8 ms·

I'm going to reply to several thoughts I've seen in this thread. 1) As u/DevX101 said, "The article is based on a collection of anecdotes from responses to a F

I'm going to reply to several thoughts I've seen in this thread. 1) As u/DevX101 said, "The article is based on a collection of anecdotes from responses to a Facebook question: '75% of med students and residents are taking either stimulants or antidepressants or both. True or false?'" It looks like the 75% number is invented and not actually reflective of survey results. 2) Med students would be exactly the type of people that would know that caffeine is technically a stimulant. There are also a decent number of students with valid prescriptions for ADHD, which they would be on regardless of medical school. 3) Medical school has always been hard. But the amount information one has to intake and regurgitate seems to have steadily increased. Meanwhile, medical school remains four years long. Technology has evolved to help students absorb more faster. Spaced repetition. Watching lectures at 2x speed. Massive Q-banks. But you have wonder whether this is sustainable. Five years of medical school is a bit untenable because of the debt. Additionally, our education system is not set up to move the preclinical years to undergrad (which I believe other countries do). EDIT 4) I suspect depression is seriously underdiagnosed in med students and MORE students should be taking antidepressants than those currently on them.

chiefalchemist 8y ago
> "Medical school has always been hard. But the amount information one has to intake and regurgitate seems to have steadily increased. Meanwhile, medical school remains four years long..." It would seem to me the med profession is an ideal place for technology / AI. Docs aren't magicians and House (the TV doc) is fictional. Furthermore, it would seem to me that the aggregation of patient data / symptoms / outcomes would be more beneficial than the single opinion of the one or two docs that see. I'm not trying to dismiss the human element or the knowledge / experience of any single doc, but certainly that shouldn't remain so silo'ed. <sidebar> My father had a (severe) stroke almost 18 months ago. He's doing well and ultimately got good / great care. That said, my sense was most docs favored their (subjective) optinions over what I presumed would be known best practices, etc. Mind you, my assessment is subjective. None the less it was a pattern that existed across multiple shift and med facilities. </sidebar>
- soared 8y ago
  Doctors 100% take advantage of technology, contrary to many comments here. There are search engines that are basically google but for everything medicine related. Your doctor doesn’t know the dosage for most medications, they just look it up on their website.
  - jahewson 8y ago
    > Your doctor doesn’t know the dosage for most medications, they just look it up on their website. And then the local pharmacist corrects it :)
    - classichasclass 8y ago
      My second day of internship, I could already identify which inpatient pharmacist from the beeper number.
  - kendallpark 8y ago
    Yup. UpToDate all day, everyday.
- kendallpark 8y ago
  > It would seem to me the med profession is an ideal place for technology / AI. Docs aren't magicians and House (the TV doc) is fictional. As someone that works on healthcare AI, you'll have to believe me when I say AI physicians are the jetpack of the 21st century. The populace might think they're right around the corner technologically, but there's a lot of obstacles, both technical and human that make it pretty unrealistic. The need for physicians isn't going away anytime soon. In the same way, the profession of piloting hasn't been threatened by autopilot.
  - elliekelly 8y ago
    > The populace might think they're right around the corner technologically, but there's a lot of obstacles, both technical and human that make it pretty unrealistic. And let's not forget regulatory/legal obstacles. Even if we convince doctors and patients of the benefits of AI in healthcare we still have to teach the old farts in Washington what AI is, what AI isn't, and convince them it isn't dangerous. Anyone who watched the Facebook hearings can see how steep that learning curve will be.
