A new book critiques medicine
blogs.scientificamerican.com
blogs.scientificamerican.com
But if the problem doesn't fit those known processes, isn't mechanical, and you are relying on doctor for real troubleshooting of problems, that is where it falls short. You can fall into the weird gap of talking to different specialists, trying to find someone who can pinpoint what is wrong. You try different treatments, you see what works. Sometimes you solve problems, sometimes you end up living your whole life managing symptoms.
And that isn't all bad - better to manage symptoms than to live in misery, or not to live. But the word 'over-rated' is quite accurate. It isn't useless, it just is over-rated.
I mean, you're not wrong, but...
No one pays docs to do this. The overpriced insurance that's squeezing you dry pays the doc peanuts for his time on your case. Most docs get allotted something like 15 minutes, all-in, per patient: see you, talk to you, examine you, write up their notes, send out their scripts and billing. If you're a really well paid specialist and don't mind not maximizing your income, call it 30 minutes. This has gotten worse with the rise of EMRs, because they're slow as hell. They have a UI designed by an insurance company billing agent. It's terrible.
And being the guy that spends more time is just a matter of pride/ego. I know an amazing doc who spent 40 hours going through boxes of old records on a patient. Figured out what years of previous docs hadn't, and solved - solved! - the lady's problem. He got paid 350$. Less than my niece makes per-hour selling iphone cases at the mall. You can't keep a practice open that way, not even a famous, "people fly in from wherever to see you" kind of practice (unless you're a surgeon - solve someone's problem with a 90 minute operation and people will cough up 30k$; solve their problem with 90 minutes of careful thinking and they're like, you didn't actually do anything, and now you want multiple hundreds of dollars?)
But if someone wants to go ahead and pay me to spend 10 hours on a patient rather than 10 minutes, so I can analyze your symptoms and history and prior reports to hell and back, do some research, iterate a few hypotheses, wrangle phone battles with laboratories to get weird-ass custom tests done, etc. well, yes. I would be happy to do that. That's most docs' dream job. Seriously, and I kid you not even a little bit. Pay me per-unit time the same peanuts that the insurance company pays out, for the amount of time it takes to be your custom biochemical sleuth, and I'll happily do that over seeing a million patients a day.
But as long as you and I are operating inside of the system where I'm squeezed on every side to get you in and out of the exam room in <10 minutes, you're not going to get medical services that take >10 minutes.
The first: an excellent question. It's hard to actually pay a doc for their time. We're all up to our eyeballs in the current system, including contracts with insurers that say things like "if this person is covered, you're bound to take what we are willing to pay, this person can't pay you extra to buy extraordinary services." It's not trivial at all to buy a doc's time. That said, the best method is to call their office and ask to speak to their practice manager. That's the person who is usually tasked with keeping an eye on finances, and has enough time and attention left over to hear things like "I need a non-clinical medical opinion, I am willing to pay for the doctor's time for an interview." That is assuming you are paying them like a consultant, and not paying them to provide an actual medical opinion for your wife. The latter gets gutted by insurance contracts (unless your insurer has absolutely no relationship with this doc, in which case, yes, you can pay them for their services. Some docs misread some state statutes as not allowing cash services for patients that aren't insured with them, which is both wrong and ridiculous.)
The second: how to find a clinical trial for your wife. Honestly, our job is to keep up with clinical trials once they're published. Clinical trials in recruitment aren't on anyone's radar - there's no convenient way of finding them (inconveniently: clinicaltrials.gov) and no value to clinicians to read such a list even if it existed. The only ones we are aware of are the ones that, as you said, are recruiting patients at our location. The people that benefit from publishing trial availability most are the pharmaceutical companies that will ultimately reap a financial reward, so they try to reach out to patients directly via advocacy groups and things like centerwatch. So,if I really needed to find one, I'd:
(0) Check www.centerwatch.com
(a) Call major centers specializing in my issue, since they're the ones that most trials will pull into recruitment and/or they're the ones originating the trials. For cancer, that means contacting the relevant physicians at Dedicated Cancer Centers such as Dana-Farber Cancer Institute (full list: http://www.adcc.org/).
(b) Most cancers have patient advocacy groups, and they're often aware of major trials underway for their relevant cancer. For instance, for Sarcoma, you'd check out something like curesarcoma.org (who have a dedicated clinical trials resource page (https://www.curesarcoma.org/patient-resources/sarcoma-clinic...).
That is frustrating to hear. I'd gladly pay a doc to spend the time to really get into things with me. Although I've learned to manage my problems, I'd prefer an actual solution to the current state of things.
I'm intrigued by a couple other things you said:
1) That we might be able to work something out with the practice to pay for consultancy. With my specific problems, I'm not even sure what specialist I need to talk to. I've seen many. They all try a couple things then point at a different specialty. Do you think someone could consult to at least narrow down which specialist can really solve the problem, or is that too close to a medical opinion?
2) That if I talk to someone not on my insurance, I probably could hire them. That sounds completely feasible. Say I did find someone with no relationship to my insurer - how would you recommend approaching them? Calling up and scheduling an appointment sounds like they'd expect me to just be part of the machine.
2) I would call the office - or drop by - and speak to the practice manager. Doc on the clock usually doesn’t have time to take a dump, and the front desk staff don’t really understand anything beyond “make an appointment.” *
* corollary to all of the above: front desk staff nearly always suck because we can’t reasonably invest in better. Since physician revenue is strictly number of patients per year * whatever the average reimbursement rate is, and since price caps mean our waiting rooms are basically always at capacity, ... a 40k/yr front desk means precisely the same as a 80k/yr front desk to our revenue, but that extra 40k comes straight out of our pockets. Thus, our staff is generally bottom of the barrel. At least in private practice, what little of it survives.
Second, unless you are extremely rich and can privately employ a doctor like a saudi prince would do, I do not know of any (non-forbidden) way to directly pay your doc for his time. Hopefully I'll stand corrected.
Third, and that's the most important, primarily allocate your money to proven treatment. Clinical trials are not designed to help participants. Be weary of what people try to sell you. But if you've been dealing with the healthcare system for long enough, you probably know all about it already.
I realize that's not very original, but godspeed nevertheless!
They then keep roughly the same business model, charging more or less what insurance would have paid them. They spend more time with patients because (a) not on the phone fighting, (b) though the patient pool goes down, they’re replaced by not having to pay for billing staff.
Very very few “concierge” practices aim for any more deviation from the standard business mode than that.
If you want someone to spend 40 minutes with you rather than 15, that’s your guy. If you want someone to spend a week analyzing all your old records and sleuthing it out, that model still doesn’t support it.
Would you be able to buy a day of one of those doctors' time? It sounds like it won't run afoul of insurance but also sounds cheaper than having a personal physician.
The German government mandates making public-option insurance available for everybody, and exercises some of control on drug and treatment prices. That means everybody is eligible for "standard" run-of-the-mill treatment for any illness. Referral to specialists is doled out by GPs, and there may be inconvenient wait time for non-emergency treatments. Prescribed drugs may be generic rather than top-tier. Various forms of quackery, i.e. drugs and treatments without good evidence of efficacy, are not covered by public-option insurance; examples include acupuncture and applications of chiropractic not directly applicable to skeletal motion, i.e. Palmer-esque "subluxation" treatment. Placebos are non-reimbursable here, but homeopathy is still covered in Germany so it's available for placebo use, though it's being excluded in other countries. Patients can opt for non-standard products, though, if they're willing to foot the bill personally.
