[HN Gopher] Google almost convinced me to spend $400 on useless ...
___________________________________________________________________
Google almost convinced me to spend $400 on useless laser
treatments
Author : tomjcleveland
Score : 389 points
Date : 2022-04-27 12:10 UTC (10 hours ago)
(HTM) web link (blog.tjcx.me)
(TXT) w3m dump (blog.tjcx.me)
| tlogan wrote:
| Internet was always full of spam. But somehow Google was able to
| correctly categorize it. Now it seems like Google is not keeping
| with it. It seems like that sites which might provide trusted
| information are not ranked well. It is interesting that these
| sites do not have Google Adsense (since they are mainly run by
| schools, public institutions, etc.) The same is happening with
| YouTube.
|
| I think it is definelly possible to sort results better (pure
| engineering problem). But there is really no short term insentive
| for that. Maybe in long term this will help Google to stay on top
| but that is not 100% clear: it is hard to predict how content
| discover will look in the future.
| pueblito wrote:
| My guess is that having to dig through the results increases
| engagement time and clicks, so they probably have their AI test
| how long you're willing to dig for an answer before giving up
| and calibrate results accordingly
| drspock11 wrote:
| What the article author doesn't seem to realize is much of
| dentistry (and medicine in general) is not based on evidence.
| There is zero clinical evidence that flossing actually does
| anything beneficial. I wouldn't be surprised if there was a lack
| of evidence for 6-month cleanings actually being beneficial.
| Similarly, doctors make decisions based mostly on hunches and gut
| feelings unless you're actively bleeding from a gunshot wound.
|
| I look forward to the day when AI is sophisticated enough to take
| medical decisions out of the hands of fallible and emotional
| human beings. (We're not anywhere close to that day)
| someotherperson wrote:
| Limited evidence doesn't mean it doesn't work.
|
| The reasoning behind flossing makes a lot of sense:
|
| 1. You remove food sources for streptococcus mutans
|
| 2. You avoid inflammation from teeth shifting
|
| 3. You disrupt biofilm (plaque) formation in the joints of your
| teeth
|
| I imagine the evidence is limited because genetics, diet and
| other oral hygiene routines significantly impact the outcome.
| There is a whole microflora system in your mouth, and the
| advice is to throw everything (floss, scrape tongue, mouthwash,
| brush) at it for everyone because personalising it is not worth
| the effort.
| mbg721 wrote:
| Something is working, even if it may not be clear specifically
| what that is. My grandfather had a full set of false teeth by
| the time he was the age my parents are now. The other big
| change in that time would be diet, but I don't think more
| refined sugar improves tooth quality.
| robertlagrant wrote:
| I love that at the end it turns out to be an advert for
| GlacierMD! Did M Night consult on this blog post?
| zaroth wrote:
| Reading blog posts from founders ranting about exactly the
| problem that their startup is trying to solve is kind of par
| for the HN course, is it not?
| dillondoyle wrote:
| There are tons of ethical issues in allowing medical ads to
| consumers as it creates perverse incentives (and just the for
| profit system in general, but let's not develve into that fight).
|
| I get tons of Testosterone replacement therapy ads. And also
| 'adhd' ads.
|
| These are real MDs, but they will give scripts to almost anyone.
| Many online only.
|
| I'm not judging people who want to use. People will use drugs
| legal or not and it is far better to get real stuff from real
| MDs.
|
| But advertising it? The whole point is to create / increase
| demand. This is not passively allowing safer use.
|
| These ads are misleading; TRT ads of young super fit people or
| getting people hooked on stims for no reason.
|
| How would people feel if there were FB ads targeting people who
| listen to EDM with dope or E ads? We are also inundated with
| alcohol already.
|
| All drugs aren't comparable or similar danger profiles, but just
| shows how prejudice and assumptions from a prohibition system are
| imho hypocritical. using a more extreme thought experiment can
| highlight this.
| erikerikson wrote:
| > 1. Consumers make most of their own health decisions
|
| Actually, this is what efforts are attempting to shift in the
| industry. It goes by the name "value based care" and is a better
| solution.
| Taylor_OD wrote:
| I've gotten to the point where if Insurance doesnt cover it then
| I don't get it. I can count on one hand the amount of non covered
| things that have been helpful in the past.
|
| This policy is what stopped me from getting a treatment from my
| dentist that involved grinding down my teeth. Google results were
| mixed on the benefits. Dentist pushed it very hard. It was like
| $500 so I said no. Teeth have been fine without it.
| maerF0x0 wrote:
| > My DH clearly pushes this LBR thing on all her patients
|
| Also for all our learnings' sake xrays often fall into this
| category. Dentists will basically demand xrays as often as the
| insurance will pay. This is not only a waste of money, but
| contributes to cumulative damage.
|
| Yes, if you have specific exceptional circumstances then the
| cost/benefit may be greater, but I understand that in the main
| and for better exceptional cases you every 3 years is fine.
| cleandreams wrote:
| I just left my dentist because they kept pushing braces on me
| (invisalign). I am over 60. The old dentist didn't do these
| things. The new dentist was hard sell. They also wanted to
| replace a crown that was fine. I found a dentist with a less
| invasive approach (and associated with the local dental school).
| I think there is a problem with dental care. You have 1 dentist
| and it's hard to verify what they say.
| mdavis6890 wrote:
| Honestly I don't see anything really wrong here. In the long run,
| you'll have people that get the treatment and people who don't,
| and over time you can compare these groups and outcomes. People
| will naturally gravitate toward the correct answer.
|
| It would be nice if we could have an omniscient oracle to gate-
| keep us away from ineffective treatments - but we don't live in
| that universe. Instead we have (in the US) the FDA, which is
| staffed by smart, well-intentioned, and very fallible human
| beings, each with their own (well-intentioned) agenda. At the
| very least these folks are simply weeding out treatments with
| major negative outcomes, like killing the patient. So some
| placebos get through and called 'treatments' like LBR - unless
| there is some better treatment that you're forgoing, there's
| really not much harm except for the $400.
|
| The folks that do a lot of research will make better choices than
| those that don't - but they will also help all those others make
| better choices over time as they communicate their ideas and
| results to the masses.
| hn_version_0023 wrote:
| Whenever I see an article about the US healthcare system, I'm
| forced to wonder:
|
| How is this system itself not a _cruel and unusual punishment_?
| Now obviously it's because it isn't applied as a _punishment_ for
| a crime, which is I think the letter of the law.
|
| Still, it feels like we live in some Kafka-esque nightmare where
| a huge number of things the US government ought to take care of
| are outright cruel... and that _the cruelty is the point_.
| renewiltord wrote:
| Pretty good observation of the fact that it is hard to get
| actually good information on Google. You have to use `reddit.com`
| or something to actually get it since that's the one place with
| lots of user-history and good SEO.
| matsemann wrote:
| Why are dentists so scammy?
|
| In Norway I've seen documentaries about them sending the same
| people to multiple dentists, and some of them receive wildly
| different advice. Some of that can be ascribed to some being in
| the school of pro-active, so they want to fix your teeth at the
| first glance of issues. But in the end, most of the things being
| quoted were unnecessary. They all seemed very intent on removing
| wisdom teeth, even when they pose no problems.
|
| They re-did the experiment recently, and I think one of the guys
| they sent got his teeth cleaned and tartar removed from 10
| dentists in a week or so. No one stopped to see if it was
| actually needed, they all just do it by default and charge you
| for it.
| a2tech wrote:
| Dentists are trying VERY hard to get included under standard
| medical insurance in the US. If you think they're scammy now,
| wait until they can start billing your insurance. People with
| insurance are often divorced from the cost of services rendered
| so they'll really be able to reap profit then.
| jnsie wrote:
| The naive part of me wonders if this will improve services. I
| have good health and dental insurance and while my health
| insurance becomes really beneficial once I've hit a threshold
| and met my deductibles, there is a hard upper limit on how
| will be paid for dental work annually, to the point I've had
| to spread (non-emergency) care over multiple years to cover
| the costs.
| seanmcdirmid wrote:
| Dentists don't remove wisdom teeth, they just refer you to an
| oral surgeon. The problem with wisdom teeth is that they
| increase maintenance requirements, it's hard to clean back
| there and they can affect adjacent teeth if they do go bad. So
| I get why many dentists default suggest to remove them (I still
| have mine but recently started running into problems at 47).
| delecti wrote:
| > Dentists don't remove wisdom teeth, they just refer you to
| an oral surgeon
|
| Bit of a meaningless distinction if they're in the same
| office.
| coryrc wrote:
| In the US, that would be rare.
| lupire wrote:
| Pointless nitpick, especially because providers pay
| referral fees.
| cma wrote:
| "Payment by or to a physician or health care institution
| solely for referral of a patient is fee splitting and is
| unethical. Physicians may not accept: Any payment of any
| kind, from any source for referring a patient other than
| distributions of a health care organization's revenues as
| permitted by law."
|
| https://www.ama-assn.org/delivering-care/ethics/fee-
| splittin...
| matsemann wrote:
| > _they just refer you to an oral surgeon_
|
| Perhaps in the US where they drug you down? Here the dentist
| just gives you a local anesthetic and pry them out, unless
| there is something extraordinary. Or perhaps it's a different
| person? But still the same company getting the money.
| toast0 wrote:
| It would also depend a lot on what's going on with your
| wisdom teeth. If they haven't erupted at all and are
| causing trouble, that's oral surgery time. If they're fully
| erupted, a regular dentist may do it. In between, it
| depends.
| bombcar wrote:
| The US usually has both options - and the dentist will
| usually recommend the surgeon, especially since some
| medical insurance will cover that but not the yank and
| jank.
|
| Oral surgeons in the US are usually found in larger
| hospitals; most dentists are just dentists.
| soylentcola wrote:
| I'm in the US. I've had one out and I just got novocaine
| and elbow grease.
|
| It was honestly an awful experience. Trying to pry that
| thing out while I couldn't feel a thing, but I felt
| incredibly drained afterward. Not sure if it was from
| adrenaline/anxiety or if you still respond to the trauma
| despite no immediate pain or sensation.
|
| Then I had the pleasure of little shards and chips working
| their way out as I healed over the next several months. It
| really did take a good 3-4 months before I felt remotely
| healed back there.
| sueders101 wrote:
| I had a wisdom tooth removed by a dentist within the last 5
| years. This was in the United States, for what it's worth.
| [deleted]
| crispyambulance wrote:
| Yes, there is a risk of complications with wisdom tooth
| removal. I was lucky twice, but when I had the lower ones
| removed, I got an infection blowing up the side of my face
| with a racketball-sized lump.
|
| The oral surgeon had to prescribe anti-biotics and follow up
| with a "debridement", reopening the site, draining and
| flushing it. No fun at all. Also not something that's
| normally done at a dentist's office.
|
| No way would I have done lower wisdom tooth removal without
| total-knockout anesthesia (Propofol). For me it's as much
| about the sensory input, sounds, and visuals of the hardware
| tools used. With the Propofol, it was a painless "30-minute
| time-travel" experience but I still felt exhausted for a
| couple days after the procedure. It's like my body knew what
| it went through even though I have no memory of it.
| Apparently this is a common feeling.
|
| The upper wisdom teeth come out easier and heal faster. I had
| those out with just local anesthetic injections, nitrous
| oxide, tightly shut eyes, and headphones blasting music.
| jrockway wrote:
| I had all of my wisdom teeth removed with just local
| anesthetic and nitrous oxide. It is certainly an
| interesting experience as you listen to your teeth being
| broken up by what amounts to a large ice pick. It didn't
| really bother me though.
|
| The worst part of the entire procedure was that they
| wouldn't call my prescriptions into the pharmacy in
| advance, so I could just go home and not run errands after
| the procedure. I guess people will schedule fake wisdom
| teeth removal so they can get a 3 day supply of Tylenol
| with codeine? I remember being very annoyed waiting around
| for a half hour in some grocery store with my mouth full of
| gauze and the pain setting in. Would have preferred to be
| at home in bed. Sigh! At least I don't have any more wisdom
| teeth.
