5 ms·

On the flip side, I had lower back pain of varying intensity for about two years before it got really bad really suddenly and I went to someone recommended by s

On the flip side, I had lower back pain of varying intensity for about two years before it got really bad really suddenly and I went to someone recommended by someone knowledgeable in the subject who fixed it in about 30 minutes of some serious stretching and twisting and turning [1]. Two months with not a hint of pain and I'm pretty sure this is yet another example of the medical industry being incentivized into ignoring existing solutions. MD I went to prescribed 4 meds (pain killer, muscle relaxant, topical gel, something else), did and xray before telling me I have arthritis at 30, and referring me to a list of acupuncturists. If there's a lot of profit to be made in treating back pain, why would anyone ever fix it in a for-profit system? 1. https://www.yelp.com/biz/tri-valley-bodyworks-dublin https://www.yelp.com/biz/tri-valley-bodyworks-dublin

royinferno 9y ago
Nice thanks for the rec
tptacek 9y ago
This argument has always seemed pretty silly to me. Why, if this is how the market for medical services worked, would medical services cure any problem, when they could find ways to milk those problems for recurring revenue? Why aren't malaria or stomach ulcers "chronic manageable illnesses", rather than curable ones?
- andreyf 9y ago
  It's a very cynical argument, I'll give you that, and I'm certainly biased by wasting a bunch of time & money on x-rays and drugs and acupuncture. A slight more realistic explanation may involve liability - twisting and stretching someone who complains of back pain may be hard to teach / accredit at scale in a way that doesn't sometimes end disastrously, and MDs prescribing meds eliminates those cases of extreme liability. Not sure about Malaria or stomach ulcers, but likely because those who developed the drugs were not acting to maximize their economic interests? Malaria seems like a relatively well understood parasite, whereas "back pain" could really be a symptom of nobody-really-knows-what.
- briantakita 9y ago
  It's funny that we have billions poured into cancer research yet we still can't find that cure. I guess we need another cure cancer walkathon with pink ribbons cause those smart scientists almost have that cure... Perhaps there is a cure (or at least the causes are well-known), but it's being withheld from the public. Why would we ever want to fix problems that employ so many people & give them nice houses & yachts?
  - tptacek 9y ago
    Indeed, and it is surely for the same reason that there isn't yet a pill I can take to make me 7'5" tall. But of course we're left with the same conundrum: why has the modern pharmaceutical industry cured any disease? Every time they do, they kill another cash cow.
  - rwh86 9y ago
    Actually, cancer treatment has made huge progress in the last decade or so. Melanoma, in particular, has gone from a virtual death sentence to being one of the more treatable forms. The idea that we haven't found "the cure" to cancer is silly because cancer isn't one disease, it's many, down to the point of everyone's cancer being genetically different, and in fact different cancer cells being genetically different within an individual. Cancer is all statistics. You slowly accumulate mutations in your tissues over your life time and if you accumulate enough mutations (especially in oncogenes[1]) you will get cancer. The only way to avoid it is to die of something else first. https://en.wikipedia.org/wiki/Oncogene https://en.wikipedia.org/wiki/Oncogene
    - HarryHirsch 9y ago
      Yeah, a log/log plot of incidence of cancer against age shows that about 6 mutations are needed in a cell to result in cancer. A decent cancer needs invasiveness, metastases, vascularization and evasion of the immune system. The last two are especially important and that's where current research is directed.
    - briantakita 9y ago
