
A new book critiques medicine - Elof
https://blogs.scientificamerican.com/cross-check/is-medicine-overrated/
======
codingdave
I've always looked at western medicine as if it was the best car mechanic you
can hire, just for your body. If your problem is mechanical, they can solve
it. Surgical techniques are amazing. Breakdowns in known processes can be
fixed.

But if the problem doesn't fit those known processes, isn't mechanical, and
you are relying on doctor for real troubleshooting of problems, that is where
it falls short. You can fall into the weird gap of talking to different
specialists, trying to find someone who can pinpoint what is wrong. You try
different treatments, you see what works. Sometimes you solve problems,
sometimes you end up living your whole life managing symptoms.

And that isn't all bad - better to manage symptoms than to live in misery, or
not to live. But the word 'over-rated' is quite accurate. It isn't useless, it
just is over-rated.

~~~
crispinb
'Western' medicine though as opposed to what? Nostalgic prescientific systems
such as Chinese, ayurvedic, etc don't do anything at all.

So yes, scientific medicine definitely has huge lacunae. Given the relative
slowness of progress in understanding complex systems science has had in
general, they'll be there for a long to come. But it's not as if there's some
other candidate 'system' that has a better understanding.

~~~
coldtea
> _' Western' medicine though as opposed to what? Nostalgic prescientific
> systems such as Chinese, ayurvedic, etc don't do anything at all._

That's not really true. Their explanations can be hocus pocus, but their
mechanics/drugs/techniques can be as effective as western versions, simply
come around by tradition/trial and error/Lindy effect and so on for millennia.

~~~
jcims
You touched on something there that has been a pet peeve of mine for ages.
People dismissing treatments like accupunture wholesale because there’s no
scientific evidence for Qi. So what? It’s the effect we’re interested in, not
the explanation.

~~~
bedobi
If acupuncture had an easily and consistently replicable effect it would have
been incorporated into medicine, even if we didn't understand how or why it
worked. (just like paracetamol and any number of other widely used drugs and
treatments we don't really know how or why they work)

------
rscho
I would like to make a personal statement to the tech community in view of
this thread's comments:

A vast majority of you drastically overestimate the information processing and
retrieval of the healthcare system.

We MDs can all see your superb AI/ML results in journals, and yes you can
improve things with technology. What we can't see is how we're going to use
it. In my day-to-day job, there are a myriad of new-super-devices-that-
automatically-do-that-thing but NONE are integrated into my workplace. NONE
make my job less painful. NONE make me gain time instead of losing it.

You want to help. Cool, then stop masturbating on the results of your unusable
new oncology deep-learning thingy and push for WORKPLACE INTEGRATION of
technology, damn it!

Maybe if the tech community comes to understand how it can really help
clinicians, things will start to change the way you fancy and we can finally
end the age of rote memorization and criminal overtime for MDs.

~~~
arpa
Yes! healthcare informatics is so much more than just dispensing magical
vitamins, when MDs and patients need painkillers. We have had terms like PHR
and EHR for thirty years now, we have HL7, together with FHIR, and we have
PACS, but these terms are still not ubiquitous. There has been major
developments in developing classifiers like SNOMED, AHCI and ICD, yet MDs
mostly still type the diagnosis up, and consider themselves lucky if the HIS
has some templating capability. And very few HISes are capable of getting the
personal health records to the patient - i mean, it is more likely you get a
xerox of your case than something in a portable format that other HISes can
understand if you change your healtcare provider...

However, it is somewhat strange that personal health projects keep dying -
google health discontinued in 2011, microsoft healthvault to be closed in 2019
- and these are by major players - maybe somebody has some insight why they
fail?

------
astura
>The New York Times reported that in 2014 physicians wrote 83,000
prescriptions for antidepressants and almost 20,000 prescriptions for
antipsychotic medications for infants two years old and younger

Wow... This seems very obviously inappropriate.

I listened to the EconoTalk interview referenced in TFA after hearing about it
on another HN thread. Highly recommended.

I have to say that I have become skeptical of medicine after personally seeing
the sheer amount of unscientific and potentially harmful practices that are
advocated for by medical practicers. I think there's a lot of good, but
wayyyyyy too much bad.

~~~
dkarl
My brother-in-law, who has a mental disability, saw a gastroenterologist for
abdominal pain. They found worms and prescribed him a drug to get rid of the
worms.

The doctor said the worms _could_ cause abdominal pain, but then again in most
cases they don't, so he also put him on a drug for irritable bowel syndrome.

After a couple of weeks, the stomach pain went away, but meanwhile my brother-
in-law was having issues with mental coherence, drowsiness, and sleep
disturbances. Other people who interacted with him were concerned about him,
too. He has a mental disability and diabetes and other health issues, so our
first thought was the usual suspects, not his IBS medication, but eventually I
realized that neither my wife nor myself knew anything about it, so I looked
it up.

It turned out the new medication was an antidepressant with a laundry list of
side effect, including drowsiness and sleep disturbances. We weaned him off
it, and he came back to normal pretty quickly. No stomach pain, either.

So, to sum up, the doctor saw a patient with worms and abdominal pain and
decided to put him on an antidepressant for the rest of his life because the
kind of worm infestation he had would only cause pain in a minority of cases.

~~~
astura
I actually suspect a fairly large amount of those prescriptions were for off
label use.

But... Seems like the sort of side effects these medicines have should give us
a pause when using them on vulnerable populations. Especially when the
benefits are not especially clear.

