Comment by javadocmd | Hacker News Reader

Comment by javadocmd | Hacker News Reader

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Forgive me for being blunt, but that's just how modern medicine works. No one has the Star Trek tricorder that can scan your body, read your genome, and detect a quantum fluctuation in your synaptic waveform matriculation to calculate how many CCs to put in the hypospray.

We really only have one amazing piece of technology at our disposal: statistics. At the absolute best (and I'm not saying it's always the best...), what comes out of a pharmaceutical development pipeline is a drug that works for some people some of the time. Sure, sometimes you get broad categories to try to narrow down effectiveness, but at the individual level there is ultimately no choice but to try a drug and see if it works. And this is especially true in psych drugs, in no small part because there are so many unanswered questions about how our mind works.

And that sucks. I get it. It must be so frustrating to deal with a revolving door of new regimens and new side effects, all while yearning for relief from the underlying ailment. Not to mention navigating our nightmarish medical bureaucracy. But please understand that doctors, generally, are just doing their best to help given the tools they have. If you don't currently have that kind of trust and partnership with your doctor, I hope you are able to find one with which you can. I wish you the best, and hope that this perspective will make your frustrations somewhat easier to bear.

The situation is much worse than you outline, from a scientific perspective, and even well-meaning doctors aren't an antidote due to systemic distortions.

Ben Goldacre, a UK physician and medical researcher, captures it really well in the opening two paragraphs of his book 'Bad Pharma':

> Drugs are tested by the people who manufacture them, in poorly designed trials, on hopelessly small numbers of weird, unrepresentative patients, and analysed using techniques which are flawed by design, in such a way that they exaggerate the benefits of treatments. Unsurprisingly, these trials tend to produce results that favour the manufacturer. When trials throw up results that companies don't like, they are perfectly entitled to hide them from doctors and patients, so we only ever see a distorted picture of any drug's true effects. Regulators see most of the trial data, but only from early on in a drug's life, and even then they don't give this data to doctors or patients, or even to other parts of government. This distorted evidence is then communicated and applied in a distorted fashion.

> In their forty years of practice after leaving medical school, doctors hear about what works through ad hoc oral traditions, from sales reps, colleagues or journals. But those colleagues can be in the pay of drug companies – often undisclosed – and the journals are too. And so are the patient groups. And finally, academic papers, which everyone thinks of as objective, are often covertly planned and written by people who work directly for the companies, without disclosure. Sometimes whole academic journals are even owned outright by one drug company. Aside from all this, for several of the most important and enduring problems in medicine, we have no idea what the best treatment is, because it's not in anyone's financial interest to conduct any trials at all.

His book, which lobbed a grenade into the heart of the pseudo-scientific state of 'modern medicine', has resulted in more energy being put into trying to move to science-based medicine with things like https://opentrials.net/, but I don't closely observe that industry, so perhaps someone else within the sector could speak to how far the idea of publicly available trial data has gone in 2019.

I would argue that even the ideal medical system would likely produce the same outcomes experienced by the author of the parent post. In our present stage of scientific and technological advancement, the following might as well be a Law of Nature: even the best of drugs will have varying effects on various people in varying circumstances.

But yes, there are plenty of inadequacies in our healthcare industry (speaking from the US), but that's a much, much broader discussion.

The statistics don't support the use of anti-depressants in the majority of cases.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3736946/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4592645/

"that's just how modern medicine work"

Or doesn't work. We don't accept this in other areas why medicine? Modern medicine in a lot of cases is as modern as when the doctor went to school and stops evolving once school finishes.

There is a disconnect between research and medical knowledge by frontline workers.

> Modern medicine in a lot of cases is as modern as when the doctor went to school and stops evolving once school finishes.

I just wanted to point out that while I can empathize with this sentiment, in the United States at least, physicians must undergo yearly retrainings to earn continuing education credits (for medicine) and there is a certain number of credits that must be acquired on a yearly basis.

That is true for Germany as well. However you can get credit points through the attendance of pharma sponsored conferences.

There's an initiative called MEZIS (Mein Essen zahle ich selbst - "I pay for my lunch myself") that wants to end this practice. https://mezis.de/

I'd argue qualitative data is far more valuable than mass quantitative data, the problem is that's expensive and difficult to gather accurately - especially on a timescale that is longer than the only the 2 weeks that many if not all behaviour changing psychotropic medications required for 'adequate' research under heavily controlled environment before unleashing them onto the masses.

Statistics can point you into a direction, however it won't account for nuances in most or perhaps all cases.

I am inclined to disagree. The N=1 anecdotes only become interesting against the rich background data. "Compared to what?" is the critical question to ask. Always.

Using this as a counterargument is absurd - it's not reasonable to assume qualitative data is compared and contrasted in a vacuum by itself; this is a good example of how perfectionism and statistics leads to failure.

This could only possibly be true if we understood way more already.

I'm not claiming there isn't already base knowledge, this isn't referencing scenarios meant to be seen or understood in a vacuum.

Oh all of a sudden we should just accept some pathetically weak argument of "we just don't know". Billions at stake here and yes we can and will severely penalize anyone on the side of nonscience and profiteering where humans are harmed. We can do better. Sorry if it means consequences for certain people.

How can we do better?

> Oh all of a sudden we should just accept some pathetically weak argument of "we just don't know".

But we don't know, despite enormous and ongoing effort. Hopefully we'll understand eventually, but right now we don't. I'm sorry if that fact is upsetting, but you can't will knowledge into existence.

Well then what's your proposed solution?

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