The response to my medical miracle post has been really gratifying. Before I published I was quite afraid to talk about my emotional response to the problem, and worried that people would strong arm in the comments. The former didn’t happen and the latter did but was overwhelmed by the number of people writing to share their stories, or how the post helped them, or just to tell me I was a good writer. Some of my friends hadn’t heard about the magic pills or realized what a big deal it was, so I got some very nice messages about how happy they were for me.
However, it also became clear I missed a few things in the original post.
In trying to convey the concept of luck-based medicine at all, I lost sight of traits I have that made my slot machine pulls relatively safe. Here is a non-exhaustive list of traits I’ve since recognized are prerequisites for luck based medicine:
Feel free to add your own conditions in the comments and I’ll add my favorites to this list.
Multiple people have asked for details on the ketone esters thing, and I sure hope that’s because I convinced them to try stuff rather than somehow sold ketone esters in particular as good. Answers to the common questions:
Again I am not recommending this, but if you would like to know what I’m doing:
A male friend lost 4 pounds on a 50% potato diet and then plateaued (but that could be from an injury). A female friend tried my minimal potato diet and experienced no change. I think if that worked reliably we would already know about it.
Shout to reader George who connected me with an offline friend who had similar symptoms with the same cure, who has done a ton of research into mechanisms and suggested some follow-ups. They’re not guaranteed to work but this feels like a rich vein to me. Thanks George and offline friend!
A system for recognizing when things are helping and hurting, and phasing treatments out if they don’t justify the mental load. It’s good to get in the habit of asking what benefits you should see when, and pinning your doctor down on when they will give a medication up as useless.
It's worth noting here that human memory can be pretty bad. If you care about an issue enough to try multiple different solutions it's likely also worthwhile to have regular measurements for the issue, so that you are not relying on your memory.
If you have an issue like pain in a body area, marking the location of the pain and then photographing it, is one way to have a good record.
One failure case is that there are a few treatments like colon cleansing, whose popularity partly relies on them producing surprising results for the person, that are medically useless. It's important to be able to say "This treatment does something surprising but it doesn't really solve the issue I'm having, so I shouldn't take the fact that it does something surprising as evidence that it's somehow working."
"an easy lever might be a guide to obvious failure modes of supplements and medications"
I desire to see more things like this.. Especially if they're presented not as a list of "gotchas", but as specifics of a general moving-parts model of how naive models/strategies operate in a complex space. Should be lots of base rates being thrown around.
A system for recognizing when things are helping and hurting, and phasing treatments out if they don’t justify the mental load
This part has been a historical blocker to me using luck/exploration based medicine. If one is dissociated, alexythmic, or has an experience completely dominated by one sensation like pain or anxiety, then it's going to be pretty hard to notice fine gradations in how well they're doing. Not having precision really narrows the possible paths to success; effect has to be almost overdetermined before one actually updates on the evidence.
An extension of the noticeable risks and helping/hurting points I think is worth separating out: how to identify and avoid literal poisons. Not risky bets, per se, but things that are likely to directly harm the objective (health) and the other conditions necessary to make your strategy viable (kill your liver, mind, ability to move under your own power).I think it's a useful comparison point to know what it takes to figure out what is safe to eat in an unfamiliar environment. There's a protocol for slow steps of Graduated exposure and Waiting to see how well it's tolerated. Accumulated culture and the FDA are so very cheating technique. It's worth understanding how much work it otherwise takes to narrow down what world you are in without leaning on them.
A system for recognizing when things are helping and hurting
Do you have a particular way you recommend to measure and track mental effects? I have not been able to find something that is sufficiently sticky and sufficiently informative and sufficiently easy.
A functioning liver.
What tests do you do or have done or consider to check for a functioning liver?
My doctor described the FibroSure test as a non-invasive alternative to a biopsy, but I haven't dug into it very hard.