~~~
dkarl
You're exactly right. IBS is a legit off-label use for the antidepressant my
brother-in-law was prescribed. I suspect doctors hear about these off-label
uses and don't weigh the psychoactive effects because they're writing the
prescription for a physical problem.

~~~
lonelappde
How is that an acceptable side effect for approving an off label use?

------
yourMadness
Modern medicine has some aspects that are miraculously good and it is easy to
fall into the trap of thinking that those are representative for all of
medicine. It's a kind of halo effect bias.

In my opinion the most amazing thing still is antibiotics (and vaccination).
Treatmeant of war/vehicle/sports injuries taking the second place (including
anesthetics). Both can take people from a path of sure death within hours or
days to often complete recovery within weeks or months.

If that is the performance expectation of the general public for all of
medicine, then it certainly is overrated.

~~~
m0zg
As someone who has had some less-acute sports injuries, I'd also break the
injuries down into "shit's really fucked up" and "you could conceivably walk
it off" categories. The former, modern US medicine excels at. The latter, I'm
not sure the doctors are even trained to treat something less acute and not
requiring expensive surgery. In fact, I strongly suspect they often prescribe
a surgery anyway, just to make a buck. I had to decline a surgery once.

------
1e-9
Medications are a particular problem. It took decades of massive use for us to
even realize that some of our most common over-the-counter drugs were being
used in dangerous ways (e.g. aspirin can cause Reye's syndrome in children,
Tylenol with alcohol can damage the liver). On top of that, I think drug
interactions are a much larger problem than most people realize and that we
have little idea of what we are doing to ourselves when we take multiple
medications. A recent study [1] on just prescription drugs counted 220 million
unique drug combinations experienced by a subset of the US population over
intervals of about 3 years. How many of those combinations have been studied
for safety? I'll make a wild guess that it's probably far less than 1%. I
think it prudent to minimize one's medication exposure to the bare minimum
that is absolutely necessary.

[1]
[https://www.nature.com/articles/sdata2017167](https://www.nature.com/articles/sdata2017167)

------
goldcd
It's not over-rated - but it's complicated.

Even that short article covered a number of items that could all happily be
spun out into full-blown essays.

"Over-medication" \- just as a term. Could be people taking medicines that:
Aren't cost-effective (whatever your system, there's a finite resource at the
core). Aren't quality of-life improving (doctors themselves tend to consume
less life-extending stuff at the very end). They paid for (You've paid
insurance, you're ill, you want to be given something).

------
lukifer
See also: Anatomy of an Epidemic [0], about when pharmaceuticals to treat
mental health issues become problems in their own right; and, the chapters on
medical intervention in Elephant in the Brain [1], which argue persuasively
that much of the medical system functions to deliver social signaling of care,
rather than improved health outcomes.

[0]
[https://en.wikipedia.org/wiki/Anatomy_of_an_Epidemic](https://en.wikipedia.org/wiki/Anatomy_of_an_Epidemic)

[1] [http://elephantinthebrain.com/](http://elephantinthebrain.com/)

------
zby
Update: If trials by manufacturers are biased - then how about some framework
that would push trials made by competition.

There are two things: One is bad science, and we have a lot of it
([https://en.wikipedia.org/wiki/Replication_crisis](https://en.wikipedia.org/wiki/Replication_crisis),
[https://library.mpib-
berlin.mpg.de/ft/gg/GG_Null_2004.pdf](https://library.mpib-
berlin.mpg.de/ft/gg/GG_Null_2004.pdf)) - but it should be improving and most
of it is probably harmless (I have some hopes on better statistics education
and
[https://www.google.com/search?q=causality+revolution](https://www.google.com/search?q=causality+revolution)).
The other is bad application - and this is more complex. When I go to doctors
(with my and my family issues) I, more often than not, have the feeling that
they have no chance to give any good diagnosis as it would require too much
time to test etc. (one simple case is when to use antibiotics and when the
disease is virus based - but I have noticed that this is probably improving
with strep and CPR tests) and they mostly just shoot first thing plausible,
proscribe some medication and then in most cases the organism just cures
itself - so the treatment is never tested. There is probably also 'medicine as
signaling' (the theory by Richard Hanson:
[http://www.overcomingbias.com/tag/medicine](http://www.overcomingbias.com/tag/medicine)),
but my intuition is that it is not verly important, and other stuff.

------
Jallal
The article starts with "Given medicine’s poor record, physicians should
prescribe and patients consume far fewer medications, a new book argues." : on
the contrary, I think the current state of medicine is outstanding, regarding
what is was only two centuries ago. Thousands of illnesses have a cure, and
for many others, we know what we can do to minimize their effects, infant
mortality is very low in most of the western world, etc. And paradoxically,
although most of the "alternative medicines" zealots criticize conventional
medicine for insufficient results and/or side effects, none of them keep track
of some indicators such as the cure rate. ANd this is one of the only relevant
metric that can assess the efficiency of a cure.

I'm not saying that the conventional medicine is far from any criticism, but
one has first to understand the difference between the current knowledge
available, and the way it is used : some drugs/treatments are promoted by some
countries, while not in others. I'm also convinced he drugs prices (which are
going crazy) should be regulated for the benefit of everyone. And of course,
modern medicine should be used wisely. People should not take drugs each time
they have a cold.

