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Comment by PaulKeeble | Hacker News Reader

Covid has been found in the brains and organs of Long Covid sufferers at autopsy while not being found in their blood in PCR testing. Bhupesh Prusty recently found in an autopsy of 4 ME/CFS sufferers they had HHV-6 in their brain and spine and 3 of the 4 also had EBV too where 28 controls did not. The DOD just last year also linked Multiple Sclerosis to EBV. There is growing evidence that many viruses stick with us in cells, are not found in the blood and can lead to severe chronic illnesses later in life.

A lot of microbiome research is leading to particular bacteria in or missing from the gut being correlated with various diseases like diabetes and obesity and almost all chronic diseases have a corresponding microbiome adjustment. We don't know yet know if there is a cause here or its just correlated but its a potential diagnostic that shows long before more serious symptoms and could potentially be used diagnostically one day. Or it might be these shifts are causal and we need to find a way to restore gut function that works well and reliably.

The fundamental idea is becoming mainstream in research with significant labs working on this for Long Covid, ME/CFS as well as EDS across the globe. Its not a fringe idea in research looking at long neglected diseases and the more they look the more they find evidence for it. Its not something the vast majority of doctors would have any knowledge on today, most would consider it ridiculous despite thousands of papers on this topic with growing evidence for the fundamental idea of ongoing infections causing increasing problems.

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“the vast majority of doctors would have any knowledge on today, most would consider it ridiculous despite thousands of papers on this topic with growing evidence”

Are doctors, as a group, becoming stupider? I’m not trying to troll by asking that question. I legitimately feel, as a patient of a large HMO, that the doctors I interact with aren’t very bright, making frequent mistakes about stuff they could google as quickly as they give out wrong information, but instead confidently insist upon something they’re misremembering or have never learned correctly in the first place. It feels like the profession has been optimizing for the wrong things: quick recall of a breadth of information rather than a scientific orientation towards the work. Perhaps I’m just seeing downstream effects of the reform of health economics in the last decade. Perhaps it’s elite overproduction. In any case reading the featured article, I’m just not at all optimistic about current medical practices experiencing any sort of kuhnian paradigm shift. They can’t even get the basics right, and seem prone to extreme group think bordering on religiosity.

> Are doctors, as a group, becoming stupider?

I don't think they're becoming stupider, but I think the information age is making their errors more accessible and obvious to the general public.

I think as the pool of knowledge balloons exponentially in size it becomes nearly impossible for a doctor to be familiar with all of it, so their only choice is to deeply specialize in one field and limit the breadth of patients they can treat (also becoming less knowledgeable about anything unrelated to their field), or they must be incredibly general and have only surface level knowledge of everything. 100 years ago a few years of study could teach you nearly everything there was to know in the medical field at the time. The expanding pool of knowledge also makes it harder to determine which knowledge is actually helpful to take in.

I think this is an area where technology can help. The best primary care providers I've had have been the ones who aren't afraid to look things up as we're talking about them. I think better tools to aggregate the cutting edge of medical knowledge would help greatly.

Very much agree. I hope language models make a big dent in the problem. Many other places tech can move the needle as well, like imaging and diagnostics.

These threads always have lots of people jumping on doctors and their decisions/callousness/lack-of-reason/missing up-to-date-into/etc.etc.etc. My wife is a physician (OBGYN) at a major city hospital that primarily serves a very poor population. I'd like to share her schedule, and see if you think what kind of care you could perform under these circumstances, or how up-to-date you could stay in field:

Monday - Friday

- Wake up at 4:30 AM - Get to hospital by 5AM to start rounding on patients - Sometimes work inpatient all day sometimes clinic thrown in, but usually not done working until 7 PM, without even a 15 min break or a chance to eat a meal (15 hour day) - Come home and do about an hour of notes, 16 hour work day - At least once per week, wake up in the middle of the night to deliver a patient who asked for that kind of continuity of care. 24 hour work day

Saturday: - Wake up around 5am to be in by 6am to start the day - Work inpatient, usually without time for a 15min break for food, until 10AM SUNDAY (28-30 hours shift)

Repeat 49 weeks/year (days of 24/hr shift can vary and she usually gets one weekend off/month). Her average time at the hospital last year was 96 hours/week. She is not a resident.

