3 ms·

Does every point of view have merits, and should it be given the same airtime as all other views. He doesn't need you to point out what has merits and what sho

Does every point of view have merits, and should it be given the same airtime as all other views. He doesn't need you to point out what has merits and what should be given airtime. His approach is designed to determine what will work, based on evidence. He should be entitled to include absolutely anything he chooses as something that may have the slimmest possible hope of being in some way beneficial. If his open-source approach is valid, anything that is ineffective will be shown to be so. there is no filter or adjustment in place to take treatment suggestions and approximate a 'better treatment' The whole open-source process is the filter. The point is that his process, if it works, will find a far better outcome than a dogmatic approach represented by such a sentiment as "anyone with a half rational brain should be alarmed by this statement".

DanBC 14y ago
> He should be entitled to include absolutely anything he chooses as something that may have the slimmest possible hope of being in some way beneficial. Ignoring the not-slim possibilities of serious harm from side-effects? (Not to mention interactions with other treatments, making them less effective or more harmful.)
- tomhoward 14y ago
  No, not ignoring them at all! Taking everything into account. Yes, everything. Did you not see the bit where he talked about having a whole lot of conventional doctors involved, and having practitioners from every discipline be made aware of the recommendations that each other were making?
  - DanBC 14y ago
    Vulnerable people in England get some protection. One form of that protection is provided by local government Social Services. (Each scheme has a different name because they're provided by different regional authorities. And this one I'm talking about is obsolete.) MARMAP - multi agency risk management & assessment panel is a group of the people involved in the care and treatment of a vulnerable person who is at high risk of harming themselves or other people. Let's make a hypothetical patient, and call him Bob. Bob has a GP. Bob has a care coordinator. Bob has a consultant psychiatrist for outpatient care. Bob has a consultant psychiatrist for inpatient mental health hospital care. Bob has a community treatment team. Bob has a community psychotherapist. Bob has a crisis team. This is about ten people just for the mental health stuff. I can tell you now that these people do not agree about the best way forward for Bob. Even though they're all in the same room as Bob, and they all get minutes of the meetings, one doctor will call Bob non-compliant when Bob follows the conflicting advice of another doctor. (EG: The in-patient consultant tells Bob to avoid going to hospital. The out-patient team admits Bob, against his will. Bob is called manipulative by the in-patient doctor.) This is a lousy situation. Even though clinicians are talking face to face with each other communication gets garbled. Imagine the problem when communication goes from a nurse observing Bob to one doctor, through their juniors, to a secretary, to another team (sometimes using weird technology such as fax machines) through to a team leader, to a team member. ("Interface Problems") And this is within the same organisation. Moving data from the MH trust to a different medical trust is tricky, and to social services or law enforcement is even trickier. Getting more people involved causes problems, and that's when the people are in the same specialism and broadly agree on modes of treatment. Getting more people involved when those people have fundamentally different opinions about treatment is going to distract them from providing good treatment as they focus on debunking stuff that's useless but has vigorous advocates.
    - tomhoward 14y ago
      Sigh. The approach described in this post is an attempt to find a method of delivering better health outcomes than current mainstream health systems (in addition to being one man's attempt to save his own life using whatever means available). Say all you want about how superior the conventional health system is: people keep dying of cancer, at increasing rates in come cases. This open-source approach may or may not yield better outcomes. Either way, won't it be interesting to see? Can't we wait to see some results before condemning it simply because acupuncture was allowed?
      - DanBC 14y ago
        > Say all you want about how superior the conventional health system is: people keep dying of cancer, at increasing rates in come cases. I haven't said the conventional system is better. I've used to flaws of the existing conventional system to point out the flaws of the proposed system. > This open-source approach may or may not yield better outcomes. How will we know? Seriously, how can we tell? There's no rigour to this. It's just idle self-indulgent noodling. That's fine, it's his life and body and he can do what he likes with it, but don't pretend it's useful when there's no possible way of it actually being any use. > Either way, won't it be interesting to see? I doubt it. But I'm happy to be wrong. Please, what could be some interesting things to come from this? > Can't we wait to see some results before condemning it simply because acupuncture was allowed? Again, that's not why I'm condemning it.