That being said, of course, there are still room for improvement, there are a
load of illnesses that cannot be cured by modern medicine, and yes, some
doctors think themselves as Gods. But this should not question the many
successes of conventional medicine.

------
JamesBarney
There are legitimate concerns about some drugs being overprescribed and others
being underprescribed. But this article doesn't really she'd much light on it.

Are some medicines probably overprescribed? Sure. Are some medicines
underprescribed? Definitely.

For most medicines are there people who could benefit from taking it and
aren't while simultaneously there are people who would benefit from stopping
the medicine? Almost assuredly.

And medical research is what we do to try to answer these questions in ways
that are helpful.

------
codingslave
I've long believed that once startups and tech companies get their hands on
medical data (patient outcomes, medication treatment outcomes, mal practice
rates, surgery outcomes) that a reckoning will take place on the medical
industry. The level of legitimacy and respect that doctors and hospitals
currently have is far too high, and hinges on branding and the exclusivity of
becoming a doctor. Once all of this data becomes available, it will be obvious
how worthless and expensive most medical treatments really are. Most
prescription drugs do nothing, and the ones that do something are more so just
covering the symptoms.

HIPAA laws are hiding patient outcomes and holding this whole sham afloat.

~~~
pixelmonkey
"The level of legitimacy and respect that doctors and hospitals currently have
is far too high, and hinges on branding and the exclusivity of becoming a
doctor. Once all of this data becomes available, it will be obvious how
worthless and expensive most medical treatments really are."

I'm the spouse/partner of a recently-trained doctor, and I'm a programmer and
startup founder with 2 decades of experience. With all respect, you have no
friggen clue what you're talking about.

~~~
chronic7382
> I'm the spouse/partner of a recently-trained doctor, and I'm a programmer
> and startup founder with 2 decades of experience. With all respect, you have
> no friggen clue what you're talking about.

Then you should know very well that the entire MD education pipeline optimizes
for rote memorization and regurgitation of facts (from undergrad pre-med all
the way through post-residency fellowships). Any patient with even the
slightest deviation from what the physician searched on WebMD is given generic
advice similar to how fortune tellers recite generic phrases. If you have a
non-standard question or health problem, go to 3 doctors (or even specialists)
and you'll get 3 different answers.

I work closely with clinicians at Tier 1 urban medical institutions daily,
both at the in-patient and outpatient settings. Most doctors are dumb as a
rock.

Note: Physicians with a MD/PhD are much better at critical thinking and make
more of an effort to solve your problem.

~~~
rscho
What you don't perceive is why medical education has to be that way in the
current state of affairs. Yes, has to.

You may be brilliant at other things, but your analysis of this particular
problem is no better than the doctors you describe.

~~~
chronic7382
> What you don't perceive is why medical education has to be that way in the
> current state of affairs. Yes, has to.

No, medical education does not have to be this way. It is purely gatekeeping.

It's similar to how "You need a PhD" to land top AI/ML jobs. That's
gatekeeping as well, though it is slowly changing.

Not many doctors or AI researchers will openly state this gatekeeping because
they benefit, at the expense of those not in their field.

~~~
rscho
Nope, not gatekeeping. I know I won't convince you, but just think about that:

Most parts of the country are approximately medical deserts. So once you're
educated, you are dispatched to said desert. Your hospital has standard
pathways where nursing teams operate. Problem is, everything that escapes the
standard pathway comes your way with no one to help you.

"Yeah, but there's UpToDate, MEDLINE, etc.". Well, no. NO! You simply don't
have the time. Your job is to operate as a well-oiled machine to handle all
the impromptu shit 70+ hours/week. That's why you did all this rote
memorization.

A doctor is not an engineer. He is trained for a hostile environment where you
have no time to think or search. As long as automation can't help (and it
currently can't), docs are bound to memorization training.

------
maxander
“Spending too much on medicine” isn’t like spending too much on clothes or
nice houses. If the consumer goods you buy are crummy and don’t improve your
life you can do without them, but we’re essentially unable to decide we can do
without _health_. Demand for cures for our diseases is different than demand
for other things, and that shows up both in the sorry economic structure of
our (U.S.) health system, and here.

If we had more medical treatments that worked, and a lab-to-hospital pipeline
with a better track record, I suspect better scientific standards would follow
naturally. But for now, raising the standards of evidence would essentially
block off the invention of new treatments altogether, which simply isn’t an
option even on a psychological level.

~~~
julienreszka
> "raising the standards of evidence would essentially block off the invention
> of new treatments altogether"

Citation needed.

------
JamesCoyne
If you are intrigued by the thesis of the book, _EconTalk_ has an episode with
the author.

[https://www.econtalk.org/jacob-stegenga-on-medical-
nihilism/](https://www.econtalk.org/jacob-stegenga-on-medical-nihilism/)

------
rhinoceraptor
Modern medicine is great when you get in a car crash, and it's horrific if you
have type 2 diabetes.

Doctors get very little training in diet and lifestyle, because those are low-
status and left to non-MD specialists, and many of them dogmatically cling to
1960s-era science.

~~~
rscho
You really think endocrinologists have no training in diet and lifestyle?

Well, what can I say. No?