Anyone with, I'll say, "upper middle class income," though, can opt out of public health insurance and sign up with a private insurance of their choice. For employees, half of the cost of private medical insurance is paid by the employer. Private insurers must cover at least the same drugs and treatments as public insurance but both commodities can be invoiced at much higher rates; 2x and more is common. This makes private patients like myself very attractive to doctors and hospitals, of course, and we get all kinds of preferential treatment. Yes, this results in a 2 class society with regard to medical treatment and I enjoy the opportunity to be in the upper class in exchange for paying higher premiums. I can access any doctor of my choice, including specialists, and those doctors can recommend any product. Private insurers also won't pay for just anything but there's more leeway and of course there's always the option of paying out of pocket for anything that's not reimbursed. While medical services will typically carry a steep (usually reimbursed) surcharge, drugs mostly cost the same for everybody and will be reimbursed if they pass muster as medically necessary and effective.
I've heard of clinical trials advertising for volunteers, but I think policy on those is similar to what you describe: a trial isn't a treatment option for just anyone who wants it.
So yes, scientific medicine definitely has huge lacunae. Given the relative slowness of progress in understanding complex systems science has had in general, they'll be there for a long to come. But it's not as if there's some other candidate 'system' that has a better understanding.
Example: if you have abdominal pains, you will be referred to a gastrointestinal specialist. After some tests and maybe a gastroscopy they will diagnose or rule out the common things: ulcers, celiac disease etc. This is what modern western medicine excels at. They find and cure the likely things quickly. They can often rule out the dangerous things like cancer.
But now imagine for a second that the abdominal pain actually was a manifestation of a back disc issue. Few gastrointestinal specialists would find that and say “I think your back is the real problem and the gut pain is just a secondary symptom”. And you have already been referred as far “down” in the specialist chain as you can. This is when people start fumbling after alternatives.
Note that there is nothing “non western” about having a more more holistic (less narrowly specialized) perspective on medicine, it’s just something that is hard so doesn’t get much attention. Perhaps the traditional specializations should be restructured? We are now seeing some headway such as the connection between gut bacteria and mental health for example.
What are you talking about? Referred pain is well known and any doctor and especially any specialist will have studied and be familiar with common and likely referred pain pathways in the same way that they're familiar with other common interactions between systems. If you're struck with left arm pain while seeing an orthapedic surgeon, they'll make sure that you're not having a heart attack rather than trying to rule out orthapedic causes first.
In your example, assuming an uncommon referred pain that your gastroenterologist is not familiar with, what more do you want from them than ruling out a gastrological cause? It's incredibly useful information that you and your primary care physician will be able to use to help track down the real cause. And if, after consulting multiple specialists, your primary care physician has no more ideas for pursuing the root cause of the issue, they'll help manage your chronic condition in consultation with a pain specialist and psychologist if required.
Bottom line, doctors think more holistically thank you realise. To the extent that isn't sufficient, the medical system as a whole should be treating the patient as a whole. If that's not happening because of a variety of perverse incentives that's the fault of how we structure and pay for our healthcare systems and not the fault of western medicine.
As for the holistic view - there's a difference between check-list diagnosis (left arm pain -> possible heart attack) and what is effectively personal medical research, which may require knowledge of everything from diet to sleeping habits to emotional stressors to historical infections and illnesses. (That's a very short list, and not in any way exhaustive.)
There are limited professional incentives for doctors to dig into patient history with that level of detail. It's not a matter of specialist referrals, because some problems can be caused by multiple minor factors interacting with each other. Or they may have very generic symptoms, like fatigue, with a ridiculously huge number of possible causes. Or the causes still aren't understood.
Medicine is an example of a huge market failure. Not only is it the single biggest cause of personal bankruptcy in the US, but most people have had personal experience of obvious delayed diagnosis or outright misdiagnosis.
An effective market - rather than a "rational" one - could easily support a much larger number of doctors and supporting medical professionals, including non-corporate researchers. The effect on "western medicine" would be a dramatic increase in effectiveness.
Given that different 'western' nations structure and pay for their health care systems entirely differently, there must be, mustn't there?
Or are you conflating "Western medicine" with "US medicine"?
Indeed you are:
> Medicine is an example of a huge market failure.
I just want to get rid of the abdominal pain - I really don’t care about whether the cause is actually gastrointestinal. I want to rule out illness, that they are good at.
If the referred pain isn’t a known condition such as a herniated disc or anything else that shows up on a test o image - then they are usually not concerned at all (no illness - job done). And even if it is a known/visible cause outside their specialization, they are extremely bad in my experience at both recognizing and “referring sideways” to another specialist.
I live under a single payer system so the economics probably don’t factor into it, but I think the siloed thinking at specialists requires that the generalists take a holistic perspective, but in reality they cure tonsillitis and point to specialists. Somewhere I feel there is a gap.
GP’s refer to specialists because medicine is such a huge body of work. Keeping up with even a small field takes a lot of time. Someone that tries to keep up with and more importantly remember everything is not going to succeed let alone have time to help you. Sometimes the next step is to take these results go up the chain and try again not hope the wrong specialist can still solve your issue.
It’s not a perfect system, especially if you actually have multiple independent unusual issues at the same time. But, that’s life with imperfect humans.
I've certainly seen the difference in the small number of countries I've lived in - some do a much better job of coordinating services between generalists & specialists than others. But this has nothing to do with 'western' medical science per se, which is the primary modality of each of those varying systems.
For issues that don't have a single-specific cause, the western medicine won't help much - it can cover specific symptoms, and tell you to do more sport, fix your diet and go to a therapist.
Example - all kinds of chronic pain (IBS etc), chronic tiredness, etc. Doctors will order all kinds of tests, and if there is no clear single issue, they won't help you.
Eastern/holistic medicine may not be perfect, but if science-backed options are exhausted, it's all there is.
Also, with all my respect and sympathy towards strict science, it has it's limitations - especially when it comes to complicated systems. That's why nobody argues for using science-based methods of running startups :)
Finally, fun fact, if we use current medical criteria, parachutes were never proven to work. No double-blind placebo-controlled human trials. :)
I agree - the science of complexity is in its infancy (as I mentioned in the parent).
But your conclusion doesn't remotely follow. That there are conditions scientific medicine isn't yet much help with (truly!) does not connote that non-scientific systems must therefore do better.
Eastern/holistic medicine may not be perfect, but if science-backed options are exhausted, it's all there is.
But the treatments promoted by the major medival 'Eastern' systems don't work. You don't need a new understanding of complexity to demonstrate this - you give sick people the treatments, and see if they get better. They don't. So 'all there is' in this case is nothing.
Hardly surprising from a prior plausibility angle: the 'whole' their so-called 'holistic' rubrics work with (chakras, qi, etc) are old metaphysical fictions.
That's not really true. Their explanations can be hocus pocus, but their mechanics/drugs/techniques can be as effective as western versions, simply come around by tradition/trial and error/Lindy effect and so on for millennia.
This may be true of some indigenous medicines, discovered by trial-and-error and careful observation over multiple generations. These are disappearing fast, and remain largely unsystematised.
But treatments from the major medievalist 'systems' are different - their very strong derivation from fictional rubrics has resulted in their use being insulated from disconfirming observation (as was medieval 'Western' medicine). I'm not a specialist, but results I've seen from contemporary studies of Indian and Chinese treatments seem to show they don't work.
And then there's the more impressionistic evidence from history. The populations of premodern India & China were horrifically unhealthy from all accounts I've read. Their medical systems did nothing for them.
I dunno, I'd trust something used for centuries (given it doesn't kill its users) over something hastily discovered, sorta understood, and rushed to market (after being extracted and distilled in the most potent chemical form) for profit...
At least traditional remedies/drugs don't have the "let's rush this to make a buck" nor the profit motive involved (well, people selling them today want to make a profit, but I'm talking about actual traditional drugs, used for millennia, and which anybody could e.g. just grow/distill/whatever in their country, so there was no exclusivity thing)...
There very likely are traditional remedies that absolutely do work, but those lie more in folk remedies (especially use of native plants in teas), which tend to be slow trial-and-error over generations, rather than formal systems based on magical principles.
Homeopathy is worse, but acupuncture is up there as a 'treatment' with a very poor empirical base.