| floren wrote:
| We recently moved and my wife & I both scheduled checkups at
| the same new dentist. She recommended a crown replacement and
| Invisalign to both of us, in my case while wearing an
| Invisalign-branded face shield. We both got weird vibes from
| that place and don't intend to go back. Didn't help that the
| hygienist said something like "oh, the crown replacement is
| easy, we just got a brand new machine to make them in-house!"
| which sounds to me like "wow we really need to pay off this
| machine"
| elliekelly wrote:
| I had a very similar experience with a new dentist this week
| and the front desk was _very_ pushy with getting me to
| schedule an appointment for a routine cleaning. I 'm still
| mad at myself for acquiescing but they were determined to
| steamroll right over all of my attempts to politely demur. I
| don't intend to return to the practice but I am absolutely
| _dreading_ the phone call to cancel the appointment because I
| know I 'm in for even more of their aggressive
| "encouragement" to change my mind.
| wpietri wrote:
| I think you'll see the same thing wherever people have complex
| problems and they consult people with an individual profit
| motive. Car repair, for example. Or alternative "medicine"
| things like chiropractors. Some of the people will be legit.
| Some will be frauds. And in the middle you have a bunch of
| people who don't intend to be frauds but that just hill-climb
| their way to good businesses but aren't skilled and disciplined
| enough to measure the value of their interventions.
|
| I suspect the same is true of people getting contract
| development done. Given the number of horror stories I've heard
| and the number of terrible code bases I've had to clean up, I'd
| guess the custom-software industry is no better than dentistry
| or car repair.
| asdff wrote:
| I think its because they don't keep up with the field. You have
| some dentists who learn how things are done when they are in
| dental school in the 1970s and that's how they continue to
| operate in their private practice until they retire. They might
| also be good friends with other specialists and will send their
| patients there because of that relationship (and they do at
| least trust their work). There are also different philosophies.
| Some dentists might prefer you keep original tooth if possible
| and have you get some advanced imaging done before they decide
| a treatment plan; others might lean on the side of avoiding
| additional imaging and just pulling the tooth assuming it is
| compromised.
|
| To get around that, I prefer to get dental work done at dental
| schools. The faculty at the schools have their own practices
| within the schools, and you can be sure that they are doing all
| the up to date stuff that is currently being taught and
| following sensible practices in terms of treatment plans.
| Prices are also fair. If you opt for a student dentist its even
| cheaper and many low income people use this service (although
| appointments are much longer since everything they do has to be
| signed off by a faculty member responsible for a floor of
| students).
| Unklejoe wrote:
| I had a dentist appointment before COVID. They found a cavity
| and scheduled me to have a filling. Then, COVID hit and I
| cancelled the appointment.
|
| I went back two years later for another checkup/cleaning. They
| didn't find any cavities.
|
| Maybe it healed itself? Apparently that's possible via re-
| mineralization. Either way, if that was possible, then perhaps
| they shouldn't have been so eager to drill and fill?
| tomxor wrote:
| To add to the confusion of the very real risk of immoral and
| unnecessary dental work mentioned elsewhere in this thread -
| xrays can be legitimately difficult to interpret when looking
| for small cavities.
|
| Ideally you do want to get even small ones filled as a
| preventative measure. However IME trustworthy dentists will
| acknowledge the potential for false positives on less obvious
| xrays upfront and offer a choice of either probing the area
| with a very fine drill first or simply defer work altogether
| and monitor it on each check-up.
|
| Point is, in your case it could be an untrustworthy dental
| practice (suggesting unnecessary procedures), or the original
| xray was ambiguous and there was never anything there, or the
| dentist was poor at interpreting it. Either way if it was
| that minor they should have made it clear - i'd recommend
| scepticism next time, feel free to interrogate them, they are
| doctors and usually welcome it... if they are unconvincing
| and defensive, go elsewhere.
| johncessna wrote:
| Pediatric dentistry is especially scummy. If you don't do
| insanely expensive treatment that almost no one did 20 years
| ago you could maybe potentially sometimes damage your kid's
| oral hygiene permanently.
| kobalsky wrote:
| my dad is a dentist (oral surgeon by usa definition) and he
| took out all my wisdom teeth (that didn't bother me at all) one
| time I visited him at his practice.
|
| from my single data point I can conclude that:
|
| 1) dentists will remove wisdom teeth that don't bother you even
| for no financial gain. 2) never visit your parents practice
| unless you have a excuse to bail out immediately if they try to
| get you on the chair.
| donatj wrote:
| I went to a new dentist for a broken filling and they tried to
| tell me I had 14 cavities and set me down with a finance person
| to set up a payment plan for how I was going to pay for them
| over the next 5 years.
|
| I went to a second dentist, they fixed the broken filling and
| said my teeth were otherwise fine. I have the paperwork to back
| this up.
|
| I'd been seeing another dentist for a while and he suddenly
| wanted to crown 3 of my teeth. Again I got a second opinion,
| and again they were like "That's probably not necessary".
|
| I think a lot of dentistry comes down to how much money they
| need that month. It certainly doesn't feel very scientific.
| ccwilson10 wrote:
| Wife is a dentist. There certainly are practices where
| treatments are recommended as a function of money and
| cashflow (laser treatment and other "optional" treatments are
| a great example of this). However, crown / cavity
| recommendations are largely dependent on how aggressive that
| particular dentist's philosophy is. E.g. my wife only goes to
| her father for treatment because he focuses on saving teeth
| whenever possible.
|
| Unlikely that a dentist would ever recommend filling cavities
| if they didn't believe it was necessary - they're not very
| profitable for practices. Crowns are sometimes recommended
| when a filling will suffice, but that's usually because
| crowns last ~10 years and fillings only delay the inevitable
| crown for a few years.
| asdff wrote:
| This is why I like going to dental schools faculty or
| student practices. They are all about saving the teeth if
| it can be saved and will need to see sufficient evidence in
| the imaging before moving forward with just about anything.
| Things seem to take longer and involve more appointments
| (e.g. i have to schedule a separate appointment with dept
| of radiology vs the private practice dentist walking me to
| the next room with the xray), but it seems like every
| decision involves multiple dental professors looking at my
| imagery or feeling up my teeth or gums before anything is
| done, which definitely boosts my confidence. I like having
| a committee and hearing them discuss the evidence in this
| war room setting when I'm laying there on the chair mouth
| open
| brightball wrote:
| This was my experience as well. I went to the same dentist
| office for years with no issues. He sold the practice so we
| went to the new guy...every single time we went in there was
| a cavity that needed to be filled.
|
| Went to a new dentist and everything is fine again.
| FollowingTheDao wrote:
| My dentist was arrested in the 80's. He gave me three
| unneeded root canals. He was sniffing laughing gas. Good
| times....
| brootstrap wrote:
| One of my good co-workers is daughter of a dentist from the
| UK. the practices there are much different. We have had him
| analyze xrays and scans, he says its fine the people here
| just want/need your money!
| OJFord wrote:
| > I think a lot of dentistry comes down to how much money
| they need that month.
|
| I notice that even with my NHS dentist and just in how long
| he recommends leaving it until next time.
|
| When I went back after 18 months (on a recommendation of
| 12-18) I got a cursory checkup, probably the most glowing
| 'all fine' I've ever had, a routine X-ray (i.e. that wouldn't
| be due again for a while) and then he asked to see me in six.
| I double-took and confirmed, so booked in for six months.
|
| (Then we had a pandemic and it was more than two years before
| I could get a non-emergent appointment. That went fine too.)
| LouisSayers wrote:
| I had a similar experience with a dentist.
|
| All my previous experiences I had minimal issues, and then
| suddenly at a different dentist I needed several fillings and
| needed to drill a good tooth to "fix a cavity" in-between my
| teeth.
|
| I didn't get any of that done.
|
| My next visit at a different dentist a couple years later and
| I had a single tooth that needed a filling.
|
| When something feels off, it's always good to get a second
| opinion.
| pc86 wrote:
| I went to the same dentist for years as a child. Brushed my
| teeth once a day, never had any issues at all. All of sudden,
| during a regular checkup, he told my parents (I was ~15 at
| the time) that I had 9 cavities and needed fillings. In the
| 20 years since, I have never had a single cavity. And what a
| shock, he sold his practice between that procedure and my
| next checkup. I fully believe he was just pumping up his
| revenue to increase the sale price, and my parents weren't
| health literate enough to get a second opinion, and I was too
| young to know that just because he has a white coat on
| doesn't mean he's a good person.
|
| Dentists are in the sweet spot where they actually are very
| important and necessary (as opposed to chiropractors, who are
| universally charlatans and frauds), but they don't get quite
| the scrutiny and oversight that physicians are used to. And
| they make as much as some of the top tier physician
| specialties. PCPs, OBs, ER, etc. all make less than dentists
| by and large.
| bostonsre wrote:
| > as opposed to chiropractors, who are universally
| charlatans and frauds
|
| I take it you've never thrown your back out and had an
| adjustment that fixed a lot of pain?
| arbitrage wrote:
| I take it you've never done much to strengthen your core
| and stretch your muscles properly?
|
| A physical therapist can help you with that long-term
| back pain you got.
| pc86 wrote:
| That a chiropractor can relieve pain doesn't mean that
| _chiropractics_ in the "medical" sense isn't a fraud.
| Imaging that shown the entire concept of "subluxations"
| in the chiropractic sense are a myth.
|
| I've gone to chiropractors for manipulations. Some even
| were able to bill my insurance (yet surprisingly the cash
| price was the same as my insurance copay, imagine that).
| But I treat it the same as getting a massage. It feels
| good, and I might feel better after, but it's absolutely
| not any sort of medical science.
| Bedon292 wrote:
| What do you mean by "subluxations" being a myth? Most of
| my back issues come from subluxation of the T2 vertebra.
| As shown by x-rays and physically being able to feel that
| is is out of alignment with the rest of the spine.
|
| Are you referring to those charts that say these are the
| random other symptoms you might have from alignment
| issues? Those definitely seem shady, and pseudoscience at
| best.
|
| Edit: Oh, I see. Overloaded term. I was coming from the
| medical side, but it can be used differently in a
| Chiropractic sense. https://en.wikipedia.org/wiki/Chiropr
| actic#Vertebral_subluxa...
| pc86 wrote:
| Yes, I just meant the chiropractic side. They're
| absolutely real and can be a problem medically. Chiros
| sort of co-opted it.
| hungryforcodes wrote:
| Yeah, I'm not sure about this. After two car accidents
| one year apart my back was killing me. I went to a year
| for physio and nothing happened. Then a friend
| recommended this chiropractor and within 3 months I was
| fine. To be fair this chiropractor said alot of
| chiropractic was a bit fluffy, and I insisted we discuss
| the science behind it and stuff which he was totally
| literate about.
|
| I'd go to another one again.
| AngryData wrote:
| Yeah I think people are blinding themselves to the huge
| differences between chiropractors and just lumping all of
| what they do into one single bucket and tossing it out.
| In physical labor heavy areas they help a lot and 90% of
| their business comes from relieving pinched nerves,
| fixing dislocations, deep tissue massages, and physical
| therapy regimes. Nothing quacky about that, especially
| when it is hard to find a doctor these days who will put
| their knee into your back and pop your shoulder out and
| back into the proper place instead of prescribing
| narcotics and endless rest for weeks on end that is not
| feasible in those communities.
|
| But on the other end of the scale, you also got ones who
| don't have that sort of business and are selling new-age
| crystal moon beam energy healing power and claiming
| anything and everything they can sell you will cure you
| of any and all ills which I think most people would
| consider irresponsible and dangerous.
|
| One side argues for chiropractors because of what they do
| above on top of being super cheap and affordable for the
| average labor worker. The other side argues against it
| because they only see new-age crystal therapy in their
| areas while also being able to themselves afford better
| healthcare with a significantly less physically damaging
| workload.
| smileysteve wrote:
| The science presents that the only proven outcome of
| Chiropractic is sudden death.
| richbell wrote:
| > I take it you've never thrown your back out and had an
| adjustment that fixed a lot of pain?
|
| A _good_ chiropractor will only perform adjustments, but
| the foundations of Chiropractic "medicine" is
| pseudoscience that many still practice to this day.
