The insiders in the medical system know who’s who. Which doctors are good and which are bad. This can save your life.
Why do you believe that? My prior is that reputations of doctors among their colleges is about a lot of factors that are not relevant to how well they treat the average patient.
There's also the conflict of interest where prestigious doctors might want to recruit patients for their clinical trial for a new drug.
- 5 year rule on new drugs
- Don’t take anything under 5 years old. Wait for it to be field tested if you have the luxury of time.
- E.g. amphetamines for weight loss, Thalidamide.
- Exception example: insulin - was life saving when it came to market.
Using examples from before the Kefauver–Harris Amendments to reason about the quality of current drug approvals seems like a bad reasoning to think about how likely a new drug is a problem.
All things being equal you should likely take an older drug, but drug approval usually needs that the company demonstrates that the drug is somehow superior to the status quo. It's a decision you want to make on a case by case basis.
- Watch the news for any drugs you are taking for any new information.
- Drug recalls, new side effects, dangerous co-factors
Given that we have LLMs, the news are a poor source. Just regularly run deep research or a thinking model that takes time to think to update you.
If trying an intervention you should be able to tell if it’s working
I think this is correct if you are very careful and follow the advice exactly as stated, but can go very wrong with slight variations. Interventions are selected for both working and for feeling like they work, collider bias rules everything around me.
An advocate can indeed be a good idea, but "pushy" can backfire - wise, assertive, well-informed and tactical/strategic/realistic could be better than pushy.
>Get a second medical opinion
Only worth doing if likely to be different - be cautious about assuming you know better, especially in mental health, where your condition may be biasing your thinking (eg anxiety) or your hope about offered solutions (eg. depression). Trust your doctor or don't trust, but don't play games or turn it into a fight.
>Consider alternative medicine treatments
If this means exercise, massage, Alexander Technique, fine, but be just as rational/critical about the others as mainstream solutions.
>Medical experts usually don’t have statistical skills (get statistics questions wrong)
Does not apply to geneticists and good surgeons in good surgical units. Does apply to many EAs.
>The median doctor reads the result section of the abstract of a paper, not even a whole paper or a whole abstract.
Doctors are not scientists or researchers, can't cover the whole field in detail. GPs are trained up on common conditions, and refer on with rarer or more challenging conditions. In many countries they have CPE to keep up with robust research. EAs and rationalists tend to cherry pick lower quality, small, open lable or animal studies with the answers they want.
In the UK, NICE helps get around this, though it may be over-influenced by some pharma (especially with chronic conditions) and cost considerations.
>Cookbook approach: medical system has very rigid rules, it’s harder and harder to be making personalised care.
That's why you still need a good GP, who specialises in YOU, and knows you over time.
> - solutions that make money if people keep taking the drugs.
True for things like heart disease, arthritis, but still better than not having a solution.
>Curing someone will make a pharma company bankrupt.
No - really good solutions make a fortune. Can be a downer with vaccines, but for a different company that was previously doing treatments - think of cervical cancer, now solved by HPV vaccine, or improved treatment for ulcers. You seem to be repeating memes/prejudices/negative dogmas without supplying evidence.
>Medical system - downplays the side effects of the treatment.
"Medical system" is a bit unspecific - who do you mean? For pharma, mostly no - tends to overplay them, especially in patient leaflets, to prevent expensive litigation. Yes with heart surgery, but their 'excuse' may have some validity: people are scared enough already, so discussing a long list of things which rarely happen can be counter-productive.
USA and Italy tend to be worse on this, because of pay-per-treatment. UK better because of NHS and innate conservatism/caution, but heart surgeons still a problem.
>Blind to the side effects
Your evidence?
>Making decisions around the body as a whole system, where specialists don’t necessarily notice the whole body.
Again this is why a GP/family doctor is good, can see you as a while person, knows if you tend to overplay or underplay symptoms.
It was an early shock to me to discover that alternative practitioners can be even more unwholistic, very fixed on a single body system and single solution. Conversely, a medical specialist can be curious about home environment, social life, etc. Anyone, from any background, can be more or less "whole person".
>Medical orthodoxy can be wrong
Of course, but overall less wrong and by law more accountable than heterodox, alternative, anti-vax, nature fallacy, and googledocs.
>Vit D from the sun is more beneficial than BCC skin cancers are bad for you.
You can take vit D supplements in winter. Outdoor exercise is good. Sunburn is bad. Common sense rocks!
>People live longer with the cancers because of the health benefits of the Vit D
Robust evidence on this? Can the vitamin D come from food/supplements?
Are hats, clothes and sunscreen still net positive if applied intelligently?
>Orthodoxy does change very slowly ~15 years from discovery to usage in the field.
Not always: in the pandemic, steroids, proning were adopted very fast, and mRNA was embraced.
Cost-saving options tend to be rolled out faster(!)
Sometimes new treatments in the private sector and new miracle supplements turn out to be nonsense. Again NICE or Mayo clinic are a good place to check, or Health Nerd (Gideon), or really good systematic reviews.
>Different countries have different recommendations (Australia, America, etc)
True, but not vastly different. NICE in UK and Scandinavians are good standbys. Beware India which tends to go for polypharmacy, HCQ and Ivermectin, and Madagascar which goes for unproven herbs.
