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Comment by hayst4ck | Hacker News Reader

Half the posts in this thread bring back the old SlashDot adage: The plural of anecdote is not data.

I am not sure what the point this article is trying to make is. I do not feel more informed for having read it.

It seems a populist appeal to the idea that the medical institution has no idea what it is doing. Is it good, is it bad? It doesn't matter. The end result is damaged institutional trust.

How many people would read this article and go "yeah doctors have no idea what they are doing," then go to their alternative medicine to spend $100 on a dubious "medicine"? How many people here are actually equipped to have a meaningful understanding of the information presented? Why did the author not present the institutional position or data supporting yearly checkups and why it's misleading?

As long as billionaires are able to influence people to fight about anything other than wealth disparity, they win. We are not experts, we should leave decision making to people who know what they don't know rather than to people who don't know what they don't know (us).

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The point I got from the article is to bias against medical interventions. That doesn't mean never consider them, but they really need to have a serious reason to occur.

It doesn't have to that doctors are bad at their jobs, but rather that they're humans, and humans are hardwired to try to make other humans happy, and patients like being actively given treatment as opposed to "have you considered sleeping well, eating well, and just letting your body do its thing?"

The sources that the article has, an article in the BMJ[0] and Cochrane[1], are actually targeted at primary care physicians (after all, random laypeople don't read medical journals!), to basically tell them to chill, and tell their patients to just let themselves be.

[0] https://www.bmj.com/content/348/bmj.g3680 [1] https://www.cochrane.org/news/featured-review-are-general-he...

> The point I got from the article is to bias against medical interventions.

I will always regret not asking what the difference in outcome was from a surgery on a ligament in my ankle. I feel like the surgeon saw a thing they could fix and said they should do so. I don't think they had an internal monologue of does it matter and I never checked.

Not a major mistake, but not one i would make again

I think this is unnecessarily conspiratorial. Medical tests often have much more uncertainty than most expect, and many interventions are net negative on average.

This particular research was new to me but I have seen a number of studies of cancer screenings and treatment showing the same or even worse effects. The recommended standards for some cancer screenings have been updated in recent years to be more restrained since it was shown they were having a negative effect in certain cases.

Many tests have fairly high false positive rates. This leads to a lot of unnecessary treatment with negative health consequences. There are also a number of scenarios where treatment reduces the mortality rate from one specific issue, but increases mortality overall because of the associated harm of treatment.

This isn't some homeopothy plug -- that stuff is nonsense. But I would suggest being somewhat skeptical of boilerplate medical advice.

> I think this is unnecessarily conspiratorial. Medical tests often have much more uncertainty than most expect, and many interventions are net negative on average.

If a crucial test is giving false positives, rather than dismissing the test altogether, it would be more beneficial to adjust the response protocols, invest in improving the test's accuracy, or focus on better informing patients about the potential risks and benefits. Discarding a test entirely could lead to missed opportunities for early detection and intervention, which can be crucial for certain conditions. There has to be some balance between skepticism and the potential value of medical tests and screenings.

This article gives people things to consider and does not dare give specific advice. Everybody is different. Some people are in touch with their bodies and can detect if something is going wrong, and others are not. Institutions and pharmaceutical companies can adversely affect our health if they are able to influence doctors to advise us wrongly in a for profit health care industry. If you look at the health of the US population with a declining life expectancy, rising obesity, immunological diseases, and cancer, some self learning seems like a good thing rather than to leave your health up to institutions, companies, and doctors.

>Some people are in touch with their bodies and can detect if something is going wrong

and how does one come to know this?

> If you look at the health of the US population with a declining life expectancy, rising obesity, immunological diseases, and cancer, some self learning seems like a good thing rather than to leave your health up to institutions, companies, and doctors

Could you show your work? Some steps are clearly missing between the premise and the conclusion

This is an issue that is by nature difficult to study in a rigorous, controlled manner. I can tell you that it is a real phenomenon but probably can't prove it in a way you would consider satisfactory. We see the highest levels of this internal body awareness among people who have spent many years using their bodies at peak performance levels. They do their normal daily training and something feels a little "off" before any obvious signs or symptoms appear. But if you only associate with sedentary office workers then you might be skeptical. A lot of people feel like crap so often that to them it begins to feel normal.

