43 ms·

A new book critiques medicine

144 points by Elof 7y ago

natrik 7y ago
Stegenga calls these latter two “magic bullets,” a phrase coined by physician/chemist Paul Ehrlich to describe treatments that target the cause of a disease without disrupting the body’s healthy functions. Researchers have labored mightily to find more magic bullets, but they remain rare. For example, imatinib, brand name Gleevec, is “an especially effective treatment” for one type of leukemia, Stegenga says. But Gleevec has “severe adverse effects, including nausea, headaches, severe cardiac failure and delayed growth in children.” Most would prefer these symptoms over death. https://en.wikipedia.org/wiki/Betteridge%27s_law_of_headlines https://en.wikipedia.org/wiki/Betteridge%27s_law_of_headline...
- deleted 7y ago
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lukifer 7y ago
See also: Anatomy of an Epidemic [0], about when pharmaceuticals to treat mental health issues become problems in their own right; and, the chapters on medical intervention in Elephant in the Brain [1], which argue persuasively that much of the medical system functions to deliver social signaling of care, rather than improved health outcomes. [0] https://en.wikipedia.org/wiki/Anatomy_of_an_Epidemic https://en.wikipedia.org/wiki/Anatomy_of_an_Epidemic [1] http://elephantinthebrain.com/ http://elephantinthebrain.com/
rayiner 7y ago
Note that the author is a “science journalist” with a degree in journalism, not medicine or even STEM.
- paulddraper 7y ago
  So...?
  - pessimizer 7y ago
    rainier said "note..." so it can't be an ad hominem, it's just a note.
- casefields 7y ago
  How about a former editor of the British Medical Journal: https://blogs.bmj.com/bmj/2018/06/04/richard-smith-the-case-for-medical-nihilism-and-gentle-medicine/ https://blogs.bmj.com/bmj/2018/06/04/richard-smith-the-case-...
- tptacek 7y ago
  I'm not sure what the quotes are for. Journalists have beats. Conflict journalists, for example, do not generally have military backgrounds. White House correspondants have not generally run for public office.
  - rayiner 7y ago
    They’re scare quotes. Some subjects can be reported on by generalists. But I think some require special expertise to put into context. I wouldn’t want to read an article from a “tech journalist” criticizing the approaches Netflix uses to scale its systems to be able to stream terabytes of data per day. Likewise, I don’t think someone without medical training is qualified to write articles about whether medicines are effective or not.
    - tptacek 7y ago
      Really? That's an interesting example to choose, since John Carreyrou didn't have any medical training and almost singlehandedly brought Theranos to its abrupt end. Later, because it was bugging me There's also distinctions to be made between a "generalist" and a "practitioner". Beat reporters are specialists, not generalists. They've cultivated sources and, over their careers, expertise. Roger Ebert wasn't a filmmaker, but he sure as hell knew more about films and their language and idiom than a WSJ business reporter (who in turn knows more about collateralized debt than Ebert). Extending the analogy further: I'm capable of critiquing cryptosystems and finding/exploiting vulnerabilities in them, but I'm not a cryptographer and am not qualified to build them myself. Do you need an example of a non-programmer tech reporter worth reading? Happy to provide one.
redder2 7y ago
Answer: Yes totally overrated!
- dang 7y ago
  Maybe so, but can you please not post unsubstantive comments here? https://news.ycombinator.com/newsguidelines.html https://news.ycombinator.com/newsguidelines.html
RandomBacon 7y ago
The anti-vaxxers think it is. We need to be careful how we say this, because then you get generalities like the title and people who shun the basic of medicines such as neccessary vacinations.
- julienreszka 7y ago
  > "We need to be careful how we say this" Who is "we" ?
  - RandomBacon 7y ago
    People who don't want to further misinformation.
- alyx 7y ago
  Many "anti-vaxxers" are simply concerned parents. Considering that vaccines (in general) have been deemed "unavoidably unsafe" at the Supreme Court level, they are not completely unjustified in their fears. [0] Vaccine manufactures cannot be held liable. Thus there is a "National Vaccine Injury Compensation Program" put in place to compensate those that have been damaged by vaccinations. To date, over $4 billion dollars has been paid out in damages. [1] Just as mentioned in this article, side effects are major deterrents of any medication. And significant efforts need to be made in order to ensure that side effects do not occlude positives effects. [0]: https://www.supremecourt.gov/opinions/10pdf/09-152.pdf https://www.supremecourt.gov/opinions/10pdf/09-152.pdf [1]: https://www.hrsa.gov/sites/default/files/hrsa/vaccine-compensation/data/monthly-stats-july-2019.pdf https://www.hrsa.gov/sites/default/files/hrsa/vaccine-compen...
  - deleted 7y ago
    [deleted]
  - RandomBacon 7y ago
    The Supreme Court consists of zero medical doctors. Do not take a legal opinion and present it as medical fact.
  - 7y ago
wtdata 7y ago
Scientific American is getting very non scientific. A couple of days ago we got the: "Fat Is Not the Problem—Fat Stigma Is", now this article. What follows, "Aliens may have built the Pyramids after all"?
- julienreszka 7y ago
  Can you quote what you think is non scientific in the article "Is medicine overrated" ?
  - sadObserver 7y ago
    Mostly everything, including associating longevity with nutrition and sports when it's been documented ad nauseam that it increased dramatically with antibiotics and vaccines. Not that nutrition and sports don't play a role, but it's insignificamt when compared to modern medicine. Just one example of many on that nonsense article.
codingslave 7y ago
I've long believed that once startups and tech companies get their hands on medical data (patient outcomes, medication treatment outcomes, mal practice rates, surgery outcomes) that a reckoning will take place on the medical industry. The level of legitimacy and respect that doctors and hospitals currently have is far too high, and hinges on branding and the exclusivity of becoming a doctor. Once all of this data becomes available, it will be obvious how worthless and expensive most medical treatments really are. Most prescription drugs do nothing, and the ones that do something are more so just covering the symptoms. HIPAA laws are hiding patient outcomes and holding this whole sham afloat.
- sica07 7y ago
  There were and are a lot of articles about the fact that many prescription drugs and many treatments are overrated and I totally belive that. But saying that "most" medical treatments & prescription drugs are worthless it's quite a radical view based on... pure speculation.
  - rjf72 7y ago
    I think your statement sounds perfectly reasonable, but it actually holds a pretty interesting corollary! If he is wrong that "most" medical treatments and prescriptions are worthless then that would necessarily mean that "most" are valuable. The reason this is interesting is because the exponentially increasing rate of both the amount of medication out there and the amount people are using. For instance from 1997 to 2016 the number of prescriptions filled grew from 2.4 billion to 4.5 billion [1]. And an exponentially increasing number of people, across all ages and demographics, are also being medicated with all sorts of drugs for various reasons. So, if we assume that most medical treatments and prescriptions are not worthless we should see increases in healthfulness that are at least somewhat comparable with our increases in pharmaceutical usage. In reality we saw sharply diminishing returns on life expectancy that have now gradually shifted towards an ongoing decline in life expectancy over the past few years. By any standard of effectiveness, this is not looking good for pharmaceuticals. So I suppose I'd turn it around. I think the view that medicines (and especially their recent exponential growth) are providing a substantial social benefit could be true, but it would seem to be the statement that needs to be explained. E.g. perhaps our own increasingly unhealthy lifestyles are contravening the gains from the medical technology? No idea there, but I do think occam's razor would tend to simply suggest that the reason we're not seeing improvements is because we're not improving. [1] - https://www.webmd.com/drug-medication/news/20170803/americans-taking-more-prescription-drugs-than-ever-survey https://www.webmd.com/drug-medication/news/20170803/american...
astura 7y ago
>The New York Times reported that in 2014 physicians wrote 83,000 prescriptions for antidepressants and almost 20,000 prescriptions for antipsychotic medications for infants two years old and younger Wow... This seems very obviously inappropriate. I listened to the EconoTalk interview referenced in TFA after hearing about it on another HN thread. Highly recommended. I have to say that I have become skeptical of medicine after personally seeing the sheer amount of unscientific and potentially harmful practices that are advocated for by medical practicers. I think there's a lot of good, but wayyyyyy too much bad.
- dkarl 7y ago
  My brother-in-law, who has a mental disability, saw a gastroenterologist for abdominal pain. They found worms and prescribed him a drug to get rid of the worms. The doctor said the worms could cause abdominal pain, but then again in most cases they don't, so he also put him on a drug for irritable bowel syndrome. After a couple of weeks, the stomach pain went away, but meanwhile my brother-in-law was having issues with mental coherence, drowsiness, and sleep disturbances. Other people who interacted with him were concerned about him, too. He has a mental disability and diabetes and other health issues, so our first thought was the usual suspects, not his IBS medication, but eventually I realized that neither my wife nor myself knew anything about it, so I looked it up. It turned out the new medication was an antidepressant with a laundry list of side effect, including drowsiness and sleep disturbances. We weaned him off it, and he came back to normal pretty quickly. No stomach pain, either. So, to sum up, the doctor saw a patient with worms and abdominal pain and decided to put him on an antidepressant for the rest of his life because the kind of worm infestation he had would only cause pain in a minority of cases.