[an aside: I worked for a while in an fmri lab alongside a guy who did acupuncture reasearch. He was the most ideological researcher I've every come across in any field - flatly refusing to accept the validity of any data (even when collected by himself) that didn't support acupuncture's use. As someone now living in Australia's hippy zone, I find this a very recognisable & alarming trait of the 'alternative' health field.]
So the effective ancient drugs are now part of medicine. Only the leftover are still classified as "traditional" medicine, so don't expect to find too much useful things there.
A vast majority of you drastically overestimate the information processing and retrieval of the healthcare system.
We MDs can all see your superb AI/ML results in journals, and yes you can improve things with technology. What we can't see is how we're going to use it. In my day-to-day job, there are a myriad of new-super-devices-that-automatically-do-that-thing but NONE are integrated into my workplace. NONE make my job less painful. NONE make me gain time instead of losing it.
You want to help. Cool, then stop masturbating on the results of your unusable new oncology deep-learning thingy and push for WORKPLACE INTEGRATION of technology, damn it!
Maybe if the tech community comes to understand how it can really help clinicians, things will start to change the way you fancy and we can finally end the age of rote memorization and criminal overtime for MDs.
However, it is somewhat strange that personal health projects keep dying - google health discontinued in 2011, microsoft healthvault to be closed in 2019 - and these are by major players - maybe somebody has some insight why they fail?
Often in a NICU there are wires and tubes everywhere. Operating or trying to help a babe invariably ends up with some person standing on some line and pinching it or ripping it out of the many many machines.
I'm super not kidding here. There are a TON of machines trying to keep the kiddo alive. Imagine a 5m sized cube filled with machines all trying to keep a kid the size of a breadbox breathing and the heart beating (or not, sometimes). It's a lot of carts, wires, amps, and waste heat in these rooms.
Wireless is not possible as a lot of the machines aren't sheilded properly or are activley trying to jam some frequency band for a medical purpose (MRIs). Wires are the only solution. Tubes filled with some form of fluid are also, obviously, not able to be wireless. Especailly when things get desperate, there are liquids, fluids, blood, tissues, urine, and saline everywhere as frantic nurses and docs trip over the tubes and pull them out of their machines.
You want to help the victims? Get rid of the wires. Stop dicking about with matrices.
Probably the huge amount of bureaucracy and regulation keeps medical focused IT in its shit pool of separate islands.
Maybe you should campaign for state regulation mandating to create a HMTL / W3 like standard for data sharing that's mandatory to use.
Wow... This seems very obviously inappropriate.
I listened to the EconoTalk interview referenced in TFA after hearing about it on another HN thread. Highly recommended.
I have to say that I have become skeptical of medicine after personally seeing the sheer amount of unscientific and potentially harmful practices that are advocated for by medical practicers. I think there's a lot of good, but wayyyyyy too much bad.
The doctor said the worms could cause abdominal pain, but then again in most cases they don't, so he also put him on a drug for irritable bowel syndrome.
After a couple of weeks, the stomach pain went away, but meanwhile my brother-in-law was having issues with mental coherence, drowsiness, and sleep disturbances. Other people who interacted with him were concerned about him, too. He has a mental disability and diabetes and other health issues, so our first thought was the usual suspects, not his IBS medication, but eventually I realized that neither my wife nor myself knew anything about it, so I looked it up.
It turned out the new medication was an antidepressant with a laundry list of side effect, including drowsiness and sleep disturbances. We weaned him off it, and he came back to normal pretty quickly. No stomach pain, either.
So, to sum up, the doctor saw a patient with worms and abdominal pain and decided to put him on an antidepressant for the rest of his life because the kind of worm infestation he had would only cause pain in a minority of cases.
But... Seems like the sort of side effects these medicines have should give us a pause when using them on vulnerable populations. Especially when the benefits are not especially clear.
In my opinion the most amazing thing still is antibiotics (and vaccination). Treatmeant of war/vehicle/sports injuries taking the second place (including anesthetics). Both can take people from a path of sure death within hours or days to often complete recovery within weeks or months.
If that is the performance expectation of the general public for all of medicine, then it certainly is overrated.
Not to mention having all valuable poisons in the planet in a nice packed, chemically pure, split in comfortable monodose capsules, accurately measured and checked for 10 years before enter in your body, packed guaranteeing non posterior adulteration as long as the plastic seal is not broken, extensively documented in several languages and available at less than ten minutes away from your home. This is probably the biggest bonus from the real medicine.
Even that short article covered a number of items that could all happily be spun out into full-blown essays.
"Over-medication" - just as a term. Could be people taking medicines that: Aren't cost-effective (whatever your system, there's a finite resource at the core). Aren't quality of-life improving (doctors themselves tend to consume less life-extending stuff at the very end). They paid for (You've paid insurance, you're ill, you want to be given something).
There are two things: One is bad science, and we have a lot of it (https://en.wikipedia.org/wiki/Replication_crisis, https://library.mpib-berlin.mpg.de/ft/gg/GG_Null_2004.pdf) - but it should be improving and most of it is probably harmless (I have some hopes on better statistics education and https://www.google.com/search?q=causality+revolution). The other is bad application - and this is more complex. When I go to doctors (with my and my family issues) I, more often than not, have the feeling that they have no chance to give any good diagnosis as it would require too much time to test etc. (one simple case is when to use antibiotics and when the disease is virus based - but I have noticed that this is probably improving with strep and CPR tests) and they mostly just shoot first thing plausible, proscribe some medication and then in most cases the organism just cures itself - so the treatment is never tested. There is probably also 'medicine as signaling' (the theory by Richard Hanson: http://www.overcomingbias.com/tag/medicine), but my intuition is that it is not verly important, and other stuff.
I'm not saying that the conventional medicine is far from any criticism, but one has first to understand the difference between the current knowledge available, and the way it is used : some drugs/treatments are promoted by some countries, while not in others. I'm also convinced he drugs prices (which are going crazy) should be regulated for the benefit of everyone. And of course, modern medicine should be used wisely. People should not take drugs each time they have a cold.
That being said, of course, there are still room for improvement, there are a load of illnesses that cannot be cured by modern medicine, and yes, some doctors think themselves as Gods. But this should not question the many successes of conventional medicine.
Are some medicines probably overprescribed? Sure. Are some medicines underprescribed? Definitely.
For most medicines are there people who could benefit from taking it and aren't while simultaneously there are people who would benefit from stopping the medicine? Almost assuredly.
And medical research is what we do to try to answer these questions in ways that are helpful.
HIPAA laws are hiding patient outcomes and holding this whole sham afloat.
I've read Bad Pharma (and will recommend it to anyone interested in this subject). And one way to summarize (perhaps oversimplify) it is: pharmaceutical corporations manipulate data to justify expensive drugs of questionable effectivness.
But to think "startups and tech companies" are going to help solve this problem... man, that's optimistic. And as Bad Pharma demonstrates, the data is already available. There's just not a lot of interest (economically or politically, especially where those two are strongly correlated) to seek it out or listen to it.
Also I don't think it was HIPAA's intention to hide data from well-meaning startups. That's just an unintended consequence perhaps. I'd like to think its primary motivation was to protect patient data from predatory insurance companies and unscrupulous marketing forces. (Does it succeed in doing that? I don't know. Are startups and tech companies going to help with that if it doesn't? Hmmm.)
The customers were the insurance companies.
Honestly I think the last people that are going to improve anything in medicine are startups and tech companies.
Quite the contrary. I know that quite a few people in evidence-based medicine are worried that Tech people who want to "disrupt" things come with their own poor scientific standards to undermine the minimum standards this field has (and has fought hard for to get).
Another area is improving existing processes. We see techniques where photos are being read more accurately and quickly compared to manual processes.
Medicine now resolves around tests. Those can be improved and automated.
We will see tools that will empower personal medicine and shift the power balance away from the family clinics.
Why would you call them a fraud. I've done a number of tests over a period after antiobiotics and I definately saw the change into diversity correlate with the foods I introduced.
