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Comment by geek_at | Hacker News Reader

> In the pre-Szaszian era, medicine was something that happened to you. You would put your health in your doctor's hands and they would unilaterally decide your course of treatment. But in today's patient-centered world, doctors are more like consultants

To be honest I've only seen this level of "patient-centered" stuff in the US. Never heard the phrase "Ask your doctor about xy" anywhere but on US TV. Sometimes pretty hard drugs like psychotropic drugs. When I first head it my response was "WTF, shouldn't the doctor tell you what you need and not the other way around?"

I guess it comes down to the batshit crazy US healthcare system and people losing trust in doctors that give them 40k$ bills for simple treatments or short hospital stays

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> Never heard the phrase "Ask your doctor about xy" anywhere but on US TV. Sometimes pretty hard drugs like psychotropic drugs. When I first head it my response was "WTF, shouldn't the doctor tell you what you need and not the other way around?"

This was the case for many years where it was illegal to have advertisements for prescription medicines. They lifted this like 15 years ago. This was very favorable for the pharmacutical companies as now patients are going to go to doctors and ask exactly that.

What is worse now IMO is these direct to patient ads on social media from Cerebral. They show a lot of common things that people do (Like slack off, not pay attention to something boring), and then encourage them to talk to them for ADHD treatement. While more awareness of mental disorders and health is great, it is a bit scary when people can get convinced they have a disorder that needs pharmaceutical intervention and shop these firms until they get a script.

It’s been closer to 25 now. Bob Dole was shilling for Pfizer’s Viagra in the 90s.

I would personally rather be involved in the decision making process related to my very existence rather than just told what to do.

I "feel" like I would like that as well. But if I every get really ill with something longterm, I'm also afraid I'd spend too much energy on all the decisions and research. Giving patients options also gives them doubts.

I think individual patients have very different preferences on this. I've taken pets to a few different vets, and some say things like "There are many possible reasons for these symptoms. Let's try XYZ and see how it goes." Others are more like "Your dog has X. We'll do Y and it should clear up."

My preference is for the one who I think is being honest with me about how certain they are about what's going on, and when a medical professional seems like they want to appear 100% certain all the time it makes me worry about their judgement.

I think many people have the opposite preference, which seems to me is asking for dishonesty. Seems like an ethically tricky area.

I mean, I agree with this but also feel that pharmaceutical companies should not be advertising directly to the public.

Note: Advertising prescription drugs to the public is only legal in the USA, and also New Zealand. Nowhere else.

I think everyone agrees, but it is a first amendment nightmare to try and regulate.

We already prohibit advertising for cigarettes (on broadcast TV and print), so this doesn't seem like that much of a stretch.

Cigarettes have the "think of the children" special ability.

But why?

Imagine your grandmother who knows nothing about computers or tech asking you about GPUs and which programming language is best because she's curious about buying Bitcoin vs investing in Ethereum.

For someone who can't tell the difference between a screen saver and a computer virus, the discussion is meaningless, and only the illusion of control exists

And to extend your analogy, instead of the grandmother talking to a helpful expert, all the information they are given comes from BitCoin salesmen, and she's expected to "do her own research."

Side effects may include losing all your money, but those side effects are like really really rare

"What's and adblocker" - my Grandma.

Well, you know a phone book? And, you know how if you want to phone someone, you tend to look up their number in a phone book?

"Yes"

Well, computers are the same. They only know numbers, they're computers after all, and DNS maps the names you see for websites, to numbers, so computers can find the website.

"Uh, OK"

The adblocker I am going to install, makes it impossible for the computer to see the numbers for advetisers. It can't find them in its phone book any more. So, no ads!

Now grandma understands how DNS works, and what some adblockers do.

Some things are not as technically complex as we think they are.

Maps names of websites? I don't know what that means. Timmy showed me The Amazon and the egg cooker from there worked wonderfully so I don't want an ad blocker.

Granmda knew what it meant. She'd been looking up names in the phonebook here whole life, mapping them to numbers.

Been doing the same thing for lots of paper databases, like address books, and been using indexes in books too.

Not to mention, how the library indexed books in her day.

Zero confusion about DNS after I explained urls to her. None.

I had a sugery for a common issue performed, as it happens, by the ex head of some surgeons union type organisation in my country (Ireland). The established technique has an uncommon but not so uncommon tendency to have issues where you just dont heal properly. I was unlucky and I didn't heal. I spent a year being tended by various nurses and reviews etc etc and when I finally started to research it myself I found there was a new far better surgical method available, but the guy who did my surgery was old and hadn't kept up to date. I found a surgeon who specialised in the new method and I was fully healed and done forever in a couple of months.

They might be an expert, but it's your (literal) skin in the game.

This is such a silly metaphor I am going to ignore it and answer the initial question.