How much confidence do you have that you'd be able to stay up-to-date in your field, or make recommendations that aren't ultra-standard, with this kind of schedule?

Is it possible intelligent people are aware of these conditions and it may be causing them to choose a different path instead of practicing medicine?

Ditto with teaching, anecdotally.

Worse yet, experienced people in these professions tend to defend the insane schedules, which I take for some sort of hazing ritual / Stockholm syndrome.

I don't see how your wife's unreasonable work schedule is supposed to make me feel better about the poor quality of health care I receive. If anything, it makes me question her judgement more, that's just not healthy. How are unhealthy people supposed to educate people on health?

It's likely not her choice.

In the UK medical professionals are doing the sensible thing, and leaving the profession. I'm sure most of them would much rather stay, but they're making the rational choice as individuals.

That's not the best choice for patients as a group though.

There's a serious under-staffing, under-pay and conditions crisis.

So if doctors are intelligent, why do they put up with such a horrible system? Surely they have some sort of power in these scenarios?

Yes, they are striking in the UK.

They have very little power in most primary care specialties. The expectation from hospitals is you will work this hard or they won’t hire you. Hospitals are more than happy to just dump more hours onto their over-exhausted doctors rather than hire new ones who ask for fewer hours. The expectation from other doctors is you will work this hard because if you don’t, someone else will have to pick up the slack. Also, most of them sign as part of their contract basically “I’ll show up outside of contracted time if it is necessary for patient safety”, turns out this is like 50% of the time because they’re so understaffed

Have they not realized that they can unionize?

Doctors have invested huge sums of time, money, and effort into getting the qualifications needed to perform their jobs, and there are few alternative jobs they can transition into if they are given a bad deal.

I don't mean to be unfair, but this isn't that far from

>If you're so smart why are you poor?

Intelligence has nothing to do with power or leverage in a situation

But it has everything to do with understanding that you can form a union, no?

If you don't even know about these organisations then you're not really qualified to talk about what doctors should or shouldn't be doing or what power they do or don't have.

https://www.bma.org.uk/

https://www.hcsa.com/

https://doctorsinunite.com/

So why haven't those orgs accomplished anything to get better working conditions for doctors?

How do you know they haven't? Just because things aren't perfect doesn't mean things can't be better than they were previously, the NHS has been around for 70 years after all.

It's always her choice. And I'm not being flip. Only individuals making good decisions will change this situation. My wife is also a physician and she has thoughtfully opted out of the "rat race." It's good for her, good for her institution, and good for the populations she serves.

My point was not at all to make you feel better. It was to explain a systematic reason why doctors underperform and empathize with their position instead of blaming them personally.

To be clear, I was not meaning to blame and sincerely apologize that my comment may have come across that way. Your comment was very helpful in conveying why, ceteris peribus, the perception of doctors may be diminishing. They are too overworked to excel beyond the standard of care, and even consistently meeting the standard of care is a tall order.

But that’s what I was trying to suggest by saying that it seems the medical field, as a whole, seems to be optimizing for the wrong thing, viz. quantity over quality. As others note, there are clearly economic forces at play, and maybe too much constraint on the supply side. And it’s not clear to me that any reasonable discussion is occurring with respect to that. And so I reiterate my pessimism that we’ll somehow get from where we at currently, to a brighter future brought about by a kuhnian revolution as hinted at in the original article. We need to fix what’s broken before adding new features, to put it in software terms.

> Sometimes work inpatient all day sometimes clinic thrown in, but usually not done working until 7 PM, without even a 15 min break or a chance to eat a meal (15 hour day)

Honestly, that makes me agree with the parent comment that the medical profession must be getting stupider to not let a doctor take a break or eat a meal on a 15 hour day.

do you see "getting stupider" as synonymous with "less profitable in a capitalist system"? Do you think doctors are overworking for fun?

> Do you think doctors are overworking for fun?

No, it's so the administrative staff can become further bloated as parasites upon the host of the actually productive doctors, and so the shareholders can take whatever breadcrumbs the administrative staff leaves behind.

There are definitely capitalistic hospital business incentives at play here, but there is more than just that. Medicine is a notoriously supply-side gated field, and intentionally so by all practitioners. It’s one of the main drivers of the sky high pay white coats get access to after all the hoop jumping.

