told them about the healing powers of a water fast, and cured their illnesses by doing it. There's really no downside. You are not "starving" yourself. That is such an insane myth.

I myself did too - got rid of a bad arthritis in the knee that I've suffered from for years - just 20 days into a fast (this was 6 years ago, no inflammation of any kind since).

So, no studies linked, just a quote collection and an interview?

I am not aware of any study (that has been made public, remember they always have that option at the end) by a pharmaceutical company or university that was set out to test whether water fasting for 5+ days is beneficial in treating or curing disease.

Several reasons:

1. They conducted one, but didn't like the results.

2. "Don't ask what you don't want to know the answer to" applies here - there is ZERO benefit in discovering that water fasting indeed reverses diseases to which these entities have vested interest in keeping their symptoms a lifelong struggle to patients. Nothing good would come out of it for them. The entire modern medical business model would collapse.

Tin foil hat? Sure, label me that. All I can do is drop tidbits that may be helpful to someone now or in the future. I already know that I've helped a couple dozen people personally in the last few years, myself included.

Those people would still be in a very bad shape if they waited for government or pharma company to endorse what has already been proven to be used successfully for hundreds of years as a primary healing treatment.

Sorry for being so dismissive, but with so much noise out there, it feels like a waste of everyone's time when such a claim is made without the science to back it up.

For sure, there are seemingly endless possibilities that are not being thoroughly explored by the many scientific bodies, but I can understand why that is.

Thanks for taking the time to reply with more information/research.

Here some more links for you to dismiss:

http://www.sciencedirect.com/science/article/pii/S1934590914...

https://bmcmedicine.biomedcentral.com/articles/10.1186/1741-...

http://www.sciencedirect.com/science/article/pii/S1550413115...

I think there's a lot to be said for sleep, diet, and exercise for combating many what are often termed lifestyle illnesses. That said, I think there's a lot of use for tech (which is really just applied science) in monitoring, diagnosing, and researching illnesses and treatments, as well. And not all maladies can be treated by sleep, diet, and exercise alone.

I can easily imagine anecdotal evidence like that you mention while dismissing the rest of the medical establishment (with loaded phrases like Big Pharma) is likely to get you dismissed as well. Perhaps that's not how you intend to come across, so perhaps you might look at tempering your arguments to make them more palatable to those you believe are brainwashed.

The way I comment here is not really how I relay this information to people IRL, especially because I'm very aware and sensitive to their health situation at the time. Here I know I'm going to get downvoted instantly, so I don't bother as much. Mostly threads like this frustrate me, because I know so many people can be helped but online communities shut down these types of discussions and people barely scroll all the way to the bottom to read the truth.

So anyway, I hear your feedback and agree with it. Offline I'm much more patient and I do make it a point to take my time and only slowly break the news to them that traditional medicine has been lying to them for so many years, coupled with real evidence and pointers as to the direction they should be looking at in evaluating what I just shared with them.

> "The way I comment here is not really how I relay this information to people IRL"

> "Offline I'm much more patient"

I encourage you to behave more like you do in real life here on HN. Much of what has unfortunately become accepted as discourse on many forums does serious damage to actual meaningful discussion. If that's not what you're interested in, please just refrain from commenting. Many on HN, for all it's faults, are trying for something better than average, even if we don't always succeed. People are still people, regardless of where you're encountering them.

Well, IRL people would give some verbal feedback before they dismiss my suggestion. In HN, they just downvote and walk away.

And I have, so far I answered every comment, including the physician who wanted links to "proof", whatever that may be. After all, who really benefits from finding proof that water fast cures illnesses that otherwise require a lifelong regimen of medication and doctor visits?

Perhaps there's some chicken/egg going on here? On HN, members will downvote based on tone as well as message because many do value civil discourse and recognize that regardless of the value of the substance, the manner in which a member communicates that substance can drag HN down. And deciding not to couch your comments as constructively as possible is much more likely to result in downvotes, if that's what you're concerned about. You've gotten plenty of feedback in this thread.