subfay 8y ago
why dont you just reply directly? there is a button labeled 'reply' you can click below every post
rurban 8y ago
With stimulants they obviously mean Ritalin. But it could also be just sugar or caffeine, which is cheaper and more effective.
yayana 8y ago
> 4) I suspect depression is seriously underdiagnosed in med students and MORE students should be taking antidepressants than those currently on them. I find that seriously messed up. Maybe it's not 75%, but let's assume an extra margin should be taking antidepressants to exist in the highly competitive med school environment. Further, let's assume that antidepressants progress and competitive programs keep raising the bar based on entrants and dropout rate.. Our public health goal seems to be to develop a society so stressful that psychiatric drugs are not for unbalance in the patient compared to a healthy control but to make unhealthy people that can survive hyper-competition and are maximally profitable for institutions.
- ravenstine 8y ago
  If med students ought to take antidepressants, then athletes ought to take anabolic steroids.
  - rscho 8y ago
    And if payers had their life depending on your 100m dash, they would absolutely do nothing to prevent it and its exactly what would happen.
    - jackpirate 8y ago
      Plenty of soldiers' lives depend on other soldiers' 100m dash times in combat... yet the military is quite good at preventing illegal drug use... and the drugs that soldiers most want to take are drugs that would harm physical performance
      - rscho 8y ago
        Yes, except that people who care for soldiers' lives outside of other soldiers are few and far in between.
      - Permit 8y ago
        No they don't. The marginal running ability (or strength) of a soldier does not save lives. That is, a solider who runs a 12.5s 100m dash will not save more lives than a soldier who runs a 12.6s 100m dash. Obviously there are minimum physical requirements to serve in the military, but once you're in you are not going to start saving more lives because you can run a little bit faster.
rscho 8y ago
I'm with you, especially on 4). Truth be told, doctors work long hours because they are used as the last line of defense for the patient in a ressource-constrained system. This in itself is certainly not optimal, but it seems no one can really come up with a good solution for the time being. Hours and shifts are a very complex problem for health care, and at the risk of appearing presumptuous, I would say that non-MDs and MDs alike do not have a sufficiently clear understanding of all the factors at play to make propositions in full knowledge of the consequences. Only healthcare policy specialists can really find their way in those waters. That said, I would love my shifts to shorten. If that's a good thing for society at large is anyone's guess.
in_cahoots 8y ago
To me the key point is #1. From reading the article, it seems that the number thrown around is 50-75% of students being on antidepressants. And yet the author of the post adds in stimulants when asking for responses. Even then, they don't provide anything but anecdotes. They run a ‘survey’ of 1800 people and don’t provide a single statistic as a result. From this, it's hard to draw any conclusion at all about the prevalence of antidepressant or stimulant use. I'm surprised to see such shoddy work on HN's frontpage; the title is provocative and leads to discussion, but there's nothing to back it up.
skwb 8y ago
1) I find it HIGHLY concerning (albeit not surprised) at the lack of knowledge by a M.D. when it comes to survey bias [0]. It's not a problem to say "hey guys, I have a highly unscientific poll here to just get feeler numbers" but to assert it with such confidence to put it in the title is journalistic malpractice. [0]. https://stattrek.com/survey-research/survey-bias.aspx https://stattrek.com/survey-research/survey-bias.aspx
kokokokoko 8y ago
Top teir schools are full of PEDs at this point. I think software developers might be less aware of how much more effective a drug like Adderall is when you pair it with and antidepressant. Even just caffeine. Removes the main problems of stimulants in the short term. Look up the percentages of professional athletes that have ADD diagnosis which grants them a waiver to use amphetamines during a game. This likely has little to do with mental health.
