25 ms·

You seem to be under the impression that there is some 'advanced technology' out there that will magically solve your problems that the US fails to have. In my

You seem to be under the impression that there is some 'advanced technology' out there that will magically solve your problems that the US fails to have. In my experience, many people have a quasi-religious belief in the capability of modern medicine to perform what would otherwise be called a miracle. This belief is typically held without any evidence whatsoever. In reality, there are a plethora of conditions, some very common and serious, that medicine simply has no idea how to treat. The set of completely treatable / curable conditions is much much much smaller than the set of all possible diseases, yet people act as if it's the opposite. This is why things like 'evidence based' medicine is so dangerous -- we don't have evidence for the vast majority of impactful conditions, simply ignoring patients with these conditions is not a workable solution.

jl6 5y ago
I feel proponents of evidence based medicine are perfectly aware of the enormity of the problem, and are working hard to improve the situation.
- twofornone 5y ago
  But the point is that laymen are not, and they put too much faith, on average, into our medical institutions. Our understanding of the human body has advanced enormously with the advent of modern science, but it is still far less complete than most people probably realize when they interact with doctors. Not to mention systemic issues (common to any technical discipline) where medical professionals have to effectively practice with a degree of faith because no one has time to actually review the literature underpinning any given consensus, and that occasionally breeds long lived orthodoxies which do more harm than good...
  - VerminOctopus1 5y ago
    Who exactly should the laymen put their faith into if not medical institutions? That, and the scientific process, are all we’ve got.
    - ipaddr 5y ago
      Medical practice and research can be decades away from each Other. Use your own judgement. Smoking was a weight cure before it wasn't.
beebmam 5y ago
Ignoring them is unethical. Treating them with an unscientific treatment is unethical.
- telchior 5y ago
  And the ethical alternative is, for chronic conditions, someone who suffers for their entire life and is not allowed to do anything about it? Look at every wastebasket diagnosis (yes, that's a real term) out there. There is no "ethical", approved treatment. In fact, there's not even an understanding of what the condition is. Instead, doctors work down a list of bad ideas with their patients: all the various medications, supplements, and even surgeries that have ever reputedly worked. Many have uncertain evidence, many more have no evidence at all. Some patients eventually hit on something that works for them. Others don't. According to your short statement: that's unethical. Bad. Stop! So what's the alternative? Suicide? Doing nothing is intolerable.
  - sterlind 5y ago
    I think you're being a little unfair to wastebasket diagnoses. you need something for insurance codes, for drug indications, for publishing research on. having a bucket of similar syndromes is a start for drilling down further. and often you can treat things supportively, even if you can't modify the disease itself. doctors need to be up front with patients about wastebaskets though, and rule out other diagnoses. it's wrong to chalk someone's fits up to FND until you've ruled out epilepsy and other organic causes, for example. and even things like FND are probably "real", we just don't know enough about them yet.
    - telchior 5y ago
      I'm criticizing the parent's comment that it's not ethical to treat people with "unscientific" treatments. This is in the context of an article criticizing phenylephrine, which differs from really, deeply unscientific stuff like, say, acupuncture or homeopathic remedies, in that it has studies going both ways but the balance (according to meta-analyses) is that it's useless as a decongestant, and is thus unscientific to have on the shelves. How does that relate to wastebasket syndromes? At least for the one I have (a migraine variant) -- every single accepted treatment falls in the same basket. Some evidence, but not enough that it's really a good idea to use it. Unless, that is, the syndrome is ruining your life. And behind this argument that yet more things should be taken off the shelves and regulated, I'll note that the US has one of the most restrictive, patient-unfriendly regulatory atmospheres in the world. It's goddamned ridiculous, pardon my French, that the "solution" to phenylephrine not being a good decongestant would be to regulate it so that it can't be sold without a prescription. Doubly so, in a country with a healthcare industry that's so thoroughly corrupt and dysfunctional that a vast swathe of patients can't afford to even go to a doctor to get whatever tenuous recommendation they may have. (Phenylephrine, by the way, has a number of uses other than decongestion.) ... that was a rant. But this system is truly screwed up, that fact has affected my life quite negatively, and it's annoying that the knee-jerk reaction so many people have is to keep playing along with this completely broken ethical system.