Speaking for the US, as it has a notorious track record for inefficiencies in its medicinal industry: the USA is getting older (aging population needing more care) with the cost of medical school higher than ever. With this, the production of doctors is unlikely to increase at a pace necessary to maintain levels of care uniformly across the board (for example, rural vs city medicine capabilities vary massively based on region).

Most hospitals attempt to use technology to squeeze more out of their doctors, as getting more doctors isn’t cheap (because there aren’t enough of them). Hospitals can’t do much to solve the doctor production shortage - that involves legislative changes and the American Medical Association (lobbying arm).

The capitalistic effects will compound all of this - but not so much in what you may be describing. If we don’t resolve things, in the medium-term future years we can see a bifurcation in medicine as we see in criminal defense law - the wealthy will have great access to world class healthcare, paid at an extreme premium, and everyone else will be out of luck. (Some would say we are already here there or rapidly approaching this state).

They are overworking because they have a lobbying organization that limits the number of doctors.

This leads to higher pay and more work.

What percent of doctors do you think contribute to the lobbying organization or agree with its direction?

Enough there is no counter-AMA organization anywhere close to the same size.

AMA membership by physicians have dropped from 75% in the 1950's to about 15% a few years ago. Doctors are actually not that great at advocacy which is the main reason why counter-AMA organizations don't exist imo.

A large chunk of their membership is just medical students and residents but thats primarily because they offer good savings to them like study materials.

The AMA does not represent physicians.

Doctor pay-per-hour-worked varies a lot by specialty. My wife gets $270k/yr on her current contract after max bonuses and paying for malpractice insurance. That comes out to about $60/hr. this is in a mid col city in the USA.

That’s in no way bad money, but per hour worked PAs and many nurses make more than that. When I worked IT support I was paid close to that. It doesn’t at all seem worth the pain.

That sounds like rough gig, but overall they are still the highest paid profession in the US by far.

Which lobbying organization is that? If you're referring to the AMA then you're wrong. They have actually been lobbying Congress to increase the number of physicians by funding more residency slots.

are you robert california?

but to your point, studies have shown that handoffs kill patients. if you've got 18 people on a floor, each shift you hand off to has a statistically significant chance of screwing up one of them. So if there are 3 shift changes a day there are potentially 3 might-screw-you-up-bad rolls of the dice.

putting people on 12- or 24-hour sifts is crazy, but the sleep deprivation kills less than the shift change mistakes.

The parent comment didn't say the medical profession, it said;

>Are doctors, as a group, becoming stupider?

May I ask why she's doing this?

It is required by the hospital. I have made her promise me we will try finding a better work-life balance hospital within a few years, but it’s hard to apply to new places with this kind of schedule

Reading the replies to your comment is so grim. I think, more than anything, I'm floored by the level of arrogance that permeates seemingly every conversation on HN lately. I'm spending less time here than I have in years because watching the culture of curiosity die just makes me sad.

Anyway, thank you for taking the time to share this.

No confidence at all, I wish doctors didn’t make so many mistakes and I wish doctors weren’t being ritualistically tortured. The fact that we get both just speaks to the incredible dysfunction of it all.

They asked if doctors are getting stupider. You provide an argument for why they could be getting stupider and pass it off as a counter-argument...

Unless the schedule was always like this. Then it wouldn’t explain them getting stupider.

It sounds like a solution might consist of vastly increasing the number of doctors that get trained and residencied each year.

Hospitals and some practices run their medical professionals on long shifts, often back to back, and on skeleton crews. They're profiting at the expense of the quality of care they're providing by spreading doctors, nurses, etc as thin as they possible can.

They're not becoming stupider, the culture of following protocols rather than understanding is a pre-scientific one. It certainly has benefits- predictable consistency, limited liability for doctors. Unfortunately, Dr. House style deep thinking in widely available medicine is legally impossible, and only a tiny percentage of the population is able to think that way.

