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Comment by lynx23 | Hacker News Reader

I am a high risk cancer patient who is blind, i.e. doesn't necessarily get a lot of sun exposure due to disability + occupation. Given the discussion in this thread regarding correlation with lattitude and cancer risk, me being around 47 deg, and my personal history, I would have expected a caring medical system to suggest vitamin D to me roughly 30 years ago already. But alas, it turns out you have to do your own studies to improve life expectency with our western medical system. I could tell you a lot more, regarding being abused as a subject for a medical experiment at the age of 7! But people like you will always step up and defend the system. Observe and learn, I say.

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> But alas, it turns out you have to do your own studies to improve life expectency with our western medical system

It's a shame this possibility wasn't suggested before to you, but I have never seen any evidence that western medicine isn't one of the primary drivers of global life expectancy increases.

Western medicine is one of the primary drivers of global life expectancy increases only though vaccines, antibiotics, and trauma care. Other than that it has had very little effect: we could eliminate all other forms of medical care and average life expectancy would decrease only marginally. Public sanitation and food safety enforcement have had much larger effects.

Where western medicine has had larger effects is increasing quality of life. Now you can get a hip replacement to restore your mobility or take a pill to fix your erectile dysfunction.

Really curious about your sources, because it doesn’t vibe with me at all (trained MD).

Statins have a phenomenal improvement in outcome on cardiovascular disease. So do many cancer drugs nowadays. Diabetes also has great improvement with good treatment.

Removing these would reduce life expectancy drastically.

Fair enough. It's true that modern drugs are fairly effective at extending the lives of patients with certain serious chronic conditions by a few years. But at the same time, ASCVD and T2D were much less serious problems prior to the establishment of modern medicine. So to a large extent we are just patching over problems that we have created for ourselves rather than fixing the root causes.

https://www.thelancet.com/gbd

Thanks for saying that, I couldn't agree more. If you break your leg, western mdeicine is great. For almost everything else, it fails pretty miserably because doctors have effectively no time to actually care for an individual. If it isn't done in 5 minutes, things are getting complicated.

This is just not true at all. E.g. in the UK 10 times as many babies died in 1950 as do today[0]. I cannot believe with all the incredible efforts and advances the medical, scientific, pharmaceutical and manufacturing and logistics fields have made, it's reduced to "this is only good if you break your leg".

[0] https://www.macrotrends.net/countries/GBR/united-kingdom/inf...

Sanitation and hygiene, dental care, antibiotics, and vaccines.

In some cases, improved diet.

Those are, I believe, the biggest factors in increasing life expectancies.

Perhaps also pregnancy and infant care, getting 0 to 5 year olds past historically high death rates. And, sadly, an area (not the only one) where the U.S. has regressed significantly.

I don't usually defend the western system, but there are plenty of other systems out there that will caringly prescribe you snake oil. Simply understand that the western system is science based within a limited range. It is usually excellent if the cause of an illness is defined on a black and white test. If not, time for the patient to do the research.

This is the issue raised by comments like the one above. We understand that evidence based medicine handles statistical averages very well. But if you fall out of that, all you're left with is snake oil salesmen. There's a need for an intermediate layer of evidence yet "taylored" (and not kidney-costing if possible).

Ya, but I think most good doctors operate with a balance of probabilities framework. Yah, there may not be conclusive evidence showing it’s widely effective, but based on this case, it’s obvious the person isn’t getting enough sunlight, and they communicated that to the doctor, and so why not do a trial of something like vitamin d? It’s widely studied, has very few serious downsides, and is cheap.

> but based on this case, it’s obvious the person isn’t getting enough sunlight, and they communicated that to the doctor, and so why not do a trial of something like vitamin d?

Can we get to the specifics? How would you propose the doctor do it? Let's say the doctor prescribes a certain dosage per day. How will the doctor know it is helping this particular patient? How long should the trial continue before he sees results?

Most studies showing Vitamin D benefits are very long term (unless it is bone related).

This is why most doctors don't start recommending such medication until it is proven to work.

They cannot and don't want to be held liable for damages. For example, if it did turn out that prolonged vitamin D supplementation causes an unexpected issue, what then? Would the patient have been OK with that? Or would their response have been the exact opposite of what the OP was suggesting?

Self-medication is acceptable, and the patient should be made aware; the doctor should give advice, but not prescribe, in this case. Most doctors prefer not to get into this level of liability.