  - astura 7y ago
    I actually suspect a fairly large amount of those prescriptions were for off label use. But... Seems like the sort of side effects these medicines have should give us a pause when using them on vulnerable populations. Especially when the benefits are not especially clear.
goldcd 7y ago
It's not over-rated - but it's complicated. Even that short article covered a number of items that could all happily be spun out into full-blown essays. "Over-medication" - just as a term. Could be people taking medicines that: Aren't cost-effective (whatever your system, there's a finite resource at the core). Aren't quality of-life improving (doctors themselves tend to consume less life-extending stuff at the very end). They paid for (You've paid insurance, you're ill, you want to be given something).
amriksohata 7y ago
Yes,it is, as it's about profit so always about cure, never prevention
braindead_in 7y ago
So why do the drug companies charge so much for the medicines then? I just finished watching the Valeant episode of Dirty Money and combined with this book, it all kind of makes no sense.
maxander 7y ago
“Spending too much on medicine” isn’t like spending too much on clothes or nice houses. If the consumer goods you buy are crummy and don’t improve your life you can do without them, but we’re essentially unable to decide we can do without health. Demand for cures for our diseases is different than demand for other things, and that shows up both in the sorry economic structure of our (U.S.) health system, and here. If we had more medical treatments that worked, and a lab-to-hospital pipeline with a better track record, I suspect better scientific standards would follow naturally. But for now, raising the standards of evidence would essentially block off the invention of new treatments altogether, which simply isn’t an option even on a psychological level.
- julienreszka 7y ago
  > "raising the standards of evidence would essentially block off the invention of new treatments altogether" Citation needed.
yourMadness 7y ago
Modern medicine has some aspects that are miraculously good and it is easy to fall into the trap of thinking that those are representative for all of medicine. It's a kind of halo effect bias. In my opinion the most amazing thing still is antibiotics (and vaccination). Treatmeant of war/vehicle/sports injuries taking the second place (including anesthetics). Both can take people from a path of sure death within hours or days to often complete recovery within weeks or months. If that is the performance expectation of the general public for all of medicine, then it certainly is overrated.
- m0zg 7y ago
  As someone who has had some less-acute sports injuries, I'd also break the injuries down into "shit's really fucked up" and "you could conceivably walk it off" categories. The former, modern US medicine excels at. The latter, I'm not sure the doctors are even trained to treat something less acute and not requiring expensive surgery. In fact, I strongly suspect they often prescribe a surgery anyway, just to make a buck. I had to decline a surgery once.
- pvaldes 7y ago
  > Modern medicine has some aspects that are miraculously good... like antibiothics and injuries treatment Not to mention having all valuable poisons in the planet in a nice packed, chemically pure, split in comfortable monodose capsules, accurately measured and checked for 10 years before enter in your body, packed guaranteeing non posterior adulteration as long as the plastic seal is not broken, extensively documented in several languages and available at less than ten minutes away from your home. This is probably the biggest bonus from the real medicine.
agumonkey 7y ago
Let me extend the query, is "modern medicine" overrated. Modern technology + western like urban lifestyle changed how we live.. and how much medicine we think we need. Walking in the woods is probably as effective as the average anti depressant. Good physical activity too. But we sell that modern life is great and that ailments are normal and that thanks to the medical field we have all these solutions.. that we probably didn't need in the first place.
- gtirloni 7y ago
  Sure, for that specific situation maybe physical activity is a good solution. But what's next? Anti-vaxxer stupidity?
- Reedx 7y ago
  Regular exercise, good diet and quality sleep prevent/solve most health problems. If exercise were in pill form, it'd be the most valuable pill.
  - agumonkey 7y ago
    Too bad gravity is free
  - scarface74 7y ago
    That leSs down the dangerous road that many who are against universal healthcare go down (not saying you were implying it). That most health problems are caused by poor decisions. These are the top 10 causes of death. https://www.cdc.gov/nchs/fastats/leading-causes-of-death.htm https://www.cdc.gov/nchs/fastats/leading-causes-of-death.htm How many of those could be prevented by good diet, quality sleep and exercise?
    - Firadeoclus 7y ago
      You can't prevent death, only prolong life. Most of those causes are accelerated by poor diet, poor sleep and lack of exercise.
- 7y ago
lordnacho 7y ago
It's quite odd to dismiss better sanitation and nutrition as not medicine, isn't it? I think the problem is that we take for granted the things that have been discovered, because they were found a long time ago. Washing surgeons' hands in carbolic acid help puerperal fever rates. Cholera has something to do with water. Vaccination works. All those things happened way before any living person remembers. From what I hear among pharma friends, the problem is also that the low hanging fruit has been picked. A lot of lines of inquiry are variations of the same thing, and over time we've found what is there to be found. If you think about it, it makes sense that it's like that. Something really powerful like vaccination is going to pop out of the stats immediately. Subtler effects require more trials to detect. In any case, it's a greater danger that there are people who don't believe in evidence based inquiry at all pretending to be medical professionals. Look at anti-vaxxers, or the Goop type quackery.
sadObserver 7y ago
Anti-vaccine groups referencing and quoting this article in 3,2,1..
rhinoceraptor 7y ago
Modern medicine is great when you get in a car crash, and it's horrific if you have type 2 diabetes. Doctors get very little training in diet and lifestyle, because those are low-status and left to non-MD specialists, and many of them dogmatically cling to 1960s-era science.
- primroot 7y ago
  No diet, no lifestyle, and not even history https://www.ncbi.nlm.nih.gov/pubmed/24811552 https://www.ncbi.nlm.nih.gov/pubmed/24811552
- qrbLPHiKpiux 7y ago
  Today we know that: limit eating, calorie restriction, little sugar consumption, can reverse type 2 diabetes and greatly reduce body inflammation, which is thought to give rise to all our modern diseases.
  - scarface74 7y ago
    All modern diseases - really?
- rscho 7y ago
  You really think endocrinologists have no training in diet and lifestyle? Well, what can I say. No?
  - rhinoceraptor 7y ago
    > On average, U.S. medical schools offer only 19.6 hours of nutrition education across four years of medical school https://health.usnews.com/wellness/food/articles/2016-12-07/how-much-do-doctors-learn-about-nutrition https://health.usnews.com/wellness/food/articles/2016-12-07/...
    - rscho 7y ago
      That's for basic med school education. Happily, medical education doesn't stop at the end of med school. It is more like, beginning just at that moment. Otherwise many more patients would die. So yes, on paper you're right. In practice, there are even clinical nutrition specialists and those are MDs.
codingdave 7y ago
I've always looked at western medicine as if it was the best car mechanic you can hire, just for your body. If your problem is mechanical, they can solve it. Surgical techniques are amazing. Breakdowns in known processes can be fixed. But if the problem doesn't fit those known processes, isn't mechanical, and you are relying on doctor for real troubleshooting of problems, that is where it falls short. You can fall into the weird gap of talking to different specialists, trying to find someone who can pinpoint what is wrong. You try different treatments, you see what works. Sometimes you solve problems, sometimes you end up living your whole life managing symptoms. And that isn't all bad - better to manage symptoms than to live in misery, or not to live. But the word 'over-rated' is quite accurate. It isn't useless, it just is over-rated.
- crispinb 7y ago
  'Western' medicine though as opposed to what? Nostalgic prescientific systems such as Chinese, ayurvedic, etc don't do anything at all. So yes, scientific medicine definitely has huge lacunae. Given the relative slowness of progress in understanding complex systems science has had in general, they'll be there for a long to come. But it's not as if there's some other candidate 'system' that has a better understanding.
  - coldtea 7y ago
    >'Western' medicine though as opposed to what? Nostalgic prescientific systems such as Chinese, ayurvedic, etc don't do anything at all. That's not really true. Their explanations can be hocus pocus, but their mechanics/drugs/techniques can be as effective as western versions, simply come around by tradition/trial and error/Lindy effect and so on for millennia.
    - rscho 7y ago
      As effective as western versions, and often even identical but in a far less controlled form. Also often just as toxic.
      - 7y ago
JamesBarney 7y ago
There are legitimate concerns about some drugs being overprescribed and others being underprescribed. But this article doesn't really she'd much light on it. Are some medicines probably overprescribed? Sure. Are some medicines underprescribed? Definitely. For most medicines are there people who could benefit from taking it and aren't while simultaneously there are people who would benefit from stopping the medicine? Almost assuredly. And medical research is what we do to try to answer these questions in ways that are helpful.
rjf72 7y ago
