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Comment by tptacek | Hacker News Reader

He's a practicing neurosurgeon with published research, but, like half of HN, doesn't know what he's talking about when it comes to radiological safety; therefore, his opinions on pharmacology are irrelevant to you?

That seems like a surprisingly dumb argument for you, John, but maybe I just misunderstood it.

At any rate, the importance of the piece isn't Gupta's authority on the subject. After all, vis a vis cannabis, Gupta is best known for his former opposition to legalization, which is a self-evidently dumb position for him to have taken.

The importance of the piece is that Gupta was Obama's first nominee for Surgeon General, and the best known medical reporter in the country; he's doing a very public about-face on the issue just as the US appears to be reaching a tipping point on legalization.

Also: it's just a good piece, or at least an atypically good one for CNN. That's why I posted it.

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He's a practicing neurosurgeon with published research, but, like half of HN, doesn't know what he's talking about when it comes to radiologic safety; therefore, his opinions on pharmacology are irrelevant to you?

I guess. I guess you are right. I probably should listen to his opinion about this. I just have a hard time with media personalities who are willing to spout crap when they don't know what they are talking about instead of simply shutting up.

I'm not saying it's a good thing the guy was CNN's subject matter expert on camera for radiation safety, just that he's got a legit claim to subject matter expertise regarding pharmacology. CNN is still awful.

What are his pharmacology credentials?

Anyways far as I can tell his big revelation here is "yeah when i told you i looked at the facts before i really didn't but this time i did!". Makes me take all of his conclusions with a grain of salt.

Does seem clear indication that the american mainstream is getting acceptance for the idea of medical ganja though.

I'm going to go with his license to prescribe drugs and his neurosurgery practice on that one.

The license to prescribe drugs is largely useless as an indicator of pharmacological expertise. We let chiropractors prescribe drugs in this country (Edit: I was mistaken; we don't). The government has no idea what it's doing in its process for deciding who gets that power. I have encountered plenty of doctors who clearly had no idea what they were doing when it came to pharmacology, to the point of prescribing drugs together with dangerous interactions and not informing the patient of the risk.

As for his neurosurgery practice... what? Why would you think that would make him an expert on pharmacology? Because they both fall under the wide umbrella of "medicine"?

Not that I disagree with him on this issue, but your reasoning seems incredibly shaky here.

This isn't a debate I think is worth having. I'm just saying that there's practically no reason to believe Gupta was an appropriate choice for CNN as an expert in radiological hazards, but there is some reason to believe he should know what he's talking about re medicine.

There is also the article, wherein he describes four pages worth of research he did, and in medical school they teach you a good bit about how to read scientific papers, because doctors have to do that sort of thing (eg. GSK releases lamotrigine, do you give it to your patients?).

So, unless he's intentionally and maliciously lying (unlikely), he presents plenty of good and valuable information, and as a media correspondent is probably better than most at conveying that to people.

>because doctors have to do that sort of thing (eg. GSK releases lamotrigine, do you give it to your patients?).

Ideally, that's how it would work. In practice, it appears that in many cases, doctors do little research beyond what pharmaceutical reps tell them[1].

This seems to have a lot to do with time constraints. Doctors report spending an average of 4.4 hours per week reading medical journals, and they only read the full text of about a third of the articles they read[2]. On average, the FDA approves about three new drugs each month. If new drugs were all a doctor needed to read about, 6 hours for each one might be enough to get a decent idea of safety and efficacy. But of course, that's not all a doctor needs to read up on.

But of course that has no bearing on whether doctors know how to read scientific papers.

[1] http://link.springer.com/article/10.1007/s11606-013-2411-7

[2] http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1495716/

That's fine. I just feel like there's a dangerous overtrust of doctors among intelligent and educated people, and I hate to see comments that encourage that.

If you're scientifically illiterate and generally uneducated, trusting doctors is a very good idea. If you have the cognitive tools to check their work, though, it is very smart to do so.

Fair, but a little knowledge really can be a dangerous thing. I'm not a practicing physician, but several members of my family are (whose characters I tend to trust).

The annoyance you may feel when a non-engineer pontificates on a technical topic they clearly only have a surface level understanding of is similar to the aggravation they (M.D's) feel when patients who have perused pubmed and webmd decide they're better informed than they actually are.

I'm of the opinion that "trust, but verify" is a reasonable way to approach subject matter experts in other fields.

Sure, but unfortunately, most doctors don't seem to be able to distinguish the patient who's been reading alt med forums and maybe skimming some cherry-picked articles (perusing would actually be the correct thing to do with a study), from the patient who is scientifically literate and has a reasonable knowledge of pharmacology and the evidence regarding their own condition.

