7 ms·

> but they mention it as if it is just the normal thing to do. As usual, you need to evaluate your doctors' incentives. Do they make more money from 1. Cutt

> but they mention it as if it is just the normal thing to do. As usual, you need to evaluate your doctors' incentives. Do they make more money from 1. Cutting your wife open, with all the associated hospital care or 2. Fecal transplant, for which their competition is free DIY? As Upton Sinclair said a long time ago: It is difficult to get a man to understand something, when his salary depends upon his not understanding it. Edit: BTW, I wish you luck with your situation. I gained familiarity because my wife had recurrent c-diff. During this episode, I saw such non-scientific quack-like behavior that I pretty much lost faith in most of the modern Medical Industrial Complex. And this was for a bacterial infection, for which the literature is accessible to anyone with a high-degree of education and a decent biology background. The takeaway lessons from our episode was: Take matters into your own hands as much as possible. You have 24 hours a day to work on your problems, the doctor has about 20 minutes. So if you're not an expert on your particular situation, then you're pretty well screwed.

ca98am79 13y ago
Thank you - yes, I agree. Not sure if this is completely relevant, but I found it very interesting: http://www.radiolab.org/blogs/radiolab-blog/2013/jan/15/bitter-end/ http://www.radiolab.org/blogs/radiolab-blog/2013/jan/15/bitt...
usefulcat 13y ago
> As usual, you need to evaluate your doctors' incentives. I would question their background even more. Think about how they were trained, and think about what are likely to be considered "best practices" in the medical field. Doctors tend to err on the side of caution (and usually with good reason). From that viewpoint, it's not surprising that something relatively new and seemingly radical is not likely to be recommended.
Osmium 13y ago
> As Upton Sinclair said a long time ago: It is difficult to get a man to understand something, when his salary depends upon his not understanding it. Incidentally, this is one of the many benefits of services like the NHS. Our doctors aren't thinking about their profit margins!
- pointyhats 13y ago
  I signed up to post to correct this comment. My wife was nearly killed twice this year by NHS bean counting: Firstly they missed a strangulated hernia because they wanted to cut back on x-ray usage in A&E. Then after five visits to A&E and threats of being sued, they did one and booked surgery on the "oh shit" moment the consultant noticed it. She was dragged in each time paralysed with pain in an ambulance, which took at least an hour to arrive each time. Secondly, after the surgery, they left her without any post-op checks for 17 hours due to staff shortages leading to a collapsed lingular, pneumonia and a massive internal bleed which took additional surgery. My wife now requires full time care as her immune system has collapsed from the repeated infections and started attacking her body which has pretty much fucked me as the NHS won't foot the bill so I have to work full time at home dangling off an RDP connection (thankfully I write software rather than fix cars or something) and look after her. This is also problematic as I have a disabled daughter who requires full time care, who incidentally receives precisely fuck all care of any significance. And they cut our child benefit because I earn too much but I have to pay a huge rent to keep a job that pays enough to live on in London which leaves me -£100 every month. Fortunately I found a solicitor to work for free on this case. The NHS is a disaster as is the rest of this country. They are thinking of their budget which is worse than their profit margins. To hell with it. Edit: There is a lot of completely un-objective, unrealistic propaganda about the NHS all over the television from documentaries to reality shows (24 hours in A&E for an example). This is all completely detached from reality.
  - Osmium 13y ago
    I'm sorry to hear what's happened to you and your family -- it's clearly unacceptable. I'm not going to defend that. But I do want to respond to your last comment, because I don't want you to think I posted what I said from a position of being brainwashed by propaganda. I wasn't. It just happens that my own experiences, and my family's experiences, with the NHS have been positive (so far at least). I'm actually due to have an operation myself next week, one that is more preventative than anything and which could've been deferred had cost been a factor. Hopefully it'll go well. I know it's of little comfort that someone else's experiences have been good, but there it is anyway. For what it's worth, how would you make things better?
lukeschlather 13y ago
Seems like it's a branding problem. "Fecal transplants" might get a lot more traction if we called them something a little more benign-sounding like "stool infusion." Transplant makes it sound like you're moving an organ around rather than just some fungible bodily excretion. A transplant also doesn't sound like something anyone ought to do daily...
- mixedbit 13y ago
  Maybe used food recycling?
- dlhavema 13y ago
  Repoop?
  - Fomite 13y ago
    You laugh, but there's a study out there called RePoopulate. My preferred term was "Intestinal Recolonization".
- gojomo 13y ago
  'Gut Flora-dation'? 'Biome rotation'? 'Intestinal re-endowment'?
