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> Protocols have been developed to ensure that we actually gain knowledge, and not at the expense of the patients. If medicine could be reduced to protocols, w

> Protocols have been developed to ensure that we actually gain knowledge, and not at the expense of the patients. If medicine could be reduced to protocols, we wouldn't need the doctors. You can rest assured right now many MDs are prescribing off-label meds, diagnostics tests, making non-protocol judgement calls etc all around the world. And I am glad they are doing that, because front-line medicine is more engineering than science and their job is ultimately to heal, not being protocol-only automatons. > SARS-CoV-2 is nothing special It is special in that everything about it has been very high profile, and in this day and age of hyper-connectedness, when expert institutions mess things up it is harder to cover up and their authority is at a greater risk. Let's be honest that is why they are being very iron fisted about out-of-band covid treatments, not because of a proportional threat to life.

derefr 5y ago
> You can rest assured right now many MDs are prescribing off-label meds, diagnostics tests, making non-protocol judgement calls etc all around the world. And I am glad they are doing that, because front-line medicine is more engineering than science and their job is ultimately to heal, not being protocol-only automatons. Well, yeah. One important point about health policy is that it's designed with the knowledge — the assumption — of some level of non-compliance. Health policy design is game-theoretic, like overbidding in a negotiation: rather than choosing rules that are logically correct, you pick optimal rules to get your own population — a portfolio of people with different feelings toward authority — to on average do the thing you want them to do, or a set of different useful things you want them to do. When regulating doctors, that means that you take into account that the doctor "on the ground" always has more knowledge than the regulator, and so you can phrase the regulations as absolutes to not do X, Y, or Z, knowing that the doctor will still do X/Y/Z anyway if they have information you don't that leads them to know better in a specific situation. This is very different from actually making a recommendation to do X/Y/Z in those situations, because such a recommendation can be interpreted out-of-context to imply that doing X/Y/Z might be helpful, and may mislead some doctors into doing X/Y/Z in situations where it wouldn't be helpful — especially in situations where they don't have enough information, but are just falling ever downward on a flowchart of things-to-try. Basically, when the regulations say "don't do X/Y/Z", what they mean is "if you do do X/Y/Z, we consider you to be taking a heterodox-to-the-medical-establishment position and will discourage others from giving you a platform to promote doing X/Y/Z, lest others not-as-informed as you hear from you and try X/Y/Z themselves without the same justified niche situation. But you can go ahead and keep doing X/Y/Z yourself; we'll turn a blind eye to that. Just do it quietly."
- deleted 5y ago
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- deleted 5y ago
  [deleted]
- derefr 5y ago
  Re: a now-deleted comment about how doctors elsewhere in the world suffer strict consequences for their actions, rather than getting "turned a blind eye": That still happens in the US regulatory environment as well! Implicit to "we'll turn a blind eye" is the context "as long as you do the due diligence of creating an alternative above-board explanation for what you were doing, so that there's no official record of your heterodox practice." The most serious and flagrant example of this effect occurs in assisted suicides. It is malfeasance to knowingly kill a patient, and even if no criminal charges occur, you'll have your license to practice permanently revoked if it can be proven that that was your intent. So no doctor who sets out to assist a patient in suicide ever has the words "assisted suicide" come out of their mouths in a provable way. Instead, they talk about "optimizing quality of life" and "mitigating suffering", through the mechanisms of large doses of drugs that can coincidentally, potentially cause death. As long as the death can be justified with the above-board explanation ("the patient's pain was so great that they needed this amount of narcotics to rest; and then this dose of narcotics ended up stopping their breathing during the night, and by the time a nurse responded, they were already gone") then the medical establishment — who 100% knows what the doctor was really doing — lets it go. But if the doctor doesn't bother to hide their approach behind a justification like this? Then they get the book thrown at them.
- acituan 5y ago
  > But you can go ahead and keep doing X/Y/Z yourself; we'll turn a blind eye to that. Just do it quietly." This is not true; the only MD in the discussion mentions he was strong-armed out of his personal off-label use, which is also contrary to the non-compliance slack you've mentioned. > This is very different from actually making a recommendation to do X/Y/Z in those situations, because such a recommendation can be interpreted out-of-context to imply that doing X/Y/Z might be helpful I don't know if you've seen the video in question, but they are not trying to make a medical recommendation at all. It is more of a meta-discussion, e.g on several institutional games (in the sense of game theory) including the implications of finding out a cheap off-patent drug that could contend with multi-billion-if-not-trillion-dollar global-scale vaccination drive. > can be interpreted out-of-context to imply that doing X/Y/Z might be helpful, and may mislead some doctors into doing X/Y/Z in situations where it wouldn't be helpful Youtube should not be in the business of assessing this risk, because they don't have the competence for this. I bet they don't even have one person with a medical degree in their policy team that made the takedown decision. When they take down an on-topic video of an MD and a PhD Biology, however unorthodox their expert position might be, it has the contrary effect of promoting folk medicine, not advancing scientific medicine.
yokaze 5y ago
> > Protocols have been developed to ensure that we actually gain knowledge, and not at the expense of the patients. > If medicine could be reduced to protocols, we wouldn't need the doctors. They are called protocols and not algorithms for a reason. > You can rest assured right now many MDs are prescribing off-label meds, diagnostics tests, making non-protocol judgement calls etc all around the world. Sure, sometimes for good reasons, others for less so. Every patient is different and the doctor has incomplete knowledge, and the protocols are in the end just that: Guidelines. I would be happy, if I get a doctor, which is critical of guidelines in the sense of being aware of their limitations and won't follow them like they are written in stone (on a case by case basis). However, as I understand it, we are talking here about deviating from the guidelines without good evidence or without a procedure to gain knowledge from it in a structured manner, not a case-by-case basis, but on principle. Quite frankly, I would stay the hell away from such doctor, which thinks that is a good idea. >It is special in that everything about it has been very high profile, and in this day and age of hyper-connectedness, when expert institutions mess things up it is harder to cover up and their authority is at a greater risk. >Let's be honest that is why they are being very iron fisted about out-of-band covid treatments, not because of a proportional threat to life. I had limited contact with the expert institutions, but do have direct contact to people who did work in an ICU with Covid-19, (and a below average mortality rate). Whenever the topic of, as you call them "out-of-band" treatments arose, the look on their faces would silence the topic. So, if you feel adventurous, I would suggest to cross-check your opinion with someone in the field.
- acituan 5y ago
  > Whenever the topic of, as you call them "out-of-band" treatments arose, the look on their faces would silence the topic. So, if you feel adventurous, I would suggest to cross-check your opinion with someone in the field. Let's agree that "the field" is not exclusive to US medicine with all the associated malpractice litigation risks. That might be an explanation for faces turning sour in your personal sample of acquaintances. > They are called protocols and not algorithms for a reason. > Every patient is different and the doctor has incomplete knowledge, and the protocols are in the end just that: Guidelines. > we are talking here about deviating from the guidelines without good evidence or without a procedure to gain knowledge from it in a structured manner I think you are taking a very elastic view on what protocols are. They either demand adherence or they are mere guidelines. Either evidence is required before straying out of protocol or doctors are expected to operate under incomplete knowledge.

