Comment by KacharKhan | Hacker News Reader

Comment by KacharKhan | Hacker News Reader

Doc here.

One thing every single member of the general public needs to get drilled into them: Medical science is NOT intuitive. You cannot just read the mechanism of action of a drug and infer a dozen things from it. A drug's mechanism of action, its indication (when it ought to be used) and its adverse effects CANNOT simply be inferred logically from each other. Biology is orders of magnitude more complex than SE/CS or any other field for that matter.

I presume majority of readers here have SE/CS background. Dudes! the artifacts and systems in SE/CS have the following two properties:

1. They are human artifacts. We know exactly how they are build. The theory is all publicly accessible in principle.

2. They are layered logically on top of each other. Machine code, assembly, C, Java ... so on. Firmware, OS, drivers, apps .. etc. Clean layering.

The above two core properties make it possible to more or less reliably reason about bit SE/CS systems from first principles. The complete absence of above two in medicine means you cannot do the same there. Be very very careful when you import thinking habits for daily life , or other fields of expertise, into medicine.

"This video is just for informational purposes. Consult your health care provider for your particular situation" ...is not just a legal precaution. It is a sound life advice. Nothing in life is more crucial to leave it to the experts as health/medical inference and decision making.

While I don’t disagree, the problem I often have with medical professionals is that they tend to be arrogant and unable to take in new information to adapt and evolve their frameworks.

I was married to a doctor, helped them study for board exams, etc and was surrounded by other doctors within our social circle. What most people don’t realize, and most doctors themselves refuse to acknowledge, is how limited by specialization their knowledge can be and how the education of most doctors stops after med school and residency. Nutrition, for example, is barely covered at all.

Yes, there are continuing education requirements and countless journals but most doctors do the bare minimum and don’t keep up. I’d even argue that most physician knowledge tends to be updated more often through drug and instrumentation reps promoting their products by taking them out to dinner and entering them into referral programs, etc.

I wouldn't label that arrogance. In my experience outside the USA, my GP has been unaware of new research / advice / guidelines published by the MoH. They generally respond to new info from reputable sources when you print it out and bring it to them.

I would expect specialists to be subscribed to journals and reading the latest articles in their field. When I saw a specialist at UCSF this was definitely the case; while my GP still has gaps where their current knowledge on a specific subject is from their time at med school.

An equivalence would be a front-end engineer being naive to the happenings on the Linux kernel mailing list. They could likely understand what's going on if they took the time to read it, but that is not their focus.

The fact that there are advertisements for cancer medications make me think a hell of a lot of specialists don’t keep up. It’s one thing to advertise to consumers about a new medication for their chronic condition and they might not have seen their doctor in 3 years. It’s another entirely to have cancer patients need to ask about the new hotness.

they tend to be arrogant

Yeah I can't with the "biology is orders of magnitude more complex than SE/CS or any other field for that matter" and then thinking he can explain to the techies how technology works. Just put the pills in the bag bro. Oh wait, we need to go to a pharmacist for that.

The med students I've known have been some of the most insufferable people I've met.

Having built software distributed in clinics and troubleshooting with doctors has absolutely confirmed this for me. They are some of the worst clients to deal with. It’s not all that different from many “technologists” though when they casually suggest “easy solutions” outside their domain of expertise. How many ignorant HN posts have started with “why don’t they just”?

The above two core properties make it possible to more or less reliably reason about bit SE/CS systems from first principles. The complete absence of above two in medicine means you cannot do the same there.

I'm a doctor as well and I think your statement here is too broad. Plenty of specialists such as cardiologists, orthopedic surgeons, radiologists, etc are able to reason things from first principles. The issue is that many non-doctors may not know several key details about these systems that would let you reason through them. And even many doctors well versed in one specialty would be unable to reason about another specialty since they may not know in detail several key pieces of information from that other speciality.