>The insiders in the medical system know who’s who.: which doctors are good and which are bad. This can save your life.
This is great advice. A good GP is really helpful for this - they want you back from any specialist or surgery in good shape. With patient reviews, try to focus on outcomes rather than charm etc. ie. prioritise results rather than "bedside manner" or agreeability.
>5 year rule on new drugs
That's bad advice with mRNA for cancer, challenge trials in a pandemic, drugs with fewer side effects, Viagra, GPL-1 (though gastric bands may be better value for some)
>Watch the news for any drugs you are taking for any new information.
OK but don't get paranoid: anxiety can cause more problems than drug side effects.
>You may know family relevant conditions and you may know them better than the medical system.
Good to discuss with family doctor/GP.
>If trying an intervention you should be able to tell if it’s working
Not always - typically people expect results too soon, which tends to favour more aggressive treatments with more side effects, or potentially addictive "feel good" drugs like diazepam and opioids for pain. A good GP, clinical psychologist or physio will nag you to keep going, give it time, especially with anti-depressants, physio exercises, CBT, etc.
Be patient.
>Every medical intervention has side effects
Vitamins? physiotherapy? polio vaccine? insulin? CBT? oxygen? abscess treatment? tooth filling? glasses?
>Surgery is dangerous
It depends which surgery. Sometimes, often, delaying surgery is dangeorus.
>Some medicines are poisons
mainly in overdose
>Get and keep a copy of every test that is ever done to you
Good advice!
>The best medical experience is not having a medical experience - be healthy instead.
Agreed. Add "enjoyable social interaction".
Does not apply to geneticists and good surgeons in good surgical units. Does apply to many EAs.
What makes you think that good surgeons are good at statistics? I would assume surgeons selects for hands-on-skills. Besides dentists, surgeons are also one of the groups between the medical establishment that care the least about evidence based medicine and practice a lot of treatments where they think placebo-blinded trials aren't really feasible.
Vitamins? physiotherapy? polio vaccine? insulin? CBT? oxygen? abscess treatment? tooth filling? glasses?
Clinical trials of broad spectrum vitamins often find that those don't provide benefits to the broad populations. If we grant that some vitamins do provide benefits, that makes the hypothesis that others in the broad spectrum vitamins have negative side effects quite plausible.
There were times I was getting diarrhea from vitamin effervescent tablets and understanding this made me cut back on them.
Physiotherapy comes in a lot of different forms but plenty of those have side effects. Schroth (which is an evidence-based treatment I got for scoliosis) for example has the idea that muscle tonus should be raised to press the spine into shape which has the side effect of making relaxation with low muscle tonus a lot harder.
Official numbers for the polio vaccine suggest mild side effects in 10-20% of the people that take it for the inactivated polio vaccine we take in developed countries. Risk-benefit calculations suggest that the vaccine is worth it, but pretending that it doesn't have side effects is not helpful.
When asked about side effects of CBT ChatGPT says "Meta-analyses and systematic reviews have documented these “adverse effects” in a non-trivial portion of patients—anywhere between 5–20% depending on the study design. They’re usually temporary, but they matter because they shape whether therapy feels supportive or overwhelming." Generally, a lot of therapy outcomes also depend a lot on the therapist. Depending on the issues that your particular therapist has, you might get related side effects.
Abscess treatment comes in multiple forms. Antibiotics have well known side effects of messing up a lot of other bacteria with whom we live in symbiosis. Cutting comes with scarring risk.
With tooth filling opinions of different dentists about which teeth should get them vary widely. Doing tooth filling quite obviously inhibits the normal healing processes of the tooth and plenty of times tooth fillings break after some time.
Conversely, a medical specialist can be curious about home environment, social life, etc.
A person who bills by the hour (which many alternative medicine practitioners do) has a lot more room to pursue their curiosity in situations like that, then the models with which doctors are usually paid.
Conflict of interest
- Medical professionals - that endorse themselves to do procedures like surgery and convince patients to pay them to do it.
A salesperson who doesn't endorse their own product is in the wrong job. The weird thing to me is that a doctor is the only kind of salesperson who expects to get paid when they don't make a sale. You go to a car dealership and don't buy a car, the salesperson doesn't get paid for that. You walk into a Best Buy, play with some of the computers on display, and ask the salesperson some questions, but leave without buying anything, Best Buy doesn't get paid for that. Yet if you go to a doctor, and the doctor fails to diagnose your condition, or to prescribe a treatment you will consent to, somehow the doctor still expects you to pay. That seems wrong to me.
As someone living with stage 4 prostate cancer for five years now, I strongly endorse this.
I would add extra emphasis on quality of life. The past few years of my life have been amazing. I get regular blood tests, but that's it. I haven't seen or talked to a doctor for years. I found being in the medical system was only causing frustration (because they so obviously don't care) that I just decided to leave it and focus on living.
Lesswrong Sydney runs a local dojo once a month to talk about rationality topics. This month our topic was "medical decision making". This is our notes for considerations on how to make decisions. Please feel free to contribute your own small pieces of advice to this repository of considerations about making decisions in the medical world.
Expect to encounter the medical system sometime between now and when you die; for serious and life altering treatment. You should be prepared to work with limited information and under stress.
The best medical experience is not having a medical experience - be healthy instead.
Thanks for reading. Hope this was helpful for your decision making.