That's not saying that they never produced useful data, but ...
https://www.livescience.com/63997-dna-ancestry-test-results-...
So, if we assume that most medical treatments and prescriptions are not worthless we should see increases in healthfulness that are at least somewhat comparable with our increases in pharmaceutical usage. In reality we saw sharply diminishing returns on life expectancy that have now gradually shifted towards an ongoing decline in life expectancy over the past few years. By any standard of effectiveness, this is not looking good for pharmaceuticals.
So I suppose I'd turn it around. I think the view that medicines (and especially their recent exponential growth) are providing a substantial social benefit could be true, but it would seem to be the statement that needs to be explained. E.g. perhaps our own increasingly unhealthy lifestyles are contravening the gains from the medical technology? No idea there, but I do think occam's razor would tend to simply suggest that the reason we're not seeing improvements is because we're not improving.
[1] - https://www.webmd.com/drug-medication/news/20170803/american...
Regarding your idea that "By any standard of effectiveness, this is not looking good for pharmaceuticals": This is a very complex topic and I don't think anyone has a clear and objective view/explanation about this.
For example, we have a big problem with the antibiotics. We eat a lot of meat from animals that where treated with antibiotics. We "overuse" antibiotics. Etc. Because of this, new antibiotics-resistant bacteria appeared and classical antibiotics became less and less effective in fighting against them. How should we categorize this issue? Should we see it as a proof of the fact that medicines are not as effective as advertised? It's not a problem with antibiotics per se. Or as a proof that modern medicine is overrated? Medicine correctly identified the problem(bacteria) and the treatment(antibiotics). In reality it is a problem generated by mostly by the rising popularity of automedication, lack of basic medical/pharmaceutical education and urban myths (antibiotics are good for anything), medicines used on animals (which is not a problem of human medicine), and, I would say, only a tiny part of the problem is the treatments that unnecessarily include antibiotics and are prescribed by medicine doctors. But, let's say that we don't know anything about the above mentioned facts and we study some statistics. What would we think when seeing a clear correlation between the increase in the number of antibiotics and decrease of the effectiveness of the treatments? We could see it as a proof that "the quality of medicine drugs has decreased resulting in an increase of ineffective treatment".
The point I'm trying to make is that the reason why the effectiveness of many treatments decreased and now we have a decline in life expectancy it's a very complex issue and it's not fair to see it as simple as a fact failure of pharmaceutics or/and medicine.
Regarding your last statement, I think that we are not seeing improvements because our modern environment and life style has changed and is changing in such a rapid and unpredictable way that medicine can keep the pace. Medicine it's improving, but it's improving too slow. It is as out environment and lifestyle is traveling by plane while medicine and pharmaceutics are traveling by bus...
So even if you were right on the lack of efficacy of modern medical treatment (and I strongly suspect you are not), I highly doubt that its exposure would lead to a collapse in the industry.
Startups have been going at this problem for years and years already and have had the data. I've worked at them. You know what the goal of most of those startups was? To make money. Patients were a means to an end. If they helped people, it was a thing that happened but not the actual goal.
See, actually trying to help patients and do so responsibly and not just cause a bigger mess is hard. Medicine is complicated, people are complicated, the health system is complicated. Easier to just ignore all that, make some money and sell out before people realize all you did was funnel some money around.
>Once all of this data becomes available, it will be obvious how worthless and expensive most medical treatments really are.
There's plenty of existing literature that notes various medical treatments are worthless. Yet they still happen and are still prescribed and are still paid for. Knowledge doesn't change behavior.
>HIPAA laws are hiding patient outcomes and holding this whole sham afloat.
You can easily get medical billing data for a massive percentage of the US population which includes doctors, dates, procedures, diagnoses and aggregated costs. De-identified but that doesn't matter for these sorts of things.
edit: Also, what is probably the biggest hurdle for health care startups isn't data. It's the fact that AB testing, the cornerstone of how every tech company iterates, is considered unethical except in very constrained forms. Something about there being a difference between crashing the web page of 1% of your customers versus literally killing 1% of your customers.
... Unfortunately, this may happen first in countries with poor human rights records (i.e. China) because there is likely a greater availability of patient data under those circumstances.
Data is really sparse and of the worst quality. It is interesting that the hype is exactly the opposite: big bad hospitals keep essential info for themselves.
Only the vast majority of people ignore that advise.
Also the combination of vaccinations and nutrient-fortified food have worked wonders for public health.
The reckoning will not go the way you think it will.
I'm the spouse/partner of a recently-trained doctor, and I'm a programmer and startup founder with 2 decades of experience. With all respect, you have no friggen clue what you're talking about.
Please do better than this, regardless of how wrong or ignorant another comment is. Your post gives us no information other than about yourself.
If you know more, please share some of what you know so the rest of us can learn. Please don't just name-call. This is in the site guidelines: https://news.ycombinator.com/newsguidelines.html.
I was not intending to name-call; to me, the entire comment was wrong and I posted a curt reaction.
I'll provide more info here:
"The level of legitimacy and respect that doctors and hospitals currently have is far too high..."
Ask any young doctor in the US whether their field has a lot of "respect". Medical residents work 80-100 hours per week in windowless, flourescently lit rooms, of which 40-60 hours is often spent doing clerical work at sub-minimum-wage to service private insurance and EMR overlords. Patients regularly tell these same doctors they don't trust them, don't respect them, think they're wrong, want to see the "real" doctor, can prove how wrong they are with WebMD, etc. My spouse is now doing her 13th and 14th year of post-secondary training toward the goal of being a specialized surgeon. She has done hundreds of successful surgeries/procedures already and saved countless lives. Yet, she is burnt out, and often ends her workdays completely destroyed by the humiliation of being a cog in the hospital machine. She is not alone; physician depression and suicide is at all-time highs.
"... and hinges on branding and the exclusivity of becoming a doctor."
Like I said, she is on her 13th and 14th year of post secondary training. Aside from this being a massive time investment, it also cost her dollars she didn't have (no support from parents) on order of $300k in post-secondary education, just in tuition. If becoming a doctor is "exclusive" and confers a "brand", I'd say the exclusivity is "extreme passion for helping humans at great personal sacrifice and cost", and the conferred "brand" is that you are allowed to practice medicine, at all.
"Once all of this data becomes available, it will be obvious how worthless and expensive most medical treatments really are."
Medicine -- and the tireless and ethical work of thousands of well-trained and professional doctors -- saves countless, countless lives every single day. Modern medical treatments are not "worthless" and your comment is honestly insulting to how effective and life-saving many treatments are. I think this part of your comment is what got the rise out of me: spreading this kind of misinformation is the closest thing HN commenting gets to "malpractice".
Society should respect and pay doctors much more for the sacrifice they put toward this profession. Patients should respect doctors a lot more for the benefit they provide society. Hospitals should give doctors a better work environment. Doctors are not perfect, nor is medicine. But to think the root cause of problems in the present medical system is an undeserving respect for doctors and modern medical treatments expresses a profound ignorance of reality.
The original comment is so wrong that it truly stunned me into an uncharacteristically curt ad hominem response, for which I apologize.
But the system as a whole is very ineffectual for chronic diseases, and I would argue, outright harmed the public with its dietary recommendations.
"Doctors are idiots following algorithms and don't actually have any knowledge or information and just scam everyone for money all the time until their eventual replacement by the first person who thinks of feeding electronic medical records to machine learning algos" would cover about 95% of HN comments in these sorts of threads. You might cover another 2% with variants of "there's no point in going to a doctor for your problem, any decent engineer can just spend a few dozen hours reading up on their problem and figure it out just as well."
It's gotten to the point where I only chime in once in a while when the thread has gone deeply, deeply, off the deep end. But then, HN seems to have variants of that attitude towards pretty much every profession that doesn't have an engineering degree.
For example, have you ever tried to sleep in a hospital? They generally run very cool, daylight temperature lights 24/7, with tons of noisy machines, and the nurses wake patients every hour.
