6 ms·

Makes you wonder which current medical procedures will be considered crazy in hindsight few decades from now.

by skocznymroczny 5y ago

darkerside 5y ago
Chemotherapy has to be high on the list. Amputation. ACL reconstruction. Gender reassignment surgery. Defibrillation.
- cyberpunk 5y ago
  Okay I’ll bite - what could replace gender reassignment surgery? We’re a long way off from Iain m banks style gender transitions…
  - jhgb 5y ago
    Three possible options, some possibly far-fetched, but most likely not impossible at some point, that come to my mind? * Non-surgical body modification (organ regrowth?). * Brain treatment of dysphoria. * Developmental treatment of the fetus to prevent body-brain mismatch.
    - delecti 5y ago
      Option 2 sounds like attack of the body snatchers. Whoever would be left in that body wouldn't be the same person who went into the procedure.
      - jhgb 5y ago
        I can assure you that if some kind of brain treatment could remove my mental problems I'd jump on it. Making an unhappy person into a different one seems to be exactly the point.
        delecti 5y ago
        Making a transgender person into a cisgender person is a bit different, though I wouldn't remove any of my mental problems either, so maybe it's a philosophical disagreement.
        jhgb 5y ago
        I'm not quite sure that's what you'd need to do; perhaps removing dysphoria would be enough.
        delecti 5y ago
        The goal of transition is to reduce the things that otherwise make you uncomfortable, and that discomfort is called dysphoria. So having dysphoria and being transgender are more or less synonymous.
        jhgb 5y ago
        From what I understood, clinical dysphoria is not always present in transgendered individuals.
  - dividedbyzero 5y ago
    Maybe not "a few decades" out (though, who knows?) but I'd really hope medicine will at some point be able to offer less traumatic and more effective options than reassignment surgery. Same with people with missing limbs, disfiguration, body image issues. There shouldn't be any fundamental obstacle in having things grow into other shapes and forms or just grow back, though the engineering challenges are probably enormous and brutal.
- QuadmasterXLII 5y ago
  What do you gain from taking shots at people who aren’t a threat to you?
  - wellthisisgreat 5y ago
    You mean football players with a reconstructed ACL? Because those listed are all very unpleasant medical procedures that should be replaced with less painful, more efficient alternatives.
mbg721 5y ago
Tommy John surgery, maybe?
permo-w 5y ago
The impression I got from this article was not that trepanation is to be considered crazy at all. We still do it, and for mostly the exact same reasons that Galen gave for it
elliekelly 5y ago
I hope the way we surgically treat cancer by cutting it out and hoping we got enough margin will be viewed by future generations as primitive. I’m hopeful medicine will eventually advance to the point where cancers can be treated (or, fingers crossed, cured) with a pill, or perhaps even prevented altogether.
- Joker_vD 5y ago
  Kinda doubt that. For example, stitching the wound's edges together is pretty damn primitive if you ask me but it's not going away anytime soon. And so is excision: if there is a part of body you'd like to be absent, then cutting it away is a pretty obvious, straightforward and reliable way to achieve that. "Doctor, my ear hurts, and the surgeon told me that he'd have to cut it off" — "Ah, those surgeons, they only know how to cut things off. Here, take this pill, and your ear will drop off on its own".
jhgb 5y ago
Reminds me of one of my favourite Star Trek scenes: https://www.youtube.com/watch?v=1i3gp_aN1cs https://www.youtube.com/watch?v=1i3gp_aN1cs "My god, what is this, the Dark Ages?" "Sounds like the goddamned Spanish Inquisition."
cwkoss 5y ago
The coarseness of pharmacological dosing: Right now, if the average effective dose is 10mg, doc just gives you 10mg. Often pharmacies can only provide multiples of this. People can have very dramatic differences in drug metabolism and tolerance, so this 'one size fits all' attitude is very coarse. I think it would be much better for certain medications, particularly ones that are taken over longer periods of time, to be titrated more carefully: - First dose should be <= 1/10th effective dose to check for hypersensitivity or allergies - Early doses should gradually titrate up - patient has no tolerance, and so early doses will have more effect. Titration should watch for both whether therapeutic effect is being achieved and whether side effects occur. - If therapeutic effect is achieved, stop increasing the dose. Possibly slowly reduce the dose until therapeutic effects are insufficient and then step up a little but in order to minimize side effects. - If side effects are too severe and no therapeutic effects are found, look for another drug. * This could be counterproductive for certain medications, like antibiotics or drugs with atypical dose response curves I think the main hurdle is that custom-dosing medications is expensive to do currently. Also requires an ability to quickly detect and react to whether therapeutic or side effects are occurring, which is also expensive and has patient compliance issues.