tayo42 5y ago
> many people have a quasi-religious belief in the capability of modern medicine to perform what would otherwise be called a miracle. That's probably because miracles are being pulled off on ocassion
ajross 5y ago
> In my experience, many people have a quasi-religious belief in the capability of modern medicine to perform what would otherwise be called a miracle. This belief is typically held without any evidence whatsoever. Modern medical results would absolutely be viewed as a miracle to someone just a few decades back. Something like 90% of cancer cases are either cured or successfully suppressed (to the extent that the sufferer ends up dying of some other cause). Almost all endemic diseases have vaccines. Virtually no one dies of a bacterial infection today. Even most autoimmune disorders have effective treatments now. The fact that there are problems yet to solve in medicine, and remaining voodoo in its practice, still doesn't change the fact that we're living in a miraculous age.
- greedo 5y ago
  90% of cancer cases are cured or suppressed? I have to call BS. Cancer is the number two cause of death in the US.
  - eurasiantiger 5y ago
    That just goes to show how unfair the medical system there is. Not everyone can afford treatment, and those who cannot are already otherwise more at risk due to the affordability of processed foods imposing unhealthy ”lifestyle choices” as well as downright hazardous living and working conditions.
    - chimeracoder 5y ago
      > That just goes to show how unfair the medical system there is. Not everyone can afford treatment, and those who cannot are already otherwise more at risk due to the affordability of processed foods imposing unhealthy ”lifestyle choices” as well as downright hazardous living and working conditions. I get that this explanation fits with a common preconception of the US, but it doesn't bear out in reality. The US has a higher survival rate for all common types of cancer than all other developed countries, and this has been consistently the case for the last three decades. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)33326-3/fulltext https://www.thelancet.com/journals/lancet/article/PIIS0140-6...
csnover 5y ago
The messaging in the US most commonly used to justify the lack of universal coverage and unreasonable cost of care is that we pay the most because we get the best treatments and best doctors and best outcomes, so I don’t think it’s fair to blame laymen for believing that. Also, it’s not just patients that think this way. (Or, at least, if the clinicians know, they aren’t saying much to their patients.) I’ve had docs gush about amazing wonder drugs, then I go and read the actual Phase 3 trial data on the patient information sheet and it has a 15% response (not remission) rate. I’ve been told I’m being given a “gold standard” treatment—but not that the “gold standard” response rate is actually only about 33%, and in another ~33% of cases it makes things worse. I’ve had doctors refer me for surgery, tell me about how amazing the surgeon is, what a great job they’ll do, that if their own kids were sick they’d send them to this person. When I ask for hard data on the surgeon’s actual success rate for this type of surgery, well, they don’t track that—but look, just trust me, the guy’s realllyyy good. Out of dozens of specialists I’ve seen over the years, I’ve only had one ever explicitly acknowledge that, yes, I had a real problem, but modern medicine just was not advanced enough yet to identify the cause, so they’re just kind of winging it. For the rest, there are “many new options”, “great responses”, “positive outcomes”, “extremely effective”—or there’s nothing wrong with you, it’s all in your head, and the princess is in another castle.
- rscho 5y ago
  > When I ask for hard data on the surgeon’s actual success rate for this type of surgery, well, they don’t track that—but look, just trust me, the guy’s realllyyy good. For good reason. Tracking of clinical outcomes is the wet dream of insurance companies. It's very toxic to the healthcare system, because it pushes practitioners to focus on easy cases where a good outcome is expected and causes major inequalities in access to healthcare. I'm not saying the present situation is ideal, but for the system as a whole in its current form, tracking clinical outcomes is a very bad idea.
  - csnover 5y ago