- eavc 13y ago
  Intestinal flora exchange. Remove the reference to feces as that's incidental anyway.
- reinhardt 13y ago
  YouPoop
  - smartician 13y ago
    InstaGut?
    - jamesjguthrie 13y ago
arn 13y ago
I hate this line of reasoning. It can be unjustly applied to everything. Your programmer's incentive is to do a half-assed job, so you are more reliant on them for bug fixes and so on. Therefore, no programmer is going to be trying to do a good job or take pride in their work. Everyone is 100% motivated by financial gain. His doctor may indeed suck, but he should get a new doctor, not write it off as the whole system being stacked against him.
- jpdoctor 13y ago
  I think you just discovered that when you apply the same line of reasoning to everything everywhere, you get nonsensical results. That's usually why it is best to apply reasoning sensibly. For instance: Your programming example is missing the traditional loans from the cost-of-medical school. It is also missing the middle-man problem of insurance billing. It is also missing the incestuous role that pharmaceutical companies play in "helping" doctors to learn how to diagnose little-understood diseases such as UC. It is better to apply the line of reasoning I gave above to situations where they apply.
  - arn 13y ago
    And I think your perspective says more about your personal motivations in your daily life than anything else. There are always going to be some people motivated by money (like perhaps yourself), some by helping others, some by some other measure of personal satisfaction. To say all physicians work on the incentive of personal money is a paranoid view which, in my experience, is grossly simplistic. There are good doctors, and there are bad doctors. It's equally (in)valid to say that everything anyone does in any profession is entirely motivated by financial gain.
    - dandelany 13y ago
      As seems to be usual on HN these days, you're vastly overreacting. Nowhere did he "say that everything anyone does in any profession is entirely motivated by financial gain". He said "you need to evaluate your doctors' incentives". The fact that someone has an incentive to do X does not mean it's their primary motivation, or even that they're taking it into account. I have a dopamine incentive to eat bacon, but it's not motivating any of my actions today. You're not helping anyone by being unreasonable or putting words in others' mouths.
Fomite 13y ago
As someone whose dissertation was on the bacterial infection your wife had (I'm not sure why you're suggesting a bacterial infection is somehow easier to treat than some others), C. difficile is far from straightforward and easy to treat.
- jpdoctor 13y ago
  What was your thesis? It was particularly difficult a few years ago when recurrent c diff was relatively unknown. At that point, I had to find a compounding pharmacy to get the oral vanco. When things would recur, docs who clearly did not know what to do next would recommend doing the same thing and surprise! they'd get the same recurrence when done. Idiots. Finally, I ended digging into the literature in order to make sure that whatever infectious disease doctor we were talking to was up-to-speed. There are few who are. I worked out some population dynamics on my own, but most of the medical community is not diffeq friendly. As the wife dropped to under a hundred pounds, we found someone who recommended Cholestyramine during the post-vanco phase. It turns out that Cholestyramine binds one of the toxins (B? iirc) which gives the rest of the intestinal flora a fighting chance as the spores germinate. Effectively, it reduces the coupling coefficient in a population dynamical system preventing the c diff population to grow and overcome other populations. Perhaps old news if you did work in this field. At least, I hope things like this are better known than back in 2005. Anyway, it worked but her health has never been the same.
  - Fomite 13y ago
    I'm very sorry to hear about your wife's condition - C. diff is a nasty and unpleasant infection at the best of times, and recurrent C. diff is downright terrible. There's some new drugs - evidence for example that Fidaxomicin may work better than Vanco, and increasing use of fecal transplant and other techniques. My dissertation was on the effect of routine fecal transplant in post-CDI patients to prevent recurrence, using some models based on diffeq transmission models (but stochastic rather than deterministic).
YZF 13y ago
Yeah. It's called conflict of interest and is very real.
0xdeadbeefbabe 13y ago
>You have 24 hours a day to work on your problems, the doctor has about 20 minutes. So if you're not an expert on your particular situation, then you're pretty well screwed. That sounds reasonable enough.
caycep 13y ago
the way i understand it, from the inpatient side of things, the medicare payment structure is structured so that for each hospitalization, you're paid a certain amount, known as a DRG. Therefore, the hospital is incentivized to boot you out as soon as possible. C diff infections (for which fecal transplants apparently look extremely promising), cause extended hospitalization, eating into the DRG, and therefore, reducing overall reimbursements. So fecal transplants aren't as disadvantaged as you might think. With this whole incentives thing - the incentives of the insurance company (to pay as little as possible) do play a role in all of this.

