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Comment by deadpannini | Hacker News Reader

The dissonance here is intense. On the one hand, "practicing MDs ... understand almost nothing when reading medical studies", but also I don't "know better than the average doc [just] because [I've] read 10 studies."

Is the idea that doctors deserve deference because they are conditioned to submit to guidelines formulated by experts?

There is a lack of consensus on many long-standing, common medical questions, much less novel diseases. When I ask my GP about prostate screening, for example, he lays out the current state of research as best he can, but delegates the decision to me. Why is the COVID situation different, given that experts are still fighting through a figurative fog of war?

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Great point. Perhaps the idea is that neither you nor the avg doc can conclude much from reading 10 studies. Therefore, defer to the experts?

As to why the COVID situation is different, presumably because prostate cancer screening affects only you (and perhaps your family in the case of a true/false positive/negative diagnosis), and COVID represents a threat to everyone around you, and everyone around them, etc.

I wasn't clear. Most of the time, as with prostrate screenings, one of the following is true:

- There is no expert consensus (on treatments, etiology, etc.).

- Consensus exists, but the level of consensus is overstated.

- There is broad consensus, but with relatively low confidence.

A generalized public health threat like a pandemic doesn't change the epistemological calculus, nor the sociology of knowledge.

There is a fourth option:

- there a consensus, it is broad and it has good experimental support and high confidence

Your GP may try to lay out the state of research before you, but that does not change the fact that he/she will do one of those things:

1. Treat you according to guidelines/expert opinion, should you choose to.

2. Give you the opportunity to participate in a relevant study.

But _never ever_ will your GP formulate an experimental treatment plan based on his own research. Not GP's job, and big risk of liability. Your GP has at best a cursory view of the research happening in a certain field. COVID is different due to several good and bad reasons: hugely politicized, confusing messages from experts, and most of all novelty. 'Lack of medical consensus' usually means 'several treatments backed by experts are available', not 'do what you like'. COVID is too new for the dust around expert debates to have settled. That's what makes it different.

More likely: your GP will pass you on to the resident expert at the nearest hospital of your choice.

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