    I could see that problem occurring if the metric was “what is the success rate of everything that Surgeon X does”. I can’t see that problem occurring for “Surgeon X performing Procedure Y has N% of patients reporting relief and M% of patients reporting complications after the surgery”. What am I missing here? Edit: Follow-up question: notwithstanding the dysfunction of congress and the ability of companies to find loopholes, and assuming no universal health care to eliminate the role of insurers, surely a solution would be to prohibit the use of this information in the same way that ACA prohibits the use of pre-existing conditions to deny coverage?
Spooky23 5y ago
We have miracle cures for many things, but medicine is worse than ever. I grew up with ER doctors. There are dozens of things that would have killed you on 1990 that you’ll walk away from today. But in the slow transition from a professional discipline to a sort of IT help desk for health delivery, billing comes first, and even that sucks.
Raineer 5y ago
"This is why things like 'evidence based' medicine is so dangerous -- we don't have evidence for the vast majority of impactful conditions, simply ignoring patients with these conditions is not a workable solution." Citation needed.
- nradov 5y ago
  What kind of citation are your looking for? It's just obvious to anyone who works in the medical field. There are only evidence based treatment guidelines for a minority of conditions, and those often don't account for individual variations between real patients. So physicians often have to resort to trial and error in order to find an effective treatment.
AussieWog93 5y ago
>In my experience, many people have a quasi-religious belief in the capability of modern medicine to perform what would otherwise be called a miracle. This belief is typically held without any evidence whatsoever. I found the same thing for science in general. When I did my PhD and saw how the sausage was made, I was blown away by how obviously unscientific and irrational the entire process of science was.
opportune 5y ago
The problem with empowering people medically is that 10% of people will benefit from it but 90% of people will get info from Facebook and infomercials and fall victim to quacks. Hence everything being gated behind credentials and prescriptions (along with some good old regulatory capture). I disagree with the characterization of medicine not being able to treat so many things. Many things are incurable but a lot of medicine/public health is so effective we barely think about it. Of course we are going to notice and pay more attention to the things medicine sucks at treating, because they’re real problems that inflict a lot of pain due to the lack of treatment. But medicine is very good at treating plenty of things like infections (of many different kinds), traumatic/acute injuries, and many disabilities. Most of the chronic issues that medicine fails to address are simply lifestyle issues that medicine tries to alleviate the symptoms for. Yes there are certain conditions medicine doesn’t begin to fully understand like Alzheimer’s or various chronic pain conditions, or where treatment is still pretty middling like Cancer, but a lot of the biggest things are treatable very well - we just don’t notice them much because they are treated so well.
- the__alchemist 5y ago
  > I disagree with the characterization of medicine not being able to treat so many things. Many things are incurable but a lot of medicine/public health is so effective we barely think about it. Of course we are going to notice and pay more attention to the things medicine sucks at treating, because they’re real problems that inflict a lot of pain due to the lack of treatment. > But medicine is very good at treating plenty of things like infections (of many different kinds), traumatic/acute injuries, and many disabilities. I agree that medicine is very good at treating infections and traumatic/acute injuries. Which disabilities are you referring to? Outside of these categories, what can we we effectively treat or cure? It seems to be very little.
  - tuatoru 5y ago
    Hip replacements? Cataract surgery? Disfigurements (cosmetic surgery)? - just off the top of my head. My own mother had "cosmetic" surgeries to re-set her toes which had been deformed by decades of fashionable shoes, and to remove varicose veins which are painful. Occasionally one reads about someone's hearing, sight, or power of speech being restored also. Maybe only a few things, but still affecting millions, if not tens of millions of people. I also think that medicine is a victim of its own success, in two ways. One, how many funerals of people in their thirties to fifties does the average person go to, these days, compared to say the 1920s? It's hard to see things that don't happen. Two, success breeds hubris which breeds a sense of being right whatever the evidence may say.
s0rce 5y ago
Since when is "evidence based medicine" defined as ignoring patients with currently untreatable conditions. There are enormous amounts of funding and effort constantly devoted to developing new treatments. I'm not sure how else you want to practice medicine other than "evidence based".
