7 ms·

I don't know any gastroenterologist over 40 that hasn't had one (Australia). Do I take the government advice or copy what the doctors themselves are doing?

Barrin92 3y ago
This is a large, randomized control trial, so obviously you should value this significantly higher than whatever doctors are doing to themselves. (history has more than a few examples of doctors practicing medicine that didn't make a whole lot of sense).
- woleium 3y ago
  If only Semmelweis wasn’t such a strange chap, we’d have been much more further forward now.
  - all2 3y ago
    I don't know what this means. Can you expand on your statement? Who is this person? What would we be farther forward to?
    - woleium 3y ago
      https://en.m.wikipedia.org/wiki/Ignaz_Semmelweis https://en.m.wikipedia.org/wiki/Ignaz_Semmelweis He had very sensible ideas about hand washing a hundred years before it was accepted by most doctors. He was a bit weird though, and ended up being ignored.
      - fodkodrasz 3y ago
        Weird as in saying the common practices are not correct, and here is my proposal for a better practice, as supported by statistics.
        touisteur 3y ago
        I can just imagine both how desperate you might feel when you discover that you've been (unwillingly) killing your patients, how you might refuse this reality of being a vector of health instead of the saviour or helper you picture yourself as and also how personable and convincing you'd need to be to get people past that. Semmelweiss was apparently lacking in social graces, but I wouldn't be able to behave normally if I'd discovered what he discovered. (Edit for coquilles and spacing)
        matheusmoreira 3y ago
        I've seen a doctor literally commit suicide when faced with the mere possibility that he caused harm to another human being.
    - uxp8u61q 3y ago
      Here's a tip for the future: typing a name into Wikipedia usually yields great results.
      - deleted 3y ago
        [deleted]
      - matheusmoreira 3y ago
        Why would you waste the chance to tell the story of Ignaz Semmelweis? I wish people asked about him more often.
    - matheusmoreira 3y ago
      Doctors used to perform procedures with their bare hands, sometimes immediately after performing necropsies on dead bodies. This guy made the connection that such contamination was causing post-birth complications such as infections. He had his medical students wash their hands in an antiseptic solution, compiled statistics which showed lower mortality rates, was ignored, started publicly denouncing the negligence of the other doctors and ended up interned in some sanatorium and killed for his trouble. Doctors used to believe they were such gentlemen their hands could not possibly be dirty and contaminated.
      - woleium 3y ago
        It wasn’t just doctors, “a gentleman never washes his hands because a gentleman’s hands are never dirty.” Was the common thought. NB, not all men were considered gentlemen. See also surgeons cuffs on coats (blazers), so as to avoid getting blood on one’s clothes when operating, which are still called the same thing today.
        quintushoratius 3y ago
        Clearly they mixed up cause and effect. "A gentleman's hands are never dirty" should have meant that he keeps them clean, not that his gentlemanliness somehow keeps them from being dirty.
      - tptacek 3y ago
        Doctors routinely washed their hands before Semmelweis, whose innovation was chlorinated hand washing; he ended up in a sanatorium because he went crazy (he likely had an advanced case of syphilis); the connection he made was that "cadaveric particles" were causing illness in hospitals, which is problematic because the phenomenon occurred in circumstances where no cadavers availed, but he was apparently absolutely hung up on the cadaveric nature of the threat. He's a complicated dude.
        matheusmoreira 3y ago
        > Doctors routinely washed their hands before Semmelweis The cringeworthy "gentlemen don't wash their hands" culture contradicts that. > he ended up in a sanatorium because he went crazy (he likely had an advanced case of syphilis) I see no evidence of this so called "craziness". Even the people who speculated about the cause included "emotional exhaustion from overwork and stress" as a possibility. That's the simplest explanation, probably what happened and it's absolutely to be expected when you discover you've been unwittingly killing your patients due to the ignorance of mankind, successfully devise countermeasures and prove their effectiveness only to have your peers and the scientific community all band together to gaslight you. He ended up in an asylum because he "embarrassed" them. > the connection he made was that "cadaveric particles" were causing illness in hospitals Of course. More women died when he and his medical students delivered their children after working with corpses than when they didn't. The connection is there, the fact it did not fully explain the phenomena does not invalidate it. Nor does it invalidate the reduction in mortality after hand sanitization was implemented. That this was denied despite reproducible statistical evidence is absolutely shameful for all involved and a heavy lesson for all time. Women died because of it. Don't minimize it.
  - dbtc 3y ago
    no strange no change
  - jldugger 3y ago
    But it cuts both ways: Walter Freeman[1] was only banned from performing lobotomies after 100 patients of his had died of hemorrhage. [1]: https://www.econtalk.org/megan-mcardle-on-the-oedipus-trap/ https://www.econtalk.org/megan-mcardle-on-the-oedipus-trap/
    - maxerickson 3y ago
      Did he have a lobotomy prior to performing 100 of them? The point at the beginning of the thread is to do as they do, not to do as they say...
- rocqua 3y ago
  Randomized controlled trials are great, they are incredibly certain to be right. But experience has a whole other quality, it is much less reliable but a whole lot more comprehensive. An RCT can only measure effects on what can be used to select a large group of people. It cannot measure the effects of a weird anomaly that is recorded nowhere. Meanwhile experience can extrapolate from a very few examples. So it is not at all obvious that we should favor RCTs over experience. Because they have very different things they can measure.
ttymck 3y ago
Where is the government advice sourced from? Why are you so confident in anecdotal evidence but skeptical of broader research?