And it's not just the patients who are getting their circadian rhythms destroyed, the residents themselves are doing 30+ hour shifts. It dates back to the first medical residency, started by William Stewart Halsted who was a cocaine fiend and expected everyone else to keep the same hours.
We know that sleep deprivation impairs your driving ability just as much as being drunk. So why do we accept doctors and nurses being sleep deprived?
Then you should know very well that the entire MD education pipeline optimizes for rote memorization and regurgitation of facts (from undergrad pre-med all the way through post-residency fellowships). Any patient with even the slightest deviation from what the physician searched on WebMD is given generic advice similar to how fortune tellers recite generic phrases. If you have a non-standard question or health problem, go to 3 doctors (or even specialists) and you'll get 3 different answers.
I work closely with clinicians at Tier 1 urban medical institutions daily, both at the in-patient and outpatient settings. Most doctors are dumb as a rock.
Note: Physicians with a MD/PhD are much better at critical thinking and make more of an effort to solve your problem.
The main reason I left med school and decided to study math and comp sci. is because of the need of rote memorization necessary in medical training. This is especially worse in the US because the system here requires 4 yrs (undergrad) + 4 yrs (med school) + 3 yrs (residency) = 11 years of training to become a doctor. In contrast, it takes 5 yrs (med school) + 2-3 yrs (residency) of training to become a doctor in my home country.
The journey to become a doctor in the US is unnecessarily lengthy and it makes doctors feel more entitled (because they have spent a lot of time and money as investment) to charge exorbitant fees despite what most of them are doing is simply prescribing antibiotics; analgesic; insulin; and garden-variety stuff (or read up "Up-to-date" [https://www.uptodate.com/home] to refresh on what they learned or what the current consensus treatment is).
Most of them do the same thing day-in-day-out. Sure, there may be some specialists that are top notch, but they are like the minority and even their work is mostly about being able to keep steady hand and cool head during emergency situations.
It makes total sense if you think about it: medicine is an infinitely complex field, and at the end of the day even though doctors have (in the past) undertaken significant training, they are still human beings, subject to the same limitations and errors as the rest of us.
New discoveries and nuanced understandings are made in medicine constantly, the idea that it is safe to assume that any individual doctor is going to know and understand all discoveries seems to me like extremely wishful thinking.
You may be brilliant at other things, but your analysis of this particular problem is no better than the doctors you describe.
No, medical education does not have to be this way. It is purely gatekeeping.
It's similar to how "You need a PhD" to land top AI/ML jobs. That's gatekeeping as well, though it is slowly changing.
Not many doctors or AI researchers will openly state this gatekeeping because they benefit, at the expense of those not in their field.
Most parts of the country are approximately medical deserts. So once you're educated, you are dispatched to said desert. Your hospital has standard pathways where nursing teams operate. Problem is, everything that escapes the standard pathway comes your way with no one to help you.
"Yeah, but there's UpToDate, MEDLINE, etc.". Well, no. NO! You simply don't have the time. Your job is to operate as a well-oiled machine to handle all the impromptu shit 70+ hours/week. That's why you did all this rote memorization.
A doctor is not an engineer. He is trained for a hostile environment where you have no time to think or search. As long as automation can't help (and it currently can't), docs are bound to memorization training.
I have enormous respect for the difficulty of the training that doctors like your spouse have gone through, and yet I share the quoted sentiment. We assume that difficulty is essential to the work, and I think that's an assumption worth questioning, as the dental profession has been recently.
Well, all the interesting bits of medicine are built on social interactions. You ask the patient where it hurts and they lie about where.
because if so i agree, there's some real low hanging fruit there.
If we had more medical treatments that worked, and a lab-to-hospital pipeline with a better track record, I suspect better scientific standards would follow naturally. But for now, raising the standards of evidence would essentially block off the invention of new treatments altogether, which simply isn’t an option even on a psychological level.
Citation needed.
https://www.econtalk.org/jacob-stegenga-on-medical-nihilism/
Doctors get very little training in diet and lifestyle, because those are low-status and left to non-MD specialists, and many of them dogmatically cling to 1960s-era science.
Well, what can I say. No?
https://health.usnews.com/wellness/food/articles/2016-12-07/...
So yes, on paper you're right. In practice, there are even clinical nutrition specialists and those are MDs.
For example, a simple ketogenic diet intervention can be a very effective treatment for type 2 diabetes. But most doctors still favor the 1960s-era, discredited science saying dietary fat causes heart disease.
So diabetics are given metformin and whatever fancy new insulin came out recently. And then in 20 years, those people will likely lose their feet and eyes.
Drugs are initially optional, unless I am mistaken. However, you seem very optimistic regarding the ability of people to follow diets.
I think the problem is that we take for granted the things that have been discovered, because they were found a long time ago. Washing surgeons' hands in carbolic acid help puerperal fever rates. Cholera has something to do with water. Vaccination works. All those things happened way before any living person remembers.
From what I hear among pharma friends, the problem is also that the low hanging fruit has been picked. A lot of lines of inquiry are variations of the same thing, and over time we've found what is there to be found.
If you think about it, it makes sense that it's like that. Something really powerful like vaccination is going to pop out of the stats immediately. Subtler effects require more trials to detect.
In any case, it's a greater danger that there are people who don't believe in evidence based inquiry at all pretending to be medical professionals. Look at anti-vaxxers, or the Goop type quackery.
I encourage those interested in the pernicious aspegts of humanity's overuse of antibiotics to read this interview with Stephen Buhner [0]
[0] https://www.thesunmagazine.org/issues/468/living-medicine
Walking in the woods is probably as effective as the average anti depressant. Good physical activity too.
But we sell that modern life is great and that ailments are normal and that thanks to the medical field we have all these solutions.. that we probably didn't need in the first place.
If exercise were in pill form, it'd be the most valuable pill.
These are the top 10 causes of death.
https://www.cdc.gov/nchs/fastats/leading-causes-of-death.htm
How many of those could be prevented by good diet, quality sleep and exercise?
Most of those causes are accelerated by poor diet, poor sleep and lack of exercise.
citation very fucking needed.
https://link.springer.com/article/10.2165/00007256-200939060...
But what's next? Anti-vaxxer stupidity?
Later, because it was bugging me
There's also distinctions to be made between a "generalist" and a "practitioner". Beat reporters are specialists, not generalists. They've cultivated sources and, over their careers, expertise. Roger Ebert wasn't a filmmaker, but he sure as hell knew more about films and their language and idiom than a WSJ business reporter (who in turn knows more about collateralized debt than Ebert). Extending the analogy further: I'm capable of critiquing cryptosystems and finding/exploiting vulnerabilities in them, but I'm not a cryptographer and am not qualified to build them myself.
Do you need an example of a non-programmer tech reporter worth reading? Happy to provide one.
Researchers have labored mightily to find more magic bullets, but they remain rare. For example, imatinib, brand name Gleevec, is “an especially effective treatment” for one type of leukemia, Stegenga says. But Gleevec has “severe adverse effects, including nausea, headaches, severe cardiac failure and delayed growth in children.”
Most would prefer these symptoms over death.
https://en.wikipedia.org/wiki/Betteridge%27s_law_of_headline...
