4 ms·

Indeed, the oath is a theatre prop and not much more. I reside in Israel these days, which has a system similar to NL ttbomk. The doctors that treat you (in th

Indeed, the oath is a theatre prop and not much more. I reside in Israel these days, which has a system similar to NL ttbomk. The doctors that treat you (in the public system) are not incentivized other than to cure you, except perhaps through the occasional marketing cruise. But high up ministry of health people have been indicted (including through corona) for pushing and in some cases mandating useless treatments after receiving a bribe. The doctor at the hospital just got the memo “the recommended treatment in case of x is y”. These indictments are for what can actually be proved. I’m sure there are more cases that have not been found, and also in other countries. The only one who really has your best interests in my mind is yourself; if you are capable of doing research, you are likely more qualified for your own situation than specialists. WHO recommends against remdesivir. FDA and IMOH promote it as a wonderdrug. Who would you trust?

jacquesm 5y ago
> WHO recommends against remdesivir. FDA and IMOH promote it as a wonderdrug. Who would you trust? My GP.
- blindmute 5y ago
  Why would you trust a local GP? They are almost certainly the least knowledgeable person in the chain of authority from which you could choose to trust. They will either follow the guidelines or their anecdotal experience. You could read the research papers and the guidelines yourself and have a better understanding of the issue than a given GP. For anything rare, you could probably read the subreddit about the diagnosis and get more trustworthy advice than from a GP.
  - jacquesm 5y ago
    No, but he is in that chain of authority, and I'm not and if he passes on advice based on what he knows in general and what he knows about me I take it that he's not doing that because he wants to diminish the size of his practice. I could read the research papers and the guidelines, but for that I would first need a medical degree in the relevant (sub)fields, figure out who is and who isn't telling the truth/stacking the deck/fudging the data/angling for funding and so on and then finally I'd have to weigh those papers and all of their contradictions and arrive at some conclusion. The chances of me getting that wrong are just as high as the chances of my GP debugging a piece of software by reading papers about debugging. For rare diseases the job of a GP is not to diagnose but to pass you on to someone who can. You also have the right to a second opinion here in case you don't trust the advice that you are getting and finally, you can ask for arbitrage if you are then still not happy. That said, plenty of errors are made, but I don't think the software industry has any right to speak about mistakes made in other fields, our own house has been on fire for the last three decades in that respect and the only thing we've done to deal with it is to avow any responsibility.
    - beagle3 5y ago
      > I take it that he's not doing that because he wants to diminish the size of his practice. But very likely (especially in the US, but also in other places), his considerations have to do with not increasing his malpractice insurance premium. Your and his interests are not aligned. And that chasm is larger than anyone likes to admit.
      - jacquesm 5y ago
        I'm not in the US and malpractice suits against doctors are extremely rare here.
        beagle3 5y ago
        The divergence is not as big as in the US then, but your incentives are still not perfectly aligned. If you want to outsource your health decisions to someone else, who may be more knowledgeable in general, but may be less knowledgeable on any specific matter you dive into, and whose incentives are only generally aligned with yours - by all means do. I don't, and this has paid great dividends for me so far. People who are capable of reading and understanding research (not all are), and have the ability to reach far out to well informed people and consult with them (not all can), are also likely to be in this situation -- and those people potentially lose dearly for not doing so.
mikeyouse 5y ago
This is a good example of how ill-equipped most people are to forming their own opinions about things this complex. The WHO recommends against using remdesivir in hospitalized patients -- which is very different from your claim! The FDA and others make their cutoff point slightly but not substantially later, e.g. remdisivir isn't indicated when a hospitalized patient is on high-flow oxygen. Their disagreement isn't one of substance, just one of scope, and all doctors treating Covid know the rationale behind each cutoff point. But instead any of that nuance, people say things like the "WHO disagrees with FDA" and decide that both are useless so they should take medical advice from morons with podcasts?
- beagle3 5y ago
  You are arguing against a point I didn't make, and supporting the point I was trying to make. I actually read the papers on remdesivir, and as a result decided that I will not take it if offered, whether hospitalized or not, because of my risk/reward preferences, which may or may not align with the doctor's or the system's. In Israel (where I now reside), AFAIK, they are happily administering it to hospitalized covid patients; at least, they were giving it out a lot until they started treating with regeneron. Now, Israel has its own definition for requiring hospitalization than the WHO or the FDA (e.g. SpO2<94% is considered severe and requiring hospitalization -- if you have a positive PCR test). Do you think the doctors treating covid are actually aware of the minute differences between WHO, FDA, IMOH definitions? I checked with a couple I know. They have no idea.

