8 ms·

It seems almost unbelievable that in this day and age we could have missed something like this. In my opinion, it put modern medicine into perspective. I've s

It seems almost unbelievable that in this day and age we could have missed something like this. In my opinion, it put modern medicine into perspective. I've suspected for some time that medicine is actually closer to the dark ages than we like to think it is, and this report seems like a good validation of that notion.

bantunes 6y ago
I feel like the fact this is rare, big news kind of negates your point.
- dynamite-ready 6y ago
  Agreed, though it also makes me think of the numerous cases of drugs developed with a specific purpose, but then afterwards found to have a completely different effect to what was originally intended. Medical science is an incredible thing, but science, by definition, does not have all the answers. A small part of me is actually somewhat surprised, that people (both lay, and professional) are surprised. Though I am not the best placed commentator to champion this view.
  - majewsky 6y ago
    > drugs developed with a specific purpose, but then afterwards found to have a completely different effect to what was originally intended I don't find that surprising. You have to do the early phases of drug development in model systems like cell cultures for practical reasons: It makes evidence obtained more reproducible and has less ethical concerns than experimenting on humans immediately. It's like how software components usually get implemented and tested in simplified environments (e.g. unit tests use doubles), and just like with drugs, sometimes we find that software components interact with each other in unexpected ways when combined into a whole.
    - iguy 6y ago
      What seems weird about this is that the process for deciding that an approved drug is useful for a certain condition (not the one it was intended for) is really informal, it seems to rely on common knowledge circulating in the guild. For the initial approval, we have this very formal process, the FDA wants this kind of data from trials of this size to show this statistical level, etc. All very scientific-looking. But once it's on the market, random doctors try it out for other conditions. If it seems to work they tell their buddies, tweak the mixtures, share anecdotes. If it becomes widespread, some industry club records this for the purpose of arguing with insurance companies. I am told this off-label use now constitutes the majority of drug prescriptions. All based on (as far as I can tell) no statistically driven testing at all, just stories. (To be clear, I'm not at all surprised that drugs have "off-target" effects, and may be very useful for things their inventor never imagines. I'm just a bit shocked how pre-modern our system for collecting this knowledge appears to be. But not an expert, and would love to know more.)
      - majewsky 6y ago
        > I'm just a bit shocked how pre-modern our system for collecting this knowledge appears to be. I'm not an expert, but I imagine any more advanced system would be extremely problematic from a data protection point of view (think HIPAA etc.). In a study, patients sign multiple pages of legalese to allow the researchers to collect all the required data. You don't have that with regular patients in a GP's office.
        iguy 6y ago
        Yes that's a hurdle. But even without that, it seems hard to design a good system. If most of the doctors treat the very sick cases (among those diagnosed with X) with drugs Y+Z currently rumoured to work, how do you disentangle the causes of their poor outcomes? More generally, how do we know it isn't mostly garbage? That seems to be the consensus about most pre-20th-C medicine, and those guys weren't idiots, they were just trying things out and sharing ideas...
      - dynamite-ready 6y ago
gswdh 6y ago
As long as people are mortal, we are in the dark ages.
wrinkl3 6y ago
> I've suspected for some time that medicine is actually closer to the dark ages than we like to think it is What does that even mean? Nobody's claiming that modern medicine is anywhere close to perfect but the "dark ages" medicine was Humorism, blood letting and faith healing. Surgeons didn't start washing their hands before childbirth until the 19th century. It's really weird to look back at the mind-boggling progress we achieved in the past 200 years and conclude "we're basically still in the dark ages!"
- ThePowerOfDirge 6y ago
  Blood letting is still the treatment for iron overload.
  - meheleventyone 6y ago
    Right but only because we know the mechanism of action and it's efficacy. It's also performed in a different manner to blood letting as a historical treatment.
  - jankotek 6y ago
    Leaches produce enzyme that prevents blood cloth from forming. It also improves oxygenation. For some wounds, leaches would protect leg or arm from amputation.