~~~
rhinoceraptor
> On average, U.S. medical schools offer only 19.6 hours of nutrition
> education across four years of medical school

[https://health.usnews.com/wellness/food/articles/2016-12-07/...](https://health.usnews.com/wellness/food/articles/2016-12-07/how-
much-do-doctors-learn-about-nutrition)

~~~
rscho
That's for basic med school education. Happily, medical education doesn't stop
at the end of med school. It is more like, beginning just at that moment.
Otherwise many more patients would die.

So yes, on paper you're right. In practice, there are even clinical nutrition
specialists and those are MDs.

~~~
rhinoceraptor
In practice, nutritional interventions are much less favored over drug
interventions.

For example, a simple ketogenic diet intervention can be a very effective
treatment for type 2 diabetes. But most doctors still favor the 1960s-era,
discredited science saying dietary fat causes heart disease.

So diabetics are given metformin and whatever fancy new insulin came out
recently. And then in 20 years, those people will likely lose their feet and
eyes.

~~~
rscho
Diet and lifestyle changes are first line as per current guidelines.

Drugs are initially optional, unless I am mistaken. However, you seem very
optimistic regarding the ability of people to follow diets.

------
lordnacho
It's quite odd to dismiss better sanitation and nutrition as not medicine,
isn't it?

I think the problem is that we take for granted the things that have been
discovered, because they were found a long time ago. Washing surgeons' hands
in carbolic acid help puerperal fever rates. Cholera has something to do with
water. Vaccination works. All those things happened way before any living
person remembers.

From what I hear among pharma friends, the problem is also that the low
hanging fruit has been picked. A lot of lines of inquiry are variations of the
same thing, and over time we've found what is there to be found.

If you think about it, it makes sense that it's like that. Something really
powerful like vaccination is going to pop out of the stats immediately.
Subtler effects require more trials to detect.

In any case, it's a greater danger that there are people who don't believe in
evidence based inquiry at all pretending to be medical professionals. Look at
anti-vaxxers, or the Goop type quackery.

------
disqard
I'm surprised that even antibiotics are considered one of two "magic bullets"
(the other being insulin, which does seem close to a perfect solution).

I encourage those interested in the pernicious aspegts of humanity's overuse
of antibiotics to read this interview with Stephen Buhner [0]

[0] [https://www.thesunmagazine.org/issues/468/living-
medicine](https://www.thesunmagazine.org/issues/468/living-medicine)

~~~
afthonos
Overuse happens precisely because they are so good at what they do. Moreover,
at a first approximation, overuse results simply in a return to a previous
state of no good defense against newly-resistant bugs. So in the worst case
scenario, antibiotics bought us a century of better health; that’s pretty
magical.

------
agumonkey
Let me extend the query, is "modern medicine" overrated. Modern technology +
western like urban lifestyle changed how we live.. and how much medicine we
think we need.

Walking in the woods is probably as effective as the average anti depressant.
Good physical activity too.

But we sell that modern life is great and that ailments are normal and that
thanks to the medical field we have all these solutions.. that we probably
didn't need in the first place.

~~~
Reedx
Regular exercise, good diet and quality sleep prevent/solve most health
problems.

If exercise were in pill form, it'd be the most valuable pill.

~~~
scarface74
That leSs down the dangerous road that many who are against universal
healthcare go down (not saying you were implying it). That most health
problems are caused by poor decisions.

These are the top 10 causes of death.

[https://www.cdc.gov/nchs/fastats/leading-causes-of-
death.htm](https://www.cdc.gov/nchs/fastats/leading-causes-of-death.htm)

How many of those could be prevented by good diet, quality sleep and exercise?

~~~
Firadeoclus
You can't prevent death, only prolong life.

Most of those causes are accelerated by poor diet, poor sleep and lack of
exercise.

------
AtomicOrbital
Dr. Jacob Stegenga - Medical Nihilism: Assessing Medical Evidence in a
Neo-­Liberal Age

[https://www.youtube.com/watch?v=SgX4BKCxTI4](https://www.youtube.com/watch?v=SgX4BKCxTI4)

------
braindead_in
So why do the drug companies charge so much for the medicines then? I just
finished watching the Valeant episode of Dirty Money and combined with this
book, it all kind of makes no sense.

------
rayiner
Note that the author is a “science journalist” with a degree in journalism,
not medicine or even STEM.

~~~
tptacek
I'm not sure what the quotes are for. Journalists have beats. Conflict
journalists, for example, do not generally have military backgrounds. White
House correspondants have not generally run for public office.

~~~
rayiner
They’re scare quotes. Some subjects can be reported on by generalists. But I
think some require special expertise to put into context. I wouldn’t want to
read an article from a “tech journalist” criticizing the approaches Netflix
uses to scale its systems to be able to stream terabytes of data per day.
Likewise, I don’t think someone without medical training is qualified to write
articles about whether medicines are effective or not.

~~~
tptacek
Really? That's an interesting example to choose, since John Carreyrou didn't
have any medical training and almost singlehandedly brought Theranos to its
abrupt end.

 _Later, because it was bugging me_

There's also distinctions to be made between a "generalist" and a
"practitioner". Beat reporters are specialists, not generalists. They've
cultivated sources and, over their careers, expertise. Roger Ebert wasn't a
filmmaker, but he sure as hell knew more about films and their language and
idiom than a WSJ business reporter (who in turn knows more about
collateralized debt than Ebert). Extending the analogy further: I'm capable of
critiquing cryptosystems and finding/exploiting vulnerabilities in them, but
I'm not a cryptographer and am not qualified to build them myself.

