6 ms·

> Many of the conditions that vets see don’t have specific drugs associated with them (or even high quality studies), so vets often have to get creative. > If

> Many of the conditions that vets see don’t have specific drugs associated with them (or even high quality studies), so vets often have to get creative. > If I want to market to doctors, I’m best served by having high-profile researchers in that specific indication and high profile studies. Ideally, I’d also get a change to the treatment protocols, too. If I want to market to vets, I’m best served by having well-known speakers (who don’t necessarily specialize in that indication) and well-run (not high-profile) studies. > There's something sad about what American physicians have become. Yes, we have an expectation today that medical procedures be backed by scientific evidence of efficacy. It's not like the "good ol' days" where doctors had carte blanche to do whatever they want. If you want to market a product without scientific evidence that it works, go ahead, just don't do it when people's lives are on the line.

betaby 4y ago
... and then we have dentists. With the treatment variability of x10 in price and procedures 'needed'.
- vanattab 4y ago
  My understanding is the price variability in dentistry is much less then for various other medical procedures. I have been told it because much of dental work is non inssured but I am just relying what I have heard.
  - deleted 4y ago
    [deleted]
stubybubs 4y ago
As the meme goes: > Being an old-timey doctor would rule, just drunk as hell like “yeah u got ghosts in your blood, you should do cocaine about it”
elif 4y ago
The problem with that perspective is that it essentially dooms every "life on the line" with a condition which can not be established with "scientific evidence" For a simple example, the multitude of young lives lost to cancer because "scientific evidence" does not support screening before age 50. That perspective seeks to minimize and mischaracterize early warning symptoms because of public health probabilities.
- i_cannot_hack 4y ago
  Are you implying that more active screening would cause more good than harm, and that the scientific evidence that shows otherwise is mistaken? What makes you think the evidence is wrong? Screening is a very complicated topic and being overly aggressive with screening can really hurt patients. https://www.youtube.com/watch?v=yNzQ_sLGIuA https://www.youtube.com/watch?v=yNzQ_sLGIuA Or do you simply not support using scientific evidence and/or harm reduction to guide medical policy? What do you propose should be used instead in that case?
  - ptero 4y ago
    I think the point is that not all cases are cut and dry. There are many for which evidence is inconclusive; and for those having a blanket regulation is worse than letting the patient and the doctor select a choice that the patient prefers.
    - i_cannot_hack 4y ago
      Then they chose a poor example to illustrate their point, since anyone is free to book a cancer screening even if they are younger than the recommended age, if they so prefer.
      - kurthr 4y ago
        You can try and book anything you like, but the doctor/technologist is under no obligation to actually run the screening test for you, and if they do there is not requirement that your insurance pay for it. So you can have a full body MRI reference done, but it will cost many k$ out of pocket, if you can get someone to do it for you.
lettergram 4y ago
Who are you or some nameless fed to tell me I can’t take drugs of choice? That’s insanely authoritarian.
- TedDoesntTalk 4y ago
  The government routinely legislates public health issues.
  - lettergram 4y ago
    Yes, an the government in the west is very totalitarian by historic views. Recall the United States declared independence over 1/4 the taxes we have today and “no representation”. Now, I can’t buy antibiotics for myself (but I can for my fish or cow) over the counter. Wtf world is this.
    - RugnirViking 4y ago
      you are angry that antibiotics are restricted? You know why that is, right?
    - atwood22 4y ago
      Antibiotic use in food-producing animals is regulated by the FDA.
  - pessimizer 4y ago
    That's not responsive. Nobody is asking what does happen, they're asking why it should happen on this specific issue. I can make you pray in school and call it public health.
derefr 4y ago
> Yes, we have an expectation today that medical procedures be backed by scientific evidence of efficacy. Statistical evidence of efficacy, you mean. Doctors today are much less "scientific", insofar as they're less willing to work with a patient to try to experimentally derive an intervention that will work uniquely well for that patient. Instead, modern doctors try to fit the patient into a coarse-grained statistical mold, and then apply the flowcharts of rote treatments that are "proven" to work for people who were labelled as fitting that mold according to some arm of a trial. They persist in this, even when it can be seen that the individual patient isn't responding. A doctor who's actually practicing medicine as science would, for example, run a patient up the current DSMV flowchart for treatment of depression, rather than down it — first determining, as the most important step, whether the most hard-line treatment will do anything at all for the patient; before then finding the weakest treatment that will still have a useful effect. Also, a doctor practicing medicine as science would be doing a lot less "try this because it has no side-effects, regardless of whether you're likely to be a responder to it", and a lot more measurement to "cleave the problem-space at the joints." (Yes, ER doctors can't afford time to measure. Most doctors are not ER doctors.)
- brnt 4y ago
  I'm glad somebody is making the distinction between scientific experimentalism and executing a protocol based on scientific research. I've worked in medicine as an experimental phycisist (radiology, imaging), and I found so-called evidence based medicine anything but. Evidence based is used to cement existing methods over new ones into protocols that are very, very slow to evolve.
- rscho 4y ago
  If doctors did science on each patient (which would open up a huge can of legal liability worms), you'd pay ten times as much for healthcare.
- kcexn 4y ago
  This is just the trolley problem from ethics. A doctor who follows those course grained recommendations derived from statistical evidence will provide the best outcomes to the most patients in aggregate. A doctor who tries to uniquely discover the best outcome for each individual as they come through, may provide the best outcome for any given individual. But overall the deviation from the statistically recommended procedure will lead to worse outcomes in aggregate. It has to, because if it lead to better outcomes, the doctors 'personalized' process should become the statistically validated process with time. When initially presented with the trolley problem, most people side with the saving the group over the individual. It's funny how quickly their minds change when they realise that in a healthcare context, they are never the group, they are always the individual. Measurement in medicine is also in many cases not particularly quantitative. E.g., fatigue, pain, cognitive dysfunction etc. So taking more measurements doesn't necessarily give you any useful information. In fact, near as I can tell. In the US, there is so much fear from doctors of misdiagnosing and starting patients on the wrong treatment plan, that they order too many measurements. Overall reducing the quality of care. The time needed to take measurements, as well as the risks of measurements are not negligible factors in healthcare outcomes.