ca98am79 13y ago

Thank you - yes, I agree. Not sure if this is completely relevant, but I found it very interesting: http://www.radiolab.org/blogs/radiolab-blog/2013/jan/15/bitter-end/ http://www.radiolab.org/blogs/radiolab-blog/2013/jan/15/bitt...

usefulcat 13y ago

> As usual, you need to evaluate your doctors' incentives. I would question their background even more. Think about how they were trained, and think about what are likely to be considered "best practices" in the medical field. Doctors tend to err on the side of caution (and usually with good reason). From that viewpoint, it's not surprising that something relatively new and seemingly radical is not likely to be recommended.

Osmium 13y ago

> As Upton Sinclair said a long time ago: It is difficult to get a man to understand something, when his salary depends upon his not understanding it. Incidentally, this is one of the many benefits of services like the NHS. Our doctors aren't thinking about their profit margins!

pointyhats 13y ago
I signed up to post to correct this comment. My wife was nearly killed twice this year by NHS bean counting: Firstly they missed a strangulated hernia because they wanted to cut back on x-ray usage in A&E. Then after five visits to A&E and threats of being sued, they did one and booked surgery on the "oh shit" moment the consultant noticed it. She was dragged in each time paralysed with pain in an ambulance, which took at least an hour to arrive each time. Secondly, after the surgery, they left her without any post-op checks for 17 hours due to staff shortages leading to a collapsed lingular, pneumonia and a massive internal bleed which took additional surgery. My wife now requires full time care as her immune system has collapsed from the repeated infections and started attacking her body which has pretty much fucked me as the NHS won't foot the bill so I have to work full time at home dangling off an RDP connection (thankfully I write software rather than fix cars or something) and look after her. This is also problematic as I have a disabled daughter who requires full time care, who incidentally receives precisely fuck all care of any significance. And they cut our child benefit because I earn too much but I have to pay a huge rent to keep a job that pays enough to live on in London which leaves me -£100 every month. Fortunately I found a solicitor to work for free on this case. The NHS is a disaster as is the rest of this country. They are thinking of their budget which is worse than their profit margins. To hell with it. Edit: There is a lot of completely un-objective, unrealistic propaganda about the NHS all over the television from documentaries to reality shows (24 hours in A&E for an example). This is all completely detached from reality.
- Osmium 13y ago
  I'm sorry to hear what's happened to you and your family -- it's clearly unacceptable. I'm not going to defend that. But I do want to respond to your last comment, because I don't want you to think I posted what I said from a position of being brainwashed by propaganda. I wasn't. It just happens that my own experiences, and my family's experiences, with the NHS have been positive (so far at least). I'm actually due to have an operation myself next week, one that is more preventative than anything and which could've been deferred had cost been a factor. Hopefully it'll go well. I know it's of little comfort that someone else's experiences have been good, but there it is anyway. For what it's worth, how would you make things better?

lukeschlather 13y ago

Seems like it's a branding problem. "Fecal transplants" might get a lot more traction if we called them something a little more benign-sounding like "stool infusion." Transplant makes it sound like you're moving an organ around rather than just some fungible bodily excretion. A transplant also doesn't sound like something anyone ought to do daily...

mixedbit 13y ago
Maybe used food recycling?
dlhavema 13y ago
Repoop?
- Fomite 13y ago
  You laugh, but there's a study out there called RePoopulate. My preferred term was "Intestinal Recolonization".
gojomo 13y ago
'Gut Flora-dation'? 'Biome rotation'? 'Intestinal re-endowment'?
eavc 13y ago
Intestinal flora exchange. Remove the reference to feces as that's incidental anyway.
reinhardt 13y ago
YouPoop
- smartician 13y ago
  InstaGut?
  - jamesjguthrie 13y ago

arn 13y ago

I hate this line of reasoning. It can be unjustly applied to everything. Your programmer's incentive is to do a half-assed job, so you are more reliant on them for bug fixes and so on. Therefore, no programmer is going to be trying to do a good job or take pride in their work. Everyone is 100% motivated by financial gain. His doctor may indeed suck, but he should get a new doctor, not write it off as the whole system being stacked against him.