| Wikipedia has a good summary on this: https://en.wikipedi
| a.org/wiki/Chiropractic#Pseudoscience_ver...
|
| But, in my opinion, if you're only going to a
| chiropractor for adjustments you'd be better off finding
| a Registered Massage Therapist or Physical Therapist
| (depending on your level of pain).
| wintermutestwin wrote:
| In the past, I spent a lot of money on chiros basically
| "cracking" my back. I eventually taught my partner how to
| do it and she does it so much better than any chiro ever
| did.
|
| One thing I will say after having seen ~10 chiros is that
| the ones who actually x-ray you are the only ones I would
| place any trust in.
| pc86 wrote:
| If you're reading this and haven't, please click the
| Wikipedia link. Scroll down to the photo labeled "A
| chiropractic manipulation of a horse."
|
| I hope it makes you laugh as much as it did for me.
| jayd16 wrote:
| There's a million videos of pets and animals getting
| adjusted on youtube. Hard to take any of it as a serious
| science. Search "Goose chiropractics."
| msrenee wrote:
| Equine chiropractors are pretty mainstream nowadays. The
| one I use is an excellent vet to start with who also does
| adjustments. There's wackos out there, but there's
| definitely some properly trained individuals who do a lot
| of good. I get my mare done every other year or so. Her
| back gets sore, it's super obvious when you're riding
| her, the chiro comes out, and she's so much more relaxed
| and moves more freely when I get on her the next day. A
| year or two later, she's sore again and we repeat.
|
| Crap, even the old school Kansas cowboy I used to ride
| with uses them. When his ranch horses start acting sore,
| he gets a chiro out. The man can do pretty much anything
| else veterinary himself, and does, but calls in an equine
| chiro for his working animals.
| Taylor_OD wrote:
| Having spent many years dealing with chiropractors...
| There are two types of issue they handle. The first is
| sharp pain due to some, likely traumatic, event like
| whiplash or trying to pick something up that is too heavy
| or a sports injury. They can often fix those issues with
| limited treatment and a few exercises.
|
| Then there is chronic pain due to some issue like disk
| breakdown or another illness. They can do little to
| nothing with these illnesses but they will not admit
| that. They will bill your insurance for all they can and
| eventually when insurance will not cover it anymore they
| will try to get you to pay out of pocket or tell you to
| kick rocks.
|
| I wish chiropractors would be upfront about this but I've
| never talked to one that is willing to. I have spoken to
| several who I know socially who have said this is more or
| less true in their clinic. At least the part about being
| able to help some but being useless with chronic pain.
|
| Are they fully charlatans and frauds? No. But they do
| take advantage of people who they cant help and promise
| something they cant give.
| joshowar wrote:
| Its complicated.
|
| Technically speaking, if there's any decay in your teeth,
| that's a cavity. The deeper it is, the faster it'll get
| worse. When you want to get that filling though, is a
| judgement call that a lot of dentists make for you sadly. Is
| it best to go ahead and get those fillings now? Probably, as
| far as your dental health is concerned. Can it be delayed
| though and done later? Almost certainly. Just a bigger
| filling later. Or maybe a crown if it gets too far gone.
|
| Also, how fast your decay progresses depends on a variety of
| factors. For some people, it won't be long before those
| questionable cavities become serious problems. For others, it
| can be many years if they decay much further at all even. I
| think it's largely genetic, but also depends on oral care,
| diet habits, etc.
|
| So, no, I don't think most dentists are just seeing dollar
| signs and putting fillings onto teeth without cavities. Its
| not outright fraud or malpractice. But some dentists are
| sympathetic to your financial situation while others think
| dental health should be a priority above everything, no
| matter the cost.
|
| So it's a mix I think, between dentists' values/philosophies
| about dental care, and the lack of science about how fast
| tooth decay can vary from person to person (and an inability
| to measure that).
| smileysteve wrote:
| > Is it best to go ahead and get those fillings now?
| Probably, as far as your dental health is concerned.
|
| Modern science says no, you should apply topical fluoride
| for most early cavities; and if the teeth use a modern
| pronamel (cough stuck behind USDA approval) should be able
| to recover quickly.
| exo-pla-net wrote:
| Could you add more regarding pronamel, so I can begin my
| negotiations with The Algorithm?
| malfist wrote:
| It's not that cut and dry. Just because you have a small
| carie doesn't mean it's only going to get worse. That's the
| reason for fluoride in our water, in our toothpaste and in
| the wax the dentists applies at the end of your cleaning
| (that for some reason, insurance never wants to pay for).
|
| Fluoride treatments and good dental hygiene can reverse
| carries. Carries should only be treated if they're large,
| or if they're still growing after discovery and alerting
| the patient.
| FollowingTheDao wrote:
| And did you know dental plaque and tartar are actually
| protecting your teeth? And just because vanity we want to
| get it removed?
|
| https://pubmed.ncbi.nlm.nih.gov/17016887/
| andreareina wrote:
| In vitro study shows that plaque protects against
| externally-applied acid. Ok. Now what about the acid
| produced by the bacteria hiding behind the plaque?
| FollowingTheDao wrote:
| Just because dental caries show up with plaque and tartar
| in no way means that plaque and tartar are causing the
| caries. These are the mechanism our body uses to protect
| our teeth from unbalanced oral bacteria. Just like the
| microbiome of the gut, we have one in our mouth. Removing
| plaque and tartar does not stop caries.
|
| Caries are initiated by direct demineralization of the
| enamel of teeth due to lactic acid and other organic
| acids which accumulate in dental plaque. What is tartar?
|
| Heavy staining and calculus deposits exhibited on the
| lingual surface of the mandibular anterior teeth, along
| the gumline
|
| Tartar is a form of hardened dental plaque. It is caused
| by precipitation of minerals from saliva and gingival
| crevicular fluid in plaque on the teeth. This process of
| precipitation kills the bacterial cells within dental
| plaque.
| resoluteteeth wrote:
| Just because having plaque on your teeth will block acids
| doesn't mean it's actually a good idea not to clean your
| teeth.
|
| I guess if you could show a study showing that leaving
| plaque/tartar on teeth leads to better health outcomes I
| might be interested.
| pessimizer wrote:
| The reason it's a good idea to clean your teeth is
| because if you don't they'll stink and become discolored.
| It's not because it keeps them healthy, because cleaning
| your teeth strips some protection from bacteria and acids
| away from them while deepening the pockets around them,
| creating a nice place for disease to live.
|
| The idea that intensely cleaning your teeth (and keeping
| them white) is healthy is an intuitive leap that
| marketers take advantage of, just like the bad intuition
| that makes people clean their faces intensely to get rid
| of skin problems. The reality is more complicated. Clean,
| pure, healthy, white.
|
| Fossils have better teeth than we do, but we have
| prettier, less fragrant teeth.
| mrguyorama wrote:
| >Fossils have better teeth than we do, but we have
| prettier, less fragrant teeth.
|
| That's because those fossils had way less access to
| sugar, which is the main reason we need so much more
| dental hygiene nowadays.
| FollowingTheDao wrote:
| You all think sugar causes tooth decay, no, sorry. It's
| lipids. Not all bacteria use glucose, most use fatty
| acids for energy.
|
| https://www.dentaleconomics.com/science-tech/oral-
| medicine-a...
|
| It is more probably that the sugar throws off lipid
| metabolic and that changes the oral microbiome.
| FollowingTheDao wrote:
| If you leave the plaque and tartar on the teeth without
| fixing the fundamental problem (immune health) then there
| of course will not be better health outcomes.
|
| Caries are a sign of an immune disorder or imbalance. As
| long as dentists only scrape peoples teeth and do not
| integrate their health into their practice you will keep
| having plaques and tartar to be remove as your body fight
| this battle.
|
| https://www.lupus.org/news/people-with-lupus-exhibit-
| increas...
| sbcd wrote:
| >Caries are a sign of an immune disorder or imbalance
|
| Or just terrible habits like drinking liters of soda
| everyday. Besides the diabetes, the mix of sugar and acid
| is terrible for dental health, and contrary to the myth,
| brushing your teeth will not save them, at all, if one
| persists in terrible habits.
| FollowingTheDao wrote:
| Sugar does not directly cause oral microbiome imbalance.
| Lipids do.
|
| https://www.dentaleconomics.com/science-tech/oral-
| medicine-a...
| [deleted]
| asdff wrote:
| If you are in need of cavities repaired I suggest getting in
| touch with your local dental school. Once a year there will
| be a practical where students have to repair caveties on a
| patient, so they will often offer free cavity screening +
| repair to the public for these exams. When I went to one,
| they discovered a few very small ones that looked like they
| could get bad in the future and opted to just do them right
| then. Dental schools outside of this are probably the
| cheapest way to have competent dental work done especially if
| you are uninsured (payment plans will be very permissive too)
| andi999 wrote:
| The thing seems to be more interesting, here I talked to the
| university dentist, and it seems there a like 4 stages of
| cavity, and you only start treatment at stage 4. But it seems
| not 100% clearcut when stage 4 is reached.
| Aeolun wrote:
| It is unbelievable how much my faith in the necessity of
| dental procedures has risen after I started going to see a
| dentist that was my friend first, and my dentist only later
| (after I got tired of constantly wondering if the others
| actually had my best interests at heart).
|
| I never doubted the dentist I had during my youth, and as far
| as I know he's actually just really good at his job, so it
| was kind of a shock to find that so many of them are just
| winging it.
| saiya-jin wrote:
| In our eastern european backwater and largely primitive
| country (Slovakia), greed has its prime. New dentist offices
| sprang up recently all over the place from where I come from.
| They took relatively big loans, and as greed is bottomless,
| want to pay them as quickly as possible to move to other
| investments.
|
| I had similar experience as others - one guy wanted to set
| series of visits (4 hours each) to remove all older fillings.
| He was doing a fine work otherwise (replacing urgently one
| that started breaking apart). The detail being, he didn't do
| an X-ray to check if older fillings actually needed
| replacement (the idea is, your teeth can handle only few
| filling replacements depending on situation, so definitely
| don't fix things that aren't broken).
|
| After that (and few months), went to another dentist who
| first did full x-ray, found that one filling needed
| replacement and the rest were fine and I ended up paying 5%
| of the price of first one. Good dentists are worth gold (same
| as many other professions for that matter) - if you find a
| skilled professional who is not ripping you off, you stay
| there till you die. This quality mix is unfortunately not
| easy to find.
| tomxor wrote:
| Unnecessary medical procedures are extremely immoral, do you
| mind sharing what country/practice this was in?
| donatj wrote:
| United States. Here's my yelp review of the first place.
|
| https://www.yelp.com/biz/shamblott-family-dentistry-
| hopkins?...
| ceejayoz wrote:
| Not OP, but there's been a lot of this in the US.
|
| https://www.pbs.org/wgbh/frontline/article/patients-
| pressure...
|
| > Former employees say Aspen Dental trained them in high-
| pressure sales. Corporate management scrutinizes the
| production of dentists and staff daily. And internal
| documents show that dentists get paid bonuses as key
| production targets are met.
|
| https://www.elpasotimes.com/story/news/health/2018/01/10/ko
| o...
|
| > "Especially when that fraud involves performing
| unnecessary procedures on kids --here, unnecessary baby
| root canals and tooth extractions, among other procedures
| --we will not hesitate to use every tool at our disposal to
| punish those who break the law," Bash said.
|
| > The accusations against Kool Smiles included prohibiting
| parents from being present during root canals "to keep
| hidden the child's suffering" and retaliation against
| "unproductive" dentists, according to a federal complaint
| filed in San Antonio in 2013.
| lupire wrote:
| > 2013.
|
| So they never got punished?
| UncleMeat wrote:
| My wife went to Aspen recently (we didn't know better).
| They told her that she had periodontal disease and needed
| an expensive procedure. She was shuffled into a
| "financing" room before even completing her checkup.
| While waiting, she Googled Aspen and figured out that
| this happens to oodles of people, declined, and went to
| another dentist. No problems detected.