I think the article (and presumably the book) bring up a lot of great points about systemic issues with medicine, but I also think there is another much more macro level argument. The Ancient Greeks were, in terms of medicine, almost completely ignorant. They had no idea about germs; instead focusing their medical theory around the 4 humors - blood, phlegm, yellow/black bile and miasma theory. What's good drinking water? Water that tastes clean. Vaccines? That'd come about 3,000 years later. And they engaged in hygiene habits we might find a wee bit dodgy. For instance at the public toilets there obviously were no toilet paper dispensers. Instead they'd use sponges - butt brushes. After one fellow finished his business you'd give it a swish around in some water or, for the fancier toilets - vinegar, and take your turn. But the thing is is that they (and I am referring to the upper class here) had life expectancies that were not what you'd think. This [1] great article from the BBC has quite a lot of interesting data. For instance of some 298 recorded individuals of ancient Greece/Rome, the median life expectancy was 72 years. Some random famous names: Pythagorus - 75, Hippocrates - 90, Plato - 80, etc. There is of course some selection bias in that sample, but you can also see evidence of longevity in other ways. For instance in Ancient Rome one could not hold the office of Consul until reaching the age of 43, first office was not available until age 30. The article also goes on to analyze numerous other sources than tend to paint a recurring picture: there was high infant and youth mortality, but people who made it to adulthood tended to have a life expectancy not all that different than we do today. It seems to suggest that a large part of our increased life expectancy is not from the trillions of dollars we've spent on trying to find a [profit making] pill for everything, but instead from very simple things like access to clean water and food. --- Finally there is a little 'paradox' that should always be brought up in medicine and in particular efforts to try to squeeze out every slimmer gains. Imagine you have a test that is 99.9% accurate for some illness. And 1 in a million people have this illness. If somebody tests positive, what are the chances that this is a false positive? 99.9%! In a million people our 99.9% accurate test will give 1,000 hits - yet only 1 person will actually have the illness. You'd probably end up seeing a negative return on life expectancy here just because of how many people you'd be scaring witless after informing them they need to come back in for follow up testing. Seriously, just take a few days off their lives and you've already gotten rid of the gains in expectancy for the 1 in 1000 guy. [1] - http://www.bbc.com/future/story/20181002-how-long-did-ancient-people-live-life-span-versus-longevity http://www.bbc.com/future/story/20181002-how-long-did-ancien...
1e-9 7y ago
Medications are a particular problem. It took decades of massive use for us to even realize that some of our most common over-the-counter drugs were being used in dangerous ways (e.g. aspirin can cause Reye's syndrome in children, Tylenol with alcohol can damage the liver). On top of that, I think drug interactions are a much larger problem than most people realize and that we have little idea of what we are doing to ourselves when we take multiple medications. A recent study [1] on just prescription drugs counted 220 million unique drug combinations experienced by a subset of the US population over intervals of about 3 years. How many of those combinations have been studied for safety? I'll make a wild guess that it's probably far less than 1%. I think it prudent to minimize one's medication exposure to the bare minimum that is absolutely necessary. [1] https://www.nature.com/articles/sdata2017167 https://www.nature.com/articles/sdata2017167
mistermann 7y ago
> decades of massive use for us to even realize that some of our most common over-the-counter drugs were being used in dangerous ways (e.g. aspirin can cause Reye's syndrome in children, Tylenol with alcohol can damage the liver) Agreed, but then to some degree could this same argument not be made about vaccines?
- carapace 7y ago
  No. It's pretty clear, even if the anti-vaxxer lunatics were not wrong (which they are, they are wrong, they are perniciously wrong, in the face of all evidence they are wrong), that vaccines would be a net benefit. In other words, even if vaccines did cause autism (which they do not) it would still be imperative to use them. The alternative to widespread vaccination is much worse.
  - mistermann 7y ago
    > No. It's pretty clear, even if the anti-vaxxer lunatics were not wrong (which they are, they are wrong, they are perniciously wrong, in the face of all evidence they are wrong), that vaccines would be a net benefit. Are the "anti-vaxxer lunatics" arguing that vaccines are not a net benefit? When you refer to "anti-vaxxer lunatics", who is it, exactly, are you referring to? Are you referring to specific people (everyone within the "anti-vaxx" "community"), or are you referring to an abstract mental model, of questionable accuracy, held in your own mind? > even if vaccines did cause autism (which they do not) These sorts of comment lack epistemic humility/awareness. We do not know that vaccines do not cause autism. Science does not say this. However, this isn't to say that science says vaccines do cause autism. What causes autism is unknown. The final knowledge of an association between vaccines and autism is unknown. To some degree, the "pro-vaxx" message is based on propaganda (here I am referring to the lesser pejorative meaning of the word). Many within the "anti-vaxx" community can see this, and it is used in various ways as leverage. Which is, of course, also propaganda (the more pejorative kind - typically, but not always). This approach has been sound in the past, but there are increasing signs that it is becoming less effective. Time will tell if that trend continues.
carapace 7y ago
Has anyone mentioned this already? > Medical errors are the third-leading cause of death after heart disease and cancer. https://www.cnbc.com/2018/02/22/medical-errors-third-leading-cause-of-death-in-america.html https://www.cnbc.com/2018/02/22/medical-errors-third-leading... I agree with Stegenga: > There is no place I would rather be after a serious accident than in an intensive care unit. For a headache, aspirin; for many infections, antibiotics; for some diabetics, insulin—there are a handful of truly amazing medical intervention, many discovered between seventy and ninety years ago. However, by most measures of medical consumption—number of patients, number of dollars, number of prescriptions—the most commonly employed interventions, especially those introduced in recent decades, provide compelling warrant for medical nihilism. - - - - I was just reading about "The China Study", https://en.wikipedia.org/wiki/The_China_Study https://en.wikipedia.org/wiki/The_China_Study > The China Study is a book by T. Colin Campbell and his son, Thomas M. Campbell II. It was first published in the United States in January 2005 and had sold over one million copies as of October 2013, making it one of America's best-selling books about nutrition.[1][2][3] > The China Study examines the link between the consumption of animal products (including dairy) and chronic illnesses such as coronary heart disease, diabetes, breast cancer, prostate cancer, and bowel cancer.[4] The authors conclude that people who eat a predominantly whole-food, plant-based diet—avoiding animal products as a main source of nutrition, including beef, pork, poultry, fish, eggs, cheese, and milk, and reducing their intake of processed foods and refined carbohydrates—will escape, reduce, or reverse the development of numerous diseases. Now I'm a pretty "fringe" kind of guy, and there's some stuff in there that even I have trouble with (animal protein is highly carcinogenic? Eh what?) But the basic idea of nutrition affecting health, or more accurately being the foundation of health, seems sound to me, and my attempts to eat a "whole-food, plant-based diet" have been very positive. Although I did send my digestion for a loop by "cutting over" too fast once. It takes about three days for your guts (microbiome and own) to adjust to a big change in diet, FWIW. In any event it's batshit insane that convention medicine treats nutrition as an afterthought. (There's a wonderful confluence between eating a whole-food, plant-based diet and the ecological repair of our food systems.) - - - - Now let me push the boundaries. I burned the tip of my thumb the other day taking a pan out of the oven, 450°F. I was careless and didn't quite hold the potholder correctly, burn reflex overridden so I wouldn't drop the pan, it melted the fingerprint whorls. After I finished hopping up and down, pissed off at my own carelessness, I took a few moments to "beam" Reiki to my thumb, while concentrating on communicating with my healing and immune responses telling them to "get in there and clean things up". The pain went away and didn't come back. A very modest blister formed under the melted skin. The spot was tender, and it stung a bit if I let hot water touch it the first day, but after that there was no tenderness. Two days later the blister was gone. The skin is slightly rough, but it's not peeling, nor is it a scab. Day three I woke up and forgot that I had burned myself. The flesh apparently reconstituted itself. I'm not sure it will even leave a scar. The skin still hasn't peeled. In sum, a minor second-degree burn, apply ten seconds of Reiki, result: no pain and accelerated healing. "The future is here, it's just not evenly distributed yet."
JamesCoyne 7y ago
If you are intrigued by the thesis of the book, EconTalk has an episode with the author. https://www.econtalk.org/jacob-stegenga-on-medical-nihilism/ https://www.econtalk.org/jacob-stegenga-on-medical-nihilism/
flying_kiwi 7y ago
These comments just reek of the silicon valley tech-bro myth that because you're good with computers you must know better than the millions of brilliant smart people in $INDUSTRY. The absolute arrogance.
- bedobi 7y ago
  Welcome to HackerNews! Threads about Medicine and Economics are some of the worst - everyone here is apparently a Nobel grade expert.
  - golemiprague 7y ago
    The problem with economics that even the Nobel grade experts have very different opinions about anything and everything. Medicine is a bit different I believe