I think this quote really sums up this issue, and it's history:

Knowledge isn’t a commodity, especially not a fungible commodity, as the medical business sees it. Consciousness and culture are part of the life process. It is exactly the commoditization of medical knowledge that makes it dangerous, and generally stupid. Doctors buy their knowledge, and then resell it over and over; it’s valuable as a commodity, so its value has to be protected by the equivalent of a copyright, the system of laws establishing the profession. Without its special status, its worthlessness would be quickly demonstrated. When A.C. Guyton wrote his textbook of medical physiology (the most widely used text in the world) in the 1950s, it was trash; as it was studied and applied by generations of physicians, it was still trash. The most compliant patients who bought their treatment from the most authoritative, Guytonesque, doctors were buying their own disability and death.

Each time you learn something, your consciousness becomes something different, and the questions you ask will be different; you don’t know what the next appropriate question will be when you haven’t assimilated the earlier answers. Until you see something as the answer to an urgent question, you can’t see that it has any value. The unexpected can’t be a commodity. When people buy professional knowledge they get what they pay for, a commodity in a system that sustains ignorance.

-Ray Peat [1]

[1] https://raypeatinsight.wordpress.com/2013/06/06/raypeat-inte...

All told I had a pretty fun time trying to self-diagnose myself, and I did a better job diagnosing myself than the docs I saw. I firmly believe that the only reason I’m not on disability and unemployed is because I took my diagnosis and treatment into my own hands.

That said, if I had to do that 20x per day with only 20 minutes allotted per patient, I can’t imagine I’d be very good at diagnosis either.

I just wish I could find a doctor that was open minded, and would discuss things. I have a PhD and do research in a medically related field, and will deeply read all of the scientific literature about any conditions I have, yet I still get the "just shut up and do what I say- your google search is not equivalent to my medical degree" treatment. I would like to be engaged by the doctor as a sort of collaborator on my medical issues, rather than be treated like an infant.

My feeling is they are hiding behind the "I'm the expert here" thing because they are actually self conscious about how little they know, and are worried it will show if they engage in a discussion.

This is my great frustration. They are trained to detect “narcissistic” patients, and having seen some of those training videos, I now understand that their treatment of patients who try and reference the literature is guided by that training. I have to pretend to be stupid and find weird “people hacks” because I can’t just come out and say, “here is a recent meta analysis in nejm that says x. Could you read that sometime in the next few weeks and see if it applies?” Often it’s not even recent research but common knowledge you can find in bio 101 textbooks or Wikipedia. But asking questions the wrong way, you can come across as “thinking you know more than the clinician” (you do!) so you have engage in bizarre kabuki theater and feign ignorance hoping they feel the urge to revisit their textbooks, or google it.

I don’t think they’re getting stupider. They’re what they’ve always been…a source of conventional wisdom. When conventional wisdom said bloodletting was good for health, they bled their patients. When mercury was considered a medicine, they administered it. When hacking off limbs was considered the best way to fight infections, their toolkit included bone saws. When electroshock therapy was considered a treatment for mental illness, they shocked the hell out of their patients. I’m sure that one day we’ll look at chemotherapy and radiation as barbaric practices representative of our ignorance of how easy it is to deal with cancer.

Scientists/researchers advance the state of our medical knowledge and doctors, over subsequent generations, absorb what they find and practices slowly change. But there’s always a lag. What we need to get past is the notion that doctors are some font of truth when it comes to medical information. They are, largely, a snapshot of what was conventionally believed at the time they graduated med school. We don’t have a system that effectively updates their knowledge or keeps them in the loop for cutting-edge research. They do learn a set of first principles that can help them reason about novel situations better than a lay person, but only if the right answer is one that follows from those principles as opposed to being counterintuitive.

It’s the nature of being a practitioner rather than a researcher.

> We don’t have a system that effectively updates their knowledge or keeps them in the loop for cutting-edge research

That's not true... generally, in order to practice doctors must be licensed, and in order to keep their license they must have annual continuing education. Generally accomplished by attending conferences where the latest research results are presented.

The details vary but the system does exist.

The required continuing education is pretty limited. It may cover new treatment strategies, drugs, etc. but not cutting-edge research unless the physician seeks that out. In emergency medicine (where I have some friends), continuing education doesn't include new procedures. Some of my friends have had much more senior docs ask to be taught a new procedure or technique that didn't exist when they were in residency. Many older docs don't seek out new knowledge (no one is forcing them to), and end up just doing what they've always done. The continuing education system does exist, but it's far from perfect.