When your doctor is giving you opiates and not even trying to find a sustainable alternative, and you do a ton of research, find an alternative drug (with few side effects and no recognized potential for abuse) that has been shown to help people with similar conditions, and send that study to the doctor, only to have him say "Well, I've never heard of that drug being used for this, so no", it is... frustrating.

actually thats not frustrating, thats what doctors are supposed to do in general

They're supposed to ignore their patients, dismiss scientific evidence without reading it, and keep their patients on dangerous, addictive, and tolerance building drugs indefinitely?

No, I don't think so.

We let chiropractors prescribe drugs in this country.

What country is that, mistercow? Here in the United States, they cannot prescribe drugs with one notable exception in New Mexico for chiropractors that have received "advance practice" training.

In fact, prescribing drugs actually goes against the chiropractic philosophy that involves physical manipulation of the body and your body's ability to heal itself.

Source: http://en.wikipedia.org/wiki/Chiropractic

Hmm, it seems I was mistaken. We do let osteopaths prescribe medicine though, and that's almost as dumb. The rest of my point still stands.

Hmm, it seems I was mistaken. We do let osteopaths prescribe medicine though, and that's almost as dumb. The rest of my point still stands.

I have to take issue again with what you have said.

You seem to be equating osteopathy (a completely accepted medical science) to homeopathy (a complete quackery). To quote Wikipedia:

http://en.wikipedia.org/wiki/Comparison_of_MD_and_DO_in_the_...

Other than teaching manual medicine, the medical training for an M.D. and D.O. is virtually indistinguishable.

To quote the American Medical Association:

http://www.ama-assn.org//ama/pub/education-careers/becoming-...

Q: What is the difference between an MD and a DO?

A: A DO (Doctor of Osteopathic Medicine) is a physician just as an MD is a physician.

Please do more research before you continue to spread additional misinformation. Thank you.

>You seem to be equating osteopathy (a completely accepted medical science)

No, osteopathy is not completely accepted by medical science. Osteopathy is absolute pseudoscience. Please do your research.

Yes, I realize that DOs undergo actual medical training in addition to the quackery that gives their field its name, but they are still taught the pseudoscience on which the practice was originally based. That they believe these techniques are legitimate medicine is indicative that their entire understanding of science and medicine is compromised. This hypothesis has been borne out by literally every experience I have had with a DO.

And some MDs were educated at Georgetown, which is a Jesuit school, so you can't trust any Georgetown grads because they believe in sky faires.

Let's also remember that "MDs" work in a field founded by bloodletters who believed in the four humors.

The important thing is whether the field is progressing via scientific method, not what its founded believed long ago.

It's not about what their predecessors believed. It's about what is still taught in their standard training.

Also, by no means should you take this to mean that I am giving MDs any special immunity. The only leg up they have is that I can't tell just by looking at the letters at the end of their name that their model of science in medicine has been poisoned by bullshit.

If you are outside the U.S. then I understand your belief that osteopathy is quackery because outside the U.S., it is. Inside the U.S. though a D.O. is equivalent to an M.D.

You would know this if you bothered to read either of the citations I provided. You and the person downvoting me apparently disagree with the American Medical Association that says a D.O. is equivalent to an M.D.

For failing to read my citations before you replied to them and for providing no citations of your own other than "every experience I have had with a DO." you are currently in the category of Ignorant Fool. If you would like to provide a citation or two for what you say and perhaps if you actually respond to my citations instead of around them I might be able to upgrade you to Misguided Goof.

EDIT: Never mind, I see in another comment below you are saying that you are just as suspicious of medical doctors. I have no further desire to discuss this with you.

> Never mind, I see in another comment below you are saying that you are just as suspicious of medical doctors.

You accuse me of not reading your citations (I did), did not actually read my response to your comment, and then somehow you got that out of my comment below?

I said that MDs don't have immunity. If I find out that my doctor believes in pseudo-medicine, I will find a new doctor. If you think that's unreasonable, then I guess this "no further desire to discuss" feeling you mentioned is mutual.

> We do let osteopaths prescribe medicine though, and that's almost as dumb.

D.O's have an education that AFAIK is equivalent to that of an M.D. Why should they not be allowed to prescribe medication?

Because their training also includes the scientifically bankrupt "osteopathic manipulative medicine", presented as if it were real medicine.

If you found out that your doctor had, in addition to her ordinary training, received training in psychic healing, and believed that this was a valid approach to medicine, how comfortable would you feel with that doctor being allowed to prescribe potentially dangerous medications to patients?

Because their training also includes the scientifically bankrupt "osteopathic manipulative medicine

I'm sorry and I don't say this lightly but you should really just shut up.

https://en.wikipedia.org/wiki/Osteopathic_manipulative_medic...