|
| In addition to being a scam organization, we got to see
| the group of people in the waiting rooms at Aspen vs our
| current dentist. As you can imagine, the folks waiting in
| the Aspen waiting room are observably less wealthy and
| are statistically going to be less able to defend
| themselves against medical scams.
|
| Evil organization.
| ceejayoz wrote:
| "Kool Smiles to pay $23.9 million" sounds like they're
| being punished?
|
| They typically settle and sometimes pay a fine.
|
| https://ag.ny.gov/press-release/2015/ag-schneiderman-
| announc...
|
| I suspect they still make more profit than they lose in
| fines.
| mindslight wrote:
| Having an unexpected cost and thereby not making a profit
| isn't actually a punishment - it makes the risk calculus
| a tame "I probably won't get caught", while the expected
| value remains positive. I realize I'm criticizing our
| entire enforcement philosophy for white collar crime
| here. But still, unless there are actual routine-
| disrupting punishments like jail time for violating basic
| professional responsibilities, we would expect unethical
| behavior to just continue increasing.
|
| And this goes double for setups to make such violations
| "nobody's fault" like the creation of perverse incentive
| structures. In the context of blue collar crime, that's
| called a "conspiracy".
| gehwartzen wrote:
| At least in the US its because dental insurance isn't part of
| normal health insurance. Dental insurance mostly just covers
| the bare bones (teeth?) treatments like regular cleanings and
| an xray every couple of years. SO in order for the Dentist to
| make money they ahve to upsell every other treatment not
| covered by insurance. With regulars health insurance the doc is
| payed for pretty much any specific treatment they deem
| necessary so they know they will be payed.
|
| I think if we had the 'pay out of pocket' kind of thing for
| other health care we would see the same thing.
| lupire wrote:
| I'm curious if you'll reread your comment and can see how you
| disproved your own point.
| gehwartzen wrote:
| I'm not sure I see the contradiction? I'm just saying that
| if regular health care only covered something like wellness
| visits and a cast every other year they would probably be
| more likely to try and sell you additional services to
| drive their revenue.
|
| And by upsell I just mean convincing you the financial
| burden is worth the proposed extra treatment. Right now as
| long as I have health insurance I don't care abut the extra
| cost of extra treatments beyond a health check because I
| don't directly bear the cost.
|
| I mean pretty much every other health related thing that's
| not covered by insurance has the same dynamics; eye care,
| cosmetic surgery.
| pc86 wrote:
| Just because it's covered by insurance doesn't mean they
| don't get paid for the work.
| nitwit005 wrote:
| If you want a laugh, walk into a chiropractor's office, and
| learn about the many issues your spine has.
|
| People tend to be unfortunately incentivized to find something
| wrong with you, as they get paid based on treatments performed.
|
| In the US, this produced the idea of Health maintenance
| organizations (HMOs), where there is a large member count
| paying a fixed fee. The hope was they'd want to spend on
| preventative care, and minimize other costs.
| throwaway0a5e wrote:
| > Why are dentists so scammy?
|
| Because everyone is and you can generally afford it when
| cheaper professionals do it and don't know when expensive ones
| (doctor, lawyer, etc) do it.
| cute_boi wrote:
| My dentist also told me to remove wisdom teeth. Its been more
| than 10 years and it hasn't caused any troubles....
|
| And, the crucial part is the hospital is considered as no 1
| hospital in my country.
| ThinkingGuy wrote:
| One explanation I've heard (don't remember which news source)
| is that dentists just don't have as much demand as in previous
| decades.
|
| Due to improvements in hygiene, and public health measures such
| as water fluoridation, children get fewer cavities and adults
| lose fewer teeth ("having an insufficient number of teeth" was
| once a major cause of men being rejected from the military
| draft).
|
| So dentists have had to pivot from providing necessary care,
| such as fillings and extractions, to more discretionary
| services such as whitening and other cosmetic procedures (oh
| how my last dentist used to try to push Invisalign(r) on me at
| every visit!)
| fallinghawks wrote:
| And some dentists are straight up charlatans wanting to line
| their pockets. When I moved across the bay I left my dentist
| of 10+ years and went in search of someone closer. I admit to
| delaying a couple years, but found a place, got cleaned and
| x-rayed. The dentist told me I had 13 cavities that needed to
| be tended to. I was pretty shocked; I don't have great teeth,
| but to have developed that many cavities in such a short time
| seemed wrong. I went back to my old dentist for a second
| opinion and he told me that I had 2 genuine cavities at the
| edges of old fillings, but the rest of it was pretty much
| nonsense: amalgam fillings that could be replaced with
| porcelain for appearance but were still perfectly good, and
| some slight discolorations that were not actually cavities.
| karencarits wrote:
| Article: https://www.nrk.no/trondelag/hvor-ofte-ma-du-ga-til-
| tannlege...
|
| "Gjessing visited eight dentists.
|
| * Five found no holes.
|
| * One found a hole.
|
| * One found two holes.
|
| * One found three holes.
|
| * Three removed tartar.
|
| * One recommended brace for 2500 kroner and a new appointment.
|
| ...
|
| Memo visited six dentists.
|
| * Three thought everything looked good.
|
| * Two recommended replacing fillings.
|
| * One found two holes and said they had to be fixed quickly.
|
| * One took a panoramic x-ray."
| matsemann wrote:
| The last one also got tartar removed at all dentists
| according to the article. Probably him I was thinking of.
|
| Wonder if this is the original I was thinking about, from 10
| years ago. Crazy difference in what they get recommended
| based on the dentist.
| https://www.aftenposten.no/norge/i/kJqKj/samme-tenner-
| helt-f...
| gs17 wrote:
| Reminds me of an experience I describe as "two out of three
| doctors agree: you're not on fire".
|
| (It was just a bit of body hair hit by an electrocauterizer
| that was smouldering, but two doctors in the room told me I
| was imaginging the heat and smell, while the third rushed to
| grab a cup of water).
| FollowingTheDao wrote:
| > Why are dentists so scammy?
|
| Why? Capitalism. And I am serious. It is just the need to make
| a profit that drives them to these places.
| mrits wrote:
| While I have heard of plenty of scammy dentists myself, I don't
| see a reason to complain about them cleaning your teeth. If you
| actually told them you just got your teeth cleaned that is a
| different issue though.
| lupire wrote:
| The 10th dentist didn't notice there was no tartar?
|
| Or the first 9 didn't remove the tartar?
|
| Which is the good option?
| bombcar wrote:
| Dentists aren't really setup to assume the patient is being
| weird. It's like going to a full service car wash right
| after getting your car washed - they'll wash it again for
| you.
| mrits wrote:
| You don't just get your teeth cleaned to remove tarter
| though. It is part of preventive holistic dental plan. If
| you want a better chance of finding early decay and get to
| the bottom of any sensitivity you need a hygienist to poke
| around a lot more than the dentist usually does.
|
| In my case they found a tumor in my jaw during a cleaning
| that even was overlooked in a full set of X-Rays.
| AndrewThrowaway wrote:
| My experience:
|
| Teeth looks fine and healthy, not much tartar to clean. When
| was the last time you visited?
|
| Two years ago.
|
| Oh no you should visit at least twice a year (?). Even if all
| looks fine x-ray is recommended which can reveal some things.
|
| I do the x-ray. All is fine. You don't even have upper wisdom
| teeth. Lower wisdom teeth are at 90deg so they can pose a risk
| if they started growing.
|
| Yeah, but I am 40 years old already? My mother is 70 and has
| the same 90deg wisdom teeth, never started growing?
|
| TBH it really starts to feel "scammy" when they start
| suggesting procedures for things that might never happen.
| egberts1 wrote:
| 90-degree? Yeah, you should get those wisdom teeth out
| because general anesthesia at your advanced age would not be
| good for your longevity. That is, if your wisdom teeth were
| ever then to surface and rot.
| malfist wrote:
| Impacted, unerupted wisdom teeth are not always a problem.
| If you're over 25 [1] it's highly unlikely they'll ever
| attempt to erupt, never causing a problem.
|
| Impacted wisdom teeth don't always stay impacted when they
| start moving too. They can straighten up when they start
| coming in.
|
| [1] Hupp J, et al. Contemporary Oral and Maxillofacial
| Surgery. Chapter: Principles of Management of Impacted
| Teeth. From https://www.animated-
| teeth.com/wisdom_teeth/t6-wisdom-tooth-...
| lotsofpulp wrote:
| I have 4 impacted wisdom teeth completely sideways, and
| dentists on the east and west coast of the US have told
| me not to bother taking them out since I was 25 or older
| unless they start causing me problems.
| askonomm wrote:
| General anesthesia? Here in Europe we don't do that. I had
| one wisdom tooth that got rotten and the injections did not
| help with the pain because of the infection, so the nurse
| held me down while the doctor pulled the tooth, me
| screaming in agony. Then they gave me a shot for the trauma
| so I would calm down. This is Northern Europe.
| merrywhether wrote:
| Holy smokes. It sounds like you weren't given the option,
| but did you prefer that to the risks of GA?
|
| (Honest question, no agenda. That sounds like something
| that would make me never go back to the dentist, but
| maybe that's just me projecting popular dentist horror.)
| askonomm wrote:
| Honestly it's just not a possibility in most of the
| dentist offices I've visited in Estonia as well as not
| really a thing (I don't know anyone who has ever gone
| under GA). Whatever horrible stuff that needs to get done
| gets done with you wide awake, and that's the norm. Good
| thing is that it's over pretty quickly.
|
| When I lived in Spain I knew they offered GA there, but
| it usually meant paying 100+ EUR more, which is quite a
| lot. And europe doesn't really have a thing such as
| dental insurance. In most countries (Not 100% sure) in
| Europe you pay out of pocket for all the dentist stuff.
| Maybe you get a free cleaning once a year.
|
| But other than the availability of GA and the money, I
| have nothing against it and would have obviously
| preferred that to my experience of medieval dentistry.
| j-krieger wrote:
| That's insane. Any practice here in middle Europe will
| give you Midazolam so you won't remember anything.
| bigbob2 wrote:
| Not only that but from what I understand, a major nerve in
| your jaw grows closer to your wisdom teeth over time. So if
| you wait on a procedure like that until later in life, it
| increases the chance that the nerve will be damaged in the
| procedure, leading to a potential loss of feeling in part
| of your face. At least this is what I was told by my oral
| surgeon, assuming he wasn't lying to me for profit...
| cityofdelusion wrote:
| I waited until later in life. I have a partial loss of
| feeling in my face now, along with referred sensation in
| the same area (I feel things on the inside and outside of
| my mouth simultaneously, it is bizarre.)
|
| So I would believe your surgeon :)
| yellow_lead wrote:
| I'm interested in an update on the author's startup. Last time I
| heard he was shutting it down, but at the end of the article I
| realized this was content marketing for it.
| pineconewarrior wrote:
| It says "Check back on August 1, 2022 for the public launch!".
|
| So, perhaps we shall do just that
| FactualActuals wrote:
| I only use Google to learn more about procedures, not to convince
| me to get said procedure. When my coworker and I got into a
| conversation about LASIK vs PRK, I found a Hacker News thread on
| Google that had discussed SMILE surgery as an alternative to
| both. I'll defer to my optometrist when I speak to him later this
| year and see what he suggests and what he knows because I know I
| can't trust Google to give me the type of answers I am looking
| for.
| noasaservice wrote:
| The title is wrong:
|
| Dentist almost convinced me to spend $400 on useless laser
| treatments; Google results of search spam SEO cesspool
| unpythonic wrote:
| If you read through to the bottom, you'll see the article
| itself is just a call to action for yet another service which
| the author is starting. It's an ad. Seeing it buried so deep
| doesn't make me feel that the author has any better intentions
| than Google itself -- credibility already gone.
| noasaservice wrote:
| Well, yuck. I did completely miss that this was just a shitty
| advert complaining about other shitty adverts.
| wackget wrote:
| I'll ask you what I asked the other commenter: should
| articles which point out problems be written completely
| independently of the people creating solutions to those
| problems?
|
| Even if it is an advert, it's not a shitty one. It presents
| scientific arguments and is well-sourced. It's about as a
| good as an "advert" as you'd ever get. Really, what more do
| you want from people?