Are doctors, as a group, becoming stupider?

I think patients are getting smarter, and conditions for doctors are worse causing some intelligent people to choose different fields. That said, I recently went through a major illness and interacted with many medical professionals. My first hand experience/anecdata is that doctors are just like every other professional. Some are good, some are mediocre. Some are so consumed by hubris they believe the public is always wrong, and Some are willing to talk things through and keep an open mind about everything, even if it is ridiculous.

The best thing we could do for healthcare is to remove the idea that "doctor knows best." While it is important for doctors to feel confident, and to teach the public to avoid snakeoil, it just places unreal expectations on these people. If patients took more accountability for their own health, then we could loosen some of the malpractice laws, and doctors insurance premiums would go down, and that would in turn cause rates to go down. But that was a bit of a tangent from my point that doctors are just people, maybe with an average intelligence that is slightly above the population at large, but still just people.

To make life and death decisions for people requires you have hubris and faith in yourself. I can't imagine what would happen to my hypercritical/overthinking self if I was a doctor making life and death choices, some resulting in death, for people for 10 years. I had a hard enough time when I did medical software, working 80 hour weeks to get a new release out the door because it was going to positively impact people's lives and a delay meant X people's lives wouldn't be improved, and I took that on as me failing those people who I didn't help every day the release didn't go out.

To make life and death decisions for people requires you have hubris and faith in yourself.

Sure, but outside of surgeons and the ER, most doctors are not making life or death decisions all too often. Your average family medicine doctor should always be presenting multiple options for care, and be honest with the patient and themselves that they may be wrong about the diagnosis. I know some people dislike so-called weasel words, but doctors should be using them regularly.

I had my first real foray into the US healthcare system in 2022. I went to three orthopedic surgeons and a neurologist, and none of them diagnosed me correctly. I was having nerve pain in my hands, and they all jumped on “carpal tunnel syndrome”, however none mentioned or even tested me for Thoracic Outlet Syndrome, which is what I actually have. Three doctors.

One of them, who was the shoulder specialist ironically (he should have nailed the diagnosis as TOS), looked at my hand X-Rays, said there is no arthritis, then did a test on me to that I said hurt, and then diagnosed me with arthritis. I’m 27. It borders on malpractice and at the very least should be considered gross negligence.

And they were all in a big hurry. I had to stop all of them on their way out of the examination room to ask my questions!

I’ve been a patient dealing with a chronic condition for about four years now. IMO you had a pretty good experience relative to the norm. It’s not uncommon for it to take years to get a proper diagnosis for chronic conditions.

It’s because I spent a tens of hours doing research. I’m sure it would take me a lot longer if I had to specialist-hop until I found someone familiar with TOS

That's weird, TOS is something taught to first year med students. It isn't that esoteric of a diagnosis.

I’ve done a lot of research on TOS and my findings are that TOS is A) very difficult to diagnose even with diagnostic imaging and B) considered much less-common than Carpal Tunnel Syndrome, Cubital Tunnel Syndrome, and Tendonitis.

I’ll add that all three ortho docs did those “provocative tests” for CTS, like bending my wrists, and NONE made my symptoms worse. This alone should have been an indicator that the nerve impingement was happening closer to the spine. Meanwhile, the provocative tests for TOS almost immediately and drastically worsened my symptoms.

Sorry about your experiences, that must have been incredibly frustrating. I guess I'm surprised that it took that many doctors to figure it out because it is taught pretty early in medical education. I remember practicing Adsons Test as a first year med student (not diagnostic in any way, but just to emphasize that TOS is taught early).

Sort of like how I would be surprised if I interviewed a developer who didn't know what an array was.

To be clear, I haven’t been formally diagnosed, but after 3 docs I give up. There’s really no point anyway unless I’m looking to get it treated surgically. Even then, people say it’s hard to get a vascular surgeon to do surgery for TOS. They really want you to exhaust physical therapy thoroughly. It’s very hard work. Way harder than programming. And it’s taken several months to see significant improvement- BUT I am improving.

None of the surgeons or neurologist did Eden’s or Adson’s or any other TOS test. I didn’t learn about TOS until the third doc, but she immediately dismissed it because “TOS is very rare” and “it would have shown on the nerve conduction study”- though the NCS wasn’t done above my elbow, and anyway studies out there say NCS only shows nerve damage, not so much nerve impingement.