If you have a message you want to convey, it's in your best interested to also convey it in a manner that has the best possible chance of being accepted. If you've already decided that's not worth the effort, it's probably not worth the effort to comment at all.

I agree, I may come off as a troll. I get your point. It's too bad if I do though, my intention is to point people in a direction that will help them and one that they've likely never come across before because no one in the traditional medical world will ever suggest this as a viable option.

I will make it a point to phrase my comments differently in the next health-related thread.

> "I will make it a point to phrase my comments differently in the next health-related thread."

Why wait? Why not start now?

Unfortunately water fasting is not effective in treating chronic procrastination.

I've worked in healthcare tech before and one thing we didn't need was more people claiming you could solve every problem with some random FOTM untested medical method that doesn't hold up to scientific scrutiny. No need to make yourself out to be some sort of scientific martyr. If you can't do people here the justice of backing up your comments, don't comment and then complain about getting down voted

I did back it up. Again, remember, there is not much "science" to back it up - because universities and pharmas have such little incentive to studying what may prove to render the medical world useless. Think about it. Why would they study it? If it doesn't work - anyway no one believed it. If it does - all their patented work becomes unncessary for many diseases.

So you are left with real life people who have seen success. And there are plenty once you open your eyes.

Accusing physicians of being dismissive of nutrition by being dismissive of technology is sort of ironic, no?

The reason many physicians are dismissive of nutrition is because they only get about 20 hours of total education on the subject.

Well you can do both. There are apps to improve food habits as well as the other stuff.

I'll throw in a slightly contrary opinion.

I work for a health-insurance startup. And many of the people we cover are on extremely low fixed incomes. It's not unusual for them to be in situations where they have to choose which bill to pay this month and thus which utility will get shut off next month for non-payment. Their premiums are heavily subsidized and they only have insurance at all because of government programs, sometimes only because they're eligible for multiple programs which combine to help them out (and which are also constantly on the chopping block). So any kind of cellular phone, let alone a multi-hundred-dollar smartphone with service contract, is simply an unaffordable luxury for them.

And that's why I worry about these kinds of efforts. More affluent people can benefit from smartphone-centric approaches, but a huge percentage of the US slips through the cracks when you do that.

So solving America's health-care problem is not going to happen by focusing on people who have smartphones. That will just heighten the divide; the people who are already in a position to get good care will continue to get it, and the people who aren't will continue to get worse. If you want to avoid the grim-meathook-future problem, smartphone-centric (and, really, most tech-centric) approaches are unlikely to work.

There are plenty of indicators that could be monitored in various patients for various diseases, but a lot of them may require doing things that are beyond the ability of someone who is not medically trained. Some of them require intravenous blood samples, for example. But others are like example you mention (which only requires that the patient weigh themselves at a given time each day).

It would be nice if we could make it simpler for people to measure things like their own hemoglobin A1C, blood urea nitrogen/creatinine, blood flow around organs/extremities, etc. and send the data to a service that can be used to alert medical staff if something looks like it's getting worse.

> Can you imagine my frustration at hearing this? It's this massive problem with an obvious (CHEAP!! SO FUCKING CHEAP!!) solution.

I suspect the nurse is there to perform the “getting the patient on the scale” function, not the “reading out the weight and tracking it” function.

Perhaps the scales could be built into the bed somehow?

Modern hospital beds do have scales built in.

Thanks - I did not know that.

Full-automation should be possible then - no need for the nurse to get the patient on the scales.

That's probably what #rayiner meant when he wrote that the solution is obvious.

It seems like the real (meta)problem is that the system’s incentives don’t reward this. If a doctor’s take home pay increased as these things were avoided, you wouldn’t need some risk-tolerant startup to dive in with some innovative protocol; someone would have figured out a fix a long time ago.

(Edit: to adapt the old saying: if life-saving were profitable, common sense would make us all saints. But alas, we live in a world where regulatory arbitrage pays more.)

I think we should ask how we got to the point that the incentives are so incompatible and how we got to that point and how to realign them.