Makes you wonder which current medical procedures will be considered crazy in hindsight few decades from now.

darkerside 5y ago

Chemotherapy has to be high on the list. Amputation. ACL reconstruction. Gender reassignment surgery. Defibrillation.

cyberpunk 5y ago
Okay I’ll bite - what could replace gender reassignment surgery? We’re a long way off from Iain m banks style gender transitions…
- jhgb 5y ago
  Three possible options, some possibly far-fetched, but most likely not impossible at some point, that come to my mind? * Non-surgical body modification (organ regrowth?). * Brain treatment of dysphoria. * Developmental treatment of the fetus to prevent body-brain mismatch.
  - delecti 5y ago
    Option 2 sounds like attack of the body snatchers. Whoever would be left in that body wouldn't be the same person who went into the procedure.
    - jhgb 5y ago
      I can assure you that if some kind of brain treatment could remove my mental problems I'd jump on it. Making an unhappy person into a different one seems to be exactly the point.
      - delecti 5y ago
        Making a transgender person into a cisgender person is a bit different, though I wouldn't remove any of my mental problems either, so maybe it's a philosophical disagreement.
        jhgb 5y ago
        I'm not quite sure that's what you'd need to do; perhaps removing dysphoria would be enough.
        delecti 5y ago
        The goal of transition is to reduce the things that otherwise make you uncomfortable, and that discomfort is called dysphoria. So having dysphoria and being transgender are more or less synonymous.
        jhgb 5y ago
        From what I understood, clinical dysphoria is not always present in transgendered individuals.
- dividedbyzero 5y ago
  Maybe not "a few decades" out (though, who knows?) but I'd really hope medicine will at some point be able to offer less traumatic and more effective options than reassignment surgery. Same with people with missing limbs, disfiguration, body image issues. There shouldn't be any fundamental obstacle in having things grow into other shapes and forms or just grow back, though the engineering challenges are probably enormous and brutal.
QuadmasterXLII 5y ago
What do you gain from taking shots at people who aren’t a threat to you?
- wellthisisgreat 5y ago
  You mean football players with a reconstructed ACL? Because those listed are all very unpleasant medical procedures that should be replaced with less painful, more efficient alternatives.

mbg721 5y ago

Tommy John surgery, maybe?

permo-w 5y ago

The impression I got from this article was not that trepanation is to be considered crazy at all. We still do it, and for mostly the exact same reasons that Galen gave for it

elliekelly 5y ago

I hope the way we surgically treat cancer by cutting it out and hoping we got enough margin will be viewed by future generations as primitive. I’m hopeful medicine will eventually advance to the point where cancers can be treated (or, fingers crossed, cured) with a pill, or perhaps even prevented altogether.

Joker_vD 5y ago
Kinda doubt that. For example, stitching the wound's edges together is pretty damn primitive if you ask me but it's not going away anytime soon. And so is excision: if there is a part of body you'd like to be absent, then cutting it away is a pretty obvious, straightforward and reliable way to achieve that. "Doctor, my ear hurts, and the surgeon told me that he'd have to cut it off" — "Ah, those surgeons, they only know how to cut things off. Here, take this pill, and your ear will drop off on its own".

jhgb 5y ago

Reminds me of one of my favourite Star Trek scenes: https://www.youtube.com/watch?v=1i3gp_aN1cs https://www.youtube.com/watch?v=1i3gp_aN1cs "My god, what is this, the Dark Ages?" "Sounds like the goddamned Spanish Inquisition."

cwkoss 5y ago

The coarseness of pharmacological dosing: Right now, if the average effective dose is 10mg, doc just gives you 10mg. Often pharmacies can only provide multiples of this. People can have very dramatic differences in drug metabolism and tolerance, so this 'one size fits all' attitude is very coarse. I think it would be much better for certain medications, particularly ones that are taken over longer periods of time, to be titrated more carefully: - First dose should be <= 1/10th effective dose to check for hypersensitivity or allergies - Early doses should gradually titrate up - patient has no tolerance, and so early doses will have more effect. Titration should watch for both whether therapeutic effect is being achieved and whether side effects occur. - If therapeutic effect is achieved, stop increasing the dose. Possibly slowly reduce the dose until therapeutic effects are insufficient and then step up a little but in order to minimize side effects. - If side effects are too severe and no therapeutic effects are found, look for another drug. * This could be counterproductive for certain medications, like antibiotics or drugs with atypical dose response curves I think the main hurdle is that custom-dosing medications is expensive to do currently. Also requires an ability to quickly detect and react to whether therapeutic or side effects are occurring, which is also expensive and has patient compliance issues.