I googled my symptoms for months, and only found TOS after exhausting literally every other nerve impingement disorder from the hand to the spine. Google results are very prejudiced to carpal tunnel syndrome and tendinitis.

I’d heard stories from people who would go to various doctors and say they were all quacks. I always thought “hey, these guys went to MEDICAL SCHOOL, what do you know about any of this stuff?”, but now I’m more in their camp.

Anyway… Good posture is very important fellas! Having ergonomic everything doesn’t matter if your posture is poor.

I don't think so, I think there's a combination of things that are happening that makes their jobs more difficult and a lot of macro changes happening in the world as well as just bad expectations that we have as patients. I am not in the medical field, this is simply my layman's interpretation of what is going on.

1. Doctors are not the same are researchers in many or most cases. They are more akin to technicians than scientists. In the same way I wouldn't expect my electrician to meaningfully innovate the way that he hooks up my house to the power grid or I wouldn't expect my plumber to fundamentally shift my city's sewer system to better serve my individual house that simply isn't their job as front line folks administering care.

2. I think we are massively overlooking simply the breadth and depth of the changes in the world and how that affects their profession. We are exposed to a staggering and exponentially increasing amount of chemicals, environmental toxins, pollutants, foods, and their patients come from a variety of different ethnic backgrounds and live in wildly different environments with wildly different lifestyles. I have to imagine 100 years ago if you were a doctor in say Ireland, you mostly knew what your patients did for work, what they ate, they all lived in roughly the same area, etc. The variables of health were simply much less.

3. The same time the amount of diseases / disorders / etc. that we've identified has grown exponentially. When the field of things that it could be even if that was an incomplete list (obviously) it was much easier to give a broad diagnosis than a specific one. This has improved treatment to be sure but also demanded specialization so any one doctor having all the answers gets less likely over time.

4. Lastly it's just financial pressures. Markets and especially insurance is part of this but I think in general as globalization has continued to accelerate and resources are being distributed more and more in some sense (and concentrated in other senses) you have to take a holistic view. You say doctors used to be "better" but better where? If all the doctors are in a handful of countries with most of the resources that sub group of people will yes get better care but what about everyone else?

I think you’re underestimating doctors.

Viral infections sticking around has been known about for a very long time. Chronic infection of Hepatitis C for example occurs in about 80% of those infected and it can be asymptomatic for years while causing liver etc damage.

This includes many viral infections that the general public don’t realize stick around: “The causative agent for shingles is the varicella zoster virus (VZV) – a double-stranded DNA virus related to the herpes simplex virus. Most individuals are infected with this virus as children which causes an episode of chickenpox. The immune system eventually eliminates the virus from most locations, but it remains dormant (or latent) in the ganglia adjacent to the spinal cord (called the dorsal root ganglion) or the trigeminal ganglion in the base of the skull.” https://en.wikipedia.org/wiki/Shingles

Typhoid marry is a famous example of this behavior occasionally extending to viruses that generally get cleared from the body.

Everybody has been aware of hepatitis C, herpes, and chicken pox becoming shingles for decades. I'm pretty sure this discussion is about viruses that we generally don't think of as chronic.

H. Pylori has been around for 20 years, hundreds of papers written on it. My wife went in and the doctor said - huh, I haven't seen that before I need to go look up how to treat it, I'll be right back.

That is, of course, after we did our own GI-MAP and took it to a doctor, not that a doctor would EVER suggest doing that. A naturopath? Yes they do it as a standard.

Standard doctors are operating on 1960's textbooks.

Doctors are required to keep getting recertification based on current practices, they can’t just regurgitate outdated information.

General practitioners refer people to specialists because nobody can keep up with every bit of new research out there. A doctor looking something unusual up isn’t a sign of incompetence but rather best practices.

> they can’t just regurgitate outdated information.

Based on my extensive experience with doctors and the extensive experience of many others that I know they sure can.

I am not saying they have to be completely up to date, just that they must keep up with many advancements because they can fail these tests.

That said you can read up on all the latest research for a condition because you don’t care about all the other research. Doctors can’t get away with such a limited focus.

