4 ms·

It's not just corruption, it is an idea that seems very correct, but which is subtly wrong. Take a substance like chlorine. It is put into municipal drinking

It's not just corruption, it is an idea that seems very correct, but which is subtly wrong. Take a substance like chlorine. It is put into municipal drinking water because it kills things - things that can kill us or harm us. It is credited with making municipal water a lot safer. It has been shown to be safe and effective for most people. The key is most people. Some people, at the edges of the bell curve, cannot tolerate chlorine. If they drink water with it, or bathe in water with it, it harms them. I have family members who have this sensitivity. Since moving to a place with well water, their health has improved immensely. If you were to be guided only by studies that show the safety and effectiveness of the chlorine treatment, then you could overlook the fact that some people are outliers. Evidence based medicine will guide you to things that will work for most people in a given situation. However, for a specific patient, you may need to depart from that evidence. Limiting doctors to only evidence based approaches prevents them from treating specific patients.

auslegung 5y ago
I think you’re getting down-voted because yourcomment indicates you think this article says that doctors should only be able to use evidence-based approaches. That’s not at all with this article is about.
stonemetal12 5y ago
What do you think evidence based means? There is evidence that some people are sensitive to chlorine. In an evidenced based approach it would be considered a possible cause until there is evidence to rule it out. If other issues present similar symptoms and are more likely then they should be tested and ruled out first.
- obscur 5y ago
  Might be wrong, but I think they just mean that when you do large scale trials you aggregate over the population, and determine if the medication had a statistically significant effect. You can get evidence that a subgroup does not react well, but you might not, if that is not your focus. A key concept and solution here is 'precision medicine', tailoring medicine based on more precise information about the individual.
nonameiguess 5y ago
The EPA guidelines limit chlorine content in potable water to 1 PPM. That is well below the level at which even the most sensitive person is affected. The problem is this guideline has no legal enforcement mechanism, so whether or not your municipal water district follows it is up to them. If they're not, they're not practicing evidence-based anything. They're ignoring evidence-based guidelines for some other reason. Whether any US water district is really doing this seems debatable anyway. Maybe this is just a consequence of the poor state of search engines, but every source I can find claiming specific US water supplies contain unsafe levels of chlorine seem to be exclusively limited to companies trying to sell you expensive filtration systems you almost certainly do not need.
rscho 5y ago
That some people are sensitive to chlorine should then be scientifically studied, to expand the knowledge on that topic. Counting on individual practitioners to cook up artisanal individualized treatment on their own is both unscientific and the antithesis of what you (and everyone) want.
- tricky777 5y ago
  Evidence is king. But hyphoteticaly... if I'm an outlier, and blind test is made on only me, and reveals that I am sensitive to chlorated water. ...I would count that as evidence based.
- tomohawk 5y ago
  Where did I say a practitioner should "cook up artisanal treatments"? That's a strawman, for sure. Doctors have a lot of education, and gain a lot of experience over time. What I pointed out is that the studies are not enough. Where they leave off is where a doctor needs to be able to apply their education, experience, and knowledge of the case to make progress. Doctors are trained to apply scientific approaches to bridge the gap between the broad science and the individual patient. The big health co's do not like doctors doing this because it takes time and is expensive. So, they tie their hands because they only want the doctors to focus on the easiest fixes that solve the most problems.
  - rscho 5y ago
    I am a doctor. That's not a strawman at all. >Doctors are trained to apply scientific approaches to bridge the gap between the broad science and the individual patient. No. Really, I mean it. Doctors are trained in textbook approaches, not in the scientific method. The less creative, the better the doctor. That's precisely what evidence-based medicine is, and it's what allowed us to leave the Dark Ages of paternalistic medicine. > The big health co's do not like doctors doing this because it takes time and is expensive. So, they tie their hands because they only want the doctors to focus on the easiest fixes that solve the most problems. We tie our own hands. With guidelines. Yes, the system is tuned to a limited investment of time and money in each patient for distributive justice reasons, but guidelines are (mostly) there to discourage crackpot medicine.
dekhn 5y ago
chloramine is replacing chlorine in municipal treatment. I'd be amazed if somebody was really sensitive to chlorine, to the point where typical municipal water caused rashes. After all, all of us contain 80grams of it and consume 500mg/day.
celdon25 5y ago
> Take a substance like chlorine. It is put into municipal drinking water because it kills things - things that can kill us or harm us. It is credited with making municipal water a lot safer. > It has been shown to be safe and effective for most people. And yet it wasn't until I was well into my 30s that I learned that not cleaning your shower head often enough or thorough enough can block the effects of the chlorine and spray aerosolized bacteria everywhere. It doesn't matter what kind of medicine you have when there are plenty of problems that would be prevented if not for the obscene asymmetry of information and poor cultural health habits. But as long as big tech continues to believe that steering people toward political propaganda is what's best for society, that will be the narrative of the day rather than real progress.
- manwe150 5y ago
  And I was today years old (not much younger than you were)

auslegung 5y ago

I think you’re getting down-voted because yourcomment indicates you think this article says that doctors should only be able to use evidence-based approaches. That’s not at all with this article is about.