      I'm not going to argue against the complexity of cancer, just as the effects of a complex system is more complicated compared to the inputs (i.e. a fractal). What is not emphasized is nutrition, environmental toxins, bioaccumulative effects of "safe" compounds that we interact with daily (plastics, chemicals, hormonal (estrogen) mimickers, Electromagnetic pollution, Stress, side effects of drugs) & their effects throwing monkey wrenches into biological processes & causing these mutations. We can study the effects & create drugs to combat the effects or we can address the causes. One strategy is more profitable, has a more defensible market position, & creates a more dependent consumer base than the other. This will be my last post as I've already done enough damage to my HN karma on this topic. It's a pretty obvious argument if one takes an honest look at motivations of the different parties. It's all too easy to get bogged down & distracted by the details at the tail end of the system; when it's the inputs that really matter. The issue is a multi-domain systemic issue that we are trying to solve in a single domain (pharmaceutical drugs/medical procedures). A Belief system is a great tool to handle the complexities of life & choosing an effective Belief System is a tool that will help one achieve optimal results. Our culture has atomized existence into domains & degenerated holistic belief systems to our detriment.
- seanwilson 9y ago
  > This argument has always seemed pretty silly to me. Why, if this is how the market for medical services worked, would medical services cure any problem, when they could find ways to milk those problems for recurring revenue? Why aren't malaria or stomach ulcers "chronic manageable illnesses", rather than curable ones? Yeah, surely if you were the first company to work out how to cure e.g. back pain or cancer you'd make an insane amount of money so you wouldn't keep it under wraps. Who exactly would stop you going to market with it? It's a silly conspiracy theory in my opinion.
- HarryHirsch 9y ago
  Consider Hepatitis C. Chronic infection puts the patient at risk for cirrhosis and eventual liver failure, and the treatment for that is a liver transplant. A couple of years ago Telepravir (Schering/Merck) and Boceprevir (Vertex/J&J) came to market. The price for a course of treatment has nothing to do with the cost of development and everything with the cost of a liver transplant, it's slightly less than that.
  - tptacek 9y ago
    What argument of mine are you attempting to rebut?
    - HarryHirsch 9y ago
      You didn't make it, but you hear far too often that drugs for management of chronic conditions are more profitable than cures for acute conditions, and that's what determines what goes into the development pipeline. The truth is more complex than that. The reason that you don't see investment in antibiotics is that the low-hanging fruit is picked and you cannot use the new compounds unless as a treatment of last resort, and sales would be far too low to be profitable. They will be needed, though, in the medium term. The financing model in pharma is broken and there is no change on the horizon in that department.
  - mhalle 9y ago
    You might want to look for a better example. Even before prices for HCV drugs went down due to competition, they offered a cure for a life threatening disease for less than $100K in the US with minimal side effects, typically in 8 weeks, and with 95% effectiveness. The agent is a small pill taken twice a day. Price is scaled to personal income in country of treatment. That's more like 1/10 of the monetary cost of a transplant, which is a scarce and rationed treatment.
maxxxxx 9y ago
I do half an hour of yoga postures almost every morning. When I don't do them for a few days I get pretty bad back pain and migraines. when I am doing them, no problems at all. Before doing that doctors would give me injections and muscle relaxers all the time. I am pretty sure I either would already had had surgery or would get it at some point if I had followed doctors' advice. The trick is that you have to adjust your exercise routine to your specific problem and adapt constantly. This is not easy.
