Hacker News Reader

Comment by joshgel | Hacker News Reader

Can I just throw a big dose of caution here? This is a review study, looking at the available literature of this technique on cancer. They found a total of FIVE studies with 88 total human participants across all 5 studies. We, the medical community, still has no idea whether this is effective or not. The only thing we can say is that initial trials don't show it to be particularly harmful. That could change with more data.

They review a lot of mice studies and theory, which is great.

But all this adds together to indicate that we should study this more before drawing any conclusions. With limited funding for cancer research, its not even clear to me from this what priority it should take

View on HN

I really don't get the excessive warnings of caution for fasting. It's not hard to try. It's not very dangerous (unless doing prolonged fasts). In the case of prolonged fasts, if the patient is monitored by qualified people then there is little risk as well.

I'm battling a crippling illness. Fortunately I've found the cure and the recovery is nothing short of miraculous. But it's a huge HUGE uphill battle because the medical community works incredibly hard to throw road blocks in my way.

Why does the medical community work so hard to throw up as many road blocks as possible to experimental treatments that are low risk? Why do you insist on being the only group of people who can say what is and isn't tried? Why do doctors and public health officials ignore the work of biochemists? Why do you ignore millions of people battling crippling illness that say your treatments are ineffective, and that other approaches are more effective?

Seriously. I don't get it. I don't believe you're a bad person, but the only explanations I can come up with are arrogance, ego, cowardice, or greed.

Fasting is low risk in healthy populations.

Let's assume you're talking about fasting as a treatment for cancer patients for the sake of argument.

Let's say that studies have examined the effect in 100 patients and it seems moderately effective.

What's the problem? Why shouldn't everyone do it?

Well the very real concern is that when they do a more rigorous study with a much greater number of patients, maybe they find that fasting actually increases the negative outcomes. The result that was found in the weaker study was only a statistical fluke.

So the thing they're trying to avoid is doing more harm than the status quo. This is a very real danger and it would be irresponsible for them to not do the due diligence.

Of course, that's not to say that there aren't valid criticisms of how medical treatments get validated and how quickly they can get to patients they can help.

These are all arguments against the medical community advising people in cancer treatment to fast.

But what if the patient just fasts? Without asking the doctor's advice, and just politely saying "Yes, I hear you, but it's my decision and I think the risk is worth it" when the doctor explains the pros and cons.

Patients gonna do what patients gonna do; the doctor's role is to advise and treat, not control the patient's life. Doesn't mean patient has a good idea, though.

I take the context of these warning comments to be a hypothetical patient who may not have been planning to fast on their own, but having read this paper, now wants to try it--i.e. a patient who may be tempted to treat this paper as medical advice. I think it's valid to point out that a single research paper does not necessarily constitute sound medical advice.

That's theoretically true, but wouldn't the fact that fasting is low-risk in healthy populations indicate that the risk is more likely to be low for populations with cancer?

Also, from your example if you're one of the 100, then fasting is in fact advisable.

I understand that purely for legal reasons we can't advise doctors to recommend fasting as a general guideline without gold-plated evidence. However it should be noted that just because the risk has not yet been perfectly quantified does not mean it is entirely unknown.

For my part if I ever contract any sort of cancer, I will never reject a potential treatment on the grounds of "well we know it's low-risk in healthy populations, and given what we know of the biology it seems like there's some potential effectiveness. But we don't have a gold-plated-chocolate-coated mass population double-blind study for your specific cancer yet, so I'd advise against trying it".

Taking minor, well-thought-out risks is the least one should do when fighting for one's life. It's a good thing doctors aren't financial advisors, or they'd tell you to avoid the S&P 500 index fund and stick to your 2% savings account.

This reminds of the abandoned practice of women being prescribed Hormone Replacement Therapy (HRT) for menopause. Essentially the reasoning was "why not, it seems to improve patient health and we don't see any ill effects". It was such common sense at the time that it took over 30 years before a clinical trial was performed. That trial demonstrated a much higher rate of breast cancer and heart disease in HRT patients.