>Could you show your work? Some steps are clearly missing between the premise and the conclusion

Life expectancy is dropping in the US according to official studies you can easily find. It is now lower than China. Obesity, immunological diseases, and cancer have also been rising over the decades. I am not going to pin anything to specific causes as that will spur a debate too long for my attention. IMO the system is generally failing us. Without your health, you have nothing. It is too important for me to completely trust to others especially with how our system is currently incentivized.

> Everybody is different. Some people are in touch with their bodies and can detect if something is going wrong, and others are not.

Piggybacking off the parent, this is a major issue that medicine doesn't seem to have figured out how to deal with. Some people are so in touch with themselves they can tell they are getting sick before they have any measurable symptoms. Other people go months or years without knowing something is seriously wrong. Because modern medicine is about systematizing decisions (everything is a code), the patient's own internal sensations are given little weight compared to the measurements of an external instrument. The result is that if the particular set of tests which were ordered show nothing abormal then it can be hard or impossible to get treatment.

> Some people are so in touch with themselves they can tell they are getting sick before they have any measurable symptoms. Other people go months or years without knowing something is seriously wrong.

And many people derive imagined diagnoses from their anxieties, then come up with confident narratives based on "researching" online. Most of us are terrible at self-diagnosis, doubly at determining the causality to wherever they've arrived. There's a reason the double blind standard was a critical innovation.

I don't think the solution is just leaving our complex decisions over to others. I think the solution is that we all need to be better informed. A doctor doesn't decide to do something for us unless we're incapacitated. The doctor informs us of our options and risks and we get to make the decisions ourselves.

In the same vein (vain pun would have been better), we need more opportunities to decide for ourselves than we currently do, not fewer. Why should any other major decision a country makes be any different? We hand over the decision making over too often when we should be turning those situations into more opportunities to let democracy to rule. Inform the public and let them decide. Allowing others to decide for us has been a shit show.

What you are arguing is that we should be a low trust society: https://en.wikipedia.org/wiki/High_trust_and_low_trust_socie...

No. The government should provide consequences for those who violate trust promoting the idea that I can trust someone else who is from the same society I am.

Here is a game that shows what happens at a societal level when doctors lie or mechanics over charge: https://ncase.me/trust/

In the game of prisoners dilemma, society itself must ensure that defection is a losing strategy. This idea has a name: rule of law.

The government is us. Not some aliens. We should be democratically deciding what is correct and what is a violation and what the consequences for violating trust are. We should not hand that decision over to a few elected representatives. This should be a collective democratic process.

* legalize abortion? yes or no

* go to war? yes or no

* arm teachers? yes or no

* corporate news outlet allowed to sell ad time to corporations they report on? yes or no

* nondemocratically run businesseses allowed to function as a news outlet? yes or no

More democracy, not less.

How do "we" decide something? It sounds like you are advocating for mob rule but calling it democracy. Help me understand how that is not what you are saying.

What is the "collective democratic process" you are advocating for? How does a law get made and how does a law get enforced?

Democracy is mob rule. Direct democracy. The fear of "too much democracy" is only a fear for people who are afraid that others might not want the same things they do. One person, one vote is mob rule. What that requires is a well informed, well educated population. Instead we have an ignorant, uninformed population that leaves all of the important decisions to a hand full of representatives that tend to run things the way their wealthy donors want.

> What that requires is a well informed, well educated population.

Isn't this very uncommon, in addition to the need to be at least somewhat compassionate (e.g. in regards to issues that might not affect individuals personally, but that affect minorities, or simply those who are different)? A certain social cooling might be needed in many societies, less extremism, less identity politics, less hate.

I don't think we live in such a world, yet.

It is the world we should create instead of waiting for others to improve things for us. The status quo is the problem.

Yes, but where are we if we are considering arming teachers?

We are already arming teachers as a result of representative democracy. Their corporate arms manufacturer donors need to keep selling guns.

But I don't think that's changing. This is key to young person vs old person thinking. Young people believe we can actually change to a well informed population. They end up getting old realizing that wasn't actually possible, become rich (because we're talking about the smart ones here) and then end up donating to representatives for getting things to run the way they believed it should be. See what I did there?

Its almost as if our society encourages wealthy people to become cynical, selfish, and apathetic.

>What you are arguing is that we should be a low trust society

Who's "we"? Not everyone lives in your country.

If you're talking about the US, that's definitely a low-trust society.

This post is an amalgam of barely formed thoughts followed by..."but fight a class war". It's nonsense from beginning to end.