| noasaservice wrote:
| Frankly, I'm just done with advertisements and commercial
| "speech" being normalized everywhere, including in
| articles, regular speech amongst humans, and more. I've
| been done with commercialism fake "culture" for a LONG
| time. And the more we have, the worse the pollution is
| with genuine conversations.
|
| I think that's the real problem with articles like this.
| The moment I realized it was a commercial piece
| masquerading as a scholarly meta-article, I have to
| question all the previous discussion they have. Is it
| right? What are they trying to sell? What viewpoint are
| they trying to get me to follow?
|
| Advertising is codified monetary deceit. We've moved long
| past "Buy my soda cause its yummy", to an ever-present
| dread of "if you dont have this, you'll be sorry" in a
| round-about way.
|
| > should articles which point out problems be written
| completely independently of the people creating solutions
| to those problems?
|
| If there's a commercial motive to use/buy/rent their
| shhit, absolutely yes.
|
| > It presents scientific arguments and is well-sourced.
|
| Depends. What are the biases of their arguments that the
| underlying commercialism is modifying? It now needs its
| own analysis to see if they were trying to sell me
| something different on dread or FOMO.
| wackget wrote:
| That's an extremely jaded outlook. Just because the OP is
| presenting an alternative solution doesn't necessarily mean
| it was all borne out of greed/profit-seeking. At least the
| OP's service was built from the outset to be facts- and
| evidence-based unlike Google search results.
|
| I'm really not sure what you expect. Should articles which
| point out problems be written completely independently of the
| people creating solutions to those problems? Cos clearly that
| is totally unrealistic.
| SubiculumCode wrote:
| I don't trust dentists. They push and push and push these extra
| treatments using guilt tactics and most of them are lies to empty
| your pocketbook. They are in no way like your doctor. Your doctor
| would never guilt you into a bypass surgery when you don't need
| it, but a dentist would.
| mguerville wrote:
| My eye doctor a few years back tried to get me to get some kind
| of treatment (a device or some snake oil potion, can't recall)
| because I was allegedly not blinking enough and had dry eyes that
| could spiral into (insert mildly scary eye disease) if left
| untreated. Some googling helped me reach the same conclusion as
| this blogger.
|
| So it's not just dentists... at least my dermatologist is pretty
| transparent about all the aesthetic treatments that complement
| their medical services, though they seem to always find a mole
| that needs a biopsy and every year it turns out benign. I wonder
| how many times it was necessary, versus how many times it was
| just an easy money grab because my insurance covers it and it's
| very minimal of a procedure. I don't have a problem with for-
| profit healthcare, but fee-for-service is driving the insane cost
| inflation in the US
| vmception wrote:
| > So here's the bottom line: All ten search results are dental
| office marketing blogs and there isn't even a whiff of peer-
| reviewed evidence.
|
| This is how all the alarm bells went off for me about VPNs as I
| was forming some OPSEC ideas.
|
| My solution was to look up court cases.
| Veuxdo wrote:
| This kind of seems to reduce to Google's inability, or
| unwillingness, to do anything about SEO.
| FollowingTheDao wrote:
| Google is not a search engine. Google is an advertising platform.
| It's 2022 and people do not know this yet?
| 323 wrote:
| I once asked the dentist why are there so many different
| toothbrush head shapes, with the bristles at all kind of angles
| and patterns, rubber inserts and so one. Surely by now we know
| what's the optimal shape?
|
| And the answer was that yes, the optimal head shape is known, but
| since it's not that consequential this is not regulated as other
| medical stuff and basically everyone does weird shapes just for
| marketing and differentiation purposes (like colored specks in
| powder detergent which do nothing)
| JamesAdir wrote:
| What's the optimal shape?
| 323 wrote:
| From my research the most important thing is for it to have
| soft bristles with round bristle heads (obviously you can't
| check bristle heads with your eyes, too small). Most you find
| in supermarkets have medium or hard bristles.
|
| The head shouldn't be too big, so that it can reach even in
| the back.
|
| Rubber inserts are not recommended, as they tend to irritate
| the gum.
|
| Typically the better ones look more plain - no multi colored
| bristles or spaceship looks. However, since this becomes more
| known, it becomes a marketing signal in itself - like "plain
| brown paper package" chocolate, etc.
| asdff wrote:
| Are there any brands with these characteristics?
| es7 wrote:
| Low-quality SEO content marketing has been taking up more and
| more of Google Search results in the past decade.
|
| Maybe it has always been this way, but anecdotally it feels like
| it has gotten so much worse in the last few years.
|
| The exception to the SEO spam rule seems to be a small subset of
| "highly trusted sources", that at least for medical information
| seem to be biased pretty heavily towards "don't say anything that
| can get us sued."
|
| I don't know the best solution to all of this, but I really think
| that content marketing is getting to a point where it has drowned
| out actual content. I wish Google would put a downvote button on
| their search results page that I can click to indicate that a
| highly-SEO'd result was not actually useful for my query.
| 93po wrote:
| It's about to become uncontrollably bad. With really powerful
| artificially generated writing available, spammers will develop
| it to be indistinguishable from real human writers when
| analyzed by google's own machines. We're going to have billions
| of websites that are 100% generated, with content that most
| humans can't distinguish as entirely generated, and a LOT of it
| is going to be wrong. It will completely drown out human
| written content to the point that websites using humans will
| give up, and there will only be spam left.
| bartimus wrote:
| It's always been bad. But Google has always been less bad then
| other search engines.
|
| Then also you need to ask the right question. Googling
| something like "Toyota RAV4" will give wildly different results
| than "common problems with Toyota RAV4".
|
| In this particular case the better question should've perhaps
| been something like:
|
| "scientific evidence effectiveness lazer bacterial reduction"
| asdff wrote:
| There are times when I just cannot come up with the terms to
| get past the SEO at all and just give up, not knowing the
| answer or finding the relevant source. It seems like it
| happens all the time these days. You end up with something
| like writers block coming up with new ways to frame the
| question to shake off the spam. The best I can hope for
| usually is appending site:usuallyrelevantinfo.com to a term
| but that requires a priori knowing these good sites for a
| given topic.
| orangepurple wrote:
| Search google for the phrase "climate change" without quotes.
| About 4,010,000,000 results (1.01 seconds) Why don't the results
| go past page 5? (Only a few dozen exist)
|
| If the dead internet theory [1] is true a new search engine may
| eventually emerge which focuses on indexing verifiably human-
| generated content with high information value. I have no idea
| what is going on with Google search results.
|
| [1] https://forum.agoraroad.com/index.php?threads/dead-
| internet-...
| gs17 wrote:
| > verifiably human-generated content with high information
| value.
|
| I'm not sure that will be possible to implement without the
| "search engine" being more of a magazine.
| faebi wrote:
| I'm in a similar situation. I am looking for the right treatment
| of a vitamin b12 and folic acid deficiency, yet the amount of SEO
| spam and scams is just insane. I wish there was more signal in
| the noise of supplements, and further, in the field of medicine.
| kcplate wrote:
| I have two "Cadillac" dental insurance plans. When I sit down in
| the chair I just inform them that I am not interested in any
| service that is not fully covered by my insurances, and if its
| partially covered, I want a pretty detailed breakdown of why I
| need it before I will agree to the service.
|
| Usually this stops the service upselling.
| asdff wrote:
| Dental insurance is sort of crappy in that what we think might
| be important treatments are sometimes classified as cosmetic
| and not covered (like implants). This is why there is a cottage
| industry of dentists doing implants for cheap in Tijuana.
| hoistbypetard wrote:
| It's a nice story about the motivation behind GlacierMD. Which
| seems like something that should be marketed to health insurance
| companies, assuming it targets a US audience. That's who stands
| to benefit enough from people making better decisions about
| discretionary health spending to actually pay for it... marketing
| it here seems like spending effort on an incompletely learned
| lesson from v1.
| josefresco wrote:
| Reminds me of my old dental hygienist who would "threaten" me
| with a more invasive (and expensive) cleaning process every time
| I'd visit. Switched dentists, mentioned my "gums" and the
| concerns of my old dentist, and they were like "no, your gums are
| fine".
|
| Also reminds my of my experience with my disease "specialist" and
| my GP. Specialist is concerned about my cholesterol, puts me on
| meds, schedules regular (now expensive) blood tests. I mention it
| to my GP and he's says "your cholesterol is fine, don't worry
| about it"
|
| Who do I trust exactly?
| CyanDeparture wrote:
| > putrid, SEO-optimized landfill
|
| Well I've not heard my recent search results summerised better
| than that. What a perfect description.
| javajosh wrote:
| Greedy doctors and dentists are the worst, because they are half
| looking at your health and half looking at what they can get out
| of you and your insurance company. It erodes trust, is highly
| unethical, and is extremely common in the US. We need a German
| style health care system in the US ASAP.
| camgunz wrote:
| More or less every time I go to the optometrist or the dentist I
| get a hard upsell on things: frames, contacts, whitening,
| lasering. It's painfully obvious and I can't find a place that
| doesn't do it.
| denvaar wrote:
| I have been dealing with "mysterious" pelvic pain (cpps) for
| about 8 months or so. No doctor has been able to figure out what
| is wrong with me. The process of working with doctors has been
| traumatizing to say the least. I once had trust in our medical
| system, but my perspective has changed.
|
| I now have little faith in most doctors ability to solve my
| medical problems. I recall someone on HN saying they are
| basically "chat bots", and sadly, I find that to be an accurate
| description. I've turned mostly to the internet for help. The
| internet has both helped and harmed me, though I would say
| overall has been less harmful than the experiences I've had with
| doctors.
|
| Doing my own research on the internet does make me feel like a
| "kook", but I would not even have a label for my condition if I
| had not done so. I can live with some discomfort if I can at
| least put a label on what I am feeling. It's also comforting to
| know there's people out there with the same condition as you.
|
| I have access to research and studies online, but if the doctor
| was not aware of it, they are quick to discredit it.
|
| The one thing I am grateful for about seeing doctors is their
| ability to rule out the common/serious conditions. That has been
| helpful, although I have found that simply "getting permission"
| for a procedure, or to see some specialist, is way too difficult.
| Often times specialists are booked out for months. It's so
| discouraging.
| cowmoo728 wrote:
| My wife has a mystery condition that flares up every few months
| / years. Every time it gets bad enough, the doctor prescribes
| antibiotics and then runs some tests. When the test results
| come back 24hr later, the conversation is always the same: "I
| thought it was [a very common problem], but the test results
| ruled that out. Since you already started the antibiotics, you
| should finish the course. Call me again if the problem gets
| worse."
|
| So we're left without answers and with an unnecessary
| prescription for antibiotics, every time. It's pretty
| frustrating, to say the least. The internet has come up with
| "interstitial cystitis" as a possible culprit, but it's not
| much of a diagnosis with an unknown cause, no diagnostic test,
| and no peer reviewed treatments.
| xyzzy21 wrote:
| This is a legal problem - allowing broadcast advertisements to
| the general public for pharma products is where the problem
| started. Before that, pharma had to advertise in targeting media
| directly addressing the medical profession only, e.g. JAMA, NEJM,
| various trade magazines, etc.
|
| That's how this should be fixed - return to those limits. In an
| online environment that would mean limiting ads to doctors et al.
| on sites that require password and professional
| identification/validation. Otherwise information on drugs et al.
| should be presented only neutrally and scientifically to the
| broader public - marketing should be banned from the process.
| aaron695 wrote:
| ada1981 wrote:
| Years ago I worked with a start-up called MetaMed, funded
| personally by Theil, to provide a team of private medical
| researchers.
|
| They didn't make it, but the premise was sound / that standard of
| care is about 30 years behind research (at best).
|
| The mindset I learned there helped me overcome a diagnosis of
| Bipolar / schizoaffective by doing primary research and rejecting
| the medications of Standford Psychiatry...
|
| 8 years later, with a mix of shamanism, spiral dynamics, mens
| work, underground mdma therapy, 5meoDMT, somatic therapy,
| biomythic.com and coaching and I've finally got some place to
| stand within itself, no need for medicines, and no longer dealing
| w suicidal depression or manic psychosis.