Do you need an example of a non-programmer tech reporter worth reading? Happy
to provide one.

------
natrik
_Stegenga calls these latter two “magic bullets,” a phrase coined by physician
/chemist Paul Ehrlich to describe treatments that target the cause of a
disease without disrupting the body’s healthy functions._

 _Researchers have labored mightily to find more magic bullets, but they
remain rare. For example, imatinib, brand name Gleevec, is “an especially
effective treatment” for one type of leukemia, Stegenga says. But Gleevec has
“severe adverse effects, including nausea, headaches, severe cardiac failure
and delayed growth in children.”_

Most would prefer these symptoms over death.

[https://en.wikipedia.org/wiki/Betteridge%27s_law_of_headline...](https://en.wikipedia.org/wiki/Betteridge%27s_law_of_headlines)

------
amriksohata
Yes,it is, as it's about profit so always about cure, never prevention

------
Gatsky
Anyone receiving or delivering healthcare is aware of these problems. These
kind of critiques suffer from the same basic problem - they treat Medicine as
a monolithic entity which is not intimately linked with society, culture, the
economy and government. This conceit is necessary to write a book about it,
and is a luxury available only to those who don't need to actually deliver or
administer healthcare. It is also not the same thing as 'trying to make things
better', despite what the author may claim. In truth the author is actually
critiquing what they have decided falls under the umbrella of medicine, which
they define at a particular point in time.

The problem is incentives, not sure why this guy wrote a whole book without
realising this, but it is an easy mistake to make if you are thinking about
the problem from your writing desk. People will minimise effort and cost,
given a choice, and maximise profit subject to constraints. This behaviour
exists even in highly trained health professionals already making many
hundreds of thousands of dollars a year. Example - why do primary care doctors
prescribe minimally effective drugs for depression? Is it because they can't
understand a meta-analysis, can't remember all the patients the drugs didn't
work for in their own practice, or because they are lazy or stupid? It is
because a patient has come in looking for help and is sitting there in tears,
and there is only 10 minutes to see them, and the history from the other
doctor this person has been seeing for the last 5 years isn't available. And
although everyone would be better off if the doctor spent an hour finding out
in detail what is going on, carefully talking over the options, the side
effects of various treatments and reaching a consensus management plan which
starts with non-pharmacological therapies, and activates a government program
which allows the patient to take extra time off work to attend therapy
sessions with childcare facilities included. But it is easier for everyone to
prescribe Prozac. This is the reality. Perverse incentives explain many of the
problems in Medicine and healthcare systems. Nobody gets paid for delivering
good care, nobody saves money by accepting good care. As shocking as it may
be, delivering good care or exceptional care is a choice a health care team
makes despite everything else. Similarly, accepting proven health care
interventions is a choice a patient makes. Usually everything doesn't line up,
and that is modern medicine.

The cited example of Gleevec also makes no sense to me. It revolutionised the
treatment of 2 conditions which were almost completely untreatable beforehand
(Chronic Myeloid Leukaemia and Gastrointestinal Stromal Tumour). The
alternatives to taking Gleevec for these patients were A) Toxic minimally
effective chemotherapy followed by death or B) Just death. All of this context
is extremely important in discussing the side-effects which can be severe.
This is what the patient and the doctor work out together. Some throwaway line
about how toxic it is just makes no sense in isolation.

------
rjf72
I think the article (and presumably the book) bring up a lot of great points
about systemic issues with medicine, but I also think there is another much
more macro level argument.

The Ancient Greeks were, in terms of medicine, almost completely ignorant.
They had no idea about germs; instead focusing their medical theory around the
4 humors - blood, phlegm, yellow/black bile and miasma theory. What's good
drinking water? Water that tastes clean. Vaccines? That'd come about 3,000
years later. And they engaged in hygiene habits we might find a wee bit dodgy.
For instance at the public toilets there obviously were no toilet paper
dispensers. Instead they'd use sponges - butt brushes. After one fellow
finished his business you'd give it a swish around in some water or, for the
fancier toilets - vinegar, and take your turn.

But the thing is is that they (and I am referring to the upper class here) had
life expectancies that were not what you'd think. This [1] great article from
the BBC has quite a lot of interesting data. For instance of some 298 recorded
individuals of ancient Greece/Rome, the median life expectancy was 72 years.
Some random famous names: Pythagorus - 75, Hippocrates - 90, Plato - 80, etc.

There is of course some selection bias in that sample, but you can also see
evidence of longevity in other ways. For instance in Ancient Rome one could
not hold the office of Consul until reaching the age of 43, first office was
not available until age 30. The article also goes on to analyze numerous other
sources than tend to paint a recurring picture: there was high infant and
youth mortality, but people who made it to adulthood tended to have a life
expectancy not all that different than we do today. It seems to suggest that a
large part of our increased life expectancy is not from the trillions of
dollars we've spent on trying to find a [profit making] pill for everything,
but instead from very simple things like access to clean water and food.

\---

Finally there is a little 'paradox' that should always be brought up in
medicine and in particular efforts to try to squeeze out every slimmer gains.
Imagine you have a test that is 99.9% accurate for some illness. And 1 in a
million people have this illness. If somebody tests positive, what are the
chances that this is a false positive? 99.9%! In a million people our 99.9%
accurate test will give 1,000 hits - yet only 1 person will actually have the
illness. You'd probably end up seeing a negative return on life expectancy
here just because of how many people you'd be scaring witless after informing
them they need to come back in for follow up testing. Seriously, just take a
few days off their lives and you've already gotten rid of the gains in
expectancy for the 1 in 1000 guy.