The NY Times has a good write-up on it and more generally the challenges with epidemiology and causal analysis in medicine. https://www.nytimes.com/2007/09/16/magazine/16epidemiology-t...

I don't see how your response relates to the GP's comment, and your comment ends with a personal attack.

Also, you may have found a solution to your problem, but you are implying to me that you believe it is the one-true solution (rather than doing a scientific trial of solutions upon yourself, and saying "this works for me" and is worth trying).

You're right, I shouldn't have directed those comments that way in the end.

But it's hard. Doctor's have personally attacked me over and over, to the point where I don't bother going to them anymore. I would show up to appointment after appointment asking for help with no clue as to what I had, and doctors and nurses were very quick to anger. I didn't question their intelligence. I didn't tell them theories about what I thought I had. All I did was try to describe what my body felt like. I think they thought I was faking to get drugs or something, but I really don't know. I never asked for any drugs. It was a nightmare.

I sympathise. The number of times I've had to push doctors to do anything at all is absurd (or should be absurd). They're frequently rude and unhelpful, often I have to try and diagnose myself and find out about tests or they'll not offer more than a shrug. I have to find out about contraindications too because of the number of times they've ignored things I tell them.

However, I don't think it's about doctors per se, but about people who are arrogant⁎, I've seen plenty of techies do the same when, for example, someone with less knowledge of computers than them asks for support. I think it's still possible to be helpful by at least showing you care, even if you can't find an answer or don't have the time to be as effective as you could be. People often appreciate that just as much as a fix.

⁎I define arrogance as not listening due to over confidence, not overconfidence itself. Those who don't listen can only be overconfident, so it's also not a synonym for confidence.

Totally agree.

But it sounds like you are taking it personally. The doctors are embedded in a system and they act they way they do because their environment teaches them to, not because it is a personal attack against you.

Doctors often deal with difficult people, and it takes care to avoid one being stereotyped: boxed into a label that doesn't help one. You don't want to be labelled: drug-seeker, hypochondriac, batshit crazy, or conceited know-it-all, etc.

Use the doctors, listen to them, and treat them as people trying to help you; if you want to get treatment from them.

I have seen it from a doctor's point of view (I have seen the patient stereotypes), and I think that the majority of us would act the same way as the doctors if we were put in their situation.

I believe you completely need to be in charge of your own health solutions, and it is a good idea to explore safe variations of a variety of treatments - science works if you can be suitably objective with your measurements. But one variation you should properly trial is whatever the doctor says to.

If it is a mental issue, then perhaps:

1. Get multiple videos of yourself interacting. Humans usually suck at self awareness when it comes to the psyche.

2. If you can find someone else with the same label that has it "worse" (as per a neutral third party), then try and watch how they act and often disown/deny/distort their world. Or watch videos online and see the weird and wonderful shit our brains do to us!!!

I wish you good luck finding a solution that helps you.

I don't think being embedded in a system is an excuse. Especially when that system takes money from people by force through mandatory insurance requirements and shuffling around costs so that you're paying for more than the service you want. Not to mention how the medical community criminalizes anyone but themselves providing healthcare, even though biochemists are better equipped to handle chronic illness. Doctors could work outside the system, and many do. Or they could quit being a doctor and work in the alternative healthcare industry in a myriad of ways, and many do.

And how am I the difficult person when I tell a doctor that I have excruciating pain everywhere, they do some tests, the tests show that I'm "fine", and the doctor gets angry at me? Sounds like the doctor is the difficult person in this scenario. They assume that they are so correct that it justifies treating me like shit. Or maybe it's my illness that is difficult and the doctors are taking that personally and taking it out on me? This has happened to me over and over again and the interactions were always pleasant until tests came back negative. If I was the problem then wouldn't the interaction go poorly from the start? If a doctor can't help but stereotype people, then they are not a good candidate for the job and should be fired. I don't think there is a single industry in this country besides the healthcare industry that says they just can't help but stereotype people.

I can't even get testing done without a doctor's approval. It's a racket.