I'm a doctor who used to be an engineer. Deriving things from first principles in medicine is a lie we doctors tell ourselves.the truth is this.we have some really good understanding of syne things at molecular levels that we then correlates to things that happen clinically at a macro level, that correlation is very very handwavy. But we teach it as if we know for sure. We don't. The few things that we think we have a somwhat good correlation for, we often test on our exams, but even for most of those things, it's some handwavy link

I recall being an engineering classes, armed with just calculus and linear algebra and newton laws, I could attack just about every problem from first principles from my entire undergrad. Every. I didn't have to take into consideration real life presentation of the problem. First principles were enough to get me nearly there

Medicine is fundamentally not that way. Yes we learn the biology, but if you reason solely from biology, you will quickly end up in the wrong places. to become a doctor, I had to learn that hard way that yeah a disease doesn't just present this way just because the underlying physics and biology suggests it should. You separately have to learn how the disease presents, then try to tie it back to our extensive but still very very limited understanding of the possible biology.

I have problems with doctors that don't acknowledge how tenous that link is and despite how much we know, we still know so so little. We are far more useful than what we know.

I understand to biology majors, the few things that seem to follow physiologically from moelculqr biology dupes us into thinking medicine currebtly derives from first pricinples. But it doesnt.

This seems like a classic "rationalism vs empiricism" issue, and it was interesting for me to learn that Galen (famous / influential ancient Roman physician) wrote a lot about that.

0: https://plato.stanford.edu/archives/win2021/entries/galen/#M...

> Clean layering.

We’d all wish it’d be so, doctor. Sometimes it’s as clean as biological systems - touch something somewhere, a different seemingly completely unrelated thing elsewhere breaks.

Even in the dawn of the era, where accumulated complexity was a while lot lower, we have tales of 500-mile emails and “magic/more magic” switch ;-)

Inferring things in a legacy codebase old enough to drink can be quite a challenge. And the way I get it, you folks are dealing with a multimillenia-old mess of layering violations - so no surprise first principles are tricky.

Good analogy except a human is several orders in magnitude more complex than that

I don't know how you MDs/DOs do it. You give a dude medication knowing that it has a small chance to turn his stomach into goo because it will stop his brain arteries from popping like a stress ball in a hydraulic press. Sometimes without knowing how the medication does either thing.

One of the greatest Silicon Valley tropes is when boring software guys get rich, lose the plot, and start reinventing physics from first principles because they think the universe is like computer science.

The solace of made-up physics is there for every mediocre dude, from Uber founder Travis Kalanick down to any random guy who made $10M as the CTO of a third-rate video conferencing app and immediately broke up with his girlfriend.

Oddly specific. The interactions and variables in biology and physics create way more permutations than many (perhaps all?) people can wrap their heads around but that doesn't mean the possibility of reasoning from first principles doesn't exist. There are very well defined pathways in both medicine and physics. The ones we haven't discovered are most likely much more complex and may contain recursive loops that make tradeoffs inevitable. Or not. The rapid improvement in pattern recognition and processing leads me to believe we are in for a wild time over the next 10 years with a ton of breakthroughs in both physics and medicine.

"Billionaires Want You To Know They Could Have Done Physics" - Angela Collier (actually has a Physics PhD)

https://www.youtube.com/watch?v=GmJI6qIqURA

It seems both true that 1. intuitive-sounding explanations about medicine can be extremely misleading for laypeople and 2. reasoning about mechanisms of action, supplemented with empirical science, is important and useful in medical science.

I'm not sure saying to not try to reason at all about mechanisms of actions is a good idea. If someone knows Tylenol is metabolized into chemicals that are toxic to liver, that is simple enough to understand and reason about

I dont know if that tracks. Medicine is a science after all.

Was the article flat out wrong or at least misleading in any way that might lead people to make poor decisions regarding which drug to take?

Yes, that's another issue - CS/IT seems to be unique that sharing knowledge and openly discussing problems is the norm, in other professions you can get finger wagging and some general "advice"

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