| jcranberry wrote:
| Sounds like Google Scholar saved the author from being swindled
| into spending $400 by their dentist.
|
| The old thing to do was to get a second opinions. I wonder how
| that would have fared comparatively in this case.
| Zigurd wrote:
| Thing is, the misinformation was prioritized to the top of the
| search.
|
| Is it the place of online platforms to filter out
| misinformation?
| crdrost wrote:
| I mean in the broadest sense that's a cultural question and
| most big online platforms have decided that it _is_ their
| place--Facebook and Twitter in particular--because of
| pressures from the public.
|
| In a much, much narrower sense, we are talking about Google
| and not an online platform. Google's explicit mission is, "to
| organize the world's information and make it universally
| accessible and useful." Like, filtering out misinformation is
| literally the thing that Google says is its purpose.
| CivBase wrote:
| The title implies that _Google_ is the culprit. The article
| paints a more nuanced picture. It blames Google for providing
| marketing results for a query about the validity of some dental
| procedure. It also shares some blame with the dentist for
| advising the procedure in the first place. However, consider the
| ending of the story. The author saw the marketing for what it was
| and turned to academic search engines for more reputable sources.
| Isn 't that what we want?
|
| I dislike Google for many reasons and generally avoid their
| products and services, but are they really to blame here? Google
| is a general purpose search engine whose business model
| fundamentally relies on including marketing in its results. It
| isn't a flaw in the algorithm; it's a feature. It's how they make
| money - and a lot of it at that[0]. If you want academic results,
| go to an academic search engine. That's exactly what the author
| did and it worked out fine. I'm down for an argument that we need
| academic works to be more accessible and digestible, but that's
| not really a problem with Google.
|
| The other accused subject was the dentist, but I'm not so sure
| about that one either. There is a lack of consensus among medical
| professionals on many treatments and procedures, and this story
| could simply be another example of that. Medical professionals
| are humans, each with their own experiences and biases. Besides,
| it's not like the academic results cited by this article
| determined that the treatment was snake oil. Maybe the author's
| dentist had her own experience with the procedure and honestly
| concluded for herself that it was worth the $400. Maybe she was
| biased by anecdotal evidence or her own theories. Maybe she
| doesn't value $400 as highly as the author. Maybe she simply
| values dental hygiene more than the author. This is a great
| example of why it's important for medical professionals to act as
| consultants and for patients to make the final decision.
|
| IMO, the big problem here isn't Google or the dentist. The
| problem is how much trust people have in those two as sources of
| accurate, unbiased medical information. If you're making a
| significant medical decision, you shouldn't accept a single
| source of information - even if it is academic - and you
| certainly shouldn't trust marketing material. Get second
| opinions. Do a little academic research. It's easier than ever
| before.
|
| That said, if a $400 laser treatment for your gums isn't a
| "significant medial decision" to you, then feel free to just
| follow your dentist's advice. That's up to you.
|
| [0] https://news.ycombinator.com/item?id=31172475
| darkerside wrote:
| This is the kind of marketing-driven content I can actually get
| behind, not joking. Glacier MD at least has the problem right.
| imglorp wrote:
| What's to stop Glacier from becoming the same as Google for the
| same reasons? That's a mountain of med ad cash on the table.
| Nextgrid wrote:
| Competition? If they become the equivalent of Google, why
| would anyone pay them to get the same kind of content they
| can get from Google for free?
| darkerside wrote:
| Google worked great for a long time. The beauty of capitalism
| is that a competitor that provides more valuable may supplant
| it. The day Glacier falls into the same short term cash trap,
| I hope someone else rises up in its place.
| pineconewarrior wrote:
| Dignity and resolve to their mission statement are what
| prevent it.
|
| Not exactly a strong hand to bet on, but it's better than
| nothing.
| willhinsa wrote:
| "Don't Be Evil" turned out to not be better than nothing.
| steve76 wrote:
| barrad0s wrote:
| This is a great post.
| albertzeyer wrote:
| You could also argue that Google is actually doing a good job
| here.
|
| Simple heuristic: All results from the first two search result
| pages don't provide much/any evidence that LBR is helpful or
| worth is -> it is not.
|
| This simple heuristic is often quite good.
|
| If it would have been a useful method, I would expect to find
| some good serious pages, or maybe Wikipedia page on it.
| loeg wrote:
| A pretty obvious clue from the beginning here was:
|
| > your insurance won't cover it
|
| So to answer
|
| > So how do most patients make this decision?
|
| 0. Insurance won't cover it, so they don't get it ($), or
|
| 4. Insurance won't cover it, which is a signal it isn't an
| evidence-based intervention, so they don't get it.
| pc86 wrote:
| Insurance doesn't cover adult orthodontia either but that
| doesn't mean it's not evidence-based (just elective). And a
| laser-based cleaning technique sounds pretty elective.
| loeg wrote:
| It's a signal, but not the only signal.
|
| Orthodontia are a cosmetic procedure with a pretty visible
| result. It's an exceptional case, not the rule.
|
| And for many people, see step 0.
| Pelam wrote:
| Btw these small brushes regularly applied _as instructed by
| professionals_ fixed this problem for me. I understand it can get
| really bad and can actually require more drastic measures.
|
| https://www.tepeusa.com/collections/tepe-interdental-brushes...
|
| (The brush is basically applied to the space between teeth and
| touching the gums, but see a pro please first.)
| JRabo wrote:
| > You're reading this in a year that starts with "2" so the only
| possible starting point is Google.
|
| LOL. Seriously? Google the biggest known data whore, worst
| privacy invader on the Internet, whoring personal data out to any
| john willing to pay. Yeah. The year starts with 2 and Goog has
| been pimping your data for 23 years now and people still haven't
| learned they are not your friend.
| mort96 wrote:
| What is your point? Did the author write something which
| indicates they think Google is an ethical company?
| JRabo wrote:
| The point is obvious but I'll spell it out for you using HIS
| own words. "Google almost convinced me to spend $400 on
| useless laser treatments". He presents himself as "in the
| know" because the year begins with "2" and anyone in the know
| would use Google to research an issue. LOL. HE then proceeds
| to place trust in an unethical company to give him
| information he needs to make a wise financial decision. Doh!
| JRabo wrote:
| These are the same people driving around with WiFi sniffing
| equipment collecting terrabytes of data and then when
| caught claim it was not intentional. All that damned
| hardware got wired up by evolutionary means and the
| software got splatted onto the boot drive by a bird passing
| overhead. What crappy luck happening throughout the world
| like that.
| JRabo wrote:
| These are the same people who started a medical privacy
| records initiative to centralize your medical records, to
| "safeguard" your privacy.
| JRabo wrote:
| These are the same people who provide "free" CDNs, and that
| moronic developers use to ensure everyone's privacy is
| compromised.
| mort96 wrote:
| But where does the author indicate that they don't think
| Google is unethical?
|
| You're showing me that the author personally uses google,
| and that the author thinks the vast majority of people use
| google (which is true). Nothing about what they said
| suggests they think Google is ethical.
| [deleted]
| eithed wrote:
| The cynic in me was thinking "ok, I've read the article, what
| product is the article selling? ok, here we go".
|
| Although to be honest, I was nodding as I was reading. It's not
| only about medical decision, but with most decisions where you
| want to buy the best X. Maybe medical decisions are less...
| selfish? I mean - if I want to buy a toaster, I'll look at Which,
| and won't splurge on the most expensive one, but will look at
| what other people are finding useful. With health however, you
| probably don't want to spare expenses, so the decision making
| process will be a bit different - we trust people from which
| we're getting health advice.
|
| I'm not in USA, and don't think this sort of thing is confined to
| USA
| bsuvc wrote:
| This is why I don't trust Google anymore, especially when it
| comes to anything medical I might buy.
|
| I always Google something and add "Reddit" to it to get better
| real, less-biased opinions on something.
|
| Or if there is a site dedicated to discussion of the topic (ie.
| an old school forum or message board), I'll go straight to that
| and search there.
| eismcc wrote:
| I had almost the exact same experience. Sitting in the chair
| prepped for a cleaning and the DH dives into this tale about "bad
| bacteria" and how if it gets into my stomach during the cleaning
| I could have all kinds of problems including heart disease and so
| on. Then the follow up treatment plan had other "beneficial"
| procedures not covered by insurance - platelet treatment to
| improve healing. I called the insurance company to ask about the
| plan and discovered the uncovered items were more than the actual
| procedure itself. The dentist wouldn't negotiate or change to a
| code the insurance company recommended.
| Zigurd wrote:
| Imagine a health care system where the insurance company is,
| relatively at least, the "good guys." That's how badly off we
| are.
|
| I personally have a story of a great doctor who went to the
| effort to try a less-well-known (but still entirely
| conventional) treatment that resulted in a much better outcome
| for me. But that just highlighted the fact that great treatment
| outcomes are a haphazard occurrence in a sea of crud where
| neither the insurer nor the provider prioritize the patient
| over maximizing revenue.
|
| What this story illustrates is that paying out of pocket, which
| presumably put greater market based pressure on health care
| providers, is even worse.
|
| Not all parts of the economy work bast when least regulated and
| maximally market driven. Without information from disinterested
| parties, and without oversight from outside the profit-driven
| parties, you just get farmed by crooks.
| dr_dshiv wrote:
| I wish Google Scholar was mainstreamed. It makes me sad that
| there is so little public capacity to read chains of evidence
| across scientific papers.
| sliken wrote:
| I read this whole thread, it seems to miss one major point.
| Insurance companies control treatments in the USA to an amazing
| degree. They push to overschedule doctors, literally down to
| minutes per visit, try to push as much as possible to lower paid
| staff (mostly nurses), and shape things for maximum profit.
| Nurses are handling things today that would have used doctors in
| the past. Much of the frustration people get is trying to
| convince doctors to go against insurance companies and order more
| tests, referrals, or treatments.
|
| This is also why a weekend on pubmed and similar gives you a
| better result than a doctor ... who spent 2 minutes reviewing
| your chart and comes into the room for a few more minutes to talk
| to you.
| wackget wrote:
| Disappointing to see the OP using Google Forms to collect data
| for their beta testing product waitlist. OP clearly knows Google
| is bad but supports their business by using their tools anyway :(
| JohnJamesRambo wrote:
| This is a great article. How do we fix it? We are experiencing
| late stage capitalism at every turn in our lives. I don't know
| where to start. Regulations? But Google has moles in every level
| of government. A real search competitor? It feels impossible to
| think it could happen at scale. There is a niche for a company
| that is like the original Google and that could grow. How can we
| help it succeed?
| unpythonic wrote:
| The article is just an ad.
|
| > This was my motivation for starting GlacierMD: I wanted to
| give consumers the information they needed to make evidence-
| based health decisions. And although I lost that battle
| (spectacularly) I'm still fighting the war! If this is a topic
| that interests you, I'd urge you to
| stevehawk wrote:
| I don't know that you can fix this. This is what people want.
| They need to feel like they've researched and made intelligent
| decisions, even when they haven't. After all, doctors aren't in
| it to make them feel better, it's all just some big conspiracy
| to make them more money (sarcasm).
|
| My wife is an oncology surgeon and it's absolutely mindblowing
| the things her patients tell her or later post on Facebook. One
| of her latest winners is someone that flew cross country to
| California to get things like 3D Bio-Scans.
|
| 3D you say? That sounds useful. It's a 3D image of you, your
| cancer, your organs, etc, right? No. I'm taking this straight
| from their website:
|
| > It has four FDA-approved technologies in one: Pulse Oximetry,
| Body Composition, Heart Rate Variability (HRV), and Galvanic
| Skin Response Devices;
|
| Not a damn one of those is going to tell you anything about
| cancer. And then there's thermagrams, where they basically
| check your skin temperature to try and diagnose internal
| medicine, like cancer, colitis, gluten allergies, etc. And
| people just buy this shit up.
|
| It really just reminds me of Steve Jobs' quote on television:
| When you're young, you look at television and think, There's a
| conspiracy. The networks have conspired to dumb us down. But
| when you get a little older, you realize that's not true. The
| networks are in business to give people exactly what they want.