betaby 4y ago

... and then we have dentists. With the treatment variability of x10 in price and procedures 'needed'.

vanattab 4y ago
My understanding is the price variability in dentistry is much less then for various other medical procedures. I have been told it because much of dental work is non inssured but I am just relying what I have heard.
- deleted 4y ago
  [deleted]

stubybubs 4y ago

As the meme goes: > Being an old-timey doctor would rule, just drunk as hell like “yeah u got ghosts in your blood, you should do cocaine about it”

elif 4y ago

The problem with that perspective is that it essentially dooms every "life on the line" with a condition which can not be established with "scientific evidence" For a simple example, the multitude of young lives lost to cancer because "scientific evidence" does not support screening before age 50. That perspective seeks to minimize and mischaracterize early warning symptoms because of public health probabilities.

i_cannot_hack 4y ago
Are you implying that more active screening would cause more good than harm, and that the scientific evidence that shows otherwise is mistaken? What makes you think the evidence is wrong? Screening is a very complicated topic and being overly aggressive with screening can really hurt patients. https://www.youtube.com/watch?v=yNzQ_sLGIuA https://www.youtube.com/watch?v=yNzQ_sLGIuA Or do you simply not support using scientific evidence and/or harm reduction to guide medical policy? What do you propose should be used instead in that case?
- ptero 4y ago
  I think the point is that not all cases are cut and dry. There are many for which evidence is inconclusive; and for those having a blanket regulation is worse than letting the patient and the doctor select a choice that the patient prefers.
  - i_cannot_hack 4y ago
    Then they chose a poor example to illustrate their point, since anyone is free to book a cancer screening even if they are younger than the recommended age, if they so prefer.
    - kurthr 4y ago
      You can try and book anything you like, but the doctor/technologist is under no obligation to actually run the screening test for you, and if they do there is not requirement that your insurance pay for it. So you can have a full body MRI reference done, but it will cost many k$ out of pocket, if you can get someone to do it for you.

lettergram 4y ago

Who are you or some nameless fed to tell me I can’t take drugs of choice? That’s insanely authoritarian.