  - TeMPOraL 7y ago
    > Threads about Medicine and Economics are some of the worst Compared to what? What you'd have on a forum of economists or doctors? Maybe. What you would be reading otherwise? Not quite. > everyone here is apparently a Nobel grade expert. Maybe not Nobel-grade, but there's plenty of actual doctors on HN.
- cheesymuffin 7y ago
  And yet, in every 100 bullshit tech-bro commenters, there are 10 who are actually getting really interested in the subject and taking the time to check their old Bio notes, research opposing viewpoints, or maybe even bring something new to the table. Hating is easy. All you have to do is point fingers at people and tell them they know nothing. 100% of the time you'll be right.
  - meruru 7y ago
    I've always seem this kind of criticism of the "tech bubble" as a great endorsement of the tech community. Where else do you see people so interested in so many subjects that they have to be constantly reminded they are speaking outside their expertise? Am I just not aware of the HN equivalent for medical doctors?
rscho 7y ago
I would like to make a personal statement to the tech community in view of this thread's comments: A vast majority of you drastically overestimate the information processing and retrieval of the healthcare system. We MDs can all see your superb AI/ML results in journals, and yes you can improve things with technology. What we can't see is how we're going to use it. In my day-to-day job, there are a myriad of new-super-devices-that-automatically-do-that-thing but NONE are integrated into my workplace. NONE make my job less painful. NONE make me gain time instead of losing it. You want to help. Cool, then stop masturbating on the results of your unusable new oncology deep-learning thingy and push for WORKPLACE INTEGRATION of technology, damn it! Maybe if the tech community comes to understand how it can really help clinicians, things will start to change the way you fancy and we can finally end the age of rote memorization and criminal overtime for MDs.
- bigred100 7y ago
  I’d imagine the people writing these wonderful journal articles care more about writing journal articles than that stuff. In fact, they are probably employed to write those articles. Anyway I can’t really comment on why they would or would not masturbate on a scientific paper. You are the doctor.
- arpa 7y ago
  Yes! healthcare informatics is so much more than just dispensing magical vitamins, when MDs and patients need painkillers. We have had terms like PHR and EHR for thirty years now, we have HL7, together with FHIR, and we have PACS, but these terms are still not ubiquitous. There has been major developments in developing classifiers like SNOMED, AHCI and ICD, yet MDs mostly still type the diagnosis up, and consider themselves lucky if the HIS has some templating capability. And very few HISes are capable of getting the personal health records to the patient - i mean, it is more likely you get a xerox of your case than something in a portable format that other HISes can understand if you change your healtcare provider... However, it is somewhat strange that personal health projects keep dying - google health discontinued in 2011, microsoft healthvault to be closed in 2019 - and these are by major players - maybe somebody has some insight why they fail?
- kowdermeister 7y ago
Gatsky 7y ago
Anyone receiving or delivering healthcare is aware of these problems. These kind of critiques suffer from the same basic problem - they treat Medicine as a monolithic entity which is not intimately linked with society, culture, the economy and government. This conceit is necessary to write a book about it, and is a luxury available only to those who don't need to actually deliver or administer healthcare. It is also not the same thing as 'trying to make things better', despite what the author may claim. In truth the author is actually critiquing what they have decided falls under the umbrella of medicine, which they define at a particular point in time. The problem is incentives, not sure why this guy wrote a whole book without realising this, but it is an easy mistake to make if you are thinking about the problem from your writing desk. People will minimise effort and cost, given a choice, and maximise profit subject to constraints. This behaviour exists even in highly trained health professionals already making many hundreds of thousands of dollars a year. Example - why do primary care doctors prescribe minimally effective drugs for depression? Is it because they can't understand a meta-analysis, can't remember all the patients the drugs didn't work for in their own practice, or because they are lazy or stupid? It is because a patient has come in looking for help and is sitting there in tears, and there is only 10 minutes to see them, and the history from the other doctor this person has been seeing for the last 5 years isn't available. And although everyone would be better off if the doctor spent an hour finding out in detail what is going on, carefully talking over the options, the side effects of various treatments and reaching a consensus management plan which starts with non-pharmacological therapies, and activates a government program which allows the patient to take extra time off work to attend therapy sessions with childcare facilities included. But it is easier for everyone to prescribe Prozac. This is the reality. Perverse incentives explain many of the problems in Medicine and healthcare systems. Nobody gets paid for delivering good care, nobody saves money by accepting good care. As shocking as it may be, delivering good care or exceptional care is a choice a health care team makes despite everything else. Similarly, accepting proven health care interventions is a choice a patient makes. Usually everything doesn't line up, and that is modern medicine. The cited example of Gleevec also makes no sense to me. It revolutionised the treatment of 2 conditions which were almost completely untreatable beforehand (Chronic Myeloid Leukaemia and Gastrointestinal Stromal Tumour). The alternatives to taking Gleevec for these patients were A) Toxic minimally effective chemotherapy followed by death or B) Just death. All of this context is extremely important in discussing the side-effects which can be severe. This is what the patient and the doctor work out together. Some throwaway line about how toxic it is just makes no sense in isolation.
zby 7y ago
Update: If trials by manufacturers are biased - then how about some framework that would push trials made by competition. There are two things: One is bad science, and we have a lot of it (https://en.wikipedia.org/wiki/Replication_crisis https://en.wikipedia.org/wiki/Replication_crisis, https://library.mpib-berlin.mpg.de/ft/gg/GG_Null_2004.pdf https://library.mpib-berlin.mpg.de/ft/gg/GG_Null_2004.pdf) - but it should be improving and most of it is probably harmless (I have some hopes on better statistics education and https://www.google.com/search?q=causality+revolution https://www.google.com/search?q=causality+revolution). The other is bad application - and this is more complex. When I go to doctors (with my and my family issues) I, more often than not, have the feeling that they have no chance to give any good diagnosis as it would require too much time to test etc. (one simple case is when to use antibiotics and when the disease is virus based - but I have noticed that this is probably improving with strep and CPR tests) and they mostly just shoot first thing plausible, proscribe some medication and then in most cases the organism just cures itself - so the treatment is never tested. There is probably also 'medicine as signaling' (the theory by Richard Hanson: http://www.overcomingbias.com/tag/medicine http://www.overcomingbias.com/tag/medicine), but my intuition is that it is not verly important, and other stuff.
disqard 7y ago
I'm surprised that even antibiotics are considered one of two "magic bullets" (the other being insulin, which does seem close to a perfect solution). I encourage those interested in the pernicious aspegts of humanity's overuse of antibiotics to read this interview with Stephen Buhner [0] [0] https://www.thesunmagazine.org/issues/468/living-medicine https://www.thesunmagazine.org/issues/468/living-medicine
- afthonos 7y ago
  Overuse happens precisely because they are so good at what they do. Moreover, at a first approximation, overuse results simply in a return to a previous state of no good defense against newly-resistant bugs. So in the worst case scenario, antibiotics bought us a century of better health; that’s pretty magical.
Jallal 7y ago
The article starts with "Given medicine’s poor record, physicians should prescribe and patients consume far fewer medications, a new book argues." : on the contrary, I think the current state of medicine is outstanding, regarding what is was only two centuries ago. Thousands of illnesses have a cure, and for many others, we know what we can do to minimize their effects, infant mortality is very low in most of the western world, etc. And paradoxically, although most of the "alternative medicines" zealots criticize conventional medicine for insufficient results and/or side effects, none of them keep track of some indicators such as the cure rate. ANd this is one of the only relevant metric that can assess the efficiency of a cure. I'm not saying that the conventional medicine is far from any criticism, but one has first to understand the difference between the current knowledge available, and the way it is used : some drugs/treatments are promoted by some countries, while not in others. I'm also convinced he drugs prices (which are going crazy) should be regulated for the benefit of everyone. And of course, modern medicine should be used wisely. People should not take drugs each time they have a cold. That being said, of course, there are still room for improvement, there are a load of illnesses that cannot be cured by modern medicine, and yes, some doctors think themselves as Gods. But this should not question the many successes of conventional medicine.
AtomicOrbital 7y ago
Dr. Jacob Stegenga - Medical Nihilism: Assessing Medical Evidence in a Neo-Liberal Age https://www.youtube.com/watch?v=SgX4BKCxTI4 https://www.youtube.com/watch?v=SgX4BKCxTI4

