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Comment by parasubvert | Hacker News Reader

When a medical doctor prescribes you a treatment plan and drugs, do you claim it's all due to marketing wanketeering, and this is the problem of why healthcare is difficult? When they say something that doesn't make sense to you, do you argue with them from a position of ignorance?

Same goes with crypto. It's fine to learn the concepts of how to use a trusted library, but you really aren't likely going to understand the underlying tradeoffs and mathematics.

People here aren't just saying "just use product X", they're saying, "learn the concepts of product X and use that". That's about as good as it's going to get for any specialized, complicated domain.

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> When a medical doctor prescribes you a treatment plan and drugs, do you claim it's all due to marketing wanketeering ...

Yes, of course it is. Doctors know a lot, but they're not competent to assess the pharmaceutical literature.

So here's how it works. In med school, drug manufacturers provide free equipment, food, liquor, etc. And push their drugs. Because once you have someone in the habit of prescribing some drug, they tend to keep prescribing that drug.

Also, you pay influential doctors to deliver talks at conferences, praising your drug(s). You also pay ghostwriters to draft papers, which said influential doctors can submit for publication.

And last, you pay sexy, charismatic young things (of both sexes) to visit doctors' offices, pushing your drugs, and giving away food and stuff.

There's also a scientific backstop in medicine to counter balance unethical commercial interests from causing unbounded harm.

It is possible (even more likely) to have experts with legitimate opinions that are scientifically valid and have measurable outcomes that also correspond to commercial interests. Ie. "it helps people and makes money".

That model has worked for over a century. Yes, it's under attack by unethical people (more than in the past?), but I'm not sure what the alternative would be.

This isn't a recent issue. It may be less of an issue than it was a decade or so ago.

For example, I recall reading that well over half (maybe 70%-90%) of the medical literature on Neurontin (gabapentin) were ghostwritten advertorial spam funded by Novartis.

Medical doctors have given me ignorant, incoherent or harmful advice many times.

When someone says something that doesn’t make sense to you, do you just put whatever they’ve handed you into your mouth without asking questions?

It's fine to ask questions to improve your understanding. But it's not fine to argue from a position of ignorance, obfuscate facts, and to project false pretences. This is how we get anti-vaxxers and the broader death of expertise.

A medical doctor prescribing a treatment plan and drugs would be akin to a trusted coworker crypto expert telling me to "do x with libsodium" without further explanation.

On the other hand, getting crypto advice from random bloggers and HN commenters is akin to getting a medical treatment plan and drugs from random bloggers and HN commenters.

Except that these aren't random bloggers and HN commenters, there are some world-renowned security experts on this very thread saying "do x with libsodium".

If you can't be bothered to read their profiles or understand who they are, I refer back to my point about arguing from a position of ignorance.

> When a medical doctor prescribes you a treatment plan and drugs, do you claim it's all due to marketing wanketeering, and this is the problem of why healthcare is difficult? When they say something that doesn't make sense to you, do you argue with them from a position of ignorance?

To be honest, this is literally the level of discourse of most Hacker News discussions about healthcare.

And it would be the correct level of discussion.

I have doctors in the family. The scariest stories of "marketing wankateering" in medicine I hear is from them.

To posit a strawman slippery slope for exposition, would your doctors in the family say the entire medical profession and science can't be trusted, and we should just stop vaccinations, nutritious diets, fitness regimens, cancer treatments, surgical procedures, etc. altogether?

Obviously not. So, where is the line drawn of what professional opinions are or are not trusted?

There's no doubt that "marketing wankateering" happens in all complex domains. Any "Market for Lemons" (i.e. a market with information asymmetry - a domain so complicated or obfuscated that consumers can't understand its fundamentals) will be exploited by charlatans. This is why we have professional (imperfect but functioning) backstops such as medical scientific research and the security/crypto research community.

OP was claiming that not even the professionals on this thread can be trusted to not be "wankateers" for a free/open source library, with no evidence, or even a hint of moderate understanding of the problem domain (i.e. why it's hard to distribute a public key), or desire to learn. Perhaps they were just frustrated with the complexity of the domain, but flaming people trying to help as being "wankateers" is rather fatalist.

> And it would be the correct level of discussion.

Arguing from a position of ignorance when people say something that doesn't make sense to you is literally how anti-vaxxing happens.

Just because arguing from a position of ignorance can sometimes produce outcomes which align with your personal anecdotes doesn't make it an intellectually valid method of discourse.

Where do you have position of ignorance? People on HN do know doctors, talk to doctors, have doctors in families, and some even are doctors themselves.

Anti-vaxxer beliefs aren't caused by people questioning the first medical advice they get from a medical professional when it doesn't sound right to them. Anti-vaxxer beliefs come from either not verifying and going with your gut, or verifying and then ignoring what you've learned.

Doctors are humans and make mistakes sometimes, and your own health is your own responsibility. So is safety of your own application, so you shouldn't plug in someone else's crypto if you don't feel comfortable with it, but instead try to understand the domain as much as you need to start feeling comfortable.

> not verifying and going with your gut

...which is exactly what "arguing from a position of ignorance" means. Once you attempt to verify medical advice (in good faith) you are no longer ignorant.

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