Both doctors and hospitals are financially incentivized to avoid rehospitilization. It is actively tracked and directly impacts billing. Check out the "Hospital Readmissions Reduction Program" that Obamacare introduced.

I’m sick of people spreading FUD about medical billing based simply on the ridiculous “the man is out to get me” narrative.

Fair enough -- I was severely understating the extent to which there are financial incentives. But I think you're making a similar error in the opposite direction, coming from the approach of of "that problem is solved because we have a law for it." Imagine in any other context:

"Everyone makes a living wage, because we have minimum wage laws." -> No, cost of living can eat it up in some areas, and some people are forced to go contractor, where take-home can get arbitrarily low.

"Taxis provide vital, universal service because they're obligated to take you anywhere." -> Yeah, but in practice they can flout this with impunity.

In this case, yes, the most obvious cases of hospital failure will be undercompensated, getting some incentives right. But is that the same thing as saying that actual, effective measures to avoid screwing up will translate into higher profits, and the people capable of identifying these will benefit from pointing them out? I think that's a stretch.

Why do you think such a simple measure, as proposed by this startup, has to drag them kicking and screaming into implementation? Isn't this something a hundred doctors might have noticed and suggested? Something system level isn't working. Either the feedback loop between hospitals and doctors is broken, or it's too easy to relabel a readmission as being a new issue, or something like that.

If startups have that kind of resistance to something so simple, that suggests a lot of easy improvements are still being held up by misaligned incentives, and supports my original point that system level fixes are a bigger target for health outcome returns.

Is there any chance you would be up for talking about where one could go about working in tech on problems like these? Every time I've looked, I usually just find hospitals maintaining poor IT infrastructure and CRM-type systems. I would love to work in this space.

Strangely, I've been able to find startups in the education space, but not in healthcare. I imagine 90% of the problem would be integration into the behemoth that is medical administration, but that's something I also have the skillset for.

Hacker news has a limit on replying to responses with less than a few votes, but my email is in my profile

The tech is the easy part. Integrating into a 24/7 high turn-over environment where all employees, IT included, are stretched to the max, is the real issue.

And pumping the data in to their myriad EHR systems, getting those records associated correctly across those systems+, the unintuitive UI/UX problems you'll inevitably face, as well as training issues. And God help you if it's a place where they home brew their own solutions instead of going with a vendor. My company is in the health care space, as well, and a lot of the problems _do_ look easy ("that's just a CRUD app, right?" easy) until it comes time to get them adopted in the health care space.

Wifi-enabled scales that connect to webservices already exist on amazon - I assume the hard part is getting some certification so doctors/nurses can 'prescribe' it to patients when they leave hospital or while they're in hospital and getting the webservice to talk to $hospitalSoftware, etc?

Failure to market an IoT product is unfortunately my experience as well. I hope the medical industry gets better, re-hospitalization sounds ridiculous for something easy to detect.

The monitoring devices are the real problem, not the people. Do you think all weight spikes simply equate to having CHF? You can't just rely on such a basic measurement when dealing with an incredibly complex system such as the human body. A lot more specialist equipment is going to be needed to come to a final conclusion (Questioning from experts, MRIs, XRays, even Microsurgery with cameras).

What consumers can currently access are weighing scales, and heartbeat monitors. Maybe even temperature monitors. Do you think this stuff is useful for diagnosing medical conditions? There is a whole lot going on under the surface that we simply can't see at all, that's the real problem.

Your comment is a great example of the disconnect between people in this space and people not in this space. Do you actually think anyone in this space would believe that weight spikes are tied to CHF in all cases? You don't diagnose CHF by weight. It's something you trend in known patients.

Comments like this are one reason why doctors give zero shits about the potential of computing. Explaining even the basics of a narrow area of human physiology to some overly arrogant IT guy is maddening (arrogant is fine, for Pete's sake, it's not like doctors aren't arrogant). Yes, the doctors can be blamed for conflating computer scientists with the IT guy who came to replace their mouse. But the IT guy and the CS guy (always a guy) can both equally be blamed for their unholy arrogance. How many lives did you save today? Zero? Ok, at least I didn't spill any data (that I know of).