jpdoctor 13y ago
I think you just discovered that when you apply the same line of reasoning to everything everywhere, you get nonsensical results. That's usually why it is best to apply reasoning sensibly. For instance: Your programming example is missing the traditional loans from the cost-of-medical school. It is also missing the middle-man problem of insurance billing. It is also missing the incestuous role that pharmaceutical companies play in "helping" doctors to learn how to diagnose little-understood diseases such as UC. It is better to apply the line of reasoning I gave above to situations where they apply.
- arn 13y ago
  And I think your perspective says more about your personal motivations in your daily life than anything else. There are always going to be some people motivated by money (like perhaps yourself), some by helping others, some by some other measure of personal satisfaction. To say all physicians work on the incentive of personal money is a paranoid view which, in my experience, is grossly simplistic. There are good doctors, and there are bad doctors. It's equally (in)valid to say that everything anyone does in any profession is entirely motivated by financial gain.
  - dandelany 13y ago
    As seems to be usual on HN these days, you're vastly overreacting. Nowhere did he "say that everything anyone does in any profession is entirely motivated by financial gain". He said "you need to evaluate your doctors' incentives". The fact that someone has an incentive to do X does not mean it's their primary motivation, or even that they're taking it into account. I have a dopamine incentive to eat bacon, but it's not motivating any of my actions today. You're not helping anyone by being unreasonable or putting words in others' mouths.

Fomite 13y ago

As someone whose dissertation was on the bacterial infection your wife had (I'm not sure why you're suggesting a bacterial infection is somehow easier to treat than some others), C. difficile is far from straightforward and easy to treat.

jpdoctor 13y ago
What was your thesis? It was particularly difficult a few years ago when recurrent c diff was relatively unknown. At that point, I had to find a compounding pharmacy to get the oral vanco. When things would recur, docs who clearly did not know what to do next would recommend doing the same thing and surprise! they'd get the same recurrence when done. Idiots. Finally, I ended digging into the literature in order to make sure that whatever infectious disease doctor we were talking to was up-to-speed. There are few who are. I worked out some population dynamics on my own, but most of the medical community is not diffeq friendly. As the wife dropped to under a hundred pounds, we found someone who recommended Cholestyramine during the post-vanco phase. It turns out that Cholestyramine binds one of the toxins (B? iirc) which gives the rest of the intestinal flora a fighting chance as the spores germinate. Effectively, it reduces the coupling coefficient in a population dynamical system preventing the c diff population to grow and overcome other populations. Perhaps old news if you did work in this field. At least, I hope things like this are better known than back in 2005. Anyway, it worked but her health has never been the same.
- Fomite 13y ago
  I'm very sorry to hear about your wife's condition - C. diff is a nasty and unpleasant infection at the best of times, and recurrent C. diff is downright terrible. There's some new drugs - evidence for example that Fidaxomicin may work better than Vanco, and increasing use of fecal transplant and other techniques. My dissertation was on the effect of routine fecal transplant in post-CDI patients to prevent recurrence, using some models based on diffeq transmission models (but stochastic rather than deterministic).

YZF 13y ago

Yeah. It's called conflict of interest and is very real.

0xdeadbeefbabe 13y ago

>You have 24 hours a day to work on your problems, the doctor has about 20 minutes. So if you're not an expert on your particular situation, then you're pretty well screwed. That sounds reasonable enough.

caycep 13y ago

the way i understand it, from the inpatient side of things, the medicare payment structure is structured so that for each hospitalization, you're paid a certain amount, known as a DRG. Therefore, the hospital is incentivized to boot you out as soon as possible. C diff infections (for which fecal transplants apparently look extremely promising), cause extended hospitalization, eating into the DRG, and therefore, reducing overall reimbursements. So fecal transplants aren't as disadvantaged as you might think. With this whole incentives thing - the incentives of the insurance company (to pay as little as possible) do play a role in all of this.