derefr 5y ago

> You can rest assured right now many MDs are prescribing off-label meds, diagnostics tests, making non-protocol judgement calls etc all around the world. And I am glad they are doing that, because front-line medicine is more engineering than science and their job is ultimately to heal, not being protocol-only automatons. Well, yeah. One important point about health policy is that it's designed with the knowledge — the assumption — of some level of non-compliance. Health policy design is game-theoretic, like overbidding in a negotiation: rather than choosing rules that are logically correct, you pick optimal rules to get your own population — a portfolio of people with different feelings toward authority — to on average do the thing you want them to do, or a set of different useful things you want them to do. When regulating doctors, that means that you take into account that the doctor "on the ground" always has more knowledge than the regulator, and so you can phrase the regulations as absolutes to not do X, Y, or Z, knowing that the doctor will still do X/Y/Z anyway if they have information you don't that leads them to know better in a specific situation. This is very different from actually making a recommendation to do X/Y/Z in those situations, because such a recommendation can be interpreted out-of-context to imply that doing X/Y/Z might be helpful, and may mislead some doctors into doing X/Y/Z in situations where it wouldn't be helpful — especially in situations where they don't have enough information, but are just falling ever downward on a flowchart of things-to-try. Basically, when the regulations say "don't do X/Y/Z", what they mean is "if you do do X/Y/Z, we consider you to be taking a heterodox-to-the-medical-establishment position and will discourage others from giving you a platform to promote doing X/Y/Z, lest others not-as-informed as you hear from you and try X/Y/Z themselves without the same justified niche situation. But you can go ahead and keep doing X/Y/Z yourself; we'll turn a blind eye to that. Just do it quietly."