tuatoru 5y ago
> many people have a quasi-religious belief in the capability of modern medicine to perform what would otherwise be called a miracle. This belief is typically held without any evidence whatsoever. The thing is, application of the germ theory of disease and Harvey's theory of circulation of the blood by action of the heart (and consequent developed understanding of the role of the blood, and of blood types) did produce miracles. Reliably safe milk and meat. Penicillin. Reliably useful blood transfusions. The tetanus vaccine. The polio vaccine. The great polio epidemic was only four-ish generations ago. In my childhood I knew one or two people in iron lungs, having contracted polio before the vaccine. The vaccine was miraculous to every parent at the time. The evidence has been culturally transmitted through the generations.
xyzzy21 5y ago
Indeed. My experience has been that 75%-90% of US doctors are borderline incompetent and that I can and do routine out-diagnose my own maladies better. Of course this also means I can lead them by the nose to get them to diagnose anything I please. Which is horrifying - they are Epic Fail if I can do that. Admittedly I was at one time planning to become a doctor myself so I ravenously consumed everything about biology and medicine while a teen but it seems very few doctors were anything like THAT with passion I had. Even worse few seem to know what the scientific method is, let alone practice it in any as doctors. This is equally horrifying.
- burntoutfire 5y ago
  The closest we currently get to scientific method in medicine is via double-blind large randomized trials, which is not applicable for a single doctor's practice.
- rprospero 5y ago
  Honestly, the "lead the by the nose" situation is a large improvement from many of the doctors I've met, who will actively ignore any evidence that doesn't fit their favourite diagnosis. Classic example: my partner was impaled through the leg in a workplace accident and had to go to the ER. The doctor declared that the wound was, in fact, a diabetic sore and that my partner had faked the accident to cover it up. Since the "diabetes" had reached the point of developing sores, he was prescribing insulin. However, the insurance company, "as a formality", insisted that he measure her blood sugar. After TWENTY blood tests came back with a perfectly healthy blood sugar level, he stuck with the diabetes diagnosis and just prescribed a different drug for it. A runner up was a co-worker who WAS diabetic after a pancreatic infection. He later went to the doctor to complain about some knee pain. The doctor looked at the symptoms (e.g. joint paint, diabetes, shortness of breath) and diagnosed asymptomatic obesity. The "asymptomatic" part comes from the fact that my co-worker was built like David Bowie. However, the doctor declared that the remaining symptoms pointed towards obesity and that losing forty pounds would clear up all his issues.
- travisathougies 5y ago
  For reals. I have alpha and beta thalassemia minor. It causes funny bloodwork (namely, it looks like I'm anemic). When I first got my results, doctors wanted me to see an oncologist and cardiologist and do all these tests and procedures. I thought it was odd because my bloodwork had always come back this way, so I researched a bunch of conditions that could cause the numbers I had (because my numbers weren't quite conducive to cancer or heart problems either). Anyway, I realized after making lots of lists and ruling things out that I likely had mild thallassemia, and when I finally got tested, it turned out I did. No surprise there given my ethnic background (which frankly should have been a dead giveaway, because thalassemias are not uncommon at all), but I saved myself from being put on iron supplementation which is already potentially dangerous for a man, but especially dangerous to someone with thalassemia.
quickthrower2 5y ago
Evidence based is good if you can get it. If not things that are suspected or even experimenting with your own body is worth it. For example if there is no evidence that a better diet or reducing EMF or strength exercise or drinking pure water etc. will help your condition but there is no harm and fairly low cost to try. Stay sceptical and open minded too.
dionidium 5y ago
> This is why things like 'evidence based' medicine is so dangerous -- we don't have evidence for the vast majority of impactful conditions, simply ignoring patients with these conditions is not a workable solution. Maybe that's true at a population level, but I can take it. Just tell me the truth. If you can't treat me, then just say that. I don't want to be "ignored," but I'm not interested in being placated, either. This, basically: https://www.youtube.com/watch?v=NyugCJ40IIw https://www.youtube.com/watch?v=NyugCJ40IIw