    - fennecfoxen 6y ago
      * leeches Leaching is a process in which you percolate a liquid (like water) through something, and it picks up chemicals and carries them out. Brewing coffee, for instance.
  - buck4roo 6y ago
    "Rationally designed" drugs do this now. An example: Exjade ; https://en.wikipedia.org/wiki/Deferasirox https://en.wikipedia.org/wiki/Deferasirox
- garbagetime 6y ago
blablabla123 6y ago
Yes there are some diseases that can be treated very reliably but a large share of commonly occurring issues can't. Also given that modern medicine is largely based on statistics, I have doubts that the sophistication of statistics in use is really appropriate. I think Physics or Psychology do a lot better in that regard. That said, I think many diseases can be treated or prevented with a high success rate without any invasive procedure. For instance the risk of coronary heart disease can be lowered a lot with good diet and mild exercise. It surprises me that doctors never pro-actively mention how to prevent such lifestyle diseases until it's too late. Probably the subject of medicine needs to be broadened a bit.
trollied 6y ago
One day in the distant future, people will look back at us having treated cancers with radiation & wonder what the hell we were thinking!
- jalk 6y ago
  I hope they will know that there was some level of science (statistics) behind doing so, and not because someone just thought it might help
- projektfu 6y ago
  Honestly, I think cytotoxic chemotherapy will be more shocking. Radiation oncology has made great strides in targeting the dose (cyberknife and other stereotactic approaches). Cytotoxic therapy is still basically poisoning everything and hoping the cancer dies first. Or, in the case of cancers like multiple myeloma, killing all immune cells and replacing the stem cells. The future of cancer therapy is likely to be heavily reliant on customization and precise drug delivery, to give an overwhelming dose of poison to the cancer without harming the patient.
  - deleted 6y ago
    [deleted]
friendlybus 6y ago
There are many people who espouse a bright and endless increase of medical power, combined with a utopia-lite for our current state of medical knowledge. There is a lot in the dark and we should not hesistate to point it out. It would be a lie to paper over the cracks with yet another affirmation about it all being figured out and we can go back to sleep.
unishark 6y ago
Medical research is devoted to diseases, particularly where there's confidence something can be done about it. It's easy to imagine science being weak on something if it doesn't cause life-threatening problems.
throwaway0a5e 6y ago
"Centuries of scientitic progress being held back by centuries of tradition" seems like an apt cliche to invoke.
et2o 6y ago
Laughable confirmation bias.
arminiusreturns 6y ago
> medicine is actually closer to the dark ages than we like to think it is I'm not sure it's entirely on point, but ever since my mother was almost murdered by medical malpractice, and then learning about exactly how bad (frequent and severe) medical malpractice is, it's extremely hard for me to not see it this way. Somewhere close to 300,000 people die a year from medical malpractice, give or take ~50k! Even adjusting for the elderly and comorbidities the number is still huge. I don't know why I never did, but it keep thinking I need to go buy and read Bruce Schneiers book about outliers[1]... it seems crazy how much we ignore much more concrete and repeated issues that cause death and love to focus on outliers that will probably never happen to us. 1. https://www.amazon.com/Liars-Outliers-Enabling-Society-Thrive/dp/1118143302 https://www.amazon.com/Liars-Outliers-Enabling-Society-Thriv...
- fwip 6y ago
  This common factoid isn't actually true. The real number is almost certainly less than 10,000 people even with a generous definition, and probably closer to a few hundred annually. Further reading: https://sciencebasedmedicine.org/are-medical-errors-really-the-third-most-common-cause-of-death-in-the-u-s-2019-edition/ https://sciencebasedmedicine.org/are-medical-errors-really-t... Takeaway: > (1) [Adverse Effects of Medical Treatment] are not uncommon; (2) the vast majority of AEMTs that occur in patients who die aren’t the primary cause of death; (3) only a relatively small fraction of AEMTs are due to misadventure or medical error; and (4) population-adjusted AEMT rates have been slowly decreasing
  - arminiusreturns 6y ago
    Well thank you for giving me a different view, now I'm going to have to dig deeper on this. I would say at first glance I already see some methodological cracks, but thanks for the rabbit hole anyway.
edoloughlin 6y ago
I've suspected for some time that medicine is actually closer to the dark ages than we like to think it is Every now and then I see a comment that makes me think HN is closer to Facebook than we like to think it is.

