Comment by janeway | Hacker News Reader

Comment by janeway | Hacker News Reader

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I am sure I miss the context but I guess the point is that authors were sick of hearing about the promise of statistical analysis and epidemiology which will outperform classical medical approach - slandering the BMJ several times for some reason.

Even today we see some hanger-ons who assert that their way is the best way - that they know from personal medical cases and their opinion and interpretation is more valuable than some statistical prediction.

Well, if I have understood their sentiment correctly; facts are facts. Today the best medical care in the world is driven by data-based adaption rather than subjective opinion. If a treatment has a robust statistical impact it will be preferred. If new methods produce outcomes no better than random noise then we must agree that they are not better. If the physician has anecdotes about why they think some trick works best then - in the words of Pearson - “statistics on the table, please”.

I am sorry to make the joke but it seems apt: “Dr Charlatan disgruntled about needing evidence for science”.

Yes and no,

Statistics have an inherent weakness when you don’t have consistent buckets to place everything into. If individual specialists classify cases differently they really can see statistically valid numbers from relatively few cases where double blind studies using different classification criteria see improvements below the noise floor.

Also, largely, there is no scientific evidence for the vast majority of problems.

The only evidential basis for causal analysis are experiments where (1) you intervene to bring about the cause deterministically; and (2) where you control all confounding causes.

Those conditions are impossible to meet for the vast majority of interactions in complex systems, such as people & medicine.

If you run associative statistics on counfounded data collected in observational studies, you may as well correlate star signs with outcomes -- no doubt people being treated under winter signs will do worse than those under gemini. Astrology QED.

Brings to mind an interesting tidbit I ran into--long ago your sign probably did correlate with meaningful things in life. Not that the stars mattered, but the seasons did. Early life nutrition would vary. Even today you'll find a correlation between signs and ADHD diagnoses--because of the school year. There is almost a year of difference between the oldest students entering school and the youngest--and those youngest are appreciably more likely to get an ADHD diagnosis.

as someone currently suffering from something I statistically have no real justification for getting fixed, I'm grateful I have a Dr who's going to fix it statistics be damned

but if you got better, how would you know it was the doctor and not just random chance? base rate fallacy applies

In my case, I've been suffering from disc herniation induced sciatica for 5 months

When I say suffering, I mean it - I haven't been able to stand, sit, lie down, walk, do anything without constant and extreme pain. For months on end now.

There is a gold standard study called SPORT that proves more or less beyond all doubt that, in the long run, there is no difference in outcomes for patients who get disc herniations surgically removed vs those who don't. Disc herniations eventually heal themselves, all surgery does is fix them sooner than they otherwise would have.

So the tax-funded public health care system in Sweden and other similar countries do not surgically remove disc herniations other than in extreme cases. (loss of bowel control etc)

Thankfully, in the States, I'm able to have the surgery, so I will.

I couldn't care less if in the long run there is no difference in the aggreggate - I don't want to wait another year or two or more for the herniation to heal itself.

I'm not a statistic, I'm a human being lol.

To add to that studies findings: in general, many people who have back surgery end up worse-off than before, because back surgery is risky.

Uh, no. That study is literally the source of truth on that topic. There's no "to add to".

I hope you never have to experience what me and others who have the same problem have experienced, but I guarantee you you'd want to do the surgery too if you ever did.

In any case, I was happy to share my story but I have zero interest in debating it, so I'll check out here.

I've had constant back pain since my teens (and I'm 50) likely due to a damaged disk. I've already gone through this (I work in the medical field and can consult with doctors and medical researchers). I concluded that the risks of back surgery making a problem worse are high enough that I am going to live with the pain for the foreseeable future.

At a personal level, why would one care? Their medical issue went away!

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