- mistermann 9y ago
  What part of your back? Is there a name or website for the routine you follow?
  - icelancer 9y ago
    Many will do McKenzie Method work ($10-15 book on Amazon, Treat Your Own Back) for lumbar pain in flexion. It is very specifically good for that and that alone, which is the most common form of low back pain. I found a lot of relief using the tools in the book (yoga-type postures) and weight lifting.
  - maxxxxx 9y ago
    For me it's the sacro illiac joint. It tends to get misaligned and then I get headaches. A yoga teacher gave me a series of exercises that bring it back into alignment and also strengthen the surrounding muscles. This is very individual and probably won't work for other people. In general look at the DVDs by Gary Kraftsov. His stuff is very simple but very effective.
Godel_unicode 9y ago
> why would anyone ever fix it in a for-profit system? For the same reason any other problem gets solved in a for-profit system; the best solver of problems will be the best getter of dollars. See for instance Apple, Honda, Nike, Harvard, etc.
- cmurf 9y ago
  Except that's not what's happening. There's a massive pile of patients who will try literally anything, they are a price and solution inelastic market, and like they say, there's a sucker born every minute. Except the sucker is a patient that isn't ever allowed, by this particular market, to get a refund for bad advice and procedures. You have to basically be injured by the doctor to have standing to sue. The idea of health care as a product like a jug of milk is just ignorant, idealist, nonsense.
  - Godel_unicode 9y ago
    Counterpoint: hundreds of effective medical treatments for a variety of problems exist. Even in the joint pain market, compare today with 30 years ago. What would be career-ending injuries in the 80s are now resolved in time to return for next year. And these treatments are available to normal people too. Edit: see the linked article on ACLs. https://www.hss.edu/conditions_acl-injuries-then-and-now.asp https://www.hss.edu/conditions_acl-injuries-then-and-now.asp
  - deleted 9y ago
    [deleted]
- jimmaswell 9y ago
  Apple kickstarted the smartphone market with one good product and went downhill from there in terms of making anything worth buying. Otherwise the only problem they're best at solving is marketing. Apple actually supports the argument. Why innovate when you can make more profit removing functionality and releasing new colors while coasting on brand recognition?
  - 9y ago
joelrunyon 9y ago
The problem with doing exercises is it's not as simple as a pill or a surgery - it's a lifestyle change. Don't want to spam HN with this as I mentioned it earlier, but this is one of the issues we're trying to address with http://MoveWellApp.com http://MoveWellApp.com - which is basically a personal mobility coach.
- HarryHirsch 9y ago
  Get a dog instead. Unlike a stupid app you can't ignore the animal once you got it. I wouldn't have believed it, but walking the dog has improved my physical and psychological health considerably.
  - weavie 9y ago
    > you can't ignore the animal once you got it Sadly you can, and many people do.
  - joelrunyon 9y ago
    Thanks for taking the time to give such helpfully feedback.
- thenomad 9y ago
  Quick note here: an Android app would go a long way to encouraging takeup in the HN crowd, I suspect. I'm already a big fan of mobilisation exercises, so my thought process went "sounds great - where do I download?"..."iPhone only. Meh. Oh well." I know you're working on it, just wanted to give you some feedback to help prioritise.
  - joelrunyon 9y ago
    Thanks - we're working on it. We usually build iOS first for the reasons outlined here - https://impossiblex.com/ios-first/ https://impossiblex.com/ios-first/
Latty 9y ago
I mean, given enough competition (which I accept isn't a given), someone will decide getting all of the profit from a cure is worth more than competing for a slice of the treatment market.