        tomhoward 14y ago
        There's no rigour to this. It's just idle self-indulgent noodling. Seriously man. It's a lot of people and enough doctors working together to achieve something. Things like: - He is cured of cancer - Other people are cured of cancer - New things are learned about how to treat cancer more effectively ... and probably other things that can't be predicted, but which could possibly turn out to be far more valuable. That's the point to remember about innovation - which I consider this to be; you can't predict where things may lead, and often what you discover is different to what you expected. But to me that's why this is interesting; I've long thought that there could be place for the processes we see in open-source projects (as well as startup companies) in medicine.
- robbiep 14y ago
  Tom: I talk about the conventional doctors (not a whole heap) and multidisciplinary team to illustrate how medicine is ACTUALLY PRACTICED, TODAY - that is, it is not doctors in isolation but conferences of nurses, doctors, radiologists, physiotherapists and others all discussing, with informed consent from the patient, what is going to achieve the best outcome for the patient. I apologise if that was not clear. I am not dogmatically advocating that the only people that can be involved and making decisions are doctors, or that we should only listen to conventional therapy recommendations, or that all other therapists press-ganged into agreeing with the convening doctors. But the contributions of alternative practitioners (the bit I believe you have issue with) needs to be evaluated with regard to its effectiveness.
  - tomhoward 14y ago
    But the contributions of alternative practitioners (the bit I believe you have issue with) Not specifically - it's the dismissal based on pre-conceived prejudices, anything that could potentially lead to interesting new discoveries or lessons. needs to be evaluated with regard to its effectiveness. Yes, indeed. If you'd said that from the start instead of "anyone with a half rational brain should be alarmed by this statement", we wouldn't have a problem.
robbiep 14y ago
I didn't realise you were such a cherry-picker. You took my first comment out of context, again, but oh well. He should be entitled to include absolutely anything he chooses as something that may have the slimmest possible hope of being in some way beneficial. I am not in anyway disagreeing with this, and indeed supported it in my above post. The whole open-source process is the filter. - No, there is no filter. There is just a blog site. On which anyone may post their views and experiences, which may be observations of n=1, or n=10,000. And there is a big difference. And no way of knowing. Maybe the process will change, and so my first post serves to illustrate a weakness in the current design if it works, will find a far better outcome than a dogmatic approach represented by such a sentiment as "anyone with a half rational brain should be alarmed by this statement". So why don't you just come out and say that you are an apologist for CAM, instead of trying to pick off other points of my argument? You are not interested in my criticism of his process, or my suggestions or comparisons about how the art of medicine is not necessarily a process that is open to engagement from everyone (and there are some very good points further down critiquing my justification of this) You say earlier I'm not here to debate the efficacy of TCM or homeopathy, that's a waste of everyone's time. But that is what you are effectively doing, as it is becoming obvious you are not concerned with my actual commentary or engaging in meaningful debate, but rather my dismissal of the use of alternative medicine. And it is a valid technique of open discussion to dismiss that which is invalid - another comparison - an open source project is only open to people who know or will do the hard work to learn the language it is written in - The same applies to the imperfectly developed concept of open source medicine: You have to speak the language to be able to contribute. If you dont speak the language (read: pseudoscience) it is not that you can't contribute, but your contributions are noise.
- tomhoward 14y ago
  So why don't you just come out and say that you are an apologist for CAM Look, that's a really disgraceful comment, for reasons you're probably not able to know. I'm not engaging with your arguments because they do all come down to one's pre-conceived position on CAM. It's a religious/identity argument, and, yes, a waste of time. BTW... Fair point - I did cherry pick something out of context, mistakenly. Your comments are very long and I was skimming. But I think my point holds: it's not for you to judge what should be in or out. Your notion of what should be allowable is governed by your apparently binary classification of modalities as being either science-based or alternative. My point is that your judgement on this is not required: the open source process should provide the evidence. This may or may not turn out to be true, but either way it will be interesting. Can't we wait to see the results?

