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Comment by psychphysic | Hacker News Reader

It's worth drawing a thick distinction between rheumatoid (autoimmune) and osteoarthritis (worn out).

Thank you. My wife suffers from this and its night and day different from osteoarthritis and my wife who has has been offered plenty of ridiculous "cures" that people somehow believe highly paid specialists just haven't though of.

Sorry your wife suffers from this. I just wouldn't be so confident that highly paid specialists have time to keep up on the latest research in their field. In my experience most do not. They're highly paid because they see a lot of patients, not because they read a lot of research.

A lot of medicine isn't latest research as standard of care isn't a fast moving target its just attention to detail.

I'm not sure what you mean, but both a co-worker and a co-workers wife found that eliminating nightshades like the GP did, eliminated their need for medication as well. My wife has a different autoimmune disorder, and had good luck eliminating a different food. The autoimmune protocol is the name for the elimination regimen. There is actually a great deal of literature to back this up. But I believe diet doesn't enter standard of care quickly because of low compliance, among more cynical reasons. This is just anecdotal, but it isn't just subjective symptom descriptions either. These people quit meds while under a doctor's care because their antibody tests reduced dramatically on the diet.

Ruling out peppers, eggplants and tomatoes isn't fun, but it isn't even close to impossible. Imagine having immune responses to corn! Maybe it won't work, but it only takes about a month to evaluate.

You are unintentionally illustrating my point. We are aware of the perception that non-medical people believe there is a miracle cure to be found in everything from eliminating tomatoes to according to one enterprising individual drinking your own pee.

My wife naturally rarely eats nightshades and consumption has zero correlation with inflammation or RA. If it were as simple as not eating tomatoes everyone would be cured. Instead every person that deals with that who goes to specialists regularly, who deals with the negative side effects of the drugs that actually reduce inflammation and keep your insides and joints from being destroyed has heard countless fake cures.

It's a legal requirement for doctors to practice continuing education to keep their medical license. It is literally part of their job to "keep up on the latest research."

In reality it's just aspirational.

… but many satisfy this requirement by going to a pharma sponsored convention, which only has a small number of talks (all vetted by the sponsor to be favorable, if not actively marketing for sponsor), and just happens to be in a great resort of some sort.

Those who care, do real continuing education - often on their own time and without asking for official credit.

Rheumatology is one of the most exciting fields of medicine at the moment, it therefore attracts some of the brightest. I can assure you that they are up with the latest research, but it’s nice of you to so casually dismiss the work of their careers

They're highly paid because they see a lot of patients, not because they read a lot of research

This just isn't true. A GP (General Practitioner) sees a lot of patients. The only realistic reason you can get seen by a GP in good time is because they tend to leave some slots open for more urgent things: The reason you can't get in to see a specialist on the same day (usually) is because they don't.

Specialists get paid more because they specialize: They won't know as much about curing everyday ills and they gave up on that when they specialized. Medicine is complex, and it only makes sense to have folks specialize in some things (like bones and neurology and whatnot).

We see the same thing with other professions, though not all pay more for different things. Knowing how to run an industrial kitchen (factory, large cafeterias, etc) is different from fast food, for example. Folks with knowledge of specialized systems get paid more, in general: This is your medical specialist.

At least in France a GP (médecin généraliste) sees people for everyday things. The "truly urgent" things are rare, this is what emergency services are for.

Yes they see "urgent" patients that happen to be painfully sick (otitis for instance) and they need to give them well know and predictable medicine (and other such "urgencies" - which I put in quotes not because they are not urgent, but because they are expected and everyday business. If you had an otitis you will know that the pain is unbearable and that you either have to see the MD quick, lose your mind of have your eardrum break).

These GPs will push you towards a specialist in case they detect something abnormal because they do not have the current knowledge to treat you correctly.

For the record - one of my best friends is a GP and their work is terrific. They are a mixture of science, magic voodoo and psychologists to actually manage the everyday health of the whole society. I truly regard them highly.

Also, the amount of hours they do is insane - way too much in my opinion and yet it is so difficult to get an appointment. They are on a strike today, the first as long as I can remember to get their regulated fee to be raised.

In my experience you are completely wrong about specialists.

Even osteoarthritis is now understood to be mostly caused by inflammation rather than wear and tear.

- https://www.youtube.com/watch?v=sUOlmI-naFs

- https://pubmed.ncbi.nlm.nih.gov/?term=osteoarthritis+inflamm...

Indeed. And with rheumatoid it can come a lot younger than your snowboarding years.

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