Liability, tell me about it. At the age of 7, I underwent an operation without knowledge or consent of my parents. A few weeks later, my remaining 20% eyesight was down to almost 0%. IOW, so that everyone understand: I was used as a subject for a medical experiment. And here you are, telling me that doctors will never do anything because they are so afraid? Sorry, you are living in a different world as I do... I hope you never enter mine.

> Let's say the doctor prescribes a certain dosage per day. How will the doctor know it is helping this particular patient?

Check on them in X weeks and see if they're improved, and maybe measure blood levels just to get some objective measurement going. Doesn't seem too terribly hard. I think I'm missing the issue.

The issue is that for most issues where people claim Vitamin D helps, X is very large (several years). If your goal is cancer prevention, this approach is virtually useless unless done in large groups.

Other than bone issues, I don't think Vitamin D works for anyone in the short term. For a few people, they see improvements in mood within a few weeks or months. Most of these few people regress afterwords even with Vitamin D intake (i.e. the improvement was just the usual noise variation).

I have my own set of chronic issues, and there is no shortage of ideas on how to help: Diet, exercise, vitamins, etc. The way I've maintained my sanity is to ask the following question:

"OK, if I go with this treatment regimen, how will I know it is not working?"

Most advocates simply don't have an answer. If it's vitamins, they'll simply shift to a different dosage, a different vitamin, or pull out the new paper of the week saying how vitamin X is only useful in combination with mineral Y (you can see plenty of that in this submission). By the time you give that a try, another idea will come up.

There will be no way they will believe the solution is not vitamins.

If it's exercise, it will always be "You're probably doing it wrong" coupled with "You need to ensure you have the proper diet". When you get to specifics, they'll pull out 20 variables that could impact your exercise regimen. You can't reasonably try 2^20 combinations, let alone 20.

There will be no way they will believe the solution is not exercise.

Same goes with diet. Must be the sugar. Or too many carbs. Not enough protein. Too much protein. Or the lack of Omega-3.

There will be no way they will believe the solution is not diet.

I'm all for trying, and I do try different things. The reason I go to the doctor is to get an expert and informed opinion. If his opinion is "the data on Vitamin D is poor", I want him to state that.

Thanks for explaining, I appreciate it. Yeah I was not considering chronic issues.

> I'm all for trying, and I do try different things. The reason I go to the doctor is to get an expert and informed opinion. If his opinion is "the data on Vitamin D is poor", I want him to state that.

That would certainly be wonderful. I've never had a doctor who would be that honest, though I'm sure they exist.

Doctors themselves exist in distributions, from very interested to not that much, from "motivated at that time" to "i have more pressing problems". Very often you get bounced for tiny reasons.

Consider that while you are one person, a doctor sees many patients. They see that prescribing Vitamin D helps almost none of their patients in the short term, and they can only rely on research for the long term (i.e. they are not seeing the same patient over decades).

Doctors run the whole gamut. There certainly are doctors who will recommend Vitamin D for any issue under the sun. I've been subjected to that, and it totally didn't impact the issues I was going to the doctor to see. At the other end you'll get doctors who will stick to the official guideline (as long as your Vitamin D levels are "normal"). And you have those in between, who will discuss it with you, give you the pros and cons, and will support you in your decision.

I've had enough doctors recommend treatments that have little backing that I'll happily take the risk and stick to the studies. ("No thanks, I won't go for that surgery which studies have not shown tackle the problem" (an assessment the doctor admitted to only when I asked him directly)). I know I'll be wrong on occasion, but I suspect I'll be wrong more often if I follow the other path.

Still, you'll get all sorts of doctors, and it shouldn't be hard to find one who will happily reflect back to you whatever you want to hear.

As for 30 years, the major study associating Vitamin D with mortality came out about 15 years ago.

People are so indoctrinated they for some reason actually think most doctors want to help them. I assume they also trust their dealerships service advisor.

It's so much worse than you think. Almost ALL doctors want to help. It's system (in this case, the reimbursement system) that makes it impossible to help, even though they want to. The doctors themselves have far less agency than you think.

This is far too US-centric. Western medicine is a lot broader than that.

Having experienced several dozen healthcare providers I'd say it's more like 50/50. Half clearly have a profit as a primary motive.

I would say they are the least caring group of society followed by nurses. Not their fault. When everyone around you is sick all of the time you have to turn off that part that cares or you will burn yourself out.

Yourself, family, friends, favourite waitress cares about you more than your doctor.

