4 ms·

My favorite bit in this, is when he gets to the really important part about how, precisely, lipoproteins cause disease, the explanation is that it "illegally pa

My favorite bit in this, is when he gets to the really important part about how, precisely, lipoproteins cause disease, the explanation is that it "illegally parks" "So what drives an LDL particle to do something as sinister as to leave the waterway (i.e., the bloodstream) and “illegally” try to park at a dock (i.e., behind an endothelial cell)? Well, it is a gradient driven process which is why particle number is the key driving parameter." Except it isn't gradient driven, because it's an active process of transcytosis... There's just so many holes in the lipid hypothesis.

scottlocklin 7y ago
It's an uncomfortable realization when you first figure out how much of modern "medical wisdom" is based on incomplete understanding, bad stats, marketing crapola from food and drug manufacturers, and weird NGO groups trying to justify their existence. Modern medicine is really good at trauma care, and certainly the discovery of vitamins, antibiotics and hand washing are good ideas; otherwise, I'm not so sure!
- YeGoblynQueenne 7y ago
  Not to be rude to you or fellow HN users, but between a comment on HN and "modern 'medical wisdom'" I think I'll choose the latter every time, just on the basis that a comment on HN is not as likely to be correct as "modern 'medical wisdom'". Also, just as a bit of pattern matching that may be completely off, but I haven't heard the most accurate things from people who challenge medical wisdom with scare quotes. Doctors study those things for a living. I don't know why people think they know best because they can read ncbi.gov. But- I'll listen more carefully if the person commenting is a doctor who works with patients day-in, day-out. That kind of experience still counts for something, flawed as subjective judgements may be.
  - scottlocklin 7y ago
    > Doctors study those things for a living. I don't know why people think they know best because they can read ncbi.gov. See, that's just the thing: Doctors absolutely do not study this sort of thing for a living. Researchers do. That's why I linked you to a researcher, rather than something written by the guy I see when I need antibiotics or to get a mole checked out. I ain't asking you to take my word for it: I provided you a link to a guy who really does study this sort of thing for a living. And he says ... it's really complicated, and the standard advice/treatments are probably baloney. Maybe he's wrong! Doesn't look that way though.
    - YeGoblynQueenne 7y ago
      Doctors have to study to become doctors and then they practice medicine every day. I expect, if someone has a reliable intuition about how things like cholesterol work out in practice, that's a doctor who has to treat patients every day. In fact, in this particular kind of knowledge (of how test results correlate with various outcomes) I would trust a doctor's intuition, formed by long experience, more than I'd trust data and research results. Kind of nonplussed that you'd diss doctors as "the guy I see when I need antibiotics or to get a mole checked out". Do you really think what doctors do is so simple?
      - scottlocklin 7y ago
        I taught medical students in a top-5 medical school and know how the sausage got made. They're great at the things I listed: trauma care, treatment of acute conditions, the concept of vitamins and use of antibiotics. For stuff involving chronic conditions, or even nutrition advice, they appear to be worse than useless.
        YeGoblynQueenne 7y ago
        This is not my experience. My experience is that- it's a mixed bag. I ... don't like to discuss personal medical details online of course. But, I recently had a dry cough that didn't go away after many months and I was obviously shitting bricks (though I don't smoke) so I went to my GP. She prescribed ...antacids. I left frustrated, and incomprehending, but of course she knows I have an ulcer, and it seems that the acid coming up my esophagus is irritating my vocal cords. Note that she didn't sit down at her computer and google my symptoms or anything like that. Our meeting took all of 5 minutes (stupid NHS guidelines...) which is btw why she had no time to explain and I had to look up things myself. But she got it right. In 5 minutes time and under the pressure of a couple dozen other patients in the waiting room. It reminded me of stories about machine learning systems modelling some complex dataset and coming up with surprising results that initially leave researchers bewildered, until digging a bit reveals the accuracy of the model. Perhaps teaching medical students rather than practicing yourself is skewing your view a bit (you didn't say you are actually a doctor though)? I have respect for doctors' intuition, but maybe, on my part, I'm just impressed because of my own lack of knowledge. On the other hand, another doctor I see for a chronic condition I don't want to discuss online is completely useless and has all the intuition and skill of a boiled piece of cabbage. But that's not a tale for HN.
  - virtuallynathan 7y ago
    Not a doctor, sorry :) I have, however, spent many many hours over the last year reading all of the research I can find on the lipid hypothesis, metabolism, lipoproteins, nutrition, etc. I started a podcast, and have started chatting to researchers, doctors, etc.
    - YeGoblynQueenne 7y ago
      >> Not a doctor, sorry :) No matter. Sorry if my comment comes across as a bit stand-offish.