The problem is incentives, not sure why this guy wrote a whole book without realising this, but it is an easy mistake to make if you are thinking about the problem from your writing desk. People will minimise effort and cost, given a choice, and maximise profit subject to constraints. This behaviour exists even in highly trained health professionals already making many hundreds of thousands of dollars a year. Example - why do primary care doctors prescribe minimally effective drugs for depression? Is it because they can't understand a meta-analysis, can't remember all the patients the drugs didn't work for in their own practice, or because they are lazy or stupid? It is because a patient has come in looking for help and is sitting there in tears, and there is only 10 minutes to see them, and the history from the other doctor this person has been seeing for the last 5 years isn't available. And although everyone would be better off if the doctor spent an hour finding out in detail what is going on, carefully talking over the options, the side effects of various treatments and reaching a consensus management plan which starts with non-pharmacological therapies, and activates a government program which allows the patient to take extra time off work to attend therapy sessions with childcare facilities included. But it is easier for everyone to prescribe Prozac. This is the reality. Perverse incentives explain many of the problems in Medicine and healthcare systems. Nobody gets paid for delivering good care, nobody saves money by accepting good care. As shocking as it may be, delivering good care or exceptional care is a choice a health care team makes despite everything else. Similarly, accepting proven health care interventions is a choice a patient makes. Usually everything doesn't line up, and that is modern medicine.
The cited example of Gleevec also makes no sense to me. It revolutionised the treatment of 2 conditions which were almost completely untreatable beforehand (Chronic Myeloid Leukaemia and Gastrointestinal Stromal Tumour). The alternatives to taking Gleevec for these patients were A) Toxic minimally effective chemotherapy followed by death or B) Just death. All of this context is extremely important in discussing the side-effects which can be severe. This is what the patient and the doctor work out together. Some throwaway line about how toxic it is just makes no sense in isolation.
The Ancient Greeks were, in terms of medicine, almost completely ignorant. They had no idea about germs; instead focusing their medical theory around the 4 humors - blood, phlegm, yellow/black bile and miasma theory. What's good drinking water? Water that tastes clean. Vaccines? That'd come about 3,000 years later. And they engaged in hygiene habits we might find a wee bit dodgy. For instance at the public toilets there obviously were no toilet paper dispensers. Instead they'd use sponges - butt brushes. After one fellow finished his business you'd give it a swish around in some water or, for the fancier toilets - vinegar, and take your turn.
But the thing is is that they (and I am referring to the upper class here) had life expectancies that were not what you'd think. This [1] great article from the BBC has quite a lot of interesting data. For instance of some 298 recorded individuals of ancient Greece/Rome, the median life expectancy was 72 years. Some random famous names: Pythagorus - 75, Hippocrates - 90, Plato - 80, etc.
There is of course some selection bias in that sample, but you can also see evidence of longevity in other ways. For instance in Ancient Rome one could not hold the office of Consul until reaching the age of 43, first office was not available until age 30. The article also goes on to analyze numerous other sources than tend to paint a recurring picture: there was high infant and youth mortality, but people who made it to adulthood tended to have a life expectancy not all that different than we do today. It seems to suggest that a large part of our increased life expectancy is not from the trillions of dollars we've spent on trying to find a [profit making] pill for everything, but instead from very simple things like access to clean water and food.
---
Finally there is a little 'paradox' that should always be brought up in medicine and in particular efforts to try to squeeze out every slimmer gains. Imagine you have a test that is 99.9% accurate for some illness. And 1 in a million people have this illness. If somebody tests positive, what are the chances that this is a false positive? 99.9%! In a million people our 99.9% accurate test will give 1,000 hits - yet only 1 person will actually have the illness. You'd probably end up seeing a negative return on life expectancy here just because of how many people you'd be scaring witless after informing them they need to come back in for follow up testing. Seriously, just take a few days off their lives and you've already gotten rid of the gains in expectancy for the 1 in 1000 guy.
[1] - http://www.bbc.com/future/story/20181002-how-long-did-ancien...
> Medical errors are the third-leading cause of death after heart disease and cancer.
https://www.cnbc.com/2018/02/22/medical-errors-third-leading...
I agree with Stegenga:
> There is no place I would rather be after a serious accident than in an intensive care unit. For a headache, aspirin; for many infections, antibiotics; for some diabetics, insulin—there are a handful of truly amazing medical intervention, many discovered between seventy and ninety years ago. However, by most measures of medical consumption—number of patients, number of dollars, number of prescriptions—the most commonly employed interventions, especially those introduced in recent decades, provide compelling warrant for medical nihilism.
- - - -
I was just reading about "The China Study", https://en.wikipedia.org/wiki/The_China_Study
> The China Study is a book by T. Colin Campbell and his son, Thomas M. Campbell II. It was first published in the United States in January 2005 and had sold over one million copies as of October 2013, making it one of America's best-selling books about nutrition.[1][2][3]
> The China Study examines the link between the consumption of animal products (including dairy) and chronic illnesses such as coronary heart disease, diabetes, breast cancer, prostate cancer, and bowel cancer.[4] The authors conclude that people who eat a predominantly whole-food, plant-based diet—avoiding animal products as a main source of nutrition, including beef, pork, poultry, fish, eggs, cheese, and milk, and reducing their intake of processed foods and refined carbohydrates—will escape, reduce, or reverse the development of numerous diseases.
Now I'm a pretty "fringe" kind of guy, and there's some stuff in there that even I have trouble with (animal protein is highly carcinogenic? Eh what?) But the basic idea of nutrition affecting health, or more accurately being the foundation of health, seems sound to me, and my attempts to eat a "whole-food, plant-based diet" have been very positive. Although I did send my digestion for a loop by "cutting over" too fast once. It takes about three days for your guts (microbiome and own) to adjust to a big change in diet, FWIW.
In any event it's batshit insane that convention medicine treats nutrition as an afterthought.
(There's a wonderful confluence between eating a whole-food, plant-based diet and the ecological repair of our food systems.)
- - - -
Now let me push the boundaries. I burned the tip of my thumb the other day taking a pan out of the oven, 450°F. I was careless and didn't quite hold the potholder correctly, burn reflex overridden so I wouldn't drop the pan, it melted the fingerprint whorls. After I finished hopping up and down, pissed off at my own carelessness, I took a few moments to "beam" Reiki to my thumb, while concentrating on communicating with my healing and immune responses telling them to "get in there and clean things up". The pain went away and didn't come back. A very modest blister formed under the melted skin. The spot was tender, and it stung a bit if I let hot water touch it the first day, but after that there was no tenderness. Two days later the blister was gone. The skin is slightly rough, but it's not peeling, nor is it a scab. Day three I woke up and forgot that I had burned myself. The flesh apparently reconstituted itself. I'm not sure it will even leave a scar. The skin still hasn't peeled.
In sum, a minor second-degree burn, apply ten seconds of Reiki, result: no pain and accelerated healing.
"The future is here, it's just not evenly distributed yet."
"At last I went to the artisans, for I was conscious that I knew nothing at all, as I may say, and I was sure that they knew many fine things; and in this I was not mistaken, for they did know many things of which I was ignorant, and in this they certainly were wiser than I was. But I observed that even the good artisans fell into the same error as the poets; because they were good workmen they thought that they also knew all sorts of high matters, and this defect in them overshadowed their wisdom (...)"
Hating is easy. All you have to do is point fingers at people and tell them they know nothing. 100% of the time you'll be right.
Am I just not aware of the HN equivalent for medical doctors?
Relevant article: https://slatestarcodex.com/2017/11/30/book-review-inadequate...
More importantly, that's not really Central to the argument of the book he's reviewing or the argument of his post itself, it's a mostly irrelevant detail that you've picked on for no discernable reason.
> Eliezer Yudkowsky’s catchily-titled Inadequate Equilibria is many things. It’s a look into whether there is any role for individual reason in a world where you can always just trust expert consensus. It’s an analysis of the efficient market hypothesis and how it relates to the idea of low-hanging fruit. It’s a self-conscious defense of the author’s own arrogance.
And then quote again the only reference to the EMH:
> It’s an analysis of the efficient market hypothesis and how it relates to the idea of low-hanging fruit.
How, just how can you say something 'bedobi upthread? It's frankly a "fake news" level comment. I hate those, because it looks legit enough that people will take the lie at face value.
Compared to what? What you'd have on a forum of economists or doctors? Maybe. What you would be reading otherwise? Not quite.
> everyone here is apparently a Nobel grade expert.
Maybe not Nobel-grade, but there's plenty of actual doctors on HN.