bantunes 6y ago

I feel like the fact this is rare, big news kind of negates your point.

dynamite-ready 6y ago
Agreed, though it also makes me think of the numerous cases of drugs developed with a specific purpose, but then afterwards found to have a completely different effect to what was originally intended. Medical science is an incredible thing, but science, by definition, does not have all the answers. A small part of me is actually somewhat surprised, that people (both lay, and professional) are surprised. Though I am not the best placed commentator to champion this view.
- majewsky 6y ago
  > drugs developed with a specific purpose, but then afterwards found to have a completely different effect to what was originally intended I don't find that surprising. You have to do the early phases of drug development in model systems like cell cultures for practical reasons: It makes evidence obtained more reproducible and has less ethical concerns than experimenting on humans immediately. It's like how software components usually get implemented and tested in simplified environments (e.g. unit tests use doubles), and just like with drugs, sometimes we find that software components interact with each other in unexpected ways when combined into a whole.
  - iguy 6y ago
    What seems weird about this is that the process for deciding that an approved drug is useful for a certain condition (not the one it was intended for) is really informal, it seems to rely on common knowledge circulating in the guild. For the initial approval, we have this very formal process, the FDA wants this kind of data from trials of this size to show this statistical level, etc. All very scientific-looking. But once it's on the market, random doctors try it out for other conditions. If it seems to work they tell their buddies, tweak the mixtures, share anecdotes. If it becomes widespread, some industry club records this for the purpose of arguing with insurance companies. I am told this off-label use now constitutes the majority of drug prescriptions. All based on (as far as I can tell) no statistically driven testing at all, just stories. (To be clear, I'm not at all surprised that drugs have "off-target" effects, and may be very useful for things their inventor never imagines. I'm just a bit shocked how pre-modern our system for collecting this knowledge appears to be. But not an expert, and would love to know more.)
    - majewsky 6y ago
      > I'm just a bit shocked how pre-modern our system for collecting this knowledge appears to be. I'm not an expert, but I imagine any more advanced system would be extremely problematic from a data protection point of view (think HIPAA etc.). In a study, patients sign multiple pages of legalese to allow the researchers to collect all the required data. You don't have that with regular patients in a GP's office.
      - iguy 6y ago
        Yes that's a hurdle. But even without that, it seems hard to design a good system. If most of the doctors treat the very sick cases (among those diagnosed with X) with drugs Y+Z currently rumoured to work, how do you disentangle the causes of their poor outcomes? More generally, how do we know it isn't mostly garbage? That seems to be the consensus about most pre-20th-C medicine, and those guys weren't idiots, they were just trying things out and sharing ideas...
    - dynamite-ready 6y ago

gswdh 6y ago

As long as people are mortal, we are in the dark ages.

wrinkl3 6y ago

> I've suspected for some time that medicine is actually closer to the dark ages than we like to think it is What does that even mean? Nobody's claiming that modern medicine is anywhere close to perfect but the "dark ages" medicine was Humorism, blood letting and faith healing. Surgeons didn't start washing their hands before childbirth until the 19th century. It's really weird to look back at the mind-boggling progress we achieved in the past 200 years and conclude "we're basically still in the dark ages!"

ThePowerOfDirge 6y ago
Blood letting is still the treatment for iron overload.
- meheleventyone 6y ago
  Right but only because we know the mechanism of action and it's efficacy. It's also performed in a different manner to blood letting as a historical treatment.
- jankotek 6y ago
  Leaches produce enzyme that prevents blood cloth from forming. It also improves oxygenation. For some wounds, leaches would protect leg or arm from amputation.
  - fennecfoxen 6y ago
    * leeches Leaching is a process in which you percolate a liquid (like water) through something, and it picks up chemicals and carries them out. Brewing coffee, for instance.
- buck4roo 6y ago
  "Rationally designed" drugs do this now. An example: Exjade ; https://en.wikipedia.org/wiki/Deferasirox https://en.wikipedia.org/wiki/Deferasirox
garbagetime 6y ago