DanBC 14y ago

> He should be entitled to include absolutely anything he chooses as something that may have the slimmest possible hope of being in some way beneficial. Ignoring the not-slim possibilities of serious harm from side-effects? (Not to mention interactions with other treatments, making them less effective or more harmful.)

tomhoward 14y ago
No, not ignoring them at all! Taking everything into account. Yes, everything. Did you not see the bit where he talked about having a whole lot of conventional doctors involved, and having practitioners from every discipline be made aware of the recommendations that each other were making?
- DanBC 14y ago
  Vulnerable people in England get some protection. One form of that protection is provided by local government Social Services. (Each scheme has a different name because they're provided by different regional authorities. And this one I'm talking about is obsolete.) MARMAP - multi agency risk management & assessment panel is a group of the people involved in the care and treatment of a vulnerable person who is at high risk of harming themselves or other people. Let's make a hypothetical patient, and call him Bob. Bob has a GP. Bob has a care coordinator. Bob has a consultant psychiatrist for outpatient care. Bob has a consultant psychiatrist for inpatient mental health hospital care. Bob has a community treatment team. Bob has a community psychotherapist. Bob has a crisis team. This is about ten people just for the mental health stuff. I can tell you now that these people do not agree about the best way forward for Bob. Even though they're all in the same room as Bob, and they all get minutes of the meetings, one doctor will call Bob non-compliant when Bob follows the conflicting advice of another doctor. (EG: The in-patient consultant tells Bob to avoid going to hospital. The out-patient team admits Bob, against his will. Bob is called manipulative by the in-patient doctor.) This is a lousy situation. Even though clinicians are talking face to face with each other communication gets garbled. Imagine the problem when communication goes from a nurse observing Bob to one doctor, through their juniors, to a secretary, to another team (sometimes using weird technology such as fax machines) through to a team leader, to a team member. ("Interface Problems") And this is within the same organisation. Moving data from the MH trust to a different medical trust is tricky, and to social services or law enforcement is even trickier. Getting more people involved causes problems, and that's when the people are in the same specialism and broadly agree on modes of treatment. Getting more people involved when those people have fundamentally different opinions about treatment is going to distract them from providing good treatment as they focus on debunking stuff that's useless but has vigorous advocates.
  - tomhoward 14y ago
    Sigh. The approach described in this post is an attempt to find a method of delivering better health outcomes than current mainstream health systems (in addition to being one man's attempt to save his own life using whatever means available). Say all you want about how superior the conventional health system is: people keep dying of cancer, at increasing rates in come cases. This open-source approach may or may not yield better outcomes. Either way, won't it be interesting to see? Can't we wait to see some results before condemning it simply because acupuncture was allowed?
    - DanBC 14y ago
      > Say all you want about how superior the conventional health system is: people keep dying of cancer, at increasing rates in come cases. I haven't said the conventional system is better. I've used to flaws of the existing conventional system to point out the flaws of the proposed system. > This open-source approach may or may not yield better outcomes. How will we know? Seriously, how can we tell? There's no rigour to this. It's just idle self-indulgent noodling. That's fine, it's his life and body and he can do what he likes with it, but don't pretend it's useful when there's no possible way of it actually being any use. > Either way, won't it be interesting to see? I doubt it. But I'm happy to be wrong. Please, what could be some interesting things to come from this? > Can't we wait to see some results before condemning it simply because acupuncture was allowed? Again, that's not why I'm condemning it.
      - tomhoward 14y ago
        There's no rigour to this. It's just idle self-indulgent noodling. Seriously man. It's a lot of people and enough doctors working together to achieve something. Things like: - He is cured of cancer - Other people are cured of cancer - New things are learned about how to treat cancer more effectively ... and probably other things that can't be predicted, but which could possibly turn out to be far more valuable. That's the point to remember about innovation - which I consider this to be; you can't predict where things may lead, and often what you discover is different to what you expected. But to me that's why this is interesting; I've long thought that there could be place for the processes we see in open-source projects (as well as startup companies) in medicine.
robbiep 14y ago
Tom: I talk about the conventional doctors (not a whole heap) and multidisciplinary team to illustrate how medicine is ACTUALLY PRACTICED, TODAY - that is, it is not doctors in isolation but conferences of nurses, doctors, radiologists, physiotherapists and others all discussing, with informed consent from the patient, what is going to achieve the best outcome for the patient. I apologise if that was not clear. I am not dogmatically advocating that the only people that can be involved and making decisions are doctors, or that we should only listen to conventional therapy recommendations, or that all other therapists press-ganged into agreeing with the convening doctors. But the contributions of alternative practitioners (the bit I believe you have issue with) needs to be evaluated with regard to its effectiveness.
- tomhoward 14y ago
  But the contributions of alternative practitioners (the bit I believe you have issue with) Not specifically - it's the dismissal based on pre-conceived prejudices, anything that could potentially lead to interesting new discoveries or lessons. needs to be evaluated with regard to its effectiveness. Yes, indeed. If you'd said that from the start instead of "anyone with a half rational brain should be alarmed by this statement", we wouldn't have a problem.