A couple of days ago we got the: "Fat Is Not the Problem—Fat Stigma Is", now this article. What follows, "Aliens may have built the Pyramids after all"?
We need to be careful how we say this, because then you get generalities like the title and people who shun the basic of medicines such as neccessary vacinations.
Considering that vaccines (in general) have been deemed "unavoidably unsafe" at the Supreme Court level, they are not completely unjustified in their fears. [0]
Vaccine manufactures cannot be held liable.
Thus there is a "National Vaccine Injury Compensation Program" put in place to compensate those that have been damaged by vaccinations.
To date, over $4 billion dollars has been paid out in damages. [1]
Just as mentioned in this article, side effects are major deterrents of any medication. And significant efforts need to be made in order to ensure that side effects do not occlude positives effects.
[0]: https://www.supremecourt.gov/opinions/10pdf/09-152.pdf
[1]: https://www.hrsa.gov/sites/default/files/hrsa/vaccine-compen...
"In short, “unavoidably unsafe” is simply a legal term that means the manufacture is not liable because they cannot do anything to make the product safer. It does not mean that the product is dangerous and should be avoided."
This could apply to peanut butter because of peanut butter allergies. The manufacture is not liable for someone who dies of a peanut butter allergy when they eat peanut butter because this is not due to manufacturing defects but is due to the inherent nature of peanut butter being "unavoidable unsafe".
This does't mean peanut butter or vaccines are dangerous.
Do not take a legal opinion and present it as medical fact.
> Whereas between 1978 and 1981 only nine product-liability suits were filed against DTP manufactur-ers, by the mid-1980’s the suits numbered more than 200 each year.6 This destabilized the DTP vaccine market, causing two of the three domestic manufacturers to with-draw; and the remaining manufacturer, Lederle Laborato-ries, estimated that its potential tort liability exceeded itsannual sales by a factor of 200.
So did vaccines suddenly become dangerous after 1980? Or did people develop irrational fear?
If you read further it plainly says that the "National Vaccine Injury Compensation Program" was started to mollify these anti-vaxxers to try to get them to vaccinate:
> significant number of parents were already declining vaccination for their children,10 and concerns about compensation threatened to depress vaccination rates even further.11 This was a source of concern to public health officials, since vaccines are effective in preventing out-breaks of disease only if a large percentage of the population is vaccinated.12
> To stabilize the vaccine market and facilitate compensa-tion, Congress enacted the NCVIA in 1986.
Agreed, but then to some degree could this same argument not be made about vaccines?
In other words, even if vaccines did cause autism (which they do not) it would still be imperative to use them. The alternative to widespread vaccination is much worse.
Are the "anti-vaxxer lunatics" arguing that vaccines are not a net benefit? When you refer to "anti-vaxxer lunatics", who is it, exactly, are you referring to? Are you referring to specific people (everyone within the "anti-vaxx" "community"), or are you referring to an abstract mental model, of questionable accuracy, held in your own mind?
> even if vaccines did cause autism (which they do not)
These sorts of comment lack epistemic humility/awareness. We do not know that vaccines do not cause autism. Science does not say this.
However, this isn't to say that science says vaccines do cause autism.
What causes autism is unknown. The final knowledge of an association between vaccines and autism is unknown.
To some degree, the "pro-vaxx" message is based on propaganda (here I am referring to the lesser pejorative meaning of the word). Many within the "anti-vaxx" community can see this, and it is used in various ways as leverage. Which is, of course, also propaganda (the more pejorative kind - typically, but not always).
This approach has been sound in the past, but there are increasing signs that it is becoming less effective. Time will tell if that trend continues.
> These sorts of comment lack epistemic humility/awareness. We do not know that vaccines do not cause autism. Science does not say this.
This is technically correct, but it's very difficult to discuss against FUD. Let's try another example:
Do vaccines cause earthquakes? Nah.
Is it 100% scientifically proved that vaccines don't cause earthquakes? It looks very difficult to prove, perhaps you can pick some areas in an earthquake prone country and only give vaccines in some areas and placebos in other areas, and see if the earthquake ratio change. I guess you will never get an approval for an study like this.
So the conclusion is that scientist say that perhaps vaccines cause earthquakes? [What is a good answer here?]
---
It may sound weird that someone think that vaccines cause earthquakes, but some people believe[d?] that playing an instrument in the wrong season can cause big frost. From https://en.wikipedia.org/wiki/Erke
> Traditionally but not commonly, only adult men play the erke, and it is considered profane to play the erke outside of a ritual context. The erke is commonly played during winter, as it is believed that playing it in spring or summer can bring snow.
The English Wikipedia says "snow" but the Spanish Wikipedia says "frost" or "ground frost" like the ones that can destroy crops.
I know the story because part of my family is of a nearby area, but I guess that most cultures have similar stories.
Is this a similar comparison to what I've said (or implied), in the slightest? Might your imagination have added a bit of extra color to your reading of the actual words I wrote?
It may be enjoyable to mock lesser intelligent people, but if the intent of pro-vaxxers was purely concern about the prevalence and risk of vaccine misunderstanding throughout society, I would expect more willingness to understand what is really happening within the community you're worried about, and less (apparent) glee at simply telling people they're stupid.
At the end of the day, you will reap what you sow.
> It may be enjoyable to mock lesser intelligent people,
No. But if you want to discuss epistemology, let's start with an easy example were we all agree that is false in spite there is no hard evidence. Sorry if it looked as a mock, but it was not my intention.
There are zealots and ridiculous claims in both sides, but at the end of the day smallpox is eradicated, polio is cornered (I hope to see the eradication day), meleases is reduced to very small levels (eradication looks more difficult). All of them used to kill a lot of people.
And by what means has any correlation been studied? What specific data is used?
Has a machine learning approach that examines all vaccination records and compares it to all subsequent patient medical issues, of all kinds, not just autism? Does the necessary data for this even exist? I wonder if that fact could even be determined from reading any official websites on vaccine safety.
> let's start with an easy example where we all agree that is false in spite there is no hard evidence.
a) I wonder how unanimous the agreement really is. I have a feeling expressing dissent in the slightest would be about as good for a doctor's career as it is for one's karma on social media sites.
b) Have there ever been cases in the medical field where "all people agreeing" turned out to be less impressive than it sounds?
https://www.nature.com/articles/437801a
"Marshall and Warren went on to show that patients with ulcers can be treated with antibiotics. Unlike patients given acid-suppressing drugs, their ulcers do not return."
"But gastroenterologists resisted the idea. Francis Mégraud, a bacteriologist at the Victor Segalen University in Bordeaux, France, remembers attending the 1988 meeting of the American Gastroenterological Association in New Orleans and hearing outraged physicians. “They seemed insulted, saying, ‘we are being asked to treat stomach ulcers with antibiotics, as if it were gonorrhoea!’” he says. “It was hard for them to accept that the disease could be a simple infection.”"
> There are zealots and ridiculous claims in both sides, but at the end of the day smallpox is eradicated, polio is cornered (I hope to see the eradication day), meleases is reduced to very small levels (eradication looks more difficult). All of them used to kill a lot of people.
True, however:
a) were vaccines the only factor involved in this improvement
b) relative (net aggregate) vaccine safety and absolute safety are related, but distinct subjects. If I'm taking my children for vaccinations, I am interested in absolute safety, not net aggregate safety.
b) Absolute safety is imposible. Let's make some calculation: There are 1.3E8 newborn per year, each one get vaccine in about 10 occasion (sometimes multiple shots), let's assume that the round trip to the hospital is 5 miles and the accident rate of cars is 1.25E-8, and in a car there are 2 persons (a child and an adult). So there are
1.3E8 x 10 x 5 x 1.25E-8 / 2 ~= 40
death of children going or returning to the hospital to get the vaccines per year. (Not everyone get to the hospital by car, but even walking has risks.) If we eliminate vaccination we can save 40 children per year.