144 points by Elof 7y ago

Stegenga calls these latter two “magic bullets,” a phrase coined by physician/chemist Paul Ehrlich to describe treatments that target the cause of a disease without disrupting the body’s healthy functions. Researchers have labored mightily to find more magic bullets, but they remain rare. For example, imatinib, brand name Gleevec, is “an especially effective treatment” for one type of leukemia, Stegenga says. But Gleevec has “severe adverse effects, including nausea, headaches, severe cardiac failure and delayed growth in children.” Most would prefer these symptoms over death. https://en.wikipedia.org/wiki/Betteridge%27s_law_of_headlines https://en.wikipedia.org/wiki/Betteridge%27s_law_of_headline...

deleted 7y ago
[deleted]

lukifer 7y ago

See also: Anatomy of an Epidemic [0], about when pharmaceuticals to treat mental health issues become problems in their own right; and, the chapters on medical intervention in Elephant in the Brain [1], which argue persuasively that much of the medical system functions to deliver social signaling of care, rather than improved health outcomes. [0] https://en.wikipedia.org/wiki/Anatomy_of_an_Epidemic https://en.wikipedia.org/wiki/Anatomy_of_an_Epidemic [1] http://elephantinthebrain.com/ http://elephantinthebrain.com/

rayiner 7y ago

Note that the author is a “science journalist” with a degree in journalism, not medicine or even STEM.

paulddraper 7y ago
So...?
- pessimizer 7y ago
  rainier said "note..." so it can't be an ad hominem, it's just a note.
casefields 7y ago
How about a former editor of the British Medical Journal: https://blogs.bmj.com/bmj/2018/06/04/richard-smith-the-case-for-medical-nihilism-and-gentle-medicine/ https://blogs.bmj.com/bmj/2018/06/04/richard-smith-the-case-...
tptacek 7y ago
I'm not sure what the quotes are for. Journalists have beats. Conflict journalists, for example, do not generally have military backgrounds. White House correspondants have not generally run for public office.
- rayiner 7y ago
  They’re scare quotes. Some subjects can be reported on by generalists. But I think some require special expertise to put into context. I wouldn’t want to read an article from a “tech journalist” criticizing the approaches Netflix uses to scale its systems to be able to stream terabytes of data per day. Likewise, I don’t think someone without medical training is qualified to write articles about whether medicines are effective or not.
  - tptacek 7y ago
    Really? That's an interesting example to choose, since John Carreyrou didn't have any medical training and almost singlehandedly brought Theranos to its abrupt end. Later, because it was bugging me There's also distinctions to be made between a "generalist" and a "practitioner". Beat reporters are specialists, not generalists. They've cultivated sources and, over their careers, expertise. Roger Ebert wasn't a filmmaker, but he sure as hell knew more about films and their language and idiom than a WSJ business reporter (who in turn knows more about collateralized debt than Ebert). Extending the analogy further: I'm capable of critiquing cryptosystems and finding/exploiting vulnerabilities in them, but I'm not a cryptographer and am not qualified to build them myself. Do you need an example of a non-programmer tech reporter worth reading? Happy to provide one.

redder2 7y ago

Answer: Yes totally overrated!

dang 7y ago
Maybe so, but can you please not post unsubstantive comments here? https://news.ycombinator.com/newsguidelines.html https://news.ycombinator.com/newsguidelines.html

RandomBacon 7y ago

The anti-vaxxers think it is. We need to be careful how we say this, because then you get generalities like the title and people who shun the basic of medicines such as neccessary vacinations.

julienreszka 7y ago
> "We need to be careful how we say this" Who is "we" ?
- RandomBacon 7y ago
  People who don't want to further misinformation.
alyx 7y ago
Many "anti-vaxxers" are simply concerned parents. Considering that vaccines (in general) have been deemed "unavoidably unsafe" at the Supreme Court level, they are not completely unjustified in their fears. [0] Vaccine manufactures cannot be held liable. Thus there is a "National Vaccine Injury Compensation Program" put in place to compensate those that have been damaged by vaccinations. To date, over $4 billion dollars has been paid out in damages. [1] Just as mentioned in this article, side effects are major deterrents of any medication. And significant efforts need to be made in order to ensure that side effects do not occlude positives effects. [0]: https://www.supremecourt.gov/opinions/10pdf/09-152.pdf https://www.supremecourt.gov/opinions/10pdf/09-152.pdf [1]: https://www.hrsa.gov/sites/default/files/hrsa/vaccine-compensation/data/monthly-stats-july-2019.pdf https://www.hrsa.gov/sites/default/files/hrsa/vaccine-compen...
- deleted 7y ago
  [deleted]
- RandomBacon 7y ago
  The Supreme Court consists of zero medical doctors. Do not take a legal opinion and present it as medical fact.
- 7y ago

wtdata 7y ago

Scientific American is getting very non scientific. A couple of days ago we got the: "Fat Is Not the Problem—Fat Stigma Is", now this article. What follows, "Aliens may have built the Pyramids after all"?

julienreszka 7y ago
Can you quote what you think is non scientific in the article "Is medicine overrated" ?
- sadObserver 7y ago
  Mostly everything, including associating longevity with nutrition and sports when it's been documented ad nauseam that it increased dramatically with antibiotics and vaccines. Not that nutrition and sports don't play a role, but it's insignificamt when compared to modern medicine. Just one example of many on that nonsense article.

codingslave 7y ago

I've long believed that once startups and tech companies get their hands on medical data (patient outcomes, medication treatment outcomes, mal practice rates, surgery outcomes) that a reckoning will take place on the medical industry. The level of legitimacy and respect that doctors and hospitals currently have is far too high, and hinges on branding and the exclusivity of becoming a doctor. Once all of this data becomes available, it will be obvious how worthless and expensive most medical treatments really are. Most prescription drugs do nothing, and the ones that do something are more so just covering the symptoms. HIPAA laws are hiding patient outcomes and holding this whole sham afloat.

sica07 7y ago
There were and are a lot of articles about the fact that many prescription drugs and many treatments are overrated and I totally belive that. But saying that "most" medical treatments & prescription drugs are worthless it's quite a radical view based on... pure speculation.
- rjf72 7y ago
  I think your statement sounds perfectly reasonable, but it actually holds a pretty interesting corollary! If he is wrong that "most" medical treatments and prescriptions are worthless then that would necessarily mean that "most" are valuable. The reason this is interesting is because the exponentially increasing rate of both the amount of medication out there and the amount people are using. For instance from 1997 to 2016 the number of prescriptions filled grew from 2.4 billion to 4.5 billion [1]. And an exponentially increasing number of people, across all ages and demographics, are also being medicated with all sorts of drugs for various reasons. So, if we assume that most medical treatments and prescriptions are not worthless we should see increases in healthfulness that are at least somewhat comparable with our increases in pharmaceutical usage. In reality we saw sharply diminishing returns on life expectancy that have now gradually shifted towards an ongoing decline in life expectancy over the past few years. By any standard of effectiveness, this is not looking good for pharmaceuticals. So I suppose I'd turn it around. I think the view that medicines (and especially their recent exponential growth) are providing a substantial social benefit could be true, but it would seem to be the statement that needs to be explained. E.g. perhaps our own increasingly unhealthy lifestyles are contravening the gains from the medical technology? No idea there, but I do think occam's razor would tend to simply suggest that the reason we're not seeing improvements is because we're not improving. [1] - https://www.webmd.com/drug-medication/news/20170803/americans-taking-more-prescription-drugs-than-ever-survey https://www.webmd.com/drug-medication/news/20170803/american...

astura 7y ago

>The New York Times reported that in 2014 physicians wrote 83,000 prescriptions for antidepressants and almost 20,000 prescriptions for antipsychotic medications for infants two years old and younger Wow... This seems very obviously inappropriate. I listened to the EconoTalk interview referenced in TFA after hearing about it on another HN thread. Highly recommended. I have to say that I have become skeptical of medicine after personally seeing the sheer amount of unscientific and potentially harmful practices that are advocated for by medical practicers. I think there's a lot of good, but wayyyyyy too much bad.