deleted 5y ago
[deleted]
deleted 5y ago
[deleted]
derefr 5y ago
Re: a now-deleted comment about how doctors elsewhere in the world suffer strict consequences for their actions, rather than getting "turned a blind eye": That still happens in the US regulatory environment as well! Implicit to "we'll turn a blind eye" is the context "as long as you do the due diligence of creating an alternative above-board explanation for what you were doing, so that there's no official record of your heterodox practice." The most serious and flagrant example of this effect occurs in assisted suicides. It is malfeasance to knowingly kill a patient, and even if no criminal charges occur, you'll have your license to practice permanently revoked if it can be proven that that was your intent. So no doctor who sets out to assist a patient in suicide ever has the words "assisted suicide" come out of their mouths in a provable way. Instead, they talk about "optimizing quality of life" and "mitigating suffering", through the mechanisms of large doses of drugs that can coincidentally, potentially cause death. As long as the death can be justified with the above-board explanation ("the patient's pain was so great that they needed this amount of narcotics to rest; and then this dose of narcotics ended up stopping their breathing during the night, and by the time a nurse responded, they were already gone") then the medical establishment — who 100% knows what the doctor was really doing — lets it go. But if the doctor doesn't bother to hide their approach behind a justification like this? Then they get the book thrown at them.
acituan 5y ago
> But you can go ahead and keep doing X/Y/Z yourself; we'll turn a blind eye to that. Just do it quietly." This is not true; the only MD in the discussion mentions he was strong-armed out of his personal off-label use, which is also contrary to the non-compliance slack you've mentioned. > This is very different from actually making a recommendation to do X/Y/Z in those situations, because such a recommendation can be interpreted out-of-context to imply that doing X/Y/Z might be helpful I don't know if you've seen the video in question, but they are not trying to make a medical recommendation at all. It is more of a meta-discussion, e.g on several institutional games (in the sense of game theory) including the implications of finding out a cheap off-patent drug that could contend with multi-billion-if-not-trillion-dollar global-scale vaccination drive. > can be interpreted out-of-context to imply that doing X/Y/Z might be helpful, and may mislead some doctors into doing X/Y/Z in situations where it wouldn't be helpful Youtube should not be in the business of assessing this risk, because they don't have the competence for this. I bet they don't even have one person with a medical degree in their policy team that made the takedown decision. When they take down an on-topic video of an MD and a PhD Biology, however unorthodox their expert position might be, it has the contrary effect of promoting folk medicine, not advancing scientific medicine.

yokaze 5y ago

> > Protocols have been developed to ensure that we actually gain knowledge, and not at the expense of the patients. > If medicine could be reduced to protocols, we wouldn't need the doctors. They are called protocols and not algorithms for a reason. > You can rest assured right now many MDs are prescribing off-label meds, diagnostics tests, making non-protocol judgement calls etc all around the world. Sure, sometimes for good reasons, others for less so. Every patient is different and the doctor has incomplete knowledge, and the protocols are in the end just that: Guidelines. I would be happy, if I get a doctor, which is critical of guidelines in the sense of being aware of their limitations and won't follow them like they are written in stone (on a case by case basis). However, as I understand it, we are talking here about deviating from the guidelines without good evidence or without a procedure to gain knowledge from it in a structured manner, not a case-by-case basis, but on principle. Quite frankly, I would stay the hell away from such doctor, which thinks that is a good idea. >It is special in that everything about it has been very high profile, and in this day and age of hyper-connectedness, when expert institutions mess things up it is harder to cover up and their authority is at a greater risk. >Let's be honest that is why they are being very iron fisted about out-of-band covid treatments, not because of a proportional threat to life. I had limited contact with the expert institutions, but do have direct contact to people who did work in an ICU with Covid-19, (and a below average mortality rate). Whenever the topic of, as you call them "out-of-band" treatments arose, the look on their faces would silence the topic. So, if you feel adventurous, I would suggest to cross-check your opinion with someone in the field.

acituan 5y ago
> Whenever the topic of, as you call them "out-of-band" treatments arose, the look on their faces would silence the topic. So, if you feel adventurous, I would suggest to cross-check your opinion with someone in the field. Let's agree that "the field" is not exclusive to US medicine with all the associated malpractice litigation risks. That might be an explanation for faces turning sour in your personal sample of acquaintances. > They are called protocols and not algorithms for a reason. > Every patient is different and the doctor has incomplete knowledge, and the protocols are in the end just that: Guidelines. > we are talking here about deviating from the guidelines without good evidence or without a procedure to gain knowledge from it in a structured manner I think you are taking a very elastic view on what protocols are. They either demand adherence or they are mere guidelines. Either evidence is required before straying out of protocol or doctors are expected to operate under incomplete knowledge.