Barrin92 3y ago

This is a large, randomized control trial, so obviously you should value this significantly higher than whatever doctors are doing to themselves. (history has more than a few examples of doctors practicing medicine that didn't make a whole lot of sense).

woleium 3y ago
If only Semmelweis wasn’t such a strange chap, we’d have been much more further forward now.
- all2 3y ago
  I don't know what this means. Can you expand on your statement? Who is this person? What would we be farther forward to?
  - woleium 3y ago
    https://en.m.wikipedia.org/wiki/Ignaz_Semmelweis https://en.m.wikipedia.org/wiki/Ignaz_Semmelweis He had very sensible ideas about hand washing a hundred years before it was accepted by most doctors. He was a bit weird though, and ended up being ignored.
    - fodkodrasz 3y ago
      Weird as in saying the common practices are not correct, and here is my proposal for a better practice, as supported by statistics.
      - touisteur 3y ago
        I can just imagine both how desperate you might feel when you discover that you've been (unwillingly) killing your patients, how you might refuse this reality of being a vector of health instead of the saviour or helper you picture yourself as and also how personable and convincing you'd need to be to get people past that. Semmelweiss was apparently lacking in social graces, but I wouldn't be able to behave normally if I'd discovered what he discovered. (Edit for coquilles and spacing)
        matheusmoreira 3y ago
        I've seen a doctor literally commit suicide when faced with the mere possibility that he caused harm to another human being.
  - uxp8u61q 3y ago
    Here's a tip for the future: typing a name into Wikipedia usually yields great results.
    - deleted 3y ago
      [deleted]
    - matheusmoreira 3y ago
      Why would you waste the chance to tell the story of Ignaz Semmelweis? I wish people asked about him more often.
  - matheusmoreira 3y ago
    Doctors used to perform procedures with their bare hands, sometimes immediately after performing necropsies on dead bodies. This guy made the connection that such contamination was causing post-birth complications such as infections. He had his medical students wash their hands in an antiseptic solution, compiled statistics which showed lower mortality rates, was ignored, started publicly denouncing the negligence of the other doctors and ended up interned in some sanatorium and killed for his trouble. Doctors used to believe they were such gentlemen their hands could not possibly be dirty and contaminated.
    - woleium 3y ago
      It wasn’t just doctors, “a gentleman never washes his hands because a gentleman’s hands are never dirty.” Was the common thought. NB, not all men were considered gentlemen. See also surgeons cuffs on coats (blazers), so as to avoid getting blood on one’s clothes when operating, which are still called the same thing today.
      - quintushoratius 3y ago
        Clearly they mixed up cause and effect. "A gentleman's hands are never dirty" should have meant that he keeps them clean, not that his gentlemanliness somehow keeps them from being dirty.
    - tptacek 3y ago
      Doctors routinely washed their hands before Semmelweis, whose innovation was chlorinated hand washing; he ended up in a sanatorium because he went crazy (he likely had an advanced case of syphilis); the connection he made was that "cadaveric particles" were causing illness in hospitals, which is problematic because the phenomenon occurred in circumstances where no cadavers availed, but he was apparently absolutely hung up on the cadaveric nature of the threat. He's a complicated dude.
      - matheusmoreira 3y ago
        > Doctors routinely washed their hands before Semmelweis The cringeworthy "gentlemen don't wash their hands" culture contradicts that. > he ended up in a sanatorium because he went crazy (he likely had an advanced case of syphilis) I see no evidence of this so called "craziness". Even the people who speculated about the cause included "emotional exhaustion from overwork and stress" as a possibility. That's the simplest explanation, probably what happened and it's absolutely to be expected when you discover you've been unwittingly killing your patients due to the ignorance of mankind, successfully devise countermeasures and prove their effectiveness only to have your peers and the scientific community all band together to gaslight you. He ended up in an asylum because he "embarrassed" them. > the connection he made was that "cadaveric particles" were causing illness in hospitals Of course. More women died when he and his medical students delivered their children after working with corpses than when they didn't. The connection is there, the fact it did not fully explain the phenomena does not invalidate it. Nor does it invalidate the reduction in mortality after hand sanitization was implemented. That this was denied despite reproducible statistical evidence is absolutely shameful for all involved and a heavy lesson for all time. Women died because of it. Don't minimize it.
- dbtc 3y ago
  no strange no change
- jldugger 3y ago
  But it cuts both ways: Walter Freeman[1] was only banned from performing lobotomies after 100 patients of his had died of hemorrhage. [1]: https://www.econtalk.org/megan-mcardle-on-the-oedipus-trap/ https://www.econtalk.org/megan-mcardle-on-the-oedipus-trap/
  - maxerickson 3y ago
    Did he have a lobotomy prior to performing 100 of them? The point at the beginning of the thread is to do as they do, not to do as they say...
rocqua 3y ago
Randomized controlled trials are great, they are incredibly certain to be right. But experience has a whole other quality, it is much less reliable but a whole lot more comprehensive. An RCT can only measure effects on what can be used to select a large group of people. It cannot measure the effects of a weird anomaly that is recorded nowhere. Meanwhile experience can extrapolate from a very few examples. So it is not at all obvious that we should favor RCTs over experience. Because they have very different things they can measure.

ttymck 3y ago

Where is the government advice sourced from? Why are you so confident in anecdotal evidence but skeptical of broader research?