I mostly see specialists and even there they’re consistently out of date. I get that not everyone can be a top tier researcher and many doctors have a business to run, but once we reach the limit of their knowledge I’d much rather hear “I don’t know” than “that’s all anyone knows.” Doctors to me are a minor inconvenience to prescription medication.

You're speaking my language. My wife and I have self diagnosed and fixed a shit-ton of ailments. Most of it with natural supplements, but occasionally we'll get the pharma stuff.

> A naturopath? Yes they do it as a standard.

Best doc I ever had was a naturopath. Unfortunately, he tired of dealing with insurance companies and moved to a retainer model with a limited number of patients. Why was he so much better than any other doc I've had? 1) he listened. Appointments were at least 45 minutes. Sometimes over an hour. When I go to an MD I'm lucky to get 10 minutes. 2) He tested. Annual blood tests were extensive (and, yes, could be expensive because of those insurance companies not wanting to cover a lot of stuff) 3) As he listened he was on his laptop pulling up relevant papers ("I was just reading a paper on this topic that came out a couple weeks ago") He'd print out the paper for you and highlight the relevant passages 4) He was interested - by that I mean, I never got the idea he was just going through the motions. He loved this stuff and nerded out on it.

The common denominator here seems to be caseload. Lower caseload, lower hours per week, lower burnout, more focus time, more deep thinking. Sound familiar to anyone in software?

Yeah I am not in this tier of wealth but being in tech / working with VCs I rub elbows with it. They consistently suggest to get a concierge doctor and its so great because they have a small number of patients and they actually listen to them and help them get whatever medicine needs, read studies on their conditions and recommend like niche and newer treatments / drugs. It sounds great but you know I can't afford a 3k a month retainer. The medical system once again seems to work incredibly well if you have means but that sort of expense is even outside the realm of most 1%ers.

I'd like to ask what GI-MAP provider you used. Based on what you said it seems like you were able to get tested without needing a provider to order the test. I've had gut issues for a while and I'm surprised this has never come up.

Diagnostic Solutions performs the actual GI MAP.

DirectLabs is a reseller that has a physician on staff that approves your GI Map. So contact direct labs, order the kit, poop and vial it, drop it in the mail, wait 15-20 days. PDF of your results will be in your DirectLabs account online.

Thanks alot!!

In my experience doctors are horrendous at statistics and have no idea how often they should be seeing rare conditions. The “think horses not zebras” mentality that’s drummed into them has blinded them to the herds of zebras galavanting around them.

Right, "horses not zebras" means "if it has four hooves and a mane check if it's a horse first", not "your patient definitely doesn't have a rare condition". I know so many with chronic conditions that were brushed off by doctors or misdiagnosed that only got the right diagnosis later when their conditions worsened.

This process of most doctors is: 'gather up available data/symptoms/test results from this patient, then compare against medical research to see which diagnoses fit and which is most likely'.

Since the process is so mechanical and so stats-driven, I think statistical computer models or even AI would do a much better job of it than your average doctor.

But due to the medical field being slow to utilize new methods, we don't see any of that yet, and the end result is far more people get false diagnoses than would otherwise. We can accept a human making a poor judgement sometimes, but we do not accept a machine doing the same, even if it's right more of the time.

People have been trying to make medical AI for years and have just failed.

More funding could help, but it’s just a hard problem.

A lot of those efforts were based around expert systems and failed for many of the same reasons many other expert systems suffered from.

I would suggest that a lot of medical questions are now answered by Dr. Google which implicitly does a lot of behavioral modeling / statistics in their machine learning and is already very successful.

Unfortunately, in medicine, there is evidence that just because a computer program is better then a Dr at diagnosing a patient is no guarantee it will be used. The classic example here was the MYCIN expert system developed in the 1970s. MYCIN was shown to outperform infectious disease experts by 1979 in a blind testing:

>... Eight independent evaluators with special expertise in the management of meningitis compared MYCIN's choice of antimicrobials with the choices of nine human prescribers for ten test cases of meningitis. MYCIN received an acceptability rating of 65% by the evaluators; the corresponding ratings for acceptability of the regimen prescribed by the five faculty specialists ranged from 42.5% to 62.5%. The system never failed to cover a treatable pathogen while demonstrating efficiency in minimizing the number of antimicrobials prescribed.

https://jamanetwork.com/journals/jama/article-abstract/36660...

https://en.wikipedia.org/wiki/Mycin

There are a lot of examples of these "expert systems" in medicine that seem to do well in research, but fail in other ways. We're seeing some of these failures again these days with ML models in medicine, especially bridging the gap between the proof-of-concept and production systems.

https://www.jstor.org/stable/3666074

https://aimi.stanford.edu/events/bridging-ais-proof-concept-...