[1] - [http://www.bbc.com/future/story/20181002-how-long-did-
ancien...](http://www.bbc.com/future/story/20181002-how-long-did-ancient-
people-live-life-span-versus-longevity)

------
carapace
Has anyone mentioned this already?

> Medical errors are the third-leading cause of death after heart disease and
> cancer.

[https://www.cnbc.com/2018/02/22/medical-errors-third-
leading...](https://www.cnbc.com/2018/02/22/medical-errors-third-leading-
cause-of-death-in-america.html)

I agree with Stegenga:

> There is no place I would rather be after a serious accident than in an
> intensive care unit. For a headache, aspirin; for many infections,
> antibiotics; for some diabetics, insulin—there are a handful of truly
> amazing medical intervention, many discovered between seventy and ninety
> years ago. However, by most measures of medical consumption—number of
> patients, number of dollars, number of prescriptions—the most commonly
> employed interventions, especially those introduced in recent decades,
> provide compelling warrant for medical nihilism.

\- - - -

I was just reading about "The China Study",
[https://en.wikipedia.org/wiki/The_China_Study](https://en.wikipedia.org/wiki/The_China_Study)

> The China Study is a book by T. Colin Campbell and his son, Thomas M.
> Campbell II. It was first published in the United States in January 2005 and
> had sold over one million copies as of October 2013, making it one of
> America's best-selling books about nutrition.[1][2][3]

> The China Study examines the link between the consumption of animal products
> (including dairy) and chronic illnesses such as coronary heart disease,
> diabetes, breast cancer, prostate cancer, and bowel cancer.[4] The authors
> conclude that people who eat a predominantly whole-food, plant-based
> diet—avoiding animal products as a main source of nutrition, including beef,
> pork, poultry, fish, eggs, cheese, and milk, and reducing their intake of
> processed foods and refined carbohydrates—will escape, reduce, or reverse
> the development of numerous diseases.

Now I'm a pretty "fringe" kind of guy, and there's some stuff in there that
even I have trouble with (animal protein is highly carcinogenic? Eh what?) But
the basic idea of nutrition affecting health, or more accurately being the
foundation of health, seems sound to me, and my attempts to eat a "whole-food,
plant-based diet" have been very positive. Although I did send my digestion
for a loop by "cutting over" too fast once. It takes about three days for your
guts (microbiome and own) to adjust to a big change in diet, FWIW.

In any event it's batshit insane that convention medicine treats nutrition as
an afterthought.

(There's a wonderful confluence between eating a whole-food, plant-based diet
and the ecological repair of our food systems.)

\- - - -

Now let me push the boundaries. I burned the tip of my thumb the other day
taking a pan out of the oven, 450°F. I was careless and didn't quite hold the
potholder correctly, burn reflex overridden so I wouldn't drop the pan, it
melted the fingerprint whorls. After I finished hopping up and down, pissed
off at my own carelessness, I took a few moments to "beam" Reiki to my thumb,
while concentrating on communicating with my healing and immune responses
telling them to "get in there and clean things up". The pain went away and
didn't come back. A very modest blister formed under the melted skin. The spot
was tender, and it stung a bit if I let hot water touch it the first day, but
after that there was no tenderness. Two days later the blister was gone. The
skin is slightly rough, but it's not peeling, nor is it a scab. Day three I
woke up and forgot that I had burned myself. The flesh apparently
reconstituted itself. I'm not sure it will even leave a scar. The skin still
hasn't peeled.

In sum, a minor second-degree burn, apply ten seconds of Reiki, result: no
pain and accelerated healing.

"The future is here, it's just not evenly distributed yet."

------
flying_kiwi
These comments just reek of the silicon valley tech-bro myth that because
you're good with computers you must know better than the millions of brilliant
smart people in $INDUSTRY. The absolute arrogance.

~~~
bedobi
Welcome to HackerNews! Threads about Medicine and Economics are some of the
worst - everyone here is apparently a Nobel grade expert.

~~~
TeMPOraL
> _Threads about Medicine and Economics are some of the worst_

Compared to what? What you'd have on a forum of economists or doctors? Maybe.
What you would be reading otherwise? Not quite.

> _everyone here is apparently a Nobel grade expert._

Maybe not Nobel-grade, but there's plenty of actual doctors on HN.

------
wtdata
Scientific American is getting very non scientific.

A couple of days ago we got the: "Fat Is Not the Problem—Fat Stigma Is", now
this article. What follows, "Aliens may have built the Pyramids after all"?

~~~
julienreszka
Can you quote what you think is non scientific in the article "Is medicine
overrated" ?

------
RandomBacon
The anti-vaxxers think it is.

We need to be careful how we say this, because then you get generalities like
the title and people who shun the basic of medicines such as neccessary
vacinations.

~~~
alyx
Many "anti-vaxxers" are simply concerned parents.

Considering that vaccines (in general) have been deemed "unavoidably unsafe"
at the Supreme Court level, they are not completely unjustified in their
fears. [0]

Vaccine manufactures cannot be held liable.

Thus there is a "National Vaccine Injury Compensation Program" put in place to
compensate those that have been damaged by vaccinations.