royinferno 9y ago

Nice thanks for the rec

tptacek 9y ago

This argument has always seemed pretty silly to me. Why, if this is how the market for medical services worked, would medical services cure any problem, when they could find ways to milk those problems for recurring revenue? Why aren't malaria or stomach ulcers "chronic manageable illnesses", rather than curable ones?

andreyf 9y ago
It's a very cynical argument, I'll give you that, and I'm certainly biased by wasting a bunch of time & money on x-rays and drugs and acupuncture. A slight more realistic explanation may involve liability - twisting and stretching someone who complains of back pain may be hard to teach / accredit at scale in a way that doesn't sometimes end disastrously, and MDs prescribing meds eliminates those cases of extreme liability. Not sure about Malaria or stomach ulcers, but likely because those who developed the drugs were not acting to maximize their economic interests? Malaria seems like a relatively well understood parasite, whereas "back pain" could really be a symptom of nobody-really-knows-what.
briantakita 9y ago
It's funny that we have billions poured into cancer research yet we still can't find that cure. I guess we need another cure cancer walkathon with pink ribbons cause those smart scientists almost have that cure... Perhaps there is a cure (or at least the causes are well-known), but it's being withheld from the public. Why would we ever want to fix problems that employ so many people & give them nice houses & yachts?
- tptacek 9y ago
  Indeed, and it is surely for the same reason that there isn't yet a pill I can take to make me 7'5" tall. But of course we're left with the same conundrum: why has the modern pharmaceutical industry cured any disease? Every time they do, they kill another cash cow.
- rwh86 9y ago
  Actually, cancer treatment has made huge progress in the last decade or so. Melanoma, in particular, has gone from a virtual death sentence to being one of the more treatable forms. The idea that we haven't found "the cure" to cancer is silly because cancer isn't one disease, it's many, down to the point of everyone's cancer being genetically different, and in fact different cancer cells being genetically different within an individual. Cancer is all statistics. You slowly accumulate mutations in your tissues over your life time and if you accumulate enough mutations (especially in oncogenes[1]) you will get cancer. The only way to avoid it is to die of something else first. https://en.wikipedia.org/wiki/Oncogene https://en.wikipedia.org/wiki/Oncogene
  - HarryHirsch 9y ago
    Yeah, a log/log plot of incidence of cancer against age shows that about 6 mutations are needed in a cell to result in cancer. A decent cancer needs invasiveness, metastases, vascularization and evasion of the immune system. The last two are especially important and that's where current research is directed.
  - briantakita 9y ago
    I'm not going to argue against the complexity of cancer, just as the effects of a complex system is more complicated compared to the inputs (i.e. a fractal). What is not emphasized is nutrition, environmental toxins, bioaccumulative effects of "safe" compounds that we interact with daily (plastics, chemicals, hormonal (estrogen) mimickers, Electromagnetic pollution, Stress, side effects of drugs) & their effects throwing monkey wrenches into biological processes & causing these mutations. We can study the effects & create drugs to combat the effects or we can address the causes. One strategy is more profitable, has a more defensible market position, & creates a more dependent consumer base than the other. This will be my last post as I've already done enough damage to my HN karma on this topic. It's a pretty obvious argument if one takes an honest look at motivations of the different parties. It's all too easy to get bogged down & distracted by the details at the tail end of the system; when it's the inputs that really matter. The issue is a multi-domain systemic issue that we are trying to solve in a single domain (pharmaceutical drugs/medical procedures). A Belief system is a great tool to handle the complexities of life & choosing an effective Belief System is a tool that will help one achieve optimal results. Our culture has atomized existence into domains & degenerated holistic belief systems to our detriment.
seanwilson 9y ago
> This argument has always seemed pretty silly to me. Why, if this is how the market for medical services worked, would medical services cure any problem, when they could find ways to milk those problems for recurring revenue? Why aren't malaria or stomach ulcers "chronic manageable illnesses", rather than curable ones? Yeah, surely if you were the first company to work out how to cure e.g. back pain or cancer you'd make an insane amount of money so you wouldn't keep it under wraps. Who exactly would stop you going to market with it? It's a silly conspiracy theory in my opinion.
HarryHirsch 9y ago
Consider Hepatitis C. Chronic infection puts the patient at risk for cirrhosis and eventual liver failure, and the treatment for that is a liver transplant. A couple of years ago Telepravir (Schering/Merck) and Boceprevir (Vertex/J&J) came to market. The price for a course of treatment has nothing to do with the cost of development and everything with the cost of a liver transplant, it's slightly less than that.
- tptacek 9y ago
  What argument of mine are you attempting to rebut?
  - HarryHirsch 9y ago
    You didn't make it, but you hear far too often that drugs for management of chronic conditions are more profitable than cures for acute conditions, and that's what determines what goes into the development pipeline. The truth is more complex than that. The reason that you don't see investment in antibiotics is that the low-hanging fruit is picked and you cannot use the new compounds unless as a treatment of last resort, and sales would be far too low to be profitable. They will be needed, though, in the medium term. The financing model in pharma is broken and there is no change on the horizon in that department.
- mhalle 9y ago
  You might want to look for a better example. Even before prices for HCV drugs went down due to competition, they offered a cure for a life threatening disease for less than $100K in the US with minimal side effects, typically in 8 weeks, and with 95% effectiveness. The agent is a small pill taken twice a day. Price is scaled to personal income in country of treatment. That's more like 1/10 of the monetary cost of a transplant, which is a scarce and rationed treatment.