Why is critical data "populist"? Why is undamaged institutional trust your goal? Are institutions inherently trustworthy, or is it that they aren't but should be presented as such? Why are you concerned with the literacy of the audience rather than the content of the article? In your mind, why is is every author's duty to present two arguments (which is not a research mandate, the article being a research summary presented in popular article format).

Anointing "experts" is not how science works.

Again, the article being equivalent to a research abstract and research being the basis for science.

We removed science from the unquestionable "expertise" of the Church many centuries ago. At which point we placed in the hands of research and its critique.

> Half the posts in this thread bring back the old SlashDot adage: The plural of anecdote is not data.

I find the application of this logic to be entirely one-sided. Positive anecdotes are data, negative anecdotes are wives tales.

Simplifying medical information into data points is a dangerous practice which by now should be revealing itself as entirely fraudulent. Anecdotes provide context which doctors and science love to dismiss. I'll take a handful of anecdotes and appreciate all the context they provide, meanwhile the context-free "science" will go back and forth never getting anywhere nearer to better health outcomes.

> The plural of anecdote is not data.

Except it literally is.

How do you think rare vaccine side effects have been discovered and recorded? By collecting thousands of "anecdotes" from individuals reporting anomalous symptoms.

How do you think illicit drug harm is measured? They can't exactly pump people full of cocaine and ketamine in a lab to study overdose effects - you collect anecdotes (individual cases), catalog them, aggregate and adjust for sample bias.

Anecdotes are individual, cherry-picked testimonies. When you collect enough of them you get a statistically significant data point. It may be biased based on how your data was collected but the same can be said for many scientific studies that turned out to be flawed in their data collection. As long as you are aware of what the possible bias is, you have data.

My best friend is diagnosed with a disease nobody has a cure, his wife, Krohns disease, his son on the spectrum. They visit the doctor every 3 months (each) since 2015. And each time they go it's more decay and more confusion.

I'm not anti science but there are echos from nntaleb Antifragile in this.

We can’t have faith in any of our society’s major institutions because they’re all corrupt https://youtu.be/z6IO2DZjOkY

Institutional corruption will not be solved by losing trust in the institutions. When the institution dies because nobody trusts it you don't all of a sudden get good health care.

So if you believe that our medical institutions are corrupted, anger at the institution itself is misdirected. The corruptive force is billionaires and the measurement for the level of corruption is wealth disparity.

Well put.

So when the US FDA is shilling for obesity drugs, says that being obese isn’t a lifestyle problem but is purely genetic. Medical schools are lowering/removing certain standards for admission under the guise of ‘equity’ - thats all just some billionaires faults? Sorry, I don’t buy it. The medical and pharmaceutical industries have been rotting for decades in the US and protecting them, “because it would be better for our healthcare system” is exactly the mentality that gets you into this mess to begin with. State the problem, state it clearly. Don’t shift blame around to invisible boogeymen.

>So when the US FDA is shilling for obesity drugs, says that being obese isn’t a lifestyle problem but is purely genetic

The FDA has never claimed obesity is purely genetic and it's own guidelines state multiple factors for obesity and stringent guidelines for the approval of drugs that target specific genetic disorders.

>Medical schools are lowering/removing certain standards for admission under the guise of ‘equity’

This doesn't seem true at all, and seems like an extension of the "woke" boogeyman we see in undergrad.

The problem with this kind of thinking is it's hard to assign anysort of motivation for these actions without sounding cartoonish. The FDA wants to say obesity is a purely genetic for what reason? Who is enriched when the FDA says this? Does the FDA get some kickback every time there's a new obese person?

>State the problem, state it clearly. Don’t shift blame around to invisible boogeymen.

The for-profit medical system has created a two-tier treatment system that is incentivized to protect profits over providing adequate care. This includes both providing poor treatment to those who cannot pay as well as providing ineffective treatment to wealthier americans in order to sell more expensive, patented drugs. Any political action to change this system is effectively stonewalled due to "invisible boogeymen" who all happen to have the same political interests in keeping current profitable system and are able to easily buy politicians to prevent any radical change from going through. The incentive is clear - to protect profit margins.

> Institutional corruption will not be solved by losing trust in the institutions. When the institution dies because nobody trusts it you don't all of a sudden get good health care.

That's a fair point. "Burn it down" is not a good solution. The system, even while corrupted, still results in vastly improved outcomes relative to what people could expect 100-150 years ago.

> So if you believe that our medical institutions are corrupted, anger at the institution itself is misdirected. The corruptive force is billionaires and the measurement for the level of corruption is wealth disparity.