robbiep 14y ago

I didn't realise you were such a cherry-picker. You took my first comment out of context, again, but oh well. He should be entitled to include absolutely anything he chooses as something that may have the slimmest possible hope of being in some way beneficial. I am not in anyway disagreeing with this, and indeed supported it in my above post. The whole open-source process is the filter. - No, there is no filter. There is just a blog site. On which anyone may post their views and experiences, which may be observations of n=1, or n=10,000. And there is a big difference. And no way of knowing. Maybe the process will change, and so my first post serves to illustrate a weakness in the current design if it works, will find a far better outcome than a dogmatic approach represented by such a sentiment as "anyone with a half rational brain should be alarmed by this statement". So why don't you just come out and say that you are an apologist for CAM, instead of trying to pick off other points of my argument? You are not interested in my criticism of his process, or my suggestions or comparisons about how the art of medicine is not necessarily a process that is open to engagement from everyone (and there are some very good points further down critiquing my justification of this) You say earlier I'm not here to debate the efficacy of TCM or homeopathy, that's a waste of everyone's time. But that is what you are effectively doing, as it is becoming obvious you are not concerned with my actual commentary or engaging in meaningful debate, but rather my dismissal of the use of alternative medicine. And it is a valid technique of open discussion to dismiss that which is invalid - another comparison - an open source project is only open to people who know or will do the hard work to learn the language it is written in - The same applies to the imperfectly developed concept of open source medicine: You have to speak the language to be able to contribute. If you dont speak the language (read: pseudoscience) it is not that you can't contribute, but your contributions are noise.

tomhoward 14y ago
So why don't you just come out and say that you are an apologist for CAM Look, that's a really disgraceful comment, for reasons you're probably not able to know. I'm not engaging with your arguments because they do all come down to one's pre-conceived position on CAM. It's a religious/identity argument, and, yes, a waste of time. BTW... Fair point - I did cherry pick something out of context, mistakenly. Your comments are very long and I was skimming. But I think my point holds: it's not for you to judge what should be in or out. Your notion of what should be allowable is governed by your apparently binary classification of modalities as being either science-based or alternative. My point is that your judgement on this is not required: the open source process should provide the evidence. This may or may not turn out to be true, but either way it will be interesting. Can't we wait to see the results?