| That's a far more depressing thought. Conspiracy is optimistic!
| You can shoot the bastards! We can have a revolution! But the
| networks are really in business to give people what they want.
| It's the truth.
| macinjosh wrote:
| Unless you have a specific issue dentists offer mainly
| preventative care. The thing with preventative care is that you
| can never really prove what is working and what is not. Also, you
| can never really know when you've done enough.
|
| I think of it kinda like a car wash. You can pay extra for the
| fancy spray on waxes or you can just get a basic wash. How much
| does wax quickly sprayed on by a machine do for your car in the
| long run? Not much. But it makes you feel like you're taking care
| of your ride. Sub in teeth (a part of the body) for a car and
| they can charge almost whatever they like for shining bright
| lights in your pie hole.
| h2odragon wrote:
| Every time someone tells you the "science is settled" is likely
| to have just as many facts behind it.
| [deleted]
| geek_at wrote:
| > In the pre-Szaszian era, medicine was something that happened
| to you. You would put your health in your doctor's hands and they
| would unilaterally decide your course of treatment. But in
| today's patient-centered world, doctors are more like consultants
|
| To be honest I've only seen this level of "patient-centered"
| stuff in the US. Never heard the phrase "Ask your doctor about
| xy" anywhere but on US TV. Sometimes pretty hard drugs like
| psychotropic drugs. When I first head it my response was "WTF,
| shouldn't the doctor tell you what you need and not the other way
| around?"
|
| I guess it comes down to the batshit crazy US healthcare system
| and people losing trust in doctors that give them 40k$ bills for
| simple treatments or short hospital stays
| mannykannot wrote:
| > WTF, shouldn't the doctor tell you what you need and not the
| other way around?
|
| The problem here is that it is the medical professional who is
| pushing the ineffective treatment.
| Spivak wrote:
| It goes the other way too. If you have anything but the most
| common illnesses or conditions that you are likely more
| knowledgeable about your situation than your PCP since
| they're the tier 1 help desk of medicine. This kind of thing
| is totally fine and expected, it's why specialists exist but
| it's really frustrating because your PCP is often treated as
| a either a gatekeeper or unnecessary busywork to get to the
| more qualified person.
| donatj wrote:
| I would personally rather be involved in the decision making
| process related to my very existence rather than just told what
| to do.
| matsemann wrote:
| I "feel" like I would like that as well. But if I every get
| really ill with something longterm, I'm also afraid I'd spend
| too much energy on all the decisions and research. Giving
| patients options also gives them doubts.
| bittercynic wrote:
| I think individual patients have very different preferences
| on this. I've taken pets to a few different vets, and some
| say things like "There are many possible reasons for these
| symptoms. Let's try XYZ and see how it goes." Others are
| more like "Your dog has X. We'll do Y and it should clear
| up."
|
| My preference is for the one who I think is being honest
| with me about how certain they are about what's going on,
| and when a medical professional seems like they want to
| appear 100% certain all the time it makes me worry about
| their judgement.
|
| I think many people have the opposite preference, which
| seems to me is asking for dishonesty. Seems like an
| ethically tricky area.
| fullstop wrote:
| I mean, I agree with this but also feel that pharmaceutical
| companies should not be advertising directly to the public.
| Workaccount2 wrote:
| I think everyone agrees, but it is a first amendment
| nightmare to try and regulate.
| fullstop wrote:
| We already prohibit advertising for cigarettes (on
| broadcast TV and print), so this doesn't seem like that
| much of a stretch.
| Workaccount2 wrote:
| Cigarettes have the "think of the children" special
| ability.
| teddyh wrote:
| Note: Advertising prescription drugs to the public is
| _only_ legal in the USA, and also New Zealand. Nowhere
| else.
| warent wrote:
| But why?
|
| Imagine your grandmother who knows nothing about computers or
| tech asking you about GPUs and which programming language is
| best because she's curious about buying Bitcoin vs investing
| in Ethereum.
|
| For someone who can't tell the difference between a screen
| saver and a computer virus, the discussion is meaningless,
| and only the illusion of control exists
| bbarnett wrote:
| "What's and adblocker" - my Grandma.
|
| _Well, you know a phone book? And, you know how if you
| want to phone someone, you tend to look up their number in
| a phone book?_
|
| "Yes"
|
| _Well, computers are the same. They only know numbers,
| they 're computers after all, and DNS maps the names you
| see for websites, to numbers, so computers can find the
| website._
|
| "Uh, OK"
|
| _The adblocker I am going to install, makes it impossible
| for the computer to see the numbers for advetisers. It can
| 't find them in its phone book any more. So, no ads!_
|
| Now grandma understands how DNS works, and what some
| adblockers do.
|
| Some things are not as technically complex as we think they
| are.
| warent wrote:
| Maps names of websites? I don't know what that means.
| Timmy showed me The Amazon and the egg cooker from there
| worked wonderfully so I don't want an ad blocker.
| bbarnett wrote:
| Granmda knew what it meant. She'd been looking up names
| in the phonebook here whole life, mapping them to
| numbers.
|
| Been doing the same thing for lots of paper databases,
| like address books, and been using indexes in books too.
|
| Not to mention, how the library indexed books in her day.
|
| Zero confusion about DNS after I explained urls to her.
| None.
| wheybags wrote:
| I had a sugery for a common issue performed, as it happens,
| by the ex head of some surgeons union type organisation in
| my country (Ireland). The established technique has an
| uncommon but not so uncommon tendency to have issues where
| you just dont heal properly. I was unlucky and I didn't
| heal. I spent a year being tended by various nurses and
| reviews etc etc and when I finally started to research it
| myself I found there was a new far better surgical method
| available, but the guy who did my surgery was old and
| hadn't kept up to date. I found a surgeon who specialised
| in the new method and I was fully healed and done forever
| in a couple of months.
|
| They might be an expert, but it's your (literal) skin in
| the game.
| donatj wrote:
| This is such a silly metaphor I am going to ignore it and
| answer the initial question.
|
| Why? Because the things I personally value in my life and
| health are not always aligned with the things doctors try
| to optimize for.
|
| I've told the story here a number of times but my tonsils
| swelled up to the size of grapefruit a number of years ago.
| After 6 months of steroids and having them drained I wanted
| them removed. My doctor did not think it was necessary,
| even though I was living in misery. I ended up just going
| to a doctor about an hour away and had them out within the
| week.
| warent wrote:
| You're abandoning the context of the thread. The original
| comment you replied to was about how the US Healthcare
| system should be fixed so that you always know doctors
| are optimized for your needs
| badtake wrote:
| Not everything is "fixable" in health and sometimes this
| means that there isn't one "right" choice for treatment.
| Involving the patient in the decision making process is
| important because people have preferences for what is right
| for them and their life and the doctor can act as a well
| informed partner in care.
|
| I have multiple sclerosis. There's not a cure but there is
| highly effective medication. There's also less effective
| medications. The highly effective stuff is various degrees
| of immunosuppressive or has a risk of fatal brain infection
| that is manageable with proper testing and monitoring. The
| less effective stuff can seem "safer" because it lacks
| these particular risks. A regular neurologist might not
| know very much at all and give outdated advice and
| treatment plans compared to some specialists and for this
| reason advocating for oneself is hugely important as long
| term outcomes can be greatly different based on the
| treatment choices. The fact is that you can't just let
| "medicine happen to you" because the person that cares the
| most about your medical outcomes is you. Obviously this is
| an extreme example but it's one of many.
| SamBam wrote:
| And to extend your analogy, instead of the grandmother
| talking to a helpful expert, all the information they are
| given comes from BitCoin salesmen, and she's expected to
| "do her own research."
| warent wrote:
| Side effects may include losing all your money, but those
| side effects are like really really rare
| IneffablePigeon wrote:
| I mean, I do see where you're coming from, and I have in the
| past second guessed some medical advice and asked if they'd
| considered a particular diagnosis I had a hunch on.
|
| On the other hand, they're a professional and they've usually
| spent the majority of their life training to be good at what
| they're advising you about. I don't demand to be involved in
| the design of planes I fly on or bridges I cross, because
| frankly I'd do a worse job than even a pretty bad qualified
| engineer.
| pram wrote:
| I think it's because the US is one of the few (only??)
| countries to allow advertisements for prescription drugs.
| Spivak wrote:
| I'm not trying to condone terrible drug advertisements but
| man there has to be something to let people know that their
| "normal" suffering isn't normal or that there are new
| developments that your PCP for sure isn't gonna keep up with.
|
| I know the meme de jour is teens diagnosing themselves with
| ADHD because of TikTok but it's the perfect example of a
| whole bunch of people being like "holy shit it's not supposed
| to be this hard all the time? You can actually do something
| about it?"
| alistairSH wrote:
| _there has to be something to let people know that their
| "normal" suffering isn't normal or that there are new
| developments that your PCP for sure isn't gonna keep up
| with._
|
| That should be the doctor's job. Doctors have too much
| financial pressure to pump patients through, so they have
| neither the time to get to know individual patients nor
| time to keep abreast of current trends in their speciality.
|
| Should MedicineX be allowed to have a website with a FAQ?
| Yes. Should MedecineX be pushing ads on TV/radio that make
| it seem like it's a cure for everything that ails you?
| Nope.
| AuryGlenz wrote:
| Sure, but people need to first know what they're dealing
| with isn't normal before they can even ask about it.
|
| I have really, really bad fatigue. It took me years to
| figure out everyone else didn't feel that way. I was in
| high school and was able to skate by on intelligence
| alone.
| refurb wrote:
| The FDA has already asked doctors if they think advertising
| is good:
|
| https://www.fda.gov/drugs/information-consumers-and-
| patients...
|
| Most physicians agreed that because their patient saw a DTC
| ad, he or she asked thoughtful questions during the visit.
|
| Many physicians thought that DTC ads made their patients
| more involved in their health care.
|
| Seventy-eight percent of physicians believe their patients
| understand the possible benefits of the drug very well or
| somewhat, compared to 40 percent who believe their patients
| understand the possible risks, and 65 percent believe DTC
| ads confuse patients about the relative risks and benefits
| of prescription drugs.
|
| Eight percent of physicians said they felt very pressured
| to prescribe the specific brand-name drug when asked.
|
| DTC ads help patients have better discussions with their
| physicians and provide greater awareness of treatments.
|
| The study demonstrated that when a patient asked about a
| specific drug, 88 percent of the time they had the
| condition that the drug treated. And 80 percent of
| physicians believed their patients understood what
| condition the advertised drug treats.
| teddyh wrote:
| It's technically not the only country, as it's also legal in
| New Zealand. But nowhere else.
| specialp wrote:
| > Never heard the phrase "Ask your doctor about xy" anywhere
| but on US TV. Sometimes pretty hard drugs like psychotropic
| drugs. When I first head it my response was "WTF, shouldn't the
| doctor tell you what you need and not the other way around?"
|
| This was the case for many years where it was illegal to have
| advertisements for prescription medicines. They lifted this
| like 15 years ago. This was very favorable for the
| pharmacutical companies as now patients are going to go to
| doctors and ask exactly that.
|
| What is worse now IMO is these direct to patient ads on social
| media from Cerebral. They show a lot of common things that
| people do (Like slack off, not pay attention to something
| boring), and then encourage them to talk to them for ADHD
| treatement. While more awareness of mental disorders and health
| is great, it is a bit scary when people can get convinced they
| have a disorder that needs pharmaceutical intervention and shop
| these firms until they get a script.
| jonhohle wrote:
| It's been closer to 25 now. Bob Dole was shilling for
| Pfizer's Viagra in the 90s.
| lupire wrote:
| Broadly, it's because the US has a culture of individual
| sovereignty and not everyone being a ward of the state.
| alistairSH wrote:
| That's not true. We have the drug ads in the US because legal
| precedent since the late-70s/early-80s (roughly) in the US
| now protects commercial speech.
| prewett wrote:
| Companies are legally considered persons, hence their
| speech is protected. This is consistent with individual
| sovereignty. If people are wards of the State, then the
| State would have the responsibility to police "harmful"
| speech; advocating untrained people to ask their doctor for
| a specific medication could be considered harmful speech
| (since apparently only two countries in the world allow it,
| and not even the US before the 70s-ish, apparently).