dkarl 7y ago
My brother-in-law, who has a mental disability, saw a gastroenterologist for abdominal pain. They found worms and prescribed him a drug to get rid of the worms. The doctor said the worms could cause abdominal pain, but then again in most cases they don't, so he also put him on a drug for irritable bowel syndrome. After a couple of weeks, the stomach pain went away, but meanwhile my brother-in-law was having issues with mental coherence, drowsiness, and sleep disturbances. Other people who interacted with him were concerned about him, too. He has a mental disability and diabetes and other health issues, so our first thought was the usual suspects, not his IBS medication, but eventually I realized that neither my wife nor myself knew anything about it, so I looked it up. It turned out the new medication was an antidepressant with a laundry list of side effect, including drowsiness and sleep disturbances. We weaned him off it, and he came back to normal pretty quickly. No stomach pain, either. So, to sum up, the doctor saw a patient with worms and abdominal pain and decided to put him on an antidepressant for the rest of his life because the kind of worm infestation he had would only cause pain in a minority of cases.
- astura 7y ago
  I actually suspect a fairly large amount of those prescriptions were for off label use. But... Seems like the sort of side effects these medicines have should give us a pause when using them on vulnerable populations. Especially when the benefits are not especially clear.

goldcd 7y ago

It's not over-rated - but it's complicated. Even that short article covered a number of items that could all happily be spun out into full-blown essays. "Over-medication" - just as a term. Could be people taking medicines that: Aren't cost-effective (whatever your system, there's a finite resource at the core). Aren't quality of-life improving (doctors themselves tend to consume less life-extending stuff at the very end). They paid for (You've paid insurance, you're ill, you want to be given something).

amriksohata 7y ago

Yes,it is, as it's about profit so always about cure, never prevention

braindead_in 7y ago

So why do the drug companies charge so much for the medicines then? I just finished watching the Valeant episode of Dirty Money and combined with this book, it all kind of makes no sense.

maxander 7y ago

“Spending too much on medicine” isn’t like spending too much on clothes or nice houses. If the consumer goods you buy are crummy and don’t improve your life you can do without them, but we’re essentially unable to decide we can do without health. Demand for cures for our diseases is different than demand for other things, and that shows up both in the sorry economic structure of our (U.S.) health system, and here. If we had more medical treatments that worked, and a lab-to-hospital pipeline with a better track record, I suspect better scientific standards would follow naturally. But for now, raising the standards of evidence would essentially block off the invention of new treatments altogether, which simply isn’t an option even on a psychological level.

julienreszka 7y ago
> "raising the standards of evidence would essentially block off the invention of new treatments altogether" Citation needed.

yourMadness 7y ago

Modern medicine has some aspects that are miraculously good and it is easy to fall into the trap of thinking that those are representative for all of medicine. It's a kind of halo effect bias. In my opinion the most amazing thing still is antibiotics (and vaccination). Treatmeant of war/vehicle/sports injuries taking the second place (including anesthetics). Both can take people from a path of sure death within hours or days to often complete recovery within weeks or months. If that is the performance expectation of the general public for all of medicine, then it certainly is overrated.

m0zg 7y ago
As someone who has had some less-acute sports injuries, I'd also break the injuries down into "shit's really fucked up" and "you could conceivably walk it off" categories. The former, modern US medicine excels at. The latter, I'm not sure the doctors are even trained to treat something less acute and not requiring expensive surgery. In fact, I strongly suspect they often prescribe a surgery anyway, just to make a buck. I had to decline a surgery once.
pvaldes 7y ago
> Modern medicine has some aspects that are miraculously good... like antibiothics and injuries treatment Not to mention having all valuable poisons in the planet in a nice packed, chemically pure, split in comfortable monodose capsules, accurately measured and checked for 10 years before enter in your body, packed guaranteeing non posterior adulteration as long as the plastic seal is not broken, extensively documented in several languages and available at less than ten minutes away from your home. This is probably the biggest bonus from the real medicine.

agumonkey 7y ago

Let me extend the query, is "modern medicine" overrated. Modern technology + western like urban lifestyle changed how we live.. and how much medicine we think we need. Walking in the woods is probably as effective as the average anti depressant. Good physical activity too. But we sell that modern life is great and that ailments are normal and that thanks to the medical field we have all these solutions.. that we probably didn't need in the first place.

gtirloni 7y ago
Sure, for that specific situation maybe physical activity is a good solution. But what's next? Anti-vaxxer stupidity?
Reedx 7y ago
Regular exercise, good diet and quality sleep prevent/solve most health problems. If exercise were in pill form, it'd be the most valuable pill.
- agumonkey 7y ago
  Too bad gravity is free
- scarface74 7y ago
  That leSs down the dangerous road that many who are against universal healthcare go down (not saying you were implying it). That most health problems are caused by poor decisions. These are the top 10 causes of death. https://www.cdc.gov/nchs/fastats/leading-causes-of-death.htm https://www.cdc.gov/nchs/fastats/leading-causes-of-death.htm How many of those could be prevented by good diet, quality sleep and exercise?
  - Firadeoclus 7y ago
    You can't prevent death, only prolong life. Most of those causes are accelerated by poor diet, poor sleep and lack of exercise.
7y ago

lordnacho 7y ago

It's quite odd to dismiss better sanitation and nutrition as not medicine, isn't it? I think the problem is that we take for granted the things that have been discovered, because they were found a long time ago. Washing surgeons' hands in carbolic acid help puerperal fever rates. Cholera has something to do with water. Vaccination works. All those things happened way before any living person remembers. From what I hear among pharma friends, the problem is also that the low hanging fruit has been picked. A lot of lines of inquiry are variations of the same thing, and over time we've found what is there to be found. If you think about it, it makes sense that it's like that. Something really powerful like vaccination is going to pop out of the stats immediately. Subtler effects require more trials to detect. In any case, it's a greater danger that there are people who don't believe in evidence based inquiry at all pretending to be medical professionals. Look at anti-vaxxers, or the Goop type quackery.

sadObserver 7y ago

Anti-vaccine groups referencing and quoting this article in 3,2,1..

rhinoceraptor 7y ago

Modern medicine is great when you get in a car crash, and it's horrific if you have type 2 diabetes. Doctors get very little training in diet and lifestyle, because those are low-status and left to non-MD specialists, and many of them dogmatically cling to 1960s-era science.

primroot 7y ago
No diet, no lifestyle, and not even history https://www.ncbi.nlm.nih.gov/pubmed/24811552 https://www.ncbi.nlm.nih.gov/pubmed/24811552
qrbLPHiKpiux 7y ago
Today we know that: limit eating, calorie restriction, little sugar consumption, can reverse type 2 diabetes and greatly reduce body inflammation, which is thought to give rise to all our modern diseases.
- scarface74 7y ago
  All modern diseases - really?
rscho 7y ago
You really think endocrinologists have no training in diet and lifestyle? Well, what can I say. No?
- rhinoceraptor 7y ago
  > On average, U.S. medical schools offer only 19.6 hours of nutrition education across four years of medical school https://health.usnews.com/wellness/food/articles/2016-12-07/how-much-do-doctors-learn-about-nutrition https://health.usnews.com/wellness/food/articles/2016-12-07/...
  - rscho 7y ago
    That's for basic med school education. Happily, medical education doesn't stop at the end of med school. It is more like, beginning just at that moment. Otherwise many more patients would die. So yes, on paper you're right. In practice, there are even clinical nutrition specialists and those are MDs.

codingdave 7y ago

I've always looked at western medicine as if it was the best car mechanic you can hire, just for your body. If your problem is mechanical, they can solve it. Surgical techniques are amazing. Breakdowns in known processes can be fixed. But if the problem doesn't fit those known processes, isn't mechanical, and you are relying on doctor for real troubleshooting of problems, that is where it falls short. You can fall into the weird gap of talking to different specialists, trying to find someone who can pinpoint what is wrong. You try different treatments, you see what works. Sometimes you solve problems, sometimes you end up living your whole life managing symptoms. And that isn't all bad - better to manage symptoms than to live in misery, or not to live. But the word 'over-rated' is quite accurate. It isn't useless, it just is over-rated.

crispinb 7y ago
'Western' medicine though as opposed to what? Nostalgic prescientific systems such as Chinese, ayurvedic, etc don't do anything at all. So yes, scientific medicine definitely has huge lacunae. Given the relative slowness of progress in understanding complex systems science has had in general, they'll be there for a long to come. But it's not as if there's some other candidate 'system' that has a better understanding.
- coldtea 7y ago
  >'Western' medicine though as opposed to what? Nostalgic prescientific systems such as Chinese, ayurvedic, etc don't do anything at all. That's not really true. Their explanations can be hocus pocus, but their mechanics/drugs/techniques can be as effective as western versions, simply come around by tradition/trial and error/Lindy effect and so on for millennia.
  - rscho 7y ago
    As effective as western versions, and often even identical but in a far less controlled form. Also often just as toxic.
    - 7y ago

