Comment by sametmax | Hacker News Reader

Comment by sametmax | Hacker News Reader

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> There is a good reason why medicine is conservative

Let's be honest, medicine is not just conservative for this reason. It's also because of inertia, politics, economics, stereotypes, and the fact people don't want to take the blame if the new thing fail. But also because of resources and human limitation.

I had an example recently in my life. I got malaria years ago because I lived in Mali. The medias, all my friends, family and doctors told me 2 things:

- you gotta take your anti malaria pills (nivaquine, lariam, malarone...) for the whole trip cause there is no curative treatment for malaria

- if you get malaria, it's for life

And surely, when I got back home with the parasite, I got hit with a malaria episode from time to time, to remind me it was here. Not funny.

7 years later, I end up having diner with a scientist from the Pasteur Institute in Paris (pretty much the biology equivalent of NASA, but in France). He calmly explained to me that actually you don't have to take your pills for the whole trip. Malarone is a curative drug, and you can just take it when the first symptoms appear. Also, I don't have to keep having malaria episodes for life: they have protocols, again based on simple Malarone, that can get rid of the little bugger.

I took the number of a colleague of his, a tropical disease specialist, and went to the institute. Surprise, everything is true. There is no mystery. No secret.

The information is just there. Scientifically robust. And yet it doesn't reach you.

So now you gotta wonder: what are the other thousands missing informations or misinformations you get every day in medicine ?

And remember how many food facts fad you lived through. Remember that companies spent a lot of money for stuff like "carots are good for sight", "drink milk to grow up", etc. Remember that red meat is considered "Group 1, carcinogenic to humans" by WHO and nobody is talking about it. Remember that it took decades between asbestos being marked as deadly and any move to forbid it.

We need to keep a healthy criticism about medicine. Doctors, after all, are only human.

Totally agree regarding doctors being fallible humans just like the rest of us. If you are diagnosed with a rare disease (or even just a disease that isn't common in your geographical region c.f. Malaria) there is a very good chance that you, if you are reasonably intelligent and have access to the internet, will rapidly become more knowledgeable in the specific details of your illness than your doctor. This is based on anecdotal evidence of mine through experiences friends and family have had, but I suspect it is a common experience.

- your doctor may not be able to spend significant time getting up to speed on all the details and angles of your particular case

- they probably have no idea about what clinical trials you might be eligible for

- they won't be as emotionally invested in the outcome as you. For most experienced doctors it becomes just a job the best you can hope for is that they are highly professional and take pride in their patient outcome record

- they may misdiagnose you or offer inappropriate or downright counter-productive treatment

- not all doctors are of equal ability. This applies to doctors just the same as any other profession, albeit the minimum bar to entry is usually strictly enforced in most countries

> He calmly explained to me that actually you don't have to take your pills for the whole trip. Malarone is a curative drug, and you can just take it when the first symptoms appear.

Huh?

A. It's always better to prevent an infection in the first place than to treat one that has already occured.

B. Malarone is not a 100% effective treatment, there have been reported resistant cases to treatment.

C. There are reasons the CDC develops guidelines. Don't ignore them frivolously.

https://www.cdc.gov/malaria/travelers/

Well, given the serious side effects of Malarone, if you stay 2 years in Africa, you probably don't want to pop it like M&N's.

A medical act is always a balance between the costs and the benefits of it.

Again, the CDC makes recommendations for that scenario as well; these are guidelines written by people who spend their entire lives studying and treating these diseases.

Imagine if someone who read a few articles about programming started to debate with you about the relative merits of direct SQL use vs. ORM--he might say "ORM c'est de la merde." I'm sure you would explain there are tradeoffs, it depends what you are trying to accomplish, etc. Experts in a field establish guidelines for a reason.

https://wwwnc.cdc.gov/travel/yellowbook/2018/advising-travel...

You keep saying that but you haven't read the document. Basically it says 'there are pros and cons' but we still recommend the drug. Very little explanation on to why, and on that consequences on long term use of the drug. There is basically zero study there on the consequences on what they advice, just educated guesses and they tell you "yeah do it but check with a doctor regularly". This is not science.