stonemetal12 5y ago

What do you think evidence based means? There is evidence that some people are sensitive to chlorine. In an evidenced based approach it would be considered a possible cause until there is evidence to rule it out. If other issues present similar symptoms and are more likely then they should be tested and ruled out first.

obscur 5y ago
Might be wrong, but I think they just mean that when you do large scale trials you aggregate over the population, and determine if the medication had a statistically significant effect. You can get evidence that a subgroup does not react well, but you might not, if that is not your focus. A key concept and solution here is 'precision medicine', tailoring medicine based on more precise information about the individual.

nonameiguess 5y ago

The EPA guidelines limit chlorine content in potable water to 1 PPM. That is well below the level at which even the most sensitive person is affected. The problem is this guideline has no legal enforcement mechanism, so whether or not your municipal water district follows it is up to them. If they're not, they're not practicing evidence-based anything. They're ignoring evidence-based guidelines for some other reason. Whether any US water district is really doing this seems debatable anyway. Maybe this is just a consequence of the poor state of search engines, but every source I can find claiming specific US water supplies contain unsafe levels of chlorine seem to be exclusively limited to companies trying to sell you expensive filtration systems you almost certainly do not need.

rscho 5y ago

That some people are sensitive to chlorine should then be scientifically studied, to expand the knowledge on that topic. Counting on individual practitioners to cook up artisanal individualized treatment on their own is both unscientific and the antithesis of what you (and everyone) want.

tricky777 5y ago
Evidence is king. But hyphoteticaly... if I'm an outlier, and blind test is made on only me, and reveals that I am sensitive to chlorated water. ...I would count that as evidence based.
tomohawk 5y ago
Where did I say a practitioner should "cook up artisanal treatments"? That's a strawman, for sure. Doctors have a lot of education, and gain a lot of experience over time. What I pointed out is that the studies are not enough. Where they leave off is where a doctor needs to be able to apply their education, experience, and knowledge of the case to make progress. Doctors are trained to apply scientific approaches to bridge the gap between the broad science and the individual patient. The big health co's do not like doctors doing this because it takes time and is expensive. So, they tie their hands because they only want the doctors to focus on the easiest fixes that solve the most problems.
- rscho 5y ago
  I am a doctor. That's not a strawman at all. >Doctors are trained to apply scientific approaches to bridge the gap between the broad science and the individual patient. No. Really, I mean it. Doctors are trained in textbook approaches, not in the scientific method. The less creative, the better the doctor. That's precisely what evidence-based medicine is, and it's what allowed us to leave the Dark Ages of paternalistic medicine. > The big health co's do not like doctors doing this because it takes time and is expensive. So, they tie their hands because they only want the doctors to focus on the easiest fixes that solve the most problems. We tie our own hands. With guidelines. Yes, the system is tuned to a limited investment of time and money in each patient for distributive justice reasons, but guidelines are (mostly) there to discourage crackpot medicine.

dekhn 5y ago

chloramine is replacing chlorine in municipal treatment. I'd be amazed if somebody was really sensitive to chlorine, to the point where typical municipal water caused rashes. After all, all of us contain 80grams of it and consume 500mg/day.

celdon25 5y ago

> Take a substance like chlorine. It is put into municipal drinking water because it kills things - things that can kill us or harm us. It is credited with making municipal water a lot safer. > It has been shown to be safe and effective for most people. And yet it wasn't until I was well into my 30s that I learned that not cleaning your shower head often enough or thorough enough can block the effects of the chlorine and spray aerosolized bacteria everywhere. It doesn't matter what kind of medicine you have when there are plenty of problems that would be prevented if not for the obscene asymmetry of information and poor cultural health habits. But as long as big tech continues to believe that steering people toward political propaganda is what's best for society, that will be the narrative of the day rather than real progress.

manwe150 5y ago
And I was today years old (not much younger than you were)