jacquesm 5y ago

> WHO recommends against remdesivir. FDA and IMOH promote it as a wonderdrug. Who would you trust? My GP.

blindmute 5y ago
Why would you trust a local GP? They are almost certainly the least knowledgeable person in the chain of authority from which you could choose to trust. They will either follow the guidelines or their anecdotal experience. You could read the research papers and the guidelines yourself and have a better understanding of the issue than a given GP. For anything rare, you could probably read the subreddit about the diagnosis and get more trustworthy advice than from a GP.
- jacquesm 5y ago
  No, but he is in that chain of authority, and I'm not and if he passes on advice based on what he knows in general and what he knows about me I take it that he's not doing that because he wants to diminish the size of his practice. I could read the research papers and the guidelines, but for that I would first need a medical degree in the relevant (sub)fields, figure out who is and who isn't telling the truth/stacking the deck/fudging the data/angling for funding and so on and then finally I'd have to weigh those papers and all of their contradictions and arrive at some conclusion. The chances of me getting that wrong are just as high as the chances of my GP debugging a piece of software by reading papers about debugging. For rare diseases the job of a GP is not to diagnose but to pass you on to someone who can. You also have the right to a second opinion here in case you don't trust the advice that you are getting and finally, you can ask for arbitrage if you are then still not happy. That said, plenty of errors are made, but I don't think the software industry has any right to speak about mistakes made in other fields, our own house has been on fire for the last three decades in that respect and the only thing we've done to deal with it is to avow any responsibility.
  - beagle3 5y ago
    > I take it that he's not doing that because he wants to diminish the size of his practice. But very likely (especially in the US, but also in other places), his considerations have to do with not increasing his malpractice insurance premium. Your and his interests are not aligned. And that chasm is larger than anyone likes to admit.
    - jacquesm 5y ago
      I'm not in the US and malpractice suits against doctors are extremely rare here.
      - beagle3 5y ago
        The divergence is not as big as in the US then, but your incentives are still not perfectly aligned. If you want to outsource your health decisions to someone else, who may be more knowledgeable in general, but may be less knowledgeable on any specific matter you dive into, and whose incentives are only generally aligned with yours - by all means do. I don't, and this has paid great dividends for me so far. People who are capable of reading and understanding research (not all are), and have the ability to reach far out to well informed people and consult with them (not all can), are also likely to be in this situation -- and those people potentially lose dearly for not doing so.

mikeyouse 5y ago

This is a good example of how ill-equipped most people are to forming their own opinions about things this complex. The WHO recommends against using remdesivir in hospitalized patients -- which is very different from your claim! The FDA and others make their cutoff point slightly but not substantially later, e.g. remdisivir isn't indicated when a hospitalized patient is on high-flow oxygen. Their disagreement isn't one of substance, just one of scope, and all doctors treating Covid know the rationale behind each cutoff point. But instead any of that nuance, people say things like the "WHO disagrees with FDA" and decide that both are useless so they should take medical advice from morons with podcasts?

beagle3 5y ago
You are arguing against a point I didn't make, and supporting the point I was trying to make. I actually read the papers on remdesivir, and as a result decided that I will not take it if offered, whether hospitalized or not, because of my risk/reward preferences, which may or may not align with the doctor's or the system's. In Israel (where I now reside), AFAIK, they are happily administering it to hospitalized covid patients; at least, they were giving it out a lot until they started treating with regeneron. Now, Israel has its own definition for requiring hospitalization than the WHO or the FDA (e.g. SpO2<94% is considered severe and requiring hospitalization -- if you have a positive PCR test). Do you think the doctors treating covid are actually aware of the minute differences between WHO, FDA, IMOH definitions? I checked with a couple I know. They have no idea.