That's why there's a bibliography on the bottom. Review the source material they relied upon.

Not justifying conclusion, saying "check with experts" and giving away sources is not a proper medical recommendation.

It's like me writing a report to my client on "should you use an HTTP API", ending up with "probably yes but it depends so check with you local web dev" and sourcing O'Reilly books. It's political correct bullshit: as the expert, it's my job to not only give a strong actionable conclusion, but to justify the hell out of it.

Have you read the list of possible side effects of the drug ?

https://www.drugs.com/sfx/malarone-side-effects.html

This is a very active product.

If you advice somebody to take it PREVENTIVELY when you are healthy, not even mentioning on a long period of time, you better have a really compelling case.

Not just "meh, yeah do it".

>Review the source material they relied upon. //

Isn't the point of orgs like the CDC that individual citizens, who aren't experienced in the field, don't have to attempt to analyse the data for themselves; experienced people with expertise who are demonstrably not biased by commercial interests, should be giving you a simple result that anyone with a 11+ yo reading comprehension can follow and know they're doing what most experts would recommend.

If the advice differs from other country's health organisations, or from the WHO's then they should say why.

Having claimed to have gone to a tropical disease expert, what lead you to believe a link to info meant for broad consumption is more accurate?

Is there science to undermine the CDC’s positions? Sound possible. What’s the process for updating that site?

The government recommended flossing for years then retracted it recently when it turned out there was no science to back it up. Seems the industry had been peddling the notion and it got on a government document

Not saying this is the case with malaria but there’s history for it

The drug industry doesn’t make money when someone is cured. Again, no evidence for that, just history of “hmm maybe government information isn’t iron clad”

> Remember that red meat is considered "Group 1, carcinogenic to humans" by WHO

The WHO carcinogenic groups are about the probability of something being carcinogenic, not about how big the carcinogenic effect is.

What you describe is just how humans behave. It's frustrating, for sure.

For example, I got the flu a couple of weeks ago. I had a low-level fever and wondered, should I take something to lower the fever, or not? I Googled it and found hardcore research papers on the subject which basically said there is a narrow set of circumstances where reducing a fever is warranted, but most of the time you should not do it. It was clear that for my circumstance, I should not lower the fever artificially. A lot of the Google hits said the opposite, though. It seems the information is out there and has been for many years, but what does every Dr I've ever talked with told me to do? Lower the fever.

Well, the fever is useful to fight the desease, so keeping it up (unless it's becoming life threatening) may help you heal faster.

But most people want comfort. Or just be productive. Or have obligations. And a fever sucks for that.

Here's a source that makes it clear enough that malaria can be cured:

https://www.cdc.gov/malaria/about/faqs.html

Is red meat really considered carcinogenic?

there are a LOT of vegan proselytizers on HN who will slip a casual off-hand remark like that into a large seemingly un-related comment.

they pop up in every nutrition thread like clockwork, especially those that involve low carb discussion. but looks like vitamin supplementation is not a topic they shy away from either.

Apart from the cited sources above I guess.

Depends on your definition of red meat - grass-fed or grain-fed? Two completely different animals. Literally.

I... don't think you know what 'literally' means?

I'll give you an example. You took my comment too literally and completely missed the point.

He actually has a point, though it was poorly made. The Omega 3: Omega 6 ratio of grass fed & grain fed beef are vastly different. If you subscribe to any of the ancestral diet theories, the difference in ratios is enough to make grass fed very good, and grain fed very bad.

Do you know if the Omega 3:6 ratio have any effect on the carcinogenic properties of read meat?

I hadn't seen this before, but it turns out the WHO has a FAQ on it.

http://who.int/features/qa/cancer-red-meat/en/

I looked it up here: https://www.cancer.org/cancer/cancer-causes/general-info/kno...

- consumption of processed meat is Group 1: Carcinogenic to humans

- consumption of red meat is Group 2A: Probably carcinogenic to humans

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