I'm not going to say greed has nothing to do with it, but this is just such a reductive take that I don't think really even begins to address the multitude of perverse incentives going on with our healthcare system.

I was not being reductive.

Money gets to vote on candidates before people do. Before any general election there is a primary, and to win the primary you do fundraising. People with money give politicians money with the implicit understanding that making anti-donor decisions will result in withdrawal of future money or (thanks to citizens united) unlimited contributions to their opponent.

Money literally votes on political candidates before any person does. That is why we have a "democracy" more responsive to money than to the will of the average voter.

Even if you look at it as a black box, Princeton did a study and asked if the legislation our politicians pass correlate most with the average citizen, interest groups, or the desires of rich people, the correlation was highest with rich people: https://scholar.princeton.edu/sites/default/files/mgilens/fi...

  Multivariate analysis indicates that economic elites and organized 
  groups representing business interests have substantial independent 
  impacts on U.S. government policy, while average citizens and 
  mass-based interest groups have little or no independent influence.

Here you can watch Harvard Law professor Lawrence Lessig talk about this issue: https://www.youtube.com/watch?v=PJy8vTu66tE

As wealth concentrates, it is able to purchase and corrupt further institutions. Bezos bought WaPo, Musk bought Twitter, I'm sure there are more examples. Do you think that is a form of power that is able to manipulate public opinion or government policy? Do you think ownership of a media outlet could help a person concentrate their wealth or fight being taxed?

Even from a mathematical approach. If Billionaires are able to earn 5% year over year interest at minimal risk, while large swathes of people will never make enough to have a savings, what do you think the long term consequences of that will be? If inequality is increasing and never decreasing, what do you think the long term effects will be? What types of things cause inequality to decrease, are we doing those things?

How much wealth has to concentrate before you are comfortable labeling it oligarchy?

Here is Yale history professor and expert in European history Timothy Snyder talking about oligarchy, the rule of the wealthy few. "What is oligarchy?": https://www.youtube.com/watch?v=biZVrh821RA

In this video he explores what oligarchy is and what effect oligarchy (the state of extreme wealth inequality -- too many billionaires) has on social programs like healthcare, namely that there won't be social programs/investment in institutions.

I agree we live in a relatively oligarchic society - that is an inescapable outcome for democracies.

We would probably disagree as to the causes and alternatives to this oligarchic structure, but I don't want to go down that rabbit hole at the moment.

What I am saying is that when you look at the problems with the medical profession, there is more at play here than the self-interest of billionaires. You talk at high levels about the impact of inequality on overall government policy, but not everything that goes wrong with an industry is a result of government policy, let alone policies favored by the wealthy. Medical research is fraught with issues of reproducibility. Government regulations artificially restrict the supply of healthcare. Technological advancement means that many people can now live sedentary lives, and it's adversely affecting health outcomes.

Snyder would say you are practicing the politics of inevitability: https://hac.bard.edu/amor-mundi/the-politics-of-inevitabilit...

  What the politics of inevitability does is that it teaches you to narrate in such 
  a way that the facts which seem to trouble the story of progress are disregarded. 
  So in the politics of inevitability, if there is huge wealth inequality as a 
  result of unbridled capitalism, we teach ourselves to say that that’s kind of a 
  necessary cost of this overall progress. We learn this dialectical way of 
  thinking by which what seems to be bad is actually good.
  And, of course, that applies to foreign affairs as well. When we look at 
  countries that are not making the quote-unquote “transition” to democracy the way  
  we expect, you know, we find excuses. We imagine that the general trend is going 
  to our direction in some deep way. And then we fail to notice, what has been the 
  case for the last 15 years or so, that the world is actually moving in a very 
  pronounced and easily observable way away from democracy.

Here is a relatively quick video of him pretty directly critiquing what you just stated: https://bigthink.com/videos/timothy-snyder-political-outrage...