JamesBarney 7y ago

There are legitimate concerns about some drugs being overprescribed and others being underprescribed. But this article doesn't really she'd much light on it. Are some medicines probably overprescribed? Sure. Are some medicines underprescribed? Definitely. For most medicines are there people who could benefit from taking it and aren't while simultaneously there are people who would benefit from stopping the medicine? Almost assuredly. And medical research is what we do to try to answer these questions in ways that are helpful.

rjf72 7y ago

I think the article (and presumably the book) bring up a lot of great points about systemic issues with medicine, but I also think there is another much more macro level argument. The Ancient Greeks were, in terms of medicine, almost completely ignorant. They had no idea about germs; instead focusing their medical theory around the 4 humors - blood, phlegm, yellow/black bile and miasma theory. What's good drinking water? Water that tastes clean. Vaccines? That'd come about 3,000 years later. And they engaged in hygiene habits we might find a wee bit dodgy. For instance at the public toilets there obviously were no toilet paper dispensers. Instead they'd use sponges - butt brushes. After one fellow finished his business you'd give it a swish around in some water or, for the fancier toilets - vinegar, and take your turn. But the thing is is that they (and I am referring to the upper class here) had life expectancies that were not what you'd think. This [1] great article from the BBC has quite a lot of interesting data. For instance of some 298 recorded individuals of ancient Greece/Rome, the median life expectancy was 72 years. Some random famous names: Pythagorus - 75, Hippocrates - 90, Plato - 80, etc. There is of course some selection bias in that sample, but you can also see evidence of longevity in other ways. For instance in Ancient Rome one could not hold the office of Consul until reaching the age of 43, first office was not available until age 30. The article also goes on to analyze numerous other sources than tend to paint a recurring picture: there was high infant and youth mortality, but people who made it to adulthood tended to have a life expectancy not all that different than we do today. It seems to suggest that a large part of our increased life expectancy is not from the trillions of dollars we've spent on trying to find a [profit making] pill for everything, but instead from very simple things like access to clean water and food. --- Finally there is a little 'paradox' that should always be brought up in medicine and in particular efforts to try to squeeze out every slimmer gains. Imagine you have a test that is 99.9% accurate for some illness. And 1 in a million people have this illness. If somebody tests positive, what are the chances that this is a false positive? 99.9%! In a million people our 99.9% accurate test will give 1,000 hits - yet only 1 person will actually have the illness. You'd probably end up seeing a negative return on life expectancy here just because of how many people you'd be scaring witless after informing them they need to come back in for follow up testing. Seriously, just take a few days off their lives and you've already gotten rid of the gains in expectancy for the 1 in 1000 guy. [1] - http://www.bbc.com/future/story/20181002-how-long-did-ancient-people-live-life-span-versus-longevity http://www.bbc.com/future/story/20181002-how-long-did-ancien...

1e-9 7y ago

Medications are a particular problem. It took decades of massive use for us to even realize that some of our most common over-the-counter drugs were being used in dangerous ways (e.g. aspirin can cause Reye's syndrome in children, Tylenol with alcohol can damage the liver). On top of that, I think drug interactions are a much larger problem than most people realize and that we have little idea of what we are doing to ourselves when we take multiple medications. A recent study [1] on just prescription drugs counted 220 million unique drug combinations experienced by a subset of the US population over intervals of about 3 years. How many of those combinations have been studied for safety? I'll make a wild guess that it's probably far less than 1%. I think it prudent to minimize one's medication exposure to the bare minimum that is absolutely necessary. [1] https://www.nature.com/articles/sdata2017167 https://www.nature.com/articles/sdata2017167

mistermann 7y ago

> decades of massive use for us to even realize that some of our most common over-the-counter drugs were being used in dangerous ways (e.g. aspirin can cause Reye's syndrome in children, Tylenol with alcohol can damage the liver) Agreed, but then to some degree could this same argument not be made about vaccines?

carapace 7y ago
No. It's pretty clear, even if the anti-vaxxer lunatics were not wrong (which they are, they are wrong, they are perniciously wrong, in the face of all evidence they are wrong), that vaccines would be a net benefit. In other words, even if vaccines did cause autism (which they do not) it would still be imperative to use them. The alternative to widespread vaccination is much worse.
- mistermann 7y ago
  > No. It's pretty clear, even if the anti-vaxxer lunatics were not wrong (which they are, they are wrong, they are perniciously wrong, in the face of all evidence they are wrong), that vaccines would be a net benefit. Are the "anti-vaxxer lunatics" arguing that vaccines are not a net benefit? When you refer to "anti-vaxxer lunatics", who is it, exactly, are you referring to? Are you referring to specific people (everyone within the "anti-vaxx" "community"), or are you referring to an abstract mental model, of questionable accuracy, held in your own mind? > even if vaccines did cause autism (which they do not) These sorts of comment lack epistemic humility/awareness. We do not know that vaccines do not cause autism. Science does not say this. However, this isn't to say that science says vaccines do cause autism. What causes autism is unknown. The final knowledge of an association between vaccines and autism is unknown. To some degree, the "pro-vaxx" message is based on propaganda (here I am referring to the lesser pejorative meaning of the word). Many within the "anti-vaxx" community can see this, and it is used in various ways as leverage. Which is, of course, also propaganda (the more pejorative kind - typically, but not always). This approach has been sound in the past, but there are increasing signs that it is becoming less effective. Time will tell if that trend continues.

carapace 7y ago

Has anyone mentioned this already? > Medical errors are the third-leading cause of death after heart disease and cancer. https://www.cnbc.com/2018/02/22/medical-errors-third-leading-cause-of-death-in-america.html https://www.cnbc.com/2018/02/22/medical-errors-third-leading... I agree with Stegenga: > There is no place I would rather be after a serious accident than in an intensive care unit. For a headache, aspirin; for many infections, antibiotics; for some diabetics, insulin—there are a handful of truly amazing medical intervention, many discovered between seventy and ninety years ago. However, by most measures of medical consumption—number of patients, number of dollars, number of prescriptions—the most commonly employed interventions, especially those introduced in recent decades, provide compelling warrant for medical nihilism. - - - - I was just reading about "The China Study", https://en.wikipedia.org/wiki/The_China_Study https://en.wikipedia.org/wiki/The_China_Study > The China Study is a book by T. Colin Campbell and his son, Thomas M. Campbell II. It was first published in the United States in January 2005 and had sold over one million copies as of October 2013, making it one of America's best-selling books about nutrition.[1][2][3] > The China Study examines the link between the consumption of animal products (including dairy) and chronic illnesses such as coronary heart disease, diabetes, breast cancer, prostate cancer, and bowel cancer.[4] The authors conclude that people who eat a predominantly whole-food, plant-based diet—avoiding animal products as a main source of nutrition, including beef, pork, poultry, fish, eggs, cheese, and milk, and reducing their intake of processed foods and refined carbohydrates—will escape, reduce, or reverse the development of numerous diseases. Now I'm a pretty "fringe" kind of guy, and there's some stuff in there that even I have trouble with (animal protein is highly carcinogenic? Eh what?) But the basic idea of nutrition affecting health, or more accurately being the foundation of health, seems sound to me, and my attempts to eat a "whole-food, plant-based diet" have been very positive. Although I did send my digestion for a loop by "cutting over" too fast once. It takes about three days for your guts (microbiome and own) to adjust to a big change in diet, FWIW. In any event it's batshit insane that convention medicine treats nutrition as an afterthought. (There's a wonderful confluence between eating a whole-food, plant-based diet and the ecological repair of our food systems.) - - - - Now let me push the boundaries. I burned the tip of my thumb the other day taking a pan out of the oven, 450°F. I was careless and didn't quite hold the potholder correctly, burn reflex overridden so I wouldn't drop the pan, it melted the fingerprint whorls. After I finished hopping up and down, pissed off at my own carelessness, I took a few moments to "beam" Reiki to my thumb, while concentrating on communicating with my healing and immune responses telling them to "get in there and clean things up". The pain went away and didn't come back. A very modest blister formed under the melted skin. The spot was tender, and it stung a bit if I let hot water touch it the first day, but after that there was no tenderness. Two days later the blister was gone. The skin is slightly rough, but it's not peeling, nor is it a scab. Day three I woke up and forgot that I had burned myself. The flesh apparently reconstituted itself. I'm not sure it will even leave a scar. The skin still hasn't peeled. In sum, a minor second-degree burn, apply ten seconds of Reiki, result: no pain and accelerated healing. "The future is here, it's just not evenly distributed yet."

