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Comment by umvi | Hacker News Reader

I hate that doctors are gatekeepers of so many things. Why should a small computer that measures blood sugar be gated behind a doctor in the first place?

The only reason I can think of is: supply is short and they need to be preserved for diabetics.

But if supply is not short, why should I need to go through a gatekeeper to measure my own biometrics?

Same with glasses. If I want to buy a pair of glasses with arbitrary optical properties, why shouldn't I be able to?

Seems like the medical world is sometimes a bit too paternalistic, probably to keep themselves cemented as middle men, like a car dealer preventing consumers from buying directly from source.

To be fair, certain things are dangerous and probably should be gated behind a doctor for safety reasons, but sometimes I think Rx fever gets a bit out of hand.

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Exactly. The medical profession is based on a ubiquitous form of elitism protected by knowledge hoarding (expensive journals and inaccessible language) and approvals (regulatory, appointments, and prescriptions) for routine, on-going condition maintenance. While there are laudable ostensible and obvious reasons for having clinicians periodically overseeing aspects, you don't need a clinician for a paper cut or every single purchase of lifelong maintenance supplies and equipment necessary or optional.

I guess the thing is that in countries where there is universal healthcare, gating is necessary to contain costs for patients who don't have a medical need. In countries without universal healthcare, the downside of prescription->OTC is shifting costs onto the patients where insurance may not cover them.

> But if supply is not short, why should I need to go through a gatekeeper to measure my own biometrics?

> Seems like the medical world is sometimes a bit too paternalistic

The charitable explanation is this: why would you want to measure those specific biometrics in the first place? Normies normally don't do stuff like that. Do you suspect you may have some medical issue that those biometrics would help you diagnose? Did someone tell you that, or did you read about it on-line? If the answer to those last questions is "yes", then the system really wants you to visit an actual doctor before you go out on your own and hurt yourself (and/or get scammed while also hurting yourself). It's not that they're worried a glucose monitor - or any other measurement tool - will kill you; it's just that it's hard enough to get people to visit the doctor over literally anything, from inconveniences to immediate life threatening dangers, so the system takes every opportunity to nudge you to cross paths with it.

> Normies normally don't do stuff like that.

Maybe this attitude needs to stop. Get people more engaged with their health while collecting data so they can show up to their doctor with more information.

We don’t shut down the sale of car parts because Normies don’t normally do their own car repairs. Even if only a small But passionate group takes control of their health data collection, why stop them?

I totally agree with everything you said, but just to further the point...

> We don’t shut down the sale of car parts because Normies don’t normally do their own car repairs.

We actually have done this, across industries. And now we have a "right to repair" movement because people realized their freedoms were curtailed.

It's important that we don't disrupt people's ability to learn about their own body. Some things are a health risk, and we want to prevent scams, but we shouldn't lock people out behind expensive and bureaucratic gate keepers.

> We actually have done this, across industries. And now we have a "right to repair" movement because people realized their freedoms were curtailed.

The difference is that for tests requiring doctor requisitions that is the government locking down access, whereas right to repair is laws preventing companies from locking down access (to increase their profits)

You’re absolutely right that most people don’t need to measure this data. That said, most people didn’t need to measure step count or heart rate or sleep and we’ve found utility in that.

Realistically, the medical community is extremely gate-keeper oriented. The doctor shortage is entirely fabricated by organizations run by doctors. Some barrier to providing medical care is good, of course.

Realistically, we don’t have a lot of data on the blood glucose levels of healthy people. The explosion of Fitbit’s and Oura rings and similar products gave us an explosion in data on basic vitals of millions of people during sleep. This can inform a ton of research, even if the quality of data is not as high as in a clinical setting. The difference between collecting 40 hours a week of data on 5 people vs 40k hours on 5k people (or more!) is huge in a research setting.

I used to work doing ML to measure and improve athletic performance, and to measure and detect physiological strain and risks during physical exercise. Our limitation was always access to enough data to not overfit. Compared to data corpus’s using in “generative AI” or image recognition models, or any other number models that are now standard in industry, we’re still in the Stone Age.

> If I want to buy a pair of glasses with arbitrary optical properties, why shouldn't I be able to?

Don't sites like Zenni Optical already offer this?

No, you need to upload a prescription.

That's blatant nonsense. In practice, you do need to have a prescription so you know exactly what to get, but you can type in the numbers without having to upload anything.

That's literally not true. Places will request your prescription and will not fulfill your order until the prescription is sent over.

Nope, not true at all. Go to eyebuydirect.com, enter any random prescription and buy those glasses. I've done this like 20 times, mostly because my prescriptions were from doctors outside United States.

It's an American company. AFAIK there is no regulation in the US that requires prescription from a doctor to get the glasses.

Yes me too! This is amazing for reading glasses -> computer glasses. Converting a normal distance -> reading means adding 1.15 to one column of numbers. But it was too strong for me, so I used eye buy direct to try a sweep from 100%, .66%, and .33% and each are great for different situations

.33 of 1.15 was amazing for computers, comfortable but I can still look at distance somewhat

This thread was a reminder that I needed some prescription sunglasses.

There was an option to upload my prescription, so they could auto-detect the values from it. But there's a button just below that for "manually enter". I never saw any other prompts, on the way to checking out.

Maybe in the US. You can just order glasses globally (friends use HK, I'm in Europe) and nobody gives a damn about any prescription.