jl6 5y ago

I feel proponents of evidence based medicine are perfectly aware of the enormity of the problem, and are working hard to improve the situation.

twofornone 5y ago
But the point is that laymen are not, and they put too much faith, on average, into our medical institutions. Our understanding of the human body has advanced enormously with the advent of modern science, but it is still far less complete than most people probably realize when they interact with doctors. Not to mention systemic issues (common to any technical discipline) where medical professionals have to effectively practice with a degree of faith because no one has time to actually review the literature underpinning any given consensus, and that occasionally breeds long lived orthodoxies which do more harm than good...
- VerminOctopus1 5y ago
  Who exactly should the laymen put their faith into if not medical institutions? That, and the scientific process, are all we’ve got.
  - ipaddr 5y ago
    Medical practice and research can be decades away from each Other. Use your own judgement. Smoking was a weight cure before it wasn't.

beebmam 5y ago

Ignoring them is unethical. Treating them with an unscientific treatment is unethical.

telchior 5y ago
And the ethical alternative is, for chronic conditions, someone who suffers for their entire life and is not allowed to do anything about it? Look at every wastebasket diagnosis (yes, that's a real term) out there. There is no "ethical", approved treatment. In fact, there's not even an understanding of what the condition is. Instead, doctors work down a list of bad ideas with their patients: all the various medications, supplements, and even surgeries that have ever reputedly worked. Many have uncertain evidence, many more have no evidence at all. Some patients eventually hit on something that works for them. Others don't. According to your short statement: that's unethical. Bad. Stop! So what's the alternative? Suicide? Doing nothing is intolerable.
- sterlind 5y ago
  I think you're being a little unfair to wastebasket diagnoses. you need something for insurance codes, for drug indications, for publishing research on. having a bucket of similar syndromes is a start for drilling down further. and often you can treat things supportively, even if you can't modify the disease itself. doctors need to be up front with patients about wastebaskets though, and rule out other diagnoses. it's wrong to chalk someone's fits up to FND until you've ruled out epilepsy and other organic causes, for example. and even things like FND are probably "real", we just don't know enough about them yet.
  - telchior 5y ago
    I'm criticizing the parent's comment that it's not ethical to treat people with "unscientific" treatments. This is in the context of an article criticizing phenylephrine, which differs from really, deeply unscientific stuff like, say, acupuncture or homeopathic remedies, in that it has studies going both ways but the balance (according to meta-analyses) is that it's useless as a decongestant, and is thus unscientific to have on the shelves. How does that relate to wastebasket syndromes? At least for the one I have (a migraine variant) -- every single accepted treatment falls in the same basket. Some evidence, but not enough that it's really a good idea to use it. Unless, that is, the syndrome is ruining your life. And behind this argument that yet more things should be taken off the shelves and regulated, I'll note that the US has one of the most restrictive, patient-unfriendly regulatory atmospheres in the world. It's goddamned ridiculous, pardon my French, that the "solution" to phenylephrine not being a good decongestant would be to regulate it so that it can't be sold without a prescription. Doubly so, in a country with a healthcare industry that's so thoroughly corrupt and dysfunctional that a vast swathe of patients can't afford to even go to a doctor to get whatever tenuous recommendation they may have. (Phenylephrine, by the way, has a number of uses other than decongestion.) ... that was a rant. But this system is truly screwed up, that fact has affected my life quite negatively, and it's annoying that the knee-jerk reaction so many people have is to keep playing along with this completely broken ethical system.