  But the way that things are breaking now in the U.S. is that our politics of 
  inevitability, which we’ve held to in the last 25 years, basically this idea that 
  “since communism ended in 1989 there are no alternatives,” basically this idea 
  that “technology must lead to enlightenment,” this idea that “the market must lead 
  to democracy.” Those ideas have now come back to clobber us. Neither of them ever 
  had any foundation. Both of them are highly persuasive to a lot of people and 
  that’s lead to some consequences, which are very dangerous for the rule of law and 
  indeed for democracy. Believing that, for example, more market means more 
  democracy means that you don’t regulate things that you really need to regulate, 
  like offshore wealth or anonymous transactions or shell companies. And that 
  creates a world, a gray zone of capitalism where, for example, a Donald Trump can 
  begin close relationships with Russian oligarchs. If you believe that technology 
  automatically leads to progress, then you don’t watch very carefully as certain 
  kinds of social platforms lead people into a politics of “us and them” and destroy 
  a sense of common factuality. The story that you’re telling yourself the whole 
  time about how “the market or tech have to lead toward enlightenment and 
  democracy” dulls your mind to what’s actually happening until you reach the point   
  that we’ve reached now.

> but not everything that goes wrong with an industry is a result of government policy,

It is not positive government policy that is the problem but government failure to act because the government operates on behalf of money (oligarchy), not on behalf of us (democracy).

If not the government, where do you think a solution comes from?

> Here is a relatively quick video of him pretty directly critiquing what you just stated...

None of that big wall of text seems to directly address anything I actually said.

> It is not positive government policy that is the problem but government failure to act because the government operates on behalf of money (oligarchy), not on behalf of us (democracy).

The only thing worse than pedantry is wrong pedantry. Your attempt at correcting me here is wrong because The absence of the kinds of policies you would like to see is still policy.

In other words, not everything that goes wrong with an industry is the result of the government not doing what you wish it would do.

And to be more specific, even those things that go wrong because of government policy are not necessarily caused by oligarchic influence.

If an institution is a net negative and it dies then we are better off immediately. Even if it’s not a net-negative and it dies we might be better off in the long term because something better replaces it.

Don't you mean not enough billionaires? It seems like they are the only ones that can circumvent the political roadblocks to deliver things like cost plus drugs. There aren't that many of them nor are they involved in a lot of the industries plagued with these issues.

Most issue are from regulator capture from honestly not even that rich of people.

Help us out here. Let's say hypothetically we confiscate all wealth above $1B. How exactly would that improve average healthcare outcomes? Please take us through the causal chain step by step.

> Institutional corruption will not be solved

I would just stop there. For over 10,000 years we've had two systems: one where a small group of very rich people control society and admit it, and one where they don't. The former was arguably better, at least it was honest.

I have watched most of Dr. Fung's videos but had not seen this one. Hopefully he also points out that the FDA is funded by the very people they are testing and often allow the people they are testing to perform the tests.

He does.

How can I have faith in this youtube video? Is it not corrupt, to? How can I trust the guy in the video?

You don’t have to trust him, he’s pointing out inconsistencies in publicly available sources that you can verify yourself.

He points out financial conflicts of interest yet he also sells books, often with click-baity titles. Seems rather hypocritical, no?

> It seems a populist appeal to the idea that the medical institution has no idea what it is doing.

Isn’t at least the section about false positives an indication that doctors know what they’re doing, and know what they cannot do?

> Why did the author not present the institutional position or data supporting yearly checkups and why it's misleading?

Because it’s not a scientific article? The article mentions the arguments and has links to a paper in the BMJ (paywalled, unfortunately)

> We are not experts, we should leave decision making to people who know what they don't know rather than to people who don't know what they don't know (us).

So, why do you want this article to show data supporting its claims?

"yeah doctors have no idea what they are doing" isn't really that far off the mark for a lot of things.

The health of the average person in the west (And globally) is in decline. Obesity, diabetes, heart disease and cancer are all massively massively increased from where they were 100 years ago.

If the standard advice given isn't working for people (And it most obviously is not) then looking for alternatives really is the only thing people feel they can do.

In todays age being average in health is a poor decision.

>The health of the average person in the west (And globally) is in decline. Obesity, diabetes, heart disease and cancer are all massively massively increased from where they were 100 years ago.

In the US, life expectancy has increased by 30 years since 1900. People weren't dying of cancer and heart disease as frequently because 24% of them had already died by the age of five.

The above is all nonsense, especially for Hacker News readers. Someone here in their early 30’s has a mean life expectancy of almost 90.

Many people opt to commit slow suicide. That’s what you’re seeing.

Possibly dumb question: can an early 30 something trust that number to apply to them?

I'd imagine the calculation is more sophisticated than I can imagine, but can it take into account things that haven't necessarily had their full impact yet? Like potential world war, deep recession/depression, massive unrest, things like microplastics, forever chemicals, dropping testosterone, the after effects of covid itself as well as everything around it.

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