To date, over $4 billion dollars has been paid out in damages. [1]

Just as mentioned in this article, side effects are major deterrents of any
medication. And significant efforts need to be made in order to ensure that
side effects do not occlude positives effects.

[0]:
[https://www.supremecourt.gov/opinions/10pdf/09-152.pdf](https://www.supremecourt.gov/opinions/10pdf/09-152.pdf)

[1]: [https://www.hrsa.gov/sites/default/files/hrsa/vaccine-
compen...](https://www.hrsa.gov/sites/default/files/hrsa/vaccine-
compensation/data/monthly-stats-july-2019.pdf)

~~~
JamesBarney
I think you're misreading the supreme court ruling because you're
misinterpreting the term unavoidably unsafe.

"In short, “unavoidably unsafe” is simply a legal term that means the
manufacture is not liable because they cannot do anything to make the product
safer. It does not mean that the product is dangerous and should be avoided."

This could apply to peanut butter because of peanut butter allergies. The
manufacture is not liable for someone who dies of a peanut butter allergy when
they eat peanut butter because this is not due to manufacturing defects but is
due to the inherent nature of peanut butter being "unavoidable unsafe".

This does't mean peanut butter or vaccines are dangerous.

------
mistermann
> decades of massive use for us to even realize that some of our most common
> over-the-counter drugs were being used in dangerous ways (e.g. aspirin can
> cause Reye's syndrome in children, Tylenol with alcohol can damage the
> liver)

Agreed, but then to some degree could this same argument not be made about
vaccines?

~~~
carapace
No. It's pretty clear, _even_ if the anti-vaxxer lunatics were not wrong
(which they are, they are wrong, they are perniciously wrong, in the face of
all evidence they are wrong), that vaccines would be a net benefit.

In other words, even if vaccines _did_ cause autism (which they do not) it
would still be imperative to use them. The alternative to widespread
vaccination is _much worse_.

~~~
mistermann
> No. It's pretty clear, even if the anti-vaxxer lunatics were not wrong
> (which they are, they are wrong, they are perniciously wrong, in the face of
> all evidence they are wrong), _that vaccines would be a net benefit_.

Are the "anti-vaxxer lunatics" arguing that vaccines are not a net benefit?
When you refer to "anti-vaxxer lunatics", who is it, _exactly_ , are you
referring to? Are you referring to specific people ( _everyone_ within the
"anti-vaxx" "community"), or are you referring to an abstract mental model, of
questionable accuracy, held in your own mind?

> even if vaccines did cause autism (which they do not)

These sorts of comment lack epistemic humility/awareness. We do not _know_
that vaccines do not cause autism. Science _does not say this_.

However, this isn't to say that science says vaccines _do_ cause autism.

What causes autism _is unknown_. The final knowledge of an association between
vaccines and autism is _unknown_.

 _To some degree_ , the "pro-vaxx" message is based on propaganda (here I am
referring to the lesser pejorative meaning of the word). Many within the
"anti-vaxx" community can see this, and it is used in various ways as
leverage. Which is, of course, also propaganda (the more pejorative kind -
typically, _but not always_ ).

This approach has been sound in the past, but there are increasing signs that
it is becoming less effective. Time will tell if that trend continues.

~~~
gus_massa
>> _even if vaccines did cause autism (which they do not)_

> _These sorts of comment lack epistemic humility /awareness. We do not know
> that vaccines do not cause autism. Science does not say this._

This is technically correct, but it's very difficult to discuss against FUD.
Let's try another example:

Do vaccines cause earthquakes? Nah.

Is it 100% scientifically proved that vaccines don't cause earthquakes? It
looks very difficult to prove, perhaps you can pick some areas in an
earthquake prone country and only give vaccines in some areas and placebos in
other areas, and see if the earthquake ratio change. I guess you will never
get an approval for an study like this.

So the conclusion is that scientist say that perhaps vaccines cause
earthquakes? [What is a good answer here?]

\---

It may sound weird that someone think that vaccines cause earthquakes, but
some people believe[d?] that playing an instrument in the wrong season can
cause big frost. From
[https://en.wikipedia.org/wiki/Erke](https://en.wikipedia.org/wiki/Erke)

> _Traditionally but not commonly, only adult men play the erke, and it is
> considered profane to play the erke outside of a ritual context. The erke is
> commonly played during winter, as it is believed that playing it in spring
> or summer can bring snow._

The English Wikipedia says "snow" but the Spanish Wikipedia says "frost" or
"ground frost" like the ones that can destroy crops.

I know the story because part of my family is of a nearby area, but I guess
that most cultures have similar stories.

~~~
mistermann
> So the conclusion is that scientist say that perhaps vaccines cause
> earthquakes? [What is a good answer here?]

Is this a similar comparison to what I've said (or implied), in the slightest?
Might your imagination have added a bit of extra color to your reading of the
actual words I wrote?

It may be enjoyable to mock lesser intelligent people, but if the intent of
pro-vaxxers was _purely_ concern about the prevalence and risk of vaccine
misunderstanding throughout society, I would expect more willingness to
understand what is really happening within the community you're worried about,
and less (apparent) glee at simply telling people they're stupid.

At the end of the day, you will reap what you sow.

~~~
gus_massa
We can't prove that vaccines don't cause autism. We can't prove that vaccines
don't cause earthquakes. So they are similar. In both cases we only can show
that the correlation is so small that we can't reject the null hypothesis. So
the correct answer is an informal "Nah" instead of a formal "No".