tayo42 5y ago

> many people have a quasi-religious belief in the capability of modern medicine to perform what would otherwise be called a miracle. That's probably because miracles are being pulled off on ocassion

ajross 5y ago

> In my experience, many people have a quasi-religious belief in the capability of modern medicine to perform what would otherwise be called a miracle. This belief is typically held without any evidence whatsoever. Modern medical results would absolutely be viewed as a miracle to someone just a few decades back. Something like 90% of cancer cases are either cured or successfully suppressed (to the extent that the sufferer ends up dying of some other cause). Almost all endemic diseases have vaccines. Virtually no one dies of a bacterial infection today. Even most autoimmune disorders have effective treatments now. The fact that there are problems yet to solve in medicine, and remaining voodoo in its practice, still doesn't change the fact that we're living in a miraculous age.

greedo 5y ago
90% of cancer cases are cured or suppressed? I have to call BS. Cancer is the number two cause of death in the US.
- eurasiantiger 5y ago
  That just goes to show how unfair the medical system there is. Not everyone can afford treatment, and those who cannot are already otherwise more at risk due to the affordability of processed foods imposing unhealthy ”lifestyle choices” as well as downright hazardous living and working conditions.
  - chimeracoder 5y ago
    > That just goes to show how unfair the medical system there is. Not everyone can afford treatment, and those who cannot are already otherwise more at risk due to the affordability of processed foods imposing unhealthy ”lifestyle choices” as well as downright hazardous living and working conditions. I get that this explanation fits with a common preconception of the US, but it doesn't bear out in reality. The US has a higher survival rate for all common types of cancer than all other developed countries, and this has been consistently the case for the last three decades. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)33326-3/fulltext https://www.thelancet.com/journals/lancet/article/PIIS0140-6...

csnover 5y ago

The messaging in the US most commonly used to justify the lack of universal coverage and unreasonable cost of care is that we pay the most because we get the best treatments and best doctors and best outcomes, so I don’t think it’s fair to blame laymen for believing that. Also, it’s not just patients that think this way. (Or, at least, if the clinicians know, they aren’t saying much to their patients.) I’ve had docs gush about amazing wonder drugs, then I go and read the actual Phase 3 trial data on the patient information sheet and it has a 15% response (not remission) rate. I’ve been told I’m being given a “gold standard” treatment—but not that the “gold standard” response rate is actually only about 33%, and in another ~33% of cases it makes things worse. I’ve had doctors refer me for surgery, tell me about how amazing the surgeon is, what a great job they’ll do, that if their own kids were sick they’d send them to this person. When I ask for hard data on the surgeon’s actual success rate for this type of surgery, well, they don’t track that—but look, just trust me, the guy’s realllyyy good. Out of dozens of specialists I’ve seen over the years, I’ve only had one ever explicitly acknowledge that, yes, I had a real problem, but modern medicine just was not advanced enough yet to identify the cause, so they’re just kind of winging it. For the rest, there are “many new options”, “great responses”, “positive outcomes”, “extremely effective”—or there’s nothing wrong with you, it’s all in your head, and the princess is in another castle.

rscho 5y ago
> When I ask for hard data on the surgeon’s actual success rate for this type of surgery, well, they don’t track that—but look, just trust me, the guy’s realllyyy good. For good reason. Tracking of clinical outcomes is the wet dream of insurance companies. It's very toxic to the healthcare system, because it pushes practitioners to focus on easy cases where a good outcome is expected and causes major inequalities in access to healthcare. I'm not saying the present situation is ideal, but for the system as a whole in its current form, tracking clinical outcomes is a very bad idea.
- csnover 5y ago
  I could see that problem occurring if the metric was “what is the success rate of everything that Surgeon X does”. I can’t see that problem occurring for “Surgeon X performing Procedure Y has N% of patients reporting relief and M% of patients reporting complications after the surgery”. What am I missing here? Edit: Follow-up question: notwithstanding the dysfunction of congress and the ability of companies to find loopholes, and assuming no universal health care to eliminate the role of insurers, surely a solution would be to prohibit the use of this information in the same way that ACA prohibits the use of pre-existing conditions to deny coverage?

