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> 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

by 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."

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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.

by derefr 5y ago

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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.