JamesCoyne 7y ago

If you are intrigued by the thesis of the book, EconTalk has an episode with the author. https://www.econtalk.org/jacob-stegenga-on-medical-nihilism/ https://www.econtalk.org/jacob-stegenga-on-medical-nihilism/

flying_kiwi 7y ago

These comments just reek of the silicon valley tech-bro myth that because you're good with computers you must know better than the millions of brilliant smart people in $INDUSTRY. The absolute arrogance.

bedobi 7y ago
Welcome to HackerNews! Threads about Medicine and Economics are some of the worst - everyone here is apparently a Nobel grade expert.
- golemiprague 7y ago
  The problem with economics that even the Nobel grade experts have very different opinions about anything and everything. Medicine is a bit different I believe
- TeMPOraL 7y ago
  > Threads about Medicine and Economics are some of the worst Compared to what? What you'd have on a forum of economists or doctors? Maybe. What you would be reading otherwise? Not quite. > everyone here is apparently a Nobel grade expert. Maybe not Nobel-grade, but there's plenty of actual doctors on HN.
cheesymuffin 7y ago
And yet, in every 100 bullshit tech-bro commenters, there are 10 who are actually getting really interested in the subject and taking the time to check their old Bio notes, research opposing viewpoints, or maybe even bring something new to the table. Hating is easy. All you have to do is point fingers at people and tell them they know nothing. 100% of the time you'll be right.
- meruru 7y ago
  I've always seem this kind of criticism of the "tech bubble" as a great endorsement of the tech community. Where else do you see people so interested in so many subjects that they have to be constantly reminded they are speaking outside their expertise? Am I just not aware of the HN equivalent for medical doctors?

rscho 7y ago

I would like to make a personal statement to the tech community in view of this thread's comments: A vast majority of you drastically overestimate the information processing and retrieval of the healthcare system. We MDs can all see your superb AI/ML results in journals, and yes you can improve things with technology. What we can't see is how we're going to use it. In my day-to-day job, there are a myriad of new-super-devices-that-automatically-do-that-thing but NONE are integrated into my workplace. NONE make my job less painful. NONE make me gain time instead of losing it. You want to help. Cool, then stop masturbating on the results of your unusable new oncology deep-learning thingy and push for WORKPLACE INTEGRATION of technology, damn it! Maybe if the tech community comes to understand how it can really help clinicians, things will start to change the way you fancy and we can finally end the age of rote memorization and criminal overtime for MDs.

bigred100 7y ago
I’d imagine the people writing these wonderful journal articles care more about writing journal articles than that stuff. In fact, they are probably employed to write those articles. Anyway I can’t really comment on why they would or would not masturbate on a scientific paper. You are the doctor.
arpa 7y ago
Yes! healthcare informatics is so much more than just dispensing magical vitamins, when MDs and patients need painkillers. We have had terms like PHR and EHR for thirty years now, we have HL7, together with FHIR, and we have PACS, but these terms are still not ubiquitous. There has been major developments in developing classifiers like SNOMED, AHCI and ICD, yet MDs mostly still type the diagnosis up, and consider themselves lucky if the HIS has some templating capability. And very few HISes are capable of getting the personal health records to the patient - i mean, it is more likely you get a xerox of your case than something in a portable format that other HISes can understand if you change your healtcare provider... However, it is somewhat strange that personal health projects keep dying - google health discontinued in 2011, microsoft healthvault to be closed in 2019 - and these are by major players - maybe somebody has some insight why they fail?
kowdermeister 7y ago

Gatsky 7y ago

Anyone receiving or delivering healthcare is aware of these problems. These kind of critiques suffer from the same basic problem - they treat Medicine as a monolithic entity which is not intimately linked with society, culture, the economy and government. This conceit is necessary to write a book about it, and is a luxury available only to those who don't need to actually deliver or administer healthcare. It is also not the same thing as 'trying to make things better', despite what the author may claim. In truth the author is actually critiquing what they have decided falls under the umbrella of medicine, which they define at a particular point in time. The problem is incentives, not sure why this guy wrote a whole book without realising this, but it is an easy mistake to make if you are thinking about the problem from your writing desk. People will minimise effort and cost, given a choice, and maximise profit subject to constraints. This behaviour exists even in highly trained health professionals already making many hundreds of thousands of dollars a year. Example - why do primary care doctors prescribe minimally effective drugs for depression? Is it because they can't understand a meta-analysis, can't remember all the patients the drugs didn't work for in their own practice, or because they are lazy or stupid? It is because a patient has come in looking for help and is sitting there in tears, and there is only 10 minutes to see them, and the history from the other doctor this person has been seeing for the last 5 years isn't available. And although everyone would be better off if the doctor spent an hour finding out in detail what is going on, carefully talking over the options, the side effects of various treatments and reaching a consensus management plan which starts with non-pharmacological therapies, and activates a government program which allows the patient to take extra time off work to attend therapy sessions with childcare facilities included. But it is easier for everyone to prescribe Prozac. This is the reality. Perverse incentives explain many of the problems in Medicine and healthcare systems. Nobody gets paid for delivering good care, nobody saves money by accepting good care. As shocking as it may be, delivering good care or exceptional care is a choice a health care team makes despite everything else. Similarly, accepting proven health care interventions is a choice a patient makes. Usually everything doesn't line up, and that is modern medicine. The cited example of Gleevec also makes no sense to me. It revolutionised the treatment of 2 conditions which were almost completely untreatable beforehand (Chronic Myeloid Leukaemia and Gastrointestinal Stromal Tumour). The alternatives to taking Gleevec for these patients were A) Toxic minimally effective chemotherapy followed by death or B) Just death. All of this context is extremely important in discussing the side-effects which can be severe. This is what the patient and the doctor work out together. Some throwaway line about how toxic it is just makes no sense in isolation.

zby 7y ago

Update: If trials by manufacturers are biased - then how about some framework that would push trials made by competition. There are two things: One is bad science, and we have a lot of it (https://en.wikipedia.org/wiki/Replication_crisis https://en.wikipedia.org/wiki/Replication_crisis, https://library.mpib-berlin.mpg.de/ft/gg/GG_Null_2004.pdf https://library.mpib-berlin.mpg.de/ft/gg/GG_Null_2004.pdf) - but it should be improving and most of it is probably harmless (I have some hopes on better statistics education and https://www.google.com/search?q=causality+revolution https://www.google.com/search?q=causality+revolution). The other is bad application - and this is more complex. When I go to doctors (with my and my family issues) I, more often than not, have the feeling that they have no chance to give any good diagnosis as it would require too much time to test etc. (one simple case is when to use antibiotics and when the disease is virus based - but I have noticed that this is probably improving with strep and CPR tests) and they mostly just shoot first thing plausible, proscribe some medication and then in most cases the organism just cures itself - so the treatment is never tested. There is probably also 'medicine as signaling' (the theory by Richard Hanson: http://www.overcomingbias.com/tag/medicine http://www.overcomingbias.com/tag/medicine), but my intuition is that it is not verly important, and other stuff.

disqard 7y ago

I'm surprised that even antibiotics are considered one of two "magic bullets" (the other being insulin, which does seem close to a perfect solution). I encourage those interested in the pernicious aspegts of humanity's overuse of antibiotics to read this interview with Stephen Buhner [0] [0] https://www.thesunmagazine.org/issues/468/living-medicine https://www.thesunmagazine.org/issues/468/living-medicine

afthonos 7y ago
Overuse happens precisely because they are so good at what they do. Moreover, at a first approximation, overuse results simply in a return to a previous state of no good defense against newly-resistant bugs. So in the worst case scenario, antibiotics bought us a century of better health; that’s pretty magical.

Jallal 7y ago

The article starts with "Given medicine’s poor record, physicians should prescribe and patients consume far fewer medications, a new book argues." : on the contrary, I think the current state of medicine is outstanding, regarding what is was only two centuries ago. Thousands of illnesses have a cure, and for many others, we know what we can do to minimize their effects, infant mortality is very low in most of the western world, etc. And paradoxically, although most of the "alternative medicines" zealots criticize conventional medicine for insufficient results and/or side effects, none of them keep track of some indicators such as the cure rate. ANd this is one of the only relevant metric that can assess the efficiency of a cure. I'm not saying that the conventional medicine is far from any criticism, but one has first to understand the difference between the current knowledge available, and the way it is used : some drugs/treatments are promoted by some countries, while not in others. I'm also convinced he drugs prices (which are going crazy) should be regulated for the benefit of everyone. And of course, modern medicine should be used wisely. People should not take drugs each time they have a cold. That being said, of course, there are still room for improvement, there are a load of illnesses that cannot be cured by modern medicine, and yes, some doctors think themselves as Gods. But this should not question the many successes of conventional medicine.

AtomicOrbital 7y ago

Dr. Jacob Stegenga - Medical Nihilism: Assessing Medical Evidence in a Neo-Liberal Age https://www.youtube.com/watch?v=SgX4BKCxTI4 https://www.youtube.com/watch?v=SgX4BKCxTI4