>> a) were vaccines the only factor involved in this improvement
> a) Yes
Once again, a confident binary answer to an extremely complex problem.
How did you form this conclusion? Do you have anything you could show to substantiate it? Something like some charts demonstrating that incidents of all of these illnesses were essentially constant, and then only upon introduction of vaccines they began to decline? I've done some reading on this specific topic, I am interested to know if you have. (I happen to have great philosophical interest in the actual vs self-perceived basis of knowledge among zealous advocates on any matter.)
> b) Absolute safety is imposible.
I notice you kind of jump between two conversational styles, the first style ("a) Yes" above) is confident proclamation of a specific truth with no substance to back it up, and then now more of a highly rhetorical, subtle changing of the subject style. And to make it even more interesting, you then include a mathematical formula to give an impression of certainty, but in the process you've completely removed the actual point of contention (harm due to vaccines) from the discussion. Things like this are what I am looking for in these conversations: how do pro-vaxxers come to believe ("know")the things they believe.
Even if absolute safety isn't possible (something you have no way of knowing), safety isn't a binary, it's a continuum.
Have we done everything we can to study vaccine safety? Are there any flaws in the current system? Have you even done any reading on what the system actually consists of?
I will offer you a second chance to demonstrate how much you know about this, by reminding you of a question in my earlier comment that you seem to have accidentally missed:
>> In both cases we only can show that the correlation is so small that we can't reject the null hypothesis.
> And by what means has any correlation been studied? What specific data is used?
> Has a machine learning approach that examines all vaccination records and compares it to all subsequent patient medical issues, of all kinds, not just autism, ever been performed? Does the necessary data for this even exist? I wonder if that fact could even be determined from reading any official websites on vaccine safety.
I'm interested to know your answer to this - perhaps you are aware of something I am not, and I can learn something new. (Also, please do not accidentally overlook the questions earlier in my comment, and if I happen to have failed to answer any of your questions, please point that out that failing as well and I will rectify it.)
I'm referring to the old lady I met in the park while I was walking the dog who insisted that her homeopathic "doctor" had the authority to tell her that "vaccines cause autism".
> We do not know that vaccines do not cause autism.
I get what you're trying to say, but no. In this case yes, we do.
Pick your goddamned battles wisely friend.
Don't play Russian Roulette with other people's children.
(One epidemic and the anti-vaxxers will be up against the wall. Or we can shame the ever-loving-shit out of them and maybe prevent the suffering entirely. It's gaoddamned insane that we even have this problem. Image search polio, image search measles. Lord have mercy.)
You've found one person who is wrong about one thing. Is it logical/prudent to then assume all "anti-vaxxers" are wrong, about everything that they believe?
Rather than assuming your ideological opponents are enemies, it might be worthwhile to put some effort into discovering their actual nature, and what their actual arguments are. As far as I can tell, your current perception is quite flawed (based on the reading I have done of conversations within the anti-vaxx community).
>> We do not know that vaccines do not cause autism.
> I get what you're trying to say, but no. In this case yes, we do.
No, we don't. An absence of evidence is not evidence of absence.
https://www.cdc.gov/vaccinesafety/concerns/autism.html
Correct, epistemically sound statement: "studies have shown that there is no link between receiving vaccines and developing ASD"
Possibly correct, but epistemically flawed statement: "There is no link between receiving vaccines and developing ASD"
There is a difference between these two statements. Are you able to you see it?
> Pick your goddamned battles wisely friend.
I do. Thanks for your advice though.
> Don't play Russian Roulette with other people's children.
I say the same to you in return. Based on recent news articles, the amount of vaccine cautious people, as a percentage of overall society, seems to be growing. Who is more responsible for this phenomenon - me, who recommends scientific honesty, or you, who opposes scientific honesty?
> One epidemic and the anti-vaxxers will be up against the wall.
I would argue that authoritarian thinking like this does not work in your favor.
A subtle form of trolling involving "bad-faith" questions. You disingenuously frame your conversation as a sincere request to be enlightened, placing the burden of educating you entirely on the other party. If your bait is successful, the other party may engage, painstakingly laying out their logic and evidence in the false hope of helping someone learn. In fact you are attempting to harass or waste the time of the other party, and have no intention of truly entertaining their point of view. Instead, you react to each piece of information by misinterpreting it or requesting further clarification, ad nauseum. The name "sea-lioning" comes from a Wondermark comic strip.
That's a new one to me, usually when I encounter someone who can't support an argument despite "all the facts being in their favor", the charge is typically gaslighting.
This reaction should not be surprising at all - if your beliefs are based on what you think are facts, but are actually something else (best guess generalizations with a lack of honest disclosure about the true underlying details, for example), a feeling of ~cognitive dissonance should be logically expected. "I know I'm right, yet I'm unable to explain how I know this. However, everyone else agreeing with me proves that I'm right, so therefore this person must be playing some sort of mind tricks on me."
This is a heuristic. Heuristics evolved because they are genuinely useful. But while often very useful, heuristics are not always correct. The history of medicine, or any other scientific field, is filled with examples of this (washing of hands, checklists, causes of ulcers, etc). And not just mild, honest mistakes, but strong, institutional resistance to the actual truth.
Perhaps there are some heuristics in play in this very conversation? Specifically, perhaps your evaluation of what the nature of the horse I have in this race is.
> may engage, painstakingly laying out their logic and evidence in the false hope of helping someone learn
I'd like to point out that in this case you haven't done this, which raises what I think is a fair question: what gives you the right to dismiss someone who disagrees based on factual statements and reasonable questions? How does one counter "sealioning" being played as a trump card? Do you think "sealioning" would be considered an acceptable form of disagreement in the field of physics? If not, then why do you believe it is acceptable in medicine?
> you are attempting to harass or waste the time of the other party, and have no intention of truly entertaining their point of view
Sometimes the case no doubt, but is that the case here? In fact, I have literally "truly entertained your point of view", and I happen to have some legitimate issues with it. If you believe my issues are unsound, why do you not demolish them with facts and logic? Perhaps you are not able to see a way to do that, so you have resorted to rhetorical techniques.
"When the facts are on your side, pound the facts. When the law is on your side, pound the law. When neither is on your side, pound the table."
> Instead, you react to each piece of information by misinterpreting it
I haven't done this.
> or requesting further clarification
If it is warranted (for example, when something is presented as fact, when it is actually just a generalization that happens to be very popular among people who haven't actually read "the science"), I will always do this. To me, this seems consistent with the scientific process, not opposed to it.
>> We do not know that vaccines do not cause autism.
> I get what you're trying to say, but no. In this case yes, we do.
This statement is epistemically flawed, which is why doctors and scientists do not make that claim.
Your stance is also inconsistent with what the authorities in the field say.
I will pose (a slightly refined version of) the same question that I asked of someone else, to you:
>> In both cases we only can show that the correlation is so small that we can't reject the null hypothesis.
> And by what means has any correlation been studied? What specific data is used? Are there any flaws in the current system? Have you even done any reading on what the system actually consists of, as opposed to what is implied, but never (or rarely) explicitly disclosed/described on authoritative websites?
> Has a machine learning approach that examines all vaccination records and compares it to all subsequent patient medical issues, of all kinds, not just autism, ever been performed? Does the necessary data for this even exist? If not, why not? And has this this shortcoming (with accompanying reasoning) been disclosed with complete transparency on official websites and within authoritative academic studies? Is it part of the "comprehensively truthful, completely science-based" discussion that everyone believes is the state of affairs, and considers themselves to be fully up informed about, or can a person only learn such interesting factual details in the conspiracy community?
What I'm doing here is checking to see if you have as much background in this topic as you imply (and possibly truly believe). These sorts of questions should not be threatening, and they shouldn't be very difficult to answer, if you have actually done a lot of reading and critical(!) thinking on the topic.
Unfortunately they're a victim of their own success. They've done such a phenomenal job people scarcely remember why we use them at all.