blablabla123 6y ago

Yes there are some diseases that can be treated very reliably but a large share of commonly occurring issues can't. Also given that modern medicine is largely based on statistics, I have doubts that the sophistication of statistics in use is really appropriate. I think Physics or Psychology do a lot better in that regard. That said, I think many diseases can be treated or prevented with a high success rate without any invasive procedure. For instance the risk of coronary heart disease can be lowered a lot with good diet and mild exercise. It surprises me that doctors never pro-actively mention how to prevent such lifestyle diseases until it's too late. Probably the subject of medicine needs to be broadened a bit.

trollied 6y ago

One day in the distant future, people will look back at us having treated cancers with radiation & wonder what the hell we were thinking!

jalk 6y ago
I hope they will know that there was some level of science (statistics) behind doing so, and not because someone just thought it might help
projektfu 6y ago
Honestly, I think cytotoxic chemotherapy will be more shocking. Radiation oncology has made great strides in targeting the dose (cyberknife and other stereotactic approaches). Cytotoxic therapy is still basically poisoning everything and hoping the cancer dies first. Or, in the case of cancers like multiple myeloma, killing all immune cells and replacing the stem cells. The future of cancer therapy is likely to be heavily reliant on customization and precise drug delivery, to give an overwhelming dose of poison to the cancer without harming the patient.
- deleted 6y ago
  [deleted]

friendlybus 6y ago

There are many people who espouse a bright and endless increase of medical power, combined with a utopia-lite for our current state of medical knowledge. There is a lot in the dark and we should not hesistate to point it out. It would be a lie to paper over the cracks with yet another affirmation about it all being figured out and we can go back to sleep.

unishark 6y ago

Medical research is devoted to diseases, particularly where there's confidence something can be done about it. It's easy to imagine science being weak on something if it doesn't cause life-threatening problems.

throwaway0a5e 6y ago

"Centuries of scientitic progress being held back by centuries of tradition" seems like an apt cliche to invoke.

et2o 6y ago

Laughable confirmation bias.

arminiusreturns 6y ago

> medicine is actually closer to the dark ages than we like to think it is I'm not sure it's entirely on point, but ever since my mother was almost murdered by medical malpractice, and then learning about exactly how bad (frequent and severe) medical malpractice is, it's extremely hard for me to not see it this way. Somewhere close to 300,000 people die a year from medical malpractice, give or take ~50k! Even adjusting for the elderly and comorbidities the number is still huge. I don't know why I never did, but it keep thinking I need to go buy and read Bruce Schneiers book about outliers[1]... it seems crazy how much we ignore much more concrete and repeated issues that cause death and love to focus on outliers that will probably never happen to us. 1. https://www.amazon.com/Liars-Outliers-Enabling-Society-Thrive/dp/1118143302 https://www.amazon.com/Liars-Outliers-Enabling-Society-Thriv...

fwip 6y ago
This common factoid isn't actually true. The real number is almost certainly less than 10,000 people even with a generous definition, and probably closer to a few hundred annually. Further reading: https://sciencebasedmedicine.org/are-medical-errors-really-the-third-most-common-cause-of-death-in-the-u-s-2019-edition/ https://sciencebasedmedicine.org/are-medical-errors-really-t... Takeaway: > (1) [Adverse Effects of Medical Treatment] are not uncommon; (2) the vast majority of AEMTs that occur in patients who die aren’t the primary cause of death; (3) only a relatively small fraction of AEMTs are due to misadventure or medical error; and (4) population-adjusted AEMT rates have been slowly decreasing
- arminiusreturns 6y ago
  Well thank you for giving me a different view, now I'm going to have to dig deeper on this. I would say at first glance I already see some methodological cracks, but thanks for the rabbit hole anyway.

edoloughlin 6y ago

I've suspected for some time that medicine is actually closer to the dark ages than we like to think it is Every now and then I see a comment that makes me think HN is closer to Facebook than we like to think it is.