TedDoesntTalk 4y ago
The government routinely legislates public health issues.
- lettergram 4y ago
  Yes, an the government in the west is very totalitarian by historic views. Recall the United States declared independence over 1/4 the taxes we have today and “no representation”. Now, I can’t buy antibiotics for myself (but I can for my fish or cow) over the counter. Wtf world is this.
  - RugnirViking 4y ago
    you are angry that antibiotics are restricted? You know why that is, right?
  - atwood22 4y ago
    Antibiotic use in food-producing animals is regulated by the FDA.
- pessimizer 4y ago
  That's not responsive. Nobody is asking what does happen, they're asking why it should happen on this specific issue. I can make you pray in school and call it public health.

derefr 4y ago

> Yes, we have an expectation today that medical procedures be backed by scientific evidence of efficacy. Statistical evidence of efficacy, you mean. Doctors today are much less "scientific", insofar as they're less willing to work with a patient to try to experimentally derive an intervention that will work uniquely well for that patient. Instead, modern doctors try to fit the patient into a coarse-grained statistical mold, and then apply the flowcharts of rote treatments that are "proven" to work for people who were labelled as fitting that mold according to some arm of a trial. They persist in this, even when it can be seen that the individual patient isn't responding. A doctor who's actually practicing medicine as science would, for example, run a patient up the current DSMV flowchart for treatment of depression, rather than down it — first determining, as the most important step, whether the most hard-line treatment will do anything at all for the patient; before then finding the weakest treatment that will still have a useful effect. Also, a doctor practicing medicine as science would be doing a lot less "try this because it has no side-effects, regardless of whether you're likely to be a responder to it", and a lot more measurement to "cleave the problem-space at the joints." (Yes, ER doctors can't afford time to measure. Most doctors are not ER doctors.)

brnt 4y ago
I'm glad somebody is making the distinction between scientific experimentalism and executing a protocol based on scientific research. I've worked in medicine as an experimental phycisist (radiology, imaging), and I found so-called evidence based medicine anything but. Evidence based is used to cement existing methods over new ones into protocols that are very, very slow to evolve.
rscho 4y ago
If doctors did science on each patient (which would open up a huge can of legal liability worms), you'd pay ten times as much for healthcare.
kcexn 4y ago
This is just the trolley problem from ethics. A doctor who follows those course grained recommendations derived from statistical evidence will provide the best outcomes to the most patients in aggregate. A doctor who tries to uniquely discover the best outcome for each individual as they come through, may provide the best outcome for any given individual. But overall the deviation from the statistically recommended procedure will lead to worse outcomes in aggregate. It has to, because if it lead to better outcomes, the doctors 'personalized' process should become the statistically validated process with time. When initially presented with the trolley problem, most people side with the saving the group over the individual. It's funny how quickly their minds change when they realise that in a healthcare context, they are never the group, they are always the individual. Measurement in medicine is also in many cases not particularly quantitative. E.g., fatigue, pain, cognitive dysfunction etc. So taking more measurements doesn't necessarily give you any useful information. In fact, near as I can tell. In the US, there is so much fear from doctors of misdiagnosing and starting patients on the wrong treatment plan, that they order too many measurements. Overall reducing the quality of care. The time needed to take measurements, as well as the risks of measurements are not negligible factors in healthcare outcomes.