I have used Zenni and several other online stores, and all of them will require you to upload a current doctor ordered prescription (one that has not expired). You cannot just take the numbers you already know and order a pair for yourself on any of these sites, as far as I know.

If you look closely, there is an option to enter your prescription numbers manually.

Glasses do not require a prescription - you can enter arbitrary values. Contacts on the other hand, require a prescription within the last year and is verified with your optometrist.

So much gatekeeping is upheld by regulations, which are in turn written by the professional organizations these medical practitioners belong to. It is a silent violation of our liberties but also a silent driver of costs. Glasses are a great example. CPAP machines are another, forcing people to take expensive sleep studies that cost thousands (before insurance) all to get machines that are freely available in many other countries.

This device in particular basically maintains and obscures view of an open wound on your body, and must keep it protected at all times to limit the chance of a bad infection. I can certainly see why it took awhile to build up the trust that their supply chain can create such a device safely.

Plus, the whole host of problems that occur when there's too much or too little insulin in your body. Comas and death in both directions! For better or worse, having certification and a professional watching after it is not the worst thing for a newbie on a dexcom monitor.

Acute low blood glucose (<10 mg/dL) is much, much worse. Acute high blood glucose (say 500 mg/dL) is really miserable and takes variable days to years to be fatal. There is an LD50 for glucose but it's difficult to reach without other problems.

> I can certainly see why it took awhile to build up the trust that their supply chain can create such a device safely.

We've had the devices for almost 20yrs, just not available over-the-counter.

> the whole host of problems that occur when there's too much or too little insulin in your body

Which healthy bodies regulate. This device does NOT administer insulin, and it's not a tool for insulin administration in any way. This tool is only approved for use for people who do NOT have insulin prescriptions. This is a tool for healthy people to monitor their levels.

The situation is actually much worse. If you go to an optician to get a prescription for eyeglasses, assuming you pay via your insurance, if the optician believes that you will not be ordering glasses from the optician, the optician intentionally and vindictively gives you an erroneous prescription that is off by 0.5 in one eye, leading to a lack of focus when seeing at a distance. It took me many years to catch on to this scam because I had to distinguish it from the prospect of Zenni shipping out bad glasses which they didn't.

This is malpractice, so if you have evidence of this you should consider reporting them. Certainly I've never had this issue with my opticians, but have certainly had plenty of bad Zenni glasses.

Are you so certain after hearing a first hand account?

When you say "bad glasses", distinguishing the two is exactly something to worry about. I found that the problem disappeared when I started paying hard cash for a prescription, although it still varies by the practitioner.

Fwiw, it would be very hard for the government to correctly investigate and accurately prove in court, since it will require a statistical proof over many patients that get tested at both good and bad places.

> If you go to an optician to get a prescription for eyeglasses, assuming you pay via your insurance, if the optician believes that you will not be ordering glasses from the optician, the optician intentionally and vindictively gives you an erroneous prescription that is off by 0.5 in one eye

You state this like it is standard practice, like all opticians do this. What evidence do you have?

It's to protect people like you (and in fact many on HN) from themselves (and their incompetence). I don't expect you to understand, but self-diagnosing and self-medicating is not safe for you when you don't have the credentials.

Because doctors never misdiagnose or prescribe wrong medications...

I'd rather make my own choices, thank you very much.

"I don't expect you to understand, but self-diagnosing and self-medicating is not safe for you when you don't have the credentials."

This is extremely condescending and also very profitable for the medical industry. On the one hand we have a wild west market where hospitals, pharmaceuticals and doctors can see all data and charge whatever prices they feel like. For the patient it's a market where we aren't even allowed to collect data about ourselves, aren't allowed to import drugs that are approved and safe somewhere else and with many treatments we won't even get an price before it's done. But we have to pay. Talk about asymmetry!

Speaking of self diagnosing: I went to several doctors about my joint pain and chronic headaches. they all wanted to describe steroids, anti inflammatories and whatever. Turns out if I reduce sugar, I am totally fine. I came up with that after reading some literature and testing on myself. None of the doctors mentioned this for the hundreds of dollars in deductible and copay this cost me. Self diagnosis works. I know there are limits to this but many of us can read the medical literature as well as doctors and draw our own conclusions.

The person obviously has a strong conflict of interest, and stands to lose when people empower themselves. You will not convince them if they're not operating in good faith.

Speaking of joint pain, also consider:

1. Avoiding microplastics. Wash everything and filter your water, but not with a resin based filter that leaks more plastics than it removes. Avoid contact of food and drink with plastic.

2. Sometimes it's due to gut dysbiosis. In fact this goes hand in hand with the sugar theory. Antibiotics can often fix it, although the exact antibiotic needed can vary significantly.

A person is no more likely to suffer from "self-diagnosing" the implications of their blood sugar readings than they are from misunderstanding their weight or blood pressure measurements.

Given the massive scam industry promising health and fitness based on CGM readings, I'd say that already has happened. And Abbott and, now, Dexcom, are more than happy to capitalize on the kind of Son of Dunning or Daughter of Kruger who think, that BG readings are the new HRV. 99 bucks/month for no discernible benefit? Buying Dexcom shares now.

Contacts and eye glasses regulations are far looser in EU and they are doing fine. They don't need yearly rechecks for contact lens for example.

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