In an article published in the New England Journal of Medicine in November 1999, researchers concluded that osteopathic manipulative medicine and traditional drug therapy resulted in equivalent resolution of lower back pain in a nearly identical time frame. The difference was that participants receiving osteopathic manipulative medicine required less pharmaceutical intervention. The advantage of osteopathic manipulative medicine was a diminution of adverse drug reactions while the disadvantage was the greater amount of physician time required for each patient.[22]

A 2005 meta-analysis and systematic review of six randomized controlled trials of osteopathic manipulative treatment (OMT) that involved blinded assessments of lower back pain in ambulatory settings concluded that OMT significantly reduces low back pain, and that the level of pain reduction is greater than expected from placebo effects alone and persists for at least three months.[23]

The National Institutes of Health's National Center for Complementary and Alternative Medicine states[24] that overall, studies have shown that spinal manipulation can provide mild to moderate relief from low-back pain and appears to be as effective as conventional medical treatments.

You are the worst kind of debater. You say something wrong, are called out on it, then you change the entire topic. Only you're wrong about that new topic too, so you cling to it to death. So now you're in the position of arguing against the American Medical Association, the National Institute of Health, the New England Journal of Medicine and frankly thousands of studies.

You are a colossal fool.

Osteopaths are doctors. They aren't chiropractors.

See my other responses. In summary, DOs are fully trained doctors who also believe that a completely pseudoscientific methodology (OMM) is valid medicine. I have very little confidence in such a person's ability to critically weigh evidence, and it seems crazy to me to let them give people drugs.

DOs are fully trained doctors that happen to have gone to medical schools affiliated with osteopathy. A previous commenter related osteopathy to Catholicism via Georgetown; that sounds about right. People choose medical schools for a variety of reasons (cost, admissions, locations). One of the practitioners at my primary care doctor's office is a DO, and does not believe in pseudoscience.

I think what happened here is that you overreached; you claimed that chiropractors could prescribe drugs, were corrected, and then scrambled to recover your argument instead of just admitting you were wrong. Now we're in a totally pointless and, from what I can tell, one-sided discussion about the legitimacy of DOs, despite the total irrelevance of osteopathy to the thread we're on.

>I think what happened here is that you overreached; you claimed that chiropractors could prescribe drugs, were corrected, and then scrambled to recover your argument instead of just admitting you were wrong.

It's a good hypothesis, but for the purposes of updating your model, I should inform you that your guess is wrong. This is a position I've given a lot of thought to. I know that a lot of people disagree with it, so I chose chiropractic for my argument, as it would have been a less controversial and more clear cut example - had I not been mistaken about their ability to write prescriptions. That was sloppy of me.

The difference between OMM and Catholicism is that Catholicism does not purport to be medicine and is not part of the medical curriculum. If it were a Pentecostal school and they taught all of real medicine, but also taught faith healing, then I would feel very similarly about that to how I feel about DOs.

Here's a test: ask the DO at your primary care office if he thinks that OMM is a valid medical practice.

You should submit a story to HN about the problems of osteopathy; that would make this an interesting discussion.

But here, it's just a sideshow. Your point was that being able to prescribe medicine is not a big deal. Whatever you may think of the philosophy of osteopathy, being a DO is a big deal; DO's are doctors, licensed by the state to practice medicine. It is approximately as hard to become a licensed DO as it is to be an MD. DO's are not like chiropractors. Chiropractors don't go to med school.

You were wrong, obviously wrong, and it is clear that no matter what your underlying feelings about osteopathy are, this subthread is irrelevant. In fact, you're doing your opinions about osteopathy a disservice by hitching them to to this particular argument!

To be fair, the one DO I know is a DO rather than an MD because he couldn't get into a normal medical school (schools of osteopathy are not as selective in general).

Though I suppose that also may not be something you'd want to know about your doctor. But as far as I know the academic rigor of his medical program was no less than that of any MD school, minus the inclusion of osteopathy itself. I wouldn't have any issues going to him as a primary care doctor.

I'm pretty sure that chiropractors are a source for both marijuana and steroid (for body building) scripts. I want to say this is in California.

It is a little more than that, he is saying that US research has an obvious bias that he was not aware of.

I'm not sure if your post is intended as sarcasm or not. If the bias was obvious, how could he not be aware of it?

Obvious can also mean Easily understood or Easily seen through because of a lack of subtlety not just Easily perceived. Basicly as soon as you look at the requirements to study pot in the US the bias is easy to notice until then it's easy to overlook.

Ehh, it'd be nice if authorities made perfect pronouncements, but they don't, which is why "appeal to authority" is a logical fallacy. You shouldn't be for or against medical marijuana based on what a celebrity says, even if he's a celebrity doctor.

But conversely it's unfair to criticize an authority for being fallible. At least today, at least in this case, Dr Sanjay Gupta is one of the good guys. Not for espousing one opinion or another, but because he's publicly changed his mind after considering more evidence. Maybe he has incomplete evidence, and maybe in the future he'll change his mind three or four ways from more evidence. But he's basing his opinion on evidence and telling you what that evidence is.