This can go round, and round, and round.

You have no idea how far down the problem goes. I know this because no one knows how far the problem goes. We sequence hundreds of thousands if not millions of genomes, and still we don't know. Do you really think we spend a decade in training and come out thinking everything is simple?!

Now, on the flip side, doctors also don't even know how to frame their problems, in no small part because they're only required to take 2 semesters of calculus. And then most of them punch out of math as fast as possible.

Computer scientists should be going to biology conferences. Go to ASCO. Pick a medical specialty, they have multiple conferences a year, I garauntee it. There's one or 10 in your city. If you want middle ground, look at microbiology, immunology, molecular biology. They use a fair number of quantitative methods (sequencing, mass spec, flow cytometry, etc).

I'm a software guy in the healthcare space, albeit not medical devices. We see this problem all the time. Despite the fact that most of the people involved have degrees, often Phd level, in CS, Math, and Physics we see no end of other software folks from typical tech companies coming in and describing how we just don't know what we're doing and that we need big tech to come in and disrupt us.

There's a reason we do things the way we do them and it's not because we're stupid and/or ignorant.

I agree that his comment was not in good taste, but I think he must have simply misread or skimmed the parent comment, or misunderstood.

Your comment is a great example of unnecessary escalation. He made a mistake, no need to pin all this angst about the disconnect between doctors and engineers on one mistaken comment on the internet. While I think the parent commenter should apologize, I think ideally you should too, this is blowing things out of proportions and that's not the kind of dialogue I like to see on HN, or anywhere on the internet.

Fair enough, happy to go first. I hearby apologize for escalating, although the disconnect and it sources stand. What is sufficient remedy? Shall I delete my comments?

chill. I personally don't think you really escalated all that much, and outside of the casual misandry (hehe, couldn't resist piling on with another complaint) I got genuine value from reading your comment.

Why on earth do you think you can generalize your anecdotal experience to conclude tech people are any more arrogant than doctors or staff in whatever field?

We can agree there is a massive disconnect, but there is plenty of arrogance to go around and I’ve seen it on both sides in these situations. Moreover, whoever’s arrogance it is, is only one part of the problem, and I think not the largest one.

Just the legal and regulatory hurdles alone pour molasses all over what would normally be a fast moving startup effort. Worse, some products or services have to worry about the reasons the bureaucracy exists in the first place: What level of risk mitigation is sufficient to keep from killing people? Here’s a hint, it’s a level that doesn’t speed up your time to market.

There can also be a lot of time wasted by people who may be very talelented within their specialties, but require lots of hand holding to ramp up on the medical issues, technologies, product design and user experience (which still always exist), and business strategies depending on their background. Ideally you have at least one person with great expertise in one, and training and/or a knack for the others, who can see the big picture, and everyone else must make honest assesments of where they can really add the most value.

We always talk around here about how ideas are cheap and the team and execution are what matter. Based on some time I’ve spent with doctors and entrepreneurs in these scenarios, my impression is that maxim is even more apt in this space.

I have been working with some extremely smart, hard working computer scientists on a real, hard problem in this space, a problem I've been working on for 6 years. Easily 20 years of work left. I have a great deal of respect for what you are capable of.

The white hot fury was directed at the sophmoric response of hacker_9 which I then used as an exemplar of a few trends in behavior I have watched for over a decade.

I understand your frustration, I believe your experience, no personal attack was intended.

I only hope we can agree that generalizations about good and bad character traits is tricky business, even if all this was not anecdotal. I hope there can be more agreement because there truly is life changing work that needs to be done, but as with so many things in life, it sometimes requires effort to remember our previos experiences may not always predict our future ones.

What an ironic comment - I tell a software developer that medical science isn't as easy as measuring weight changes, supporting the point that doctors need to do a lot more than that to come to a diagnosis, and then a doctor (I assume) tells me to STFU because.. oh, of what I originally said in the first place. What was your point here? I hope you don't make these kind of mistakes with actual patients.