markdown 8y ago
> Meanwhile, medical school remains four years long. In my country, it's six years long.
- yhoneycomb 8y ago
  Ok, but that means that in your country medicine is an undergrad program. In the US you need a 4 year degree before entering medical school, which is another 4 years.
  - markdown 8y ago
    Interesting. Does the requisite 4yr degree need to be in a relevant field, like biology? Or can a literature or accounting decree count for just as much?
    - gbear605 8y ago
      It can be in any field, but being in a relevant field makes it easier to get into med school.
      - yhoneycomb 8y ago
        > It can be in any field, but being in a relevant field makes it easier to get into med school. Yup. The reason being is that the prereqs for med school are all classes you need to take as a bio major anyway. These are the common prereqs (each school is slightly different, which is stupid): 1 yr biology 1 yr general chemistry 1 yr organic chemistry 1 yr physics 1 yr calculus 1 course in writing
TrainedMonkey 8y ago
Coffee is a stimulant... 64% of Americans take stimulants daily. https://www.foodandwine.com/news/americans-drinking-more-coffee-ever https://www.foodandwine.com/news/americans-drinking-more-cof...
jcoffland 8y ago
> 4) I suspect depression is seriously underdiagnosed in med students and MORE students should be taking antidepressants than those currently on them. Antidepressants are a terrible solution to depression and should only be used in rare cases. They blunt your feelings so that you can keep on with your depressing life choices with out making the changes you need to be really happy. Depression is an indication that you need to make major life changes. It's not a chemical imbalance.
- bluedevil2k 8y ago
  Are you a doctor? A trained medical professional in any way? I’m gonna guess no
  - lolc 8y ago
    Your point being?
    - bluedevil2k 8y ago
      That they’re just some random person on the internet spouting nonsense not backed by any science, no different than an ani-vaxxer or birther.
      - kendallpark 8y ago
        Exactly this. "Depression is an indication that you need to make major life changes. It's not a chemical imbalance" is about as un-researched and un-qualified of a statement one could make. Google Scholar exists. Wikipedia exists. Everyone is has access to these resources.
      - jcoffland 8y ago
        Unlike vaccines, antidepressants have a poor track record of producing measurable quality of life improvements. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3736946/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3736946/ https://www.thecut.com/article/antidepressant-side-effects-quality-of-life.html https://www.thecut.com/article/antidepressant-side-effects-q...
jMyles 8y ago
> There are also a decent number of students with valid prescriptions for ADHD, which they would be on regardless of medical school. This seems far from a foregone conclusion. What makes you think that people use prescription drugs without regard to their life circumstances? Many people acquire prescriptions for their stimulants of choice based specifically on their life plans. I literally personally know two people who, in preparation for (one medical, one law) school, secured supplies of amphetamine from their doctor.
temporallobe 8y ago
More antidepressants are not the answer. I’ve been on them, and while they do “help”, they’re actually quite horrible in the long run. Messing with your brain’s seotonin have all kinds of known and unknown side effects. I think they’re ok as a short-term solution, but resolving the root of the problem is the best way to alleviate depression. Students now, as in the past, have always had a lot of social, financial, and parental pressure to excel in school, however the financial burden for medical school has become ridiculously high, therefore the risk of financial ruin in case of failure or dropout is accordingly higher. Add to that the increasing course loads and complications arising from continual changes in local and national regulations, and it’s no wonder students are depressed at alarming rates.

