Comment by Retric | Hacker News Reader

Comment by Retric | Hacker News Reader

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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.

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.

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-...

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.

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.

> 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.

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.

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?

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.

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!!

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.

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