scottlocklin 7y ago

It's an uncomfortable realization when you first figure out how much of modern "medical wisdom" is based on incomplete understanding, bad stats, marketing crapola from food and drug manufacturers, and weird NGO groups trying to justify their existence. Modern medicine is really good at trauma care, and certainly the discovery of vitamins, antibiotics and hand washing are good ideas; otherwise, I'm not so sure!

YeGoblynQueenne 7y ago
Not to be rude to you or fellow HN users, but between a comment on HN and "modern 'medical wisdom'" I think I'll choose the latter every time, just on the basis that a comment on HN is not as likely to be correct as "modern 'medical wisdom'". Also, just as a bit of pattern matching that may be completely off, but I haven't heard the most accurate things from people who challenge medical wisdom with scare quotes. Doctors study those things for a living. I don't know why people think they know best because they can read ncbi.gov. But- I'll listen more carefully if the person commenting is a doctor who works with patients day-in, day-out. That kind of experience still counts for something, flawed as subjective judgements may be.
- scottlocklin 7y ago
  > Doctors study those things for a living. I don't know why people think they know best because they can read ncbi.gov. See, that's just the thing: Doctors absolutely do not study this sort of thing for a living. Researchers do. That's why I linked you to a researcher, rather than something written by the guy I see when I need antibiotics or to get a mole checked out. I ain't asking you to take my word for it: I provided you a link to a guy who really does study this sort of thing for a living. And he says ... it's really complicated, and the standard advice/treatments are probably baloney. Maybe he's wrong! Doesn't look that way though.
  - YeGoblynQueenne 7y ago
    Doctors have to study to become doctors and then they practice medicine every day. I expect, if someone has a reliable intuition about how things like cholesterol work out in practice, that's a doctor who has to treat patients every day. In fact, in this particular kind of knowledge (of how test results correlate with various outcomes) I would trust a doctor's intuition, formed by long experience, more than I'd trust data and research results. Kind of nonplussed that you'd diss doctors as "the guy I see when I need antibiotics or to get a mole checked out". Do you really think what doctors do is so simple?
    - scottlocklin 7y ago
      I taught medical students in a top-5 medical school and know how the sausage got made. They're great at the things I listed: trauma care, treatment of acute conditions, the concept of vitamins and use of antibiotics. For stuff involving chronic conditions, or even nutrition advice, they appear to be worse than useless.
      - YeGoblynQueenne 7y ago
        This is not my experience. My experience is that- it's a mixed bag. I ... don't like to discuss personal medical details online of course. But, I recently had a dry cough that didn't go away after many months and I was obviously shitting bricks (though I don't smoke) so I went to my GP. She prescribed ...antacids. I left frustrated, and incomprehending, but of course she knows I have an ulcer, and it seems that the acid coming up my esophagus is irritating my vocal cords. Note that she didn't sit down at her computer and google my symptoms or anything like that. Our meeting took all of 5 minutes (stupid NHS guidelines...) which is btw why she had no time to explain and I had to look up things myself. But she got it right. In 5 minutes time and under the pressure of a couple dozen other patients in the waiting room. It reminded me of stories about machine learning systems modelling some complex dataset and coming up with surprising results that initially leave researchers bewildered, until digging a bit reveals the accuracy of the model. Perhaps teaching medical students rather than practicing yourself is skewing your view a bit (you didn't say you are actually a doctor though)? I have respect for doctors' intuition, but maybe, on my part, I'm just impressed because of my own lack of knowledge. On the other hand, another doctor I see for a chronic condition I don't want to discuss online is completely useless and has all the intuition and skill of a boiled piece of cabbage. But that's not a tale for HN.
- virtuallynathan 7y ago
  Not a doctor, sorry :) I have, however, spent many many hours over the last year reading all of the research I can find on the lipid hypothesis, metabolism, lipoproteins, nutrition, etc. I started a podcast, and have started chatting to researchers, doctors, etc.
  - YeGoblynQueenne 7y ago
    >> Not a doctor, sorry :) No matter. Sorry if my comment comes across as a bit stand-offish.