chiefalchemist 8y ago

> "Medical school has always been hard. But the amount information one has to intake and regurgitate seems to have steadily increased. Meanwhile, medical school remains four years long..." It would seem to me the med profession is an ideal place for technology / AI. Docs aren't magicians and House (the TV doc) is fictional. Furthermore, it would seem to me that the aggregation of patient data / symptoms / outcomes would be more beneficial than the single opinion of the one or two docs that see. I'm not trying to dismiss the human element or the knowledge / experience of any single doc, but certainly that shouldn't remain so silo'ed. <sidebar> My father had a (severe) stroke almost 18 months ago. He's doing well and ultimately got good / great care. That said, my sense was most docs favored their (subjective) optinions over what I presumed would be known best practices, etc. Mind you, my assessment is subjective. None the less it was a pattern that existed across multiple shift and med facilities. </sidebar>

soared 8y ago
Doctors 100% take advantage of technology, contrary to many comments here. There are search engines that are basically google but for everything medicine related. Your doctor doesn’t know the dosage for most medications, they just look it up on their website.
- jahewson 8y ago
  > Your doctor doesn’t know the dosage for most medications, they just look it up on their website. And then the local pharmacist corrects it :)
  - classichasclass 8y ago
    My second day of internship, I could already identify which inpatient pharmacist from the beeper number.
- kendallpark 8y ago
  Yup. UpToDate all day, everyday.
kendallpark 8y ago
> It would seem to me the med profession is an ideal place for technology / AI. Docs aren't magicians and House (the TV doc) is fictional. As someone that works on healthcare AI, you'll have to believe me when I say AI physicians are the jetpack of the 21st century. The populace might think they're right around the corner technologically, but there's a lot of obstacles, both technical and human that make it pretty unrealistic. The need for physicians isn't going away anytime soon. In the same way, the profession of piloting hasn't been threatened by autopilot.
- elliekelly 8y ago
  > The populace might think they're right around the corner technologically, but there's a lot of obstacles, both technical and human that make it pretty unrealistic. And let's not forget regulatory/legal obstacles. Even if we convince doctors and patients of the benefits of AI in healthcare we still have to teach the old farts in Washington what AI is, what AI isn't, and convince them it isn't dangerous. Anyone who watched the Facebook hearings can see how steep that learning curve will be.

subfay 8y ago

why dont you just reply directly? there is a button labeled 'reply' you can click below every post

rurban 8y ago

With stimulants they obviously mean Ritalin. But it could also be just sugar or caffeine, which is cheaper and more effective.

yayana 8y ago

> 4) I suspect depression is seriously underdiagnosed in med students and MORE students should be taking antidepressants than those currently on them. I find that seriously messed up. Maybe it's not 75%, but let's assume an extra margin should be taking antidepressants to exist in the highly competitive med school environment. Further, let's assume that antidepressants progress and competitive programs keep raising the bar based on entrants and dropout rate.. Our public health goal seems to be to develop a society so stressful that psychiatric drugs are not for unbalance in the patient compared to a healthy control but to make unhealthy people that can survive hyper-competition and are maximally profitable for institutions.

ravenstine 8y ago
If med students ought to take antidepressants, then athletes ought to take anabolic steroids.
- rscho 8y ago
  And if payers had their life depending on your 100m dash, they would absolutely do nothing to prevent it and its exactly what would happen.
  - jackpirate 8y ago
    Plenty of soldiers' lives depend on other soldiers' 100m dash times in combat... yet the military is quite good at preventing illegal drug use... and the drugs that soldiers most want to take are drugs that would harm physical performance
    - rscho 8y ago
      Yes, except that people who care for soldiers' lives outside of other soldiers are few and far in between.
    - Permit 8y ago
      No they don't. The marginal running ability (or strength) of a soldier does not save lives. That is, a solider who runs a 12.5s 100m dash will not save more lives than a soldier who runs a 12.6s 100m dash. Obviously there are minimum physical requirements to serve in the military, but once you're in you are not going to start saving more lives because you can run a little bit faster.

rscho 8y ago

I'm with you, especially on 4). Truth be told, doctors work long hours because they are used as the last line of defense for the patient in a ressource-constrained system. This in itself is certainly not optimal, but it seems no one can really come up with a good solution for the time being. Hours and shifts are a very complex problem for health care, and at the risk of appearing presumptuous, I would say that non-MDs and MDs alike do not have a sufficiently clear understanding of all the factors at play to make propositions in full knowledge of the consequences. Only healthcare policy specialists can really find their way in those waters. That said, I would love my shifts to shorten. If that's a good thing for society at large is anyone's guess.

in_cahoots 8y ago

To me the key point is #1. From reading the article, it seems that the number thrown around is 50-75% of students being on antidepressants. And yet the author of the post adds in stimulants when asking for responses. Even then, they don't provide anything but anecdotes. They run a ‘survey’ of 1800 people and don’t provide a single statistic as a result. From this, it's hard to draw any conclusion at all about the prevalence of antidepressant or stimulant use. I'm surprised to see such shoddy work on HN's frontpage; the title is provocative and leads to discussion, but there's nothing to back it up.