I actually dated a med student all through medical school and thus made a huge social circle of doctors I've kept in touch with for over a decade as they all became doctors and now have almost a decade of experience too.

I'd say about half want to help, but can not due to the system. The other half enjoy maximizing their income through the system and don't care either. So that leaves very very few that are actually able and willing to actually help an average person.

Now, do they help their family and close friends? Yes, as much as they still care to and remember how to. Which isn't at a very high level either IMO.

Recent example, my friend dislocated his shoulder. Immediately was recommended to have surgery and attempts were made to schedule. With his insurance, he'd have to come out of pocket $7500, which he doesn't really have.

I told him I know many motorcyclists at the pro level that dislocate shoulders in crashes, and without surgery are back competing on the bike. Only a handful have surgery to repair it, usually to stop it from reoccurring (since they crash often).

He pressed his doctor on if he really needs the surgery and for an explanation why many athletes don't have it done and what the reasoning for auto recommending him to get it done. Their tone instantly shifted and he chose to wait it out. Shoulder back to normal now. Thousands saved, and potential medical mistakes saved during the surgery.

Shoulder surgery should not be delayed. The probable retraction of some damaged parts is not a joke. Your friend could have been the lucky one in the pool, but there is also a possibility that in a few years the problem will grow and the surgery required will be much heavier and expensive.

> and without surgery are back competing on the bike.

My bet is that they are on painkillers for life

> My bet is that they are on painkillers for life

Also, they are professional athletes at the peak of their bodies' physical fitness capacity with teams of doctors, physical therapists, and trainers looking after their health with a focus that few of us can imagine, and an overriding ethos of sacrificing their future health on the altar of present performance.

In general, professional athletes' healthcare decisions should probably not be used as a gauge for healthcare decisions by people with priorities other than "maximal physical performance right this moment".

If a group of great doctors lets people crashing at 180mph ride again without surgery after a shoulder dislocation, doesnt that mean that maybe his doctor in nonametown USA might be able to learn a thing or two from them? Or are they just trying to keep their operating room billing hours maxed out? I guess we won't know for sure but I have a hunch.

Sure. That doctor could suggest his patients to wear kevlar reinforced biker jackets all the time.

A kevlar jacket isn't going to help stop your shoulder from dislocating as your flail around tumbling end over end at 100mph.. which is what dislocated the shoulder in the first place.

Are you saying that the doctor, upon closer questioning simply flopped and gave bad medical advice to my friend when they told him that yes it's reasonable to expect to regain full shoulder straight again without surgery? Because if so maybe my friend should sue? What is this blanket statement of "shoulder surgery should not be delayed" based on?

Doctors will often change their recommendation if patients express different priorities than the doctor initially assumed. Some people's priorities are no surgery unless absolutely necessary.

> Some people's priorities are no surgery unless absolutely necessary.

which is a good general rule to go by - surgery is not without dangers.

The doctor's role, imho, is to firstly explain all of the available options (pros, cons, etc).

Once the patient understands all of the options, the doctor can recommend one of them, and explain why the option is good. The patient needs to evaluate the other options as well, and think about whether the doctor's recommendation is sound, and what assumptions they might've made (may be unknowingly).

The patient is not, and should not be, a passive party to medical treatment.

"no surgery unless absolutely necessary" is becoming the default around here, because the number of hospital-acquired infections is skyrocketing in the last years. While there were absolutely no anecdotes before 2017, the number of people infected in the hospital in my circles has exploded since then. People are talking about it, and realising that going to the hospital has a real risk of making things even worse.

Where I grew up, with a comprehensive taxpayer funded healthcare system that works I believe standard is you are given the option of surgery after dislocating your shoulder 3 times.

The thinking is a lot of people dislocate their shoulder, it pops back in with or without help and heals with no long-term damage. For a lot of patients it never happens again and surgery is not needed.

However, each time you dislocate your shoulder it gets easier to dislocate and is more likely to do doing damage that won't heal. So, don't go in for shoulder surgery until you are showing a pattern of dislocating it or have other lasting damage that requires repair.

GP wasn't defending the system, just this specific decision. I'm no fan of the medical system myself, but this is an unfair take. There are plenty of examples of the medical system doing the wrong thing... no need to twist other examples to fit.

TBF though this could have been avoided if the doctor explained that studies were mixed (and even gave you a few studies as examples), and I'm not sure I believe the doctor actually knew studies were mixed.

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