Why? Because the things I personally value in my life and health are not always aligned with the things doctors try to optimize for.

I’ve told the story here a number of times but my tonsils swelled up to the size of grapefruit a number of years ago. After 6 months of steroids and having them drained I wanted them removed. My doctor did not think it was necessary, even though I was living in misery. I ended up just going to a doctor about an hour away and had them out within the week.

You're abandoning the context of the thread. The original comment you replied to was about how the US Healthcare system should be fixed so that you always know doctors are optimized for your needs

Not everything is “fixable” in health and sometimes this means that there isn’t one “right” choice for treatment. Involving the patient in the decision making process is important because people have preferences for what is right for them and their life and the doctor can act as a well informed partner in care.

I have multiple sclerosis. There’s not a cure but there is highly effective medication. There’s also less effective medications. The highly effective stuff is various degrees of immunosuppressive or has a risk of fatal brain infection that is manageable with proper testing and monitoring. The less effective stuff can seem “safer” because it lacks these particular risks. A regular neurologist might not know very much at all and give outdated advice and treatment plans compared to some specialists and for this reason advocating for oneself is hugely important as long term outcomes can be greatly different based on the treatment choices. The fact is that you can’t just let “medicine happen to you” because the person that cares the most about your medical outcomes is you. Obviously this is an extreme example but it’s one of many.

I mean, I do see where you're coming from, and I have in the past second guessed some medical advice and asked if they'd considered a particular diagnosis I had a hunch on.

On the other hand, they're a professional and they've usually spent the majority of their life training to be good at what they're advising you about. I don't demand to be involved in the design of planes I fly on or bridges I cross, because frankly I'd do a worse job than even a pretty bad qualified engineer.

> WTF, shouldn't the doctor tell you what you need and not the other way around?

The problem here is that it is the medical professional who is pushing the ineffective treatment.

It goes the other way too. If you have anything but the most common illnesses or conditions that you are likely more knowledgeable about your situation than your PCP since they're the tier 1 help desk of medicine. This kind of thing is totally fine and expected, it's why specialists exist but it's really frustrating because your PCP is often treated as a either a gatekeeper or unnecessary busywork to get to the more qualified person.

Broadly, it's because the US has a culture of individual sovereignty and not everyone being a ward of the state.

That's not true. We have the drug ads in the US because legal precedent since the late-70s/early-80s (roughly) in the US now protects commercial speech.

Companies are legally considered persons, hence their speech is protected. This is consistent with individual sovereignty. If people are wards of the State, then the State would have the responsibility to police "harmful" speech; advocating untrained people to ask their doctor for a specific medication could be considered harmful speech (since apparently only two countries in the world allow it, and not even the US before the 70s-ish, apparently).

I think it's because the US is one of the few (only??) countries to allow advertisements for prescription drugs.

It’s technically not the only country, as it’s also legal in New Zealand. But nowhere else.

I'm not trying to condone terrible drug advertisements but man there has to be something to let people know that their "normal" suffering isn't normal or that there are new developments that your PCP for sure isn't gonna keep up with.

I know the meme de jour is teens diagnosing themselves with ADHD because of TikTok but it's the perfect example of a whole bunch of people being like "holy shit it's not supposed to be this hard all the time? You can actually do something about it?"

there has to be something to let people know that their "normal" suffering isn't normal or that there are new developments that your PCP for sure isn't gonna keep up with.

That should be the doctor's job. Doctors have too much financial pressure to pump patients through, so they have neither the time to get to know individual patients nor time to keep abreast of current trends in their speciality.

Should MedicineX be allowed to have a website with a FAQ? Yes. Should MedecineX be pushing ads on TV/radio that make it seem like it's a cure for everything that ails you? Nope.

Sure, but people need to first know what they're dealing with isn't normal before they can even ask about it.

I have really, really bad fatigue. It took me years to figure out everyone else didn't feel that way. I was in high school and was able to skate by on intelligence alone.

The FDA has already asked doctors if they think advertising is good:

https://www.fda.gov/drugs/information-consumers-and-patients...

Most physicians agreed that because their patient saw a DTC ad, he or she asked thoughtful questions during the visit.

Many physicians thought that DTC ads made their patients more involved in their health care.

Seventy-eight percent of physicians believe their patients understand the possible benefits of the drug very well or somewhat, compared to 40 percent who believe their patients understand the possible risks, and 65 percent believe DTC ads confuse patients about the relative risks and benefits of prescription drugs.

Eight percent of physicians said they felt very pressured to prescribe the specific brand-name drug when asked.

DTC ads help patients have better discussions with their physicians and provide greater awareness of treatments.

The study demonstrated that when a patient asked about a specific drug, 88 percent of the time they had the condition that the drug treated. And 80 percent of physicians believed their patients understood what condition the advertised drug treats.

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