maxxxxx 9y ago

I do half an hour of yoga postures almost every morning. When I don't do them for a few days I get pretty bad back pain and migraines. when I am doing them, no problems at all. Before doing that doctors would give me injections and muscle relaxers all the time. I am pretty sure I either would already had had surgery or would get it at some point if I had followed doctors' advice. The trick is that you have to adjust your exercise routine to your specific problem and adapt constantly. This is not easy.

mistermann 9y ago
What part of your back? Is there a name or website for the routine you follow?
- icelancer 9y ago
  Many will do McKenzie Method work ($10-15 book on Amazon, Treat Your Own Back) for lumbar pain in flexion. It is very specifically good for that and that alone, which is the most common form of low back pain. I found a lot of relief using the tools in the book (yoga-type postures) and weight lifting.
- maxxxxx 9y ago
  For me it's the sacro illiac joint. It tends to get misaligned and then I get headaches. A yoga teacher gave me a series of exercises that bring it back into alignment and also strengthen the surrounding muscles. This is very individual and probably won't work for other people. In general look at the DVDs by Gary Kraftsov. His stuff is very simple but very effective.

Godel_unicode 9y ago

> why would anyone ever fix it in a for-profit system? For the same reason any other problem gets solved in a for-profit system; the best solver of problems will be the best getter of dollars. See for instance Apple, Honda, Nike, Harvard, etc.

cmurf 9y ago
Except that's not what's happening. There's a massive pile of patients who will try literally anything, they are a price and solution inelastic market, and like they say, there's a sucker born every minute. Except the sucker is a patient that isn't ever allowed, by this particular market, to get a refund for bad advice and procedures. You have to basically be injured by the doctor to have standing to sue. The idea of health care as a product like a jug of milk is just ignorant, idealist, nonsense.
- Godel_unicode 9y ago
  Counterpoint: hundreds of effective medical treatments for a variety of problems exist. Even in the joint pain market, compare today with 30 years ago. What would be career-ending injuries in the 80s are now resolved in time to return for next year. And these treatments are available to normal people too. Edit: see the linked article on ACLs. https://www.hss.edu/conditions_acl-injuries-then-and-now.asp https://www.hss.edu/conditions_acl-injuries-then-and-now.asp
- deleted 9y ago
  [deleted]
jimmaswell 9y ago
Apple kickstarted the smartphone market with one good product and went downhill from there in terms of making anything worth buying. Otherwise the only problem they're best at solving is marketing. Apple actually supports the argument. Why innovate when you can make more profit removing functionality and releasing new colors while coasting on brand recognition?
- 9y ago

joelrunyon 9y ago

The problem with doing exercises is it's not as simple as a pill or a surgery - it's a lifestyle change. Don't want to spam HN with this as I mentioned it earlier, but this is one of the issues we're trying to address with http://MoveWellApp.com http://MoveWellApp.com - which is basically a personal mobility coach.

HarryHirsch 9y ago
Get a dog instead. Unlike a stupid app you can't ignore the animal once you got it. I wouldn't have believed it, but walking the dog has improved my physical and psychological health considerably.
- weavie 9y ago
  > you can't ignore the animal once you got it Sadly you can, and many people do.
- joelrunyon 9y ago
  Thanks for taking the time to give such helpfully feedback.
thenomad 9y ago
Quick note here: an Android app would go a long way to encouraging takeup in the HN crowd, I suspect. I'm already a big fan of mobilisation exercises, so my thought process went "sounds great - where do I download?"..."iPhone only. Meh. Oh well." I know you're working on it, just wanted to give you some feedback to help prioritise.
- joelrunyon 9y ago
  Thanks - we're working on it. We usually build iOS first for the reasons outlined here - https://impossiblex.com/ios-first/ https://impossiblex.com/ios-first/

Latty 9y ago

I mean, given enough competition (which I accept isn't a given), someone will decide getting all of the profit from a cure is worth more than competing for a slice of the treatment market.