Perhaps you are venting your outrage about U.S. based armchair experts in lieu of tackling your own homegrown quacks and associations promoting quackery in your country, because moronic English scofflaws forbid you from so much as expressing your frustration, much less dishing out a sound shellacking.

The British Chiropractic Association has sued science writer Simon Singh for a piece written in the Guardian's comment pages criticizing the association for defending chiropractors who use treatments on children with conditions such as colic and asthma, when there is little evidence such treatments work.

http://en.wikipedia.org/wiki/Simon_Singh#Chiropractic_lawsui...

"English libel law is so intimidating, so expensive, so hostile to serious journalists that it has a chilling effect on all areas of debate, silencing scientists, journalists, bloggers, human rights activists and everyone else who dares to tackle serious matters of public interest.

In the area of medicine alone, fear of libel means that good research is not always published because those with vested interests might sue, and bad research that should be withdrawn is not pulled because the authors might sue the journal, and in both cases it is the public that loses out because the truth is never exposed. My victory does not mean that our libel laws are OK, because I won despite the libel laws. We still have the most notoriously anti-free speech libel laws in the free world."

http://www.theguardian.com/science/2010/apr/15/simon-singh-l...

So next time around, practice what you preach, perhaps.

Did I misunderstand something here? Are you really saying that because the country he happens to be from has some problems in a certain area, he can't criticise similar problems in countries he happens not to be from?

The Singh case flagged up a problem which drew massive support (which is still ongoing and should improve the situation some epoch). Also, he won.

  Also, he won.

The case has cost Singh more than £200,000 that he will never fully recover. "It still staggers me that the British Chiropractic Association and half the chiropractors in the UK were making unsubstantiated claims," he said. "It still baffles me that the BCA then dared to sue me for libel and put me through two years of hell before I was vindicated. And it still makes me angry that our libel laws not only tolerate but also encourage such ludicrous libel suits.

Being an expert in something doesn't prevent you from talking crap on the subject, you need trust for that.

> but, like half of HN, doesn't know what he's talking about when it comes to radiological safety

I think you're being awfully generous to HN...

But seriously, the key takeaway from articles like this one is that marijuana acceptance is finally becoming mainstream; five or ten years ago this kind of article would have been considered quite controversial for a major news organization like CNN, and may have been quashed at the editorial level.

Thankfully, it's only a matter of time before it's legalized and we can empty our jails of people who should never have been there in the first place for possession. The sooner the better.

I agree this is the major takeaway of the article.

Interesting to think that what is "mainstream" can be observed in what print-media outlet editors are brave (or un-scared) enough to publish. As you said, I imagine this would have been a pretty controversial article 10 years ago. Now, it feels almost like a me-too opinion piece from Sanjay Gupta, which is a big enough name on a trending topic for a CNN editor to call it news.

People who don't know when to say "I don't know" get their 'ignore' flag set by me as well. If he's a genius in field X then makes ludicrous comments about field Y I might set his ignore flag as well. Maybe it's just one of my pet peeves as an engineer, but I really can't stand it when people aren't comfortable saying 'I don't know'. I consider it a character flaw.

If your job is to talk about stuff on TV, then you do the best with what you've got.

I've written Perl code. Really, really bad Perl code. I would've loved to throw my hands up and say "let someone who knows their shit do this" but I was the only person, and the job needed to be done.

You have to understand that for media personalities, offering their opinions... that's their work output. You can shut up and still keep earning a paycheck. Their job is to keep talking.

Essentially what you're advocating is to have TV channels just broadcast dead air most of the time. Maybe that's what you want. But it's not really a reasonable suggestion. I guess we can have a laugh about it though.

I think the problem is much more clear from just reading the article.

Gupta admits throughout that in the past, his decisions were based on incorrect information and assumptions. He seems to have a penchant for deciding "I'm against this!, here is the evidence that supports my point". Whereas now he finally seems to be coming around to the idea that maybe, just maybe, other evidence beside the evidence that supports his point should be considered. Perhaps he could even...gasp...put himself in someone else's shoes before making judgements based only on his own experience.

It's getting a little old hearing the "well I finally considered this from someone else's point of view and realized my viewpoint was insane" why does this take us so long?

Ok I'm ignorant on the subject. I watched the CNN video but the page just says read Wikipedia. Gupta says the suits are to protect you from gamma radiation (maybe not those exact words). Is that not an accurate way to describe the purpose to their target audience? From what I understand, there are radioactive particles everywhere near the reactor and you don't want these in or on your body, because they are emitting high levels of radiation. Correct me if I'm wrong.

Wouldn't it be great if you were only allowed to use your honorifics when talking about things you actually had a doctorate in.

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