Double checking, by ‘EDS’ that wasn’t a typo and you meant Ehlers Danlos Syndrome? I’ve been beating the drum for underdaignosed EDS for a long time. It’s insane how prevent it is in so many statistics and yet doctors still think it’s super rare. I think a huge number of Long Covid people have EDS, way more than the general population, they’re highly disposed to it. It would make sense that a treatment for EDS would help LongCovid and visa versa.

> we need to find a way to restore gut function that works well and reliably.

Microbiota engraftment from faecal transplants _is_ reliable - it brings along a raft of bacteriophages that clear a niche for the incoming colonies - unlike just slinging some probiotics down your neck and hoping some survive.

Ig. It be worth to add that total dental care costs in US are more than $160bln / year (which isn't much less than cancer spending) and my guess would be that 95% of that costs are caused by chronic infections.

This is precisely why I still wear an N95 mask outside of our household - we need decades to learn about a meaningful part of the damage SARS-CoV-2 does to us. A lot of people still consider this to be a form of the seasonal flu, but it's a totally different thing, and the excess deaths are just an early indication that we should be more careful with it. Some blame vaccines for them, it's an acceptable hypothesis, of course, but I doubt it's only that. Having a reinfection every other month is not something we get with the flu!

If you contract covid will you stop wearing the mask outside?

Not really unless we have decent antivirals and knowledge - I got used to it. Out of 4 people in my household, 2 had it only once this summer (BA.4 or BA.5) - it was contracted outside on a sunny August day and from a large distance - 20-30 feet from our neighbor, but my son and I wore masks at home and didn't catch it (I trust PCR tests, we've had several).

People do stupid things! I observe and wonder how can call us intelligent species! For example, I see the following scenarios:

- only some people in a family wear masks in a closed space.

- people wear a mask inside but take it off to eat or sometimes talk to others.

- people talk in each other face outside, but wear masks inside.

- people wear surgical masks without any certification (such as ASTM) and wear the same masks for days (you can tell from how dirty their masks are) - not only they are not protected from COVID-19, but they can bring bacteria, fungi, and microplastics straight into their lungs!

I do not participate in circuses - if I do something, I do it properly, and in a meaningful way! XBB.1.5 is as contagious as measles, i.e. it's the most infectious virus known to science! And new variants could go beyond the r0 of measles soon (r0 has only being going up so far)! You cannot act the same way as this is the flu with a much lower basic reproductive number, which is very-well studied, has decent antivirals, yet still kills a lot of people and costs trillion dollars to the global economy each year!

there are literally no peer reviewed scientific study demonstrating the pathology of "long covid". In fact, there aren't really any knowledge that there is such as thing as "long covid" in the way we traditionally define diseases

Google long covid ncbi for a long list of papers. I don’t know what you mean with your no true Scotsman fallacy, there’s definitely something and quite a lot of research establishing what.

Where did you get your information?

> Where did you get your information?

I'd suggest just sharing a good paper. Asking somebody where they got their information that something doesn't exist is pointless. You could say the same thing to somebody who doesn't believe unicorns exist; better to just show them a unicorn.

I did, in suggesting a google search which results in many papers, the question being "you said this doesn't exist, here are many examples, why don't they count according to you?" which is mostly rhetorical because it seems I'm replying to someone whose sources are politicized medical information but I left room for real information if it existed. (perhaps an actual expert has an opinion on the corpus of existing research being inadequate I'm not aware of, I don't think this is true but I'm ready to be wrong)

There are hundreds of papers on Long Covid, many peer reviewed.

Someone on reddit keeps track of them all:

https://reddit.com/r/LongHaulResearch

also:

https://reddit.com/r/COVID19/search/?q=pasc

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