This is what I was responding to:

> Do you think all weight spikes simply equate to having CHF? You can't just rely on such a basic measurement when dealing with an incredibly complex system such as the human body.

Considering you were knowingly addressing someone who worked in the space and blew right past something you obviously knew within seconds (not all weight spikes equate to CHF), thinking there was even a remote possiblity they hadn't thought of that, despite having a physician on staff to discuss with.

Your response here (as quoted) is exactly why doctors throw their hands in the air and wait for someone else to come along. You actually thought you had an insight and despite remonstration, you persist in thinking you outwitted everyone on this thread. That's the point.

You're lack of humility coupled with your snowflake sensitivity is why we don't want to work with a lot of computer people. The sad fact that a lot of doctors also equate computer science with IT is another problem.

You would think OP would know that, but the original comment basically tells us all to measure our weight simply to check for CHF. If it were that simple we'd all do it I presume, but of course weight change can be a range of things. Many of which are not problematic. Hence why I pointed out that better measurement devices are needed. I've also got a feeling that it may just be you in particular that 'IT' don't like dealing with.

You're still missing killjoywashere's point.

Their point was that _of course_ everyone involved (including the person you were originally replying to) knows that a weight-measurement is not sufficient to diagnose CHF. Literally everyone in the conversation has already presupposed that point.

However, blhack working with a physician learned that it would be a super useful medical tool to have an automated mechanism for taking those weight measurements because it's a useful early indicator.

Your response was exceptionally dismissive, given that there were people in that space who knew what they were doing and knew it was useful. Yet, you came by and in 10 seconds decided it wasn't useful and wasn't worth doing.

So, what makes you more qualified to make that decision that blhack and the physician they were working with? Why are you so arrogant to assume that the physician who stated that would be useful was just wrong?

Your insight wasn't particularly insightful, and you presented it in a way that was condescending and dismissive of others in the space.

OP said that CHF always causes sudden weight gain; they never said that sudden weight gain always indicates CHF. You're the only person here who implied that.

A doctor accusing other professions of being arrogant? That's rich.

You mean where I said

> I didn't spill any data (that I know of)

> doctors also don't even know how to frame their problems,

> most of them punch out of math as fast as possible.

How about the part where you said:

> How many lives did you save today? Zero? Ok, STFU

Last time I was at the hospital they seriously asked if I wanted Reiki. If you can get through med school and still believe in that, sorry If I don't have much respect for your education.

Doctors and IT people are the two most arrogant professions I've ever come across, and I even work in finance.

Thank you, point partially taken. I deleted the expletives. Have an upvote.

This isn't about diagnosis, it's about monitoring already at-risk patients. He clearly stated nurses take this sort of measurement manually for at-risk patients, it's a simple solution to automate an existing workflow that involves an unnecessary amount of manual labor.

It is possible that some of the noise (non-medically relevant changes) could be filtered algorithmically, and conversely conditions might be able to be picked up that might not be noticed by a normal provider. Physicians use those tools to diagnose disease all the time, that's why there is a thermometer, scale, and stethoscope in every doctor's office in the world, I don't understand how these tools aren't useful.

They can tell you something is different, or out of the normal range, they don't give you the real cause of the problem though. This is left to the doctor who will take into account age, gender, medical history, as well as the fuzzy description of the problem from the patient. Then they'll give you some medication and hope that it heals in a few days, if not, then re-assess and do more trial and error diagnostics and medications (which can go on for months, even years).

If we had technology that could monitor internal changes on a real time basis though, then the face of medicine would change forever.

If you're going to monitor every aspect of a person's life, you're going to generate so much data that you'll generate almost nothing but false positives. None the less, I don't see why you couldn't just scale your level of significance way up and be a useful screening device. Obviously any diagnosis must be made by a doctor, but that doesn't mean your biometric information wouldn't be useful.

I think they only use weight to screen people specifically at risk to determine if they need to take a closer look.

An easy, fast, cheap test which usually means a more expensive test or exam doesn’t need to take place.

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