skwb 8y ago

1) I find it HIGHLY concerning (albeit not surprised) at the lack of knowledge by a M.D. when it comes to survey bias [0]. It's not a problem to say "hey guys, I have a highly unscientific poll here to just get feeler numbers" but to assert it with such confidence to put it in the title is journalistic malpractice. [0]. https://stattrek.com/survey-research/survey-bias.aspx https://stattrek.com/survey-research/survey-bias.aspx

kokokokoko 8y ago

Top teir schools are full of PEDs at this point. I think software developers might be less aware of how much more effective a drug like Adderall is when you pair it with and antidepressant. Even just caffeine. Removes the main problems of stimulants in the short term. Look up the percentages of professional athletes that have ADD diagnosis which grants them a waiver to use amphetamines during a game. This likely has little to do with mental health.

markdown 8y ago

> Meanwhile, medical school remains four years long. In my country, it's six years long.

yhoneycomb 8y ago
Ok, but that means that in your country medicine is an undergrad program. In the US you need a 4 year degree before entering medical school, which is another 4 years.
- markdown 8y ago
  Interesting. Does the requisite 4yr degree need to be in a relevant field, like biology? Or can a literature or accounting decree count for just as much?
  - gbear605 8y ago
    It can be in any field, but being in a relevant field makes it easier to get into med school.
    - yhoneycomb 8y ago
      > It can be in any field, but being in a relevant field makes it easier to get into med school. Yup. The reason being is that the prereqs for med school are all classes you need to take as a bio major anyway. These are the common prereqs (each school is slightly different, which is stupid): 1 yr biology 1 yr general chemistry 1 yr organic chemistry 1 yr physics 1 yr calculus 1 course in writing

TrainedMonkey 8y ago

Coffee is a stimulant... 64% of Americans take stimulants daily. https://www.foodandwine.com/news/americans-drinking-more-coffee-ever https://www.foodandwine.com/news/americans-drinking-more-cof...

jcoffland 8y ago

> 4) I suspect depression is seriously underdiagnosed in med students and MORE students should be taking antidepressants than those currently on them. Antidepressants are a terrible solution to depression and should only be used in rare cases. They blunt your feelings so that you can keep on with your depressing life choices with out making the changes you need to be really happy. Depression is an indication that you need to make major life changes. It's not a chemical imbalance.

bluedevil2k 8y ago
Are you a doctor? A trained medical professional in any way? I’m gonna guess no
- lolc 8y ago
  Your point being?
  - bluedevil2k 8y ago
    That they’re just some random person on the internet spouting nonsense not backed by any science, no different than an ani-vaxxer or birther.
    - kendallpark 8y ago
      Exactly this. "Depression is an indication that you need to make major life changes. It's not a chemical imbalance" is about as un-researched and un-qualified of a statement one could make. Google Scholar exists. Wikipedia exists. Everyone is has access to these resources.
    - jcoffland 8y ago
      Unlike vaccines, antidepressants have a poor track record of producing measurable quality of life improvements. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3736946/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3736946/ https://www.thecut.com/article/antidepressant-side-effects-quality-of-life.html https://www.thecut.com/article/antidepressant-side-effects-q...

jMyles 8y ago

> There are also a decent number of students with valid prescriptions for ADHD, which they would be on regardless of medical school. This seems far from a foregone conclusion. What makes you think that people use prescription drugs without regard to their life circumstances? Many people acquire prescriptions for their stimulants of choice based specifically on their life plans. I literally personally know two people who, in preparation for (one medical, one law) school, secured supplies of amphetamine from their doctor.

temporallobe 8y ago

More antidepressants are not the answer. I’ve been on them, and while they do “help”, they’re actually quite horrible in the long run. Messing with your brain’s seotonin have all kinds of known and unknown side effects. I think they’re ok as a short-term solution, but resolving the root of the problem is the best way to alleviate depression. Students now, as in the past, have always had a lot of social, financial, and parental pressure to excel in school, however the financial burden for medical school has become ridiculously high, therefore the risk of financial ruin in case of failure or dropout is accordingly higher. Add to that the increasing course loads and complications arising from continual changes in local and national regulations, and it’s no wonder students are depressed at alarming rates.