Spooky23 5y ago

We have miracle cures for many things, but medicine is worse than ever. I grew up with ER doctors. There are dozens of things that would have killed you on 1990 that you’ll walk away from today. But in the slow transition from a professional discipline to a sort of IT help desk for health delivery, billing comes first, and even that sucks.

Raineer 5y ago

"This is why things like 'evidence based' medicine is so dangerous -- we don't have evidence for the vast majority of impactful conditions, simply ignoring patients with these conditions is not a workable solution." Citation needed.

nradov 5y ago
What kind of citation are your looking for? It's just obvious to anyone who works in the medical field. There are only evidence based treatment guidelines for a minority of conditions, and those often don't account for individual variations between real patients. So physicians often have to resort to trial and error in order to find an effective treatment.

AussieWog93 5y ago

>In my experience, many people have a quasi-religious belief in the capability of modern medicine to perform what would otherwise be called a miracle. This belief is typically held without any evidence whatsoever. I found the same thing for science in general. When I did my PhD and saw how the sausage was made, I was blown away by how obviously unscientific and irrational the entire process of science was.

opportune 5y ago

The problem with empowering people medically is that 10% of people will benefit from it but 90% of people will get info from Facebook and infomercials and fall victim to quacks. Hence everything being gated behind credentials and prescriptions (along with some good old regulatory capture). I disagree with the characterization of medicine not being able to treat so many things. Many things are incurable but a lot of medicine/public health is so effective we barely think about it. Of course we are going to notice and pay more attention to the things medicine sucks at treating, because they’re real problems that inflict a lot of pain due to the lack of treatment. But medicine is very good at treating plenty of things like infections (of many different kinds), traumatic/acute injuries, and many disabilities. Most of the chronic issues that medicine fails to address are simply lifestyle issues that medicine tries to alleviate the symptoms for. Yes there are certain conditions medicine doesn’t begin to fully understand like Alzheimer’s or various chronic pain conditions, or where treatment is still pretty middling like Cancer, but a lot of the biggest things are treatable very well - we just don’t notice them much because they are treated so well.

the__alchemist 5y ago
> I disagree with the characterization of medicine not being able to treat so many things. Many things are incurable but a lot of medicine/public health is so effective we barely think about it. Of course we are going to notice and pay more attention to the things medicine sucks at treating, because they’re real problems that inflict a lot of pain due to the lack of treatment. > But medicine is very good at treating plenty of things like infections (of many different kinds), traumatic/acute injuries, and many disabilities. I agree that medicine is very good at treating infections and traumatic/acute injuries. Which disabilities are you referring to? Outside of these categories, what can we we effectively treat or cure? It seems to be very little.
- tuatoru 5y ago
  Hip replacements? Cataract surgery? Disfigurements (cosmetic surgery)? - just off the top of my head. My own mother had "cosmetic" surgeries to re-set her toes which had been deformed by decades of fashionable shoes, and to remove varicose veins which are painful. Occasionally one reads about someone's hearing, sight, or power of speech being restored also. Maybe only a few things, but still affecting millions, if not tens of millions of people. I also think that medicine is a victim of its own success, in two ways. One, how many funerals of people in their thirties to fifties does the average person go to, these days, compared to say the 1920s? It's hard to see things that don't happen. Two, success breeds hubris which breeds a sense of being right whatever the evidence may say.

s0rce 5y ago

Since when is "evidence based medicine" defined as ignoring patients with currently untreatable conditions. There are enormous amounts of funding and effort constantly devoted to developing new treatments. I'm not sure how else you want to practice medicine other than "evidence based".