It's not a mental illness. And there are millions of sick people getting together online talking about the exact same experiences that I've had.

when i read the parent comment i thought the switch to "you" was not aimed at the GP but at the doctors. iaw, while writing the poster got worked up with frustration and changed to address the doctors directly.

My experience with the medical community is exactly the same, it's frustrating. If it's difficult to diagnose and doesn't have clear visible symptoms, almost all doctors immediately say it's a psychological issue. If you show them any research and ideas what could be done they immediately dismiss it, because you are not a medical professional.

Everyone that never had an issue like that has a really high image of the medical profession, so when you tell them about your problems they just think you're crazy and you should listen to the medical professionals.

Would you mind telling me how you solved your issue? I found some things to make my issues a lot better, but it's not completely fixed, yet, so I'm very interested in hearing other peoples' experiences. My email is in my profile, if you don't want to discuss it here.

> "Why does the medical community work so hard to throw up as many road blocks as possible to experimental treatments that are low risk?"

Well, at least in the fasting, it's a complete break with tradition. No scripts. No Big Pharma outfit marketing it. Etc.

My feelimg is, many doctors are wired to want to take action. The idea of something as simple as "I want you to fast every other" is completely foreign to them.

Another issue is compliance. If a doctor could say: eat 2000 calories a day and break a sweat for 30 minutes, and expect people to do it, the general population would look totally different.

Compliance isn't the issue. Food Inc. marketing is. As is, humans naturally assimilate to "the norm." As the waistline of the norm increase, the waistline of the norm increases. A doctor's words lose meaning when all other inputs say "Don't worry about it. You're just like everyone else."

Long to short, what used to save us, is now doing us in.

For treatments that involve some action on the medical community's part, I can see how they could put up roadblocks. But how can they put up roadblocks to fasting?

Finding someone to monitor your vitals during a fast would be difficult as most doctor's don't want to risk losing their license doing something experimental.

But I wasn't just referring to fasting. It's incredibly difficult to do anything that isn't approved by a doctor. Even lab tests is a huge battle unless you pay out of pocket via mail order.

> It's incredibly difficult to do anything that isn't approved by a doctor. Even lab tests is a huge battle unless you pay out of pocket via mail order.

As your last statement here illustrates, this is because of the way most health care is paid for. In a system where third parties pay for most health care, the doctor has to answer to the people who pay even though they are not the patient. Even if he personally is convinced that a particular experimental treatment is low-risk and has some chance of success, he still has to convince the people who pay, which is a much higher bar.

If a doctor thinks the system they work for is the problem then maybe they should be getting a different job instead of always making excuses.

> Finding someone to monitor your vitals during a fast would be difficult

If a person is undergoing cancer treatment their vitals are being monitored anyway. I'm not talking about the person asking for any additional lab tests. I'm just talking about them deciding to fast.

Why is that surprising? Why would insurance cover a lab you ordered yourself?

What's surprising is that doctors are legally required to order lab tests when they are non-invasive and have 0 risk of harm. They do not need a doctor's approval and could be much cheaper by cutting them out of the loop entirely.

I'm curious: What would you want monitored? And why?

There are lots of low tech/no tech ways to monitor your health and people pursuing alternative remedies routinely pay out of pocket as both a cheap alternative to paying a doctor and because they often don't want a doctor involved in their health choices.

What do you have? If you don't mind me asking.

I don't want to bring it up here because sometimes it invites a deluge of downvotes. If you go back through my older posts you'll find it. There's not that many.

What do you mean limited funding? Seems like there's a TON of funding for cancer research right now, given the moonshot campaign (extra $1.8B over 7 years).

It's hard to study something like this, because you have to find a large enough population for the statistics to work out, but also keep the study going long enough without massive attrition (would have to do intent-to-treat) to have results worth publishing.

There is probably limited funding for this because even if it is true, it will not result in a large stream of revenue for anyone. In fact, if it works it might reduce some health industry organizations' revenues.

Reply on news.ycombinator.com