> _It may be enjoyable to mock lesser intelligent people,_

No. But if you want to discuss epistemology, let's start with an easy example
were we all agree that is false in spite there is no hard evidence. Sorry if
it looked as a mock, but it was not my intention.

There are zealots and ridiculous claims in both sides, but at the end of the
day smallpox is eradicated, polio is cornered (I hope to see the eradication
day), meleases is reduced to very small levels (eradication looks more
difficult). All of them used to kill a lot of people.

~~~
mistermann
> In both cases we only can show that the correlation is so small that we
> can't reject the null hypothesis.

And by what means has any correlation been studied? What _specific_ data is
used?

Has a machine learning approach that examines _all_ vaccination records and
compares it to _all_ subsequent patient medical issues, _of all kinds_ , not
just autism? Does the necessary data for this even exist? I wonder if that
fact could even be determined from reading any official websites on vaccine
safety.

> let's start with an easy example where _we all agree that is false_ in spite
> there is no hard evidence.

a) I wonder how unanimous the agreement really is. I have a feeling expressing
dissent in the slightest would be about as good for a doctor's career as it is
for one's karma on social media sites.

b) Have there ever been cases in the medical field where "all people agreeing"
turned out to be less impressive than it sounds?

[https://www.nature.com/articles/437801a](https://www.nature.com/articles/437801a)

"Marshall and Warren went on to show that patients with ulcers can be treated
with antibiotics. Unlike patients given acid-suppressing drugs, their ulcers
do not return."

"But gastroenterologists resisted the idea. Francis Mégraud, a bacteriologist
at the Victor Segalen University in Bordeaux, France, remembers attending the
1988 meeting of the American Gastroenterological Association in New Orleans
and hearing _outraged physicians_. “They seemed insulted, saying, ‘we are
being asked to treat stomach ulcers with antibiotics, as if it were
gonorrhoea!’” he says. “It was hard for them to accept that the disease could
be a simple infection.”"

> There are zealots and ridiculous claims in both sides, but at the end of the
> day smallpox is eradicated, polio is cornered (I hope to see the eradication
> day), meleases is reduced to very small levels (eradication looks more
> difficult). All of them used to kill a lot of people.

True, however:

a) were vaccines the only factor involved in this improvement

b) relative (net aggregate) vaccine safety and absolute safety are related,
but distinct subjects. If I'm taking my children for vaccinations, I am
interested in absolute safety, not net aggregate safety.

~~~
gus_massa
a) Yes

b) Absolute safety is imposible. Let's make some calculation: There are 1.3E8
newborn per year, each one get vaccine in about 10 occasion (sometimes
multiple shots), let's assume that the round trip to the hospital is 5 miles
and the accident rate of cars is 1.25E-8, and in a car there are 2 persons (a
child and an adult). So there are

1.3E8 x 10 x 5 x 1.25E-8 / 2 ~= 40

death of children going or returning to the hospital to get the vaccines per
year. (Not everyone get to the hospital by car, but even walking has risks.)
If we eliminate vaccination we can save 40 children per year.

~~~
mistermann
>>> at the end of the day smallpox is eradicated, polio is cornered (I hope to
see the eradication day), meleases is reduced to very small levels
(eradication looks more difficult). All of them used to kill a lot of people.

>> a) were vaccines the only factor involved in this improvement

> a) Yes

 _Once again_ , a confident binary answer to an _extremely_ complex problem.

How did you form this conclusion? Do you have anything you could show to
substantiate it? Something like some charts demonstrating that incidents of
all of these illnesses were essentially constant, and then _only_ upon
introduction of vaccines they began to decline? I've done some reading _on
this specific topic_ , I am interested to know if you have. (I happen to have
great philosophical interest in the actual vs self-perceived basis of
knowledge among zealous advocates on any matter.)

> b) Absolute safety is imposible.

I notice you kind of jump between two conversational styles, the first style
("a) Yes" above) is confident proclamation of a specific truth with no
substance to back it up, and then now more of a highly rhetorical, subtle
changing of the subject style. And to make it even more interesting, you then
include a mathematical formula to give an impression of certainty, but in the
process you've completely removed the actual point of contention (harm due to
vaccines) from the discussion. Things like this are what I am looking for in
these conversations: _how do pro-vaxxers come to believe ( "know")the things
they believe._

Even if absolute safety isn't possible (something you have no way of knowing),
safety isn't a binary, it's a continuum.

Have we done everything we can to study vaccine safety? Are there any flaws in
the current system? Have you even done any reading on what the system actually
consists of?

I will offer you a second chance to demonstrate how much you know about this,
by reminding you of a question in my earlier comment that you seem to have
accidentally missed:

>> In both cases we only can show that the correlation is so small that we
can't reject the null hypothesis.

> And by what means has any correlation been studied? What specific data is
> used?

> Has a machine learning approach that examines all vaccination records and
> compares it to all subsequent patient medical issues, of all kinds, not just
> autism, ever been performed? Does the necessary data for this even exist? I
> wonder if that fact could even be determined from reading any official
> websites on vaccine safety.

I'm interested to know your answer to this - perhaps you are aware of
something I am not, and I can learn something new. (Also, please do not
accidentally overlook the questions earlier in my comment, and if I happen to
have failed to answer any of your questions, please point that out that
failing as well and I will rectify it.)