tuatoru 5y ago

> many people have a quasi-religious belief in the capability of modern medicine to perform what would otherwise be called a miracle. This belief is typically held without any evidence whatsoever. The thing is, application of the germ theory of disease and Harvey's theory of circulation of the blood by action of the heart (and consequent developed understanding of the role of the blood, and of blood types) did produce miracles. Reliably safe milk and meat. Penicillin. Reliably useful blood transfusions. The tetanus vaccine. The polio vaccine. The great polio epidemic was only four-ish generations ago. In my childhood I knew one or two people in iron lungs, having contracted polio before the vaccine. The vaccine was miraculous to every parent at the time. The evidence has been culturally transmitted through the generations.

xyzzy21 5y ago

Indeed. My experience has been that 75%-90% of US doctors are borderline incompetent and that I can and do routine out-diagnose my own maladies better. Of course this also means I can lead them by the nose to get them to diagnose anything I please. Which is horrifying - they are Epic Fail if I can do that. Admittedly I was at one time planning to become a doctor myself so I ravenously consumed everything about biology and medicine while a teen but it seems very few doctors were anything like THAT with passion I had. Even worse few seem to know what the scientific method is, let alone practice it in any as doctors. This is equally horrifying.

burntoutfire 5y ago
The closest we currently get to scientific method in medicine is via double-blind large randomized trials, which is not applicable for a single doctor's practice.
rprospero 5y ago
Honestly, the "lead the by the nose" situation is a large improvement from many of the doctors I've met, who will actively ignore any evidence that doesn't fit their favourite diagnosis. Classic example: my partner was impaled through the leg in a workplace accident and had to go to the ER. The doctor declared that the wound was, in fact, a diabetic sore and that my partner had faked the accident to cover it up. Since the "diabetes" had reached the point of developing sores, he was prescribing insulin. However, the insurance company, "as a formality", insisted that he measure her blood sugar. After TWENTY blood tests came back with a perfectly healthy blood sugar level, he stuck with the diabetes diagnosis and just prescribed a different drug for it. A runner up was a co-worker who WAS diabetic after a pancreatic infection. He later went to the doctor to complain about some knee pain. The doctor looked at the symptoms (e.g. joint paint, diabetes, shortness of breath) and diagnosed asymptomatic obesity. The "asymptomatic" part comes from the fact that my co-worker was built like David Bowie. However, the doctor declared that the remaining symptoms pointed towards obesity and that losing forty pounds would clear up all his issues.
travisathougies 5y ago
For reals. I have alpha and beta thalassemia minor. It causes funny bloodwork (namely, it looks like I'm anemic). When I first got my results, doctors wanted me to see an oncologist and cardiologist and do all these tests and procedures. I thought it was odd because my bloodwork had always come back this way, so I researched a bunch of conditions that could cause the numbers I had (because my numbers weren't quite conducive to cancer or heart problems either). Anyway, I realized after making lots of lists and ruling things out that I likely had mild thallassemia, and when I finally got tested, it turned out I did. No surprise there given my ethnic background (which frankly should have been a dead giveaway, because thalassemias are not uncommon at all), but I saved myself from being put on iron supplementation which is already potentially dangerous for a man, but especially dangerous to someone with thalassemia.

quickthrower2 5y ago

Evidence based is good if you can get it. If not things that are suspected or even experimenting with your own body is worth it. For example if there is no evidence that a better diet or reducing EMF or strength exercise or drinking pure water etc. will help your condition but there is no harm and fairly low cost to try. Stay sceptical and open minded too.

dionidium 5y ago

> This is why things like 'evidence based' medicine is so dangerous -- we don't have evidence for the vast majority of impactful conditions, simply ignoring patients with these conditions is not a workable solution. Maybe that's true at a population level, but I can take it. Just tell me the truth. If you can't treat me, then just say that. I don't want to be "ignored," but I'm not interested in being placated, either. This, basically: https://www.youtube.com/watch?v=NyugCJ40IIw https://www.youtube.com/watch?v=NyugCJ40IIw