| gumby wrote:
| I'm quite critical about Google declining search quality but in
| this case I think pointing the finger at them is clickbait. The
| fact is that the dentists have "flooded the zone with shit" and
| google hasn't much to work with.
|
| I would appreciate if google could elevate more "google scholar"
| results and also have a zone of clearly marked "likely low
| quality matches" but apart from the howls of outrage from the
| bullshitters, this would be very hard.
|
| Also note at the end the author pitches their alternative.
|
| ==
|
| BTW the laser is a capital investment (or lease) for the provider
| so the laser manufacturers are always coming up with new ways to
| use the device and sending them to their customers (mainly
| dermatologists and dentists -- people outside the managed care,
| and often insurance, infrastructures). These suggestions are
| typically worded in a way that doesn't get them in trouble with
| the FDA.
|
| So even if a dermatologist buys a laser to remove birthmarks,
| most of the time it will just sit unused in the corner of the
| room. So they add tattoo removal. Next thing you know it's a
| cosmetic liposuction alternative for the area around your mouth.
| snemvalts wrote:
| The biggest problem with Google and medicine are the summary
| boxes and QA widgets up top, matching a search term to an
| excerpt.
|
| It's hilariously bad, it pulls misleading info out of context. It
| is probably responsible for more than zero deaths worldwide.
| SamBam wrote:
| It's really weird. One of the widget boxes rephrases some of
| your search into explicit questions, and then the result is an
| out-of-context snippet that is definitely _not_ answering the
| question.
| nullc wrote:
| It's the best when it manages to give exactly the opposite
| advice to the source.
| wara23arish wrote:
| This is 100% true. While attending an NLP class in college, a
| speaker from Google came and spoke about how they evolved their
| systems etc. He admitted himself that results from those QA
| excerpts are hilariously wrong.
| jcranberry wrote:
| Sometimes they're alright but the new feature where if you open
| one ten more appear is annoying.
| cptskippy wrote:
| I feel at this point that dentistry is closer to chiropractics
| and homeopathy than actual science.
|
| Many years ago I wasn't in the best financial position and went
| to the dentist. He identified a number cavities needing filled
| and quoted a hefty sum, and I put off the procedures because I
| couldn't afford them. I diligently saved for 6 months to pay for
| them and when I went in for my next checkup, I asked about them.
| What cavities? No your mouth looks fine.
|
| I've had similar situations with my children, getting quotes for
| thousands of dollars worth of work. Getting second opinions and
| using different insurance changes those quotes and scope of work
| dramatically.
|
| At this point in my life, I don't trust dentists at all. I'm sure
| they're not all crooks but how do tell?
| elteto wrote:
| I have found that dental clinics in the US can be some of the
| shadiest health related businesses you have to deal with.
|
| There are few independent clinics around. Most of them belong to
| huge corporate conglomerates that push down shady treatments like
| this, or offer predatory financing for these "treatments".
|
| I've had only two instances of a health professional outright
| lying to me and telling me I had a health condition that I didn't
| have, and both times were dentists. One of those times was also
| about periodontal disease, so it seems like this is a common
| thing.
|
| A good heuristic is that if the treatment isn't covered at all by
| insurance it very well might be worthless.
| chrisdhal wrote:
| Maybe that's regional? In my area (Minneapolis/St. Paul metro),
| there are tons of independent dentists and few conglomerates
| (at least that I know of). In my little-ish suburb (25k people)
| there are no corporate ones but about 6 independent ones.
|
| I go to an independent office (2 dentists) and I've never felt
| pressured by them and they've even said things like, "It looks
| like that may turn into a cavity, but we can wait and see what
| happens."
|
| Obviously I'm not saying it doesn't happen, but like anything,
| it's not everywhere.
| asdfasgasdgasdg wrote:
| One thing I've found is that many doctors are willing to share
| the rationale for their decisions and recommendations if you
| question them on the state of the research. Some have even gone
| as far as to send me papers after we've met. Doctors in many
| cases are human body-nerds and are willing to talk with
| interested patients about their subject.
|
| Doctors who won't justify themselves can often be avoided at
| least in medium-sized and larger urban areas.
|
| The main observation is that in medicine you need to be your
| own advocate. The doctor is used to people who just want an
| answer or a cure. They're not going to break out the journals
| for every patient because most patients don't want that. This
| also goes for dentistry.
| Zigurd wrote:
| But... free speech!
| jnovek wrote:
| " Medicine has become a three-way negotiation between you, your
| doctor, and The Algorithm."
|
| This characterization makes it sound like a good thing. In
| reality, the doctor's responsibility is being pushed to the
| patient because they are overbooked in the name of economic
| efficiency.
|
| As a patient with complex, non-specific medical condition, I can
| tell you how miserable this is.
|
| I can't count on doctors _at all_ to move the process forward.
| It's always me, reading articles on PubMed and coming up with
| ideas.
|
| I'm not medically trained nor am I scientist. It's a lot of
| legwork for me normally, but the ways that being sick limits me
| make it much harder.
|
| Further, the emotional and intellectual overhead required to
| negotiate with medical professionals is high.
|
| Back when I could afford to, I saw a neurologist at an office
| that didn't accept insurance. She choose to see fewer patients
| and give them more time, as well as spend time doing research to
| look for new clues and ideas.
|
| This worked really well and I made progress with her.
|
| The rest of the American medical system? Gatekeepers that block
| access to potential treatment pathways until you can convince
| them it's worth a try.
| ALittleLight wrote:
| A few years ago I noticed my stool was unusually dark (sorry
| for too much information). I did some googling and discovered
| this was an indication of blood in stool. I went to the
| pharmacy to buy a fecal occult blood test - a strip of paper
| that you add to the toilet bowl and it changes color if it
| detects blood in the water. When I got a positive result I
| retrieved my strip with tweezers and put it in a ziploc bag and
| went to go see a doctor.
|
| The doctor decided this was an ulcer and said the ulcer could
| be bacterial, viral, or idiopathic (meaning without a cause).
| His solution was to prescribe an anti-bacterial and a steroid
| and to take both. I asked if there would be any complications
| or drawbacks to taking both, and he said there would not. I
| asked if I should take one first and then the other so I could
| narrow down whether the ulcer was bacterial or viral. The
| doctor thought this was a good idea and said I could do it if I
| wanted. I asked if I should take the medications in any
| specific order and he said it did not matter.
|
| I went home and read up on the two medications he had
| prescribed. Sure enough, the steroid would make a bacterial
| infection worse. Following the doctor's advice, without my own
| research, could have made things worse. Without doing my own
| diagnosing and testing I would have had a much longer time to
| treatment too. (Wound up going away with the anti-biotics)
| whatshisface wrote:
| If you were on both at once would the antibiotics have
| stopped the steroids from making it worse?
| ALittleLight wrote:
| I don't know that. My research didn't turn up anything
| about taking both at once. I think, either way, it would
| have been safer to try anti-biotics first then the
| steroids. It's not like I was suffering from the ulcer, I
| had time to experiment, so why not go with the simplest and
| safest treatment route?
| cm2187 wrote:
| Not saying that you are wrong, there are bad doctors like any
| other profession.
|
| But in general, the counterpoint to that view is that medicine
| is one of the only professions that never industrialised. You
| have to put a highly trained MD in front of every patient for
| every problem. It just doesn't scale. And some patients have
| the expectation that this MD should also cuddle them, provide
| emotional support and listen to their life. I am glad when I
| see a doctor for something and I am in and out within 5
| minutes, it makes me feel that I resolved my problem without
| burdening a precious resource.
| foobarian wrote:
| It seems that they have very little incentive to take
| risks/deviate from the common path. Why help an outlier
| patient, when even if their unusual treatment doesn't do any
| harm, it could be wrongfully associated with some random bad
| outcome?
|
| With the system set up like this, game theory basically
| guarantees we end up with the state as OP describes.
| gtirloni wrote:
| _> Gatekeepers that block access to potential treatment
| pathways until you can convince them it's worth a try._
|
| You assume they actually know what needs to be done. In my
| experience, you can see they don't have a clue and aren't
| willing to do research to learn. They just hand out their usual
| prescriptions, etc and sometimes hope an exam will give them an
| obvious answer.
|
| On top of that, most doctors only have a very narrow
| understanding of the human body and don't know when to refer
| you to some other doctor they will be better equipped to help
| you.
| falseprofit wrote:
| I took that comment to mean they had specific treatments in
| mind they wanted to try, and had difficulty convincing docs
| to write the Rx.
| xyzzy123 wrote:
| Unfortunately the median doctor is busy treating the median
| human.
| ErikVandeWater wrote:
| > On top of that, most doctors only have a very narrow
| understanding of the human body and don't know when to refer
| you to some other doctor they will be better equipped to help
| you.
|
| Are we talking about doctors, not nurse practitioners? It's
| hard to understand how a doctor with 4 years of medical
| school and 3-7 years of residency would have a "very narrow
| understanding" of the human body.
|
| Also, my experience has been that I have always been referred
| to a specialist when there was any uncertainty about
| diagnosis or treatment. My trouble has come from them not
| following up when an RX is denied by insurance, and making it
| difficult to schedule a doctor's appointment due to not being
| able to transfer my previous information.
| JohnWhigham wrote:
| The average PCP is usually also an internist, which is just
| a fancy term for someone who knows just enough to be able
| to send you to the right specialists. And since in the US
| many specialists require a referral, that's all most PCPs
| are good for.
| AuryGlenz wrote:
| Let me give you my own example:
|
| I suffer from pretty debilitating fatigue. It started when
| I was 13 or so, which was also a few months after I
| suffered a bad concussion. I have low testosterone, and
| treating that helps some. Autoimmune diseases run in my
| family; my father has lupus, his siblings all have
| something, and I have a small patch of psoriasis on my head
| (to which my doctor said "huh.."). My white blood cell
| count is always moderately low, even after an infection. I
| get sick extremely easily and stay sick longer than other
| people. I frequently get chills in my limbs like a person
| does when they're sick, though the testosterone helps. The
| chills are a sure thing when I don't get enough sleep. I
| get cluster headaches, and recently I started getting
| really frequent eye twitches leading up to when the cluster
| of headaches start.
|
| Who should I see to try and figure out the root cause of
| the fatigue? An endocrinologist? Urologist? Sleep doctor?
| Neurologist? Immunologist? Rheumatologist?
|
| It's hard to know what's relevant to the fatigue. When I
| was first treated they simply put me on antidepressants.
| After giving up on those, years later I did some research
| and had to practically beg just to have my testosterone
| levels checked along with some other things that were fine.
| Domenic_S wrote:
| Doctors are T-shaped [0] - a GP knows a little about a lot
| and most have an area of interest or two that they're
| really well-versed in. There's just too much complexity,
| even within a single system, to be an up-to-date expert on
| everything.
|
| For instance I have an endocrinologist (at Stanford, not to
| name drop but to signal this person is _really good_ even
| among doctors) who only deals with thyroid. I naively
| figured that an endocrinologist would deal with all kinds
| of hormone issues but no, she 's thyroid and thyroid only
| -- she has a colleague for testosterone, another for
| diabetes, etc etc.
|
| I don't know that I'd say GPs "don't know" when to refer
| you; GPs are gatekeepers who will try conventional
| solutions to conventional problems and generally unless you
| push won't often suggest going deeper with a specialist.
| It's not that they don't know to refer you, it's that
| they're Level 1 Tech Support for the body and often times
| unless you make a stink they won't connect you to Level 2.
|
| [0] https://en.wikipedia.org/wiki/T-shaped_skills
| salsadip wrote:
| I'm really not trying to sound snarky, but - is this the
| supposedly high quality treatment that U.S. citizens get that
| is so much more expensive as opposed to the ,,socialized"
| insurance we get in Europe that is cheaper for everybody and
| supposedly therefore not as good/cutting edge?
| bcoughlan wrote:
| So tired of these "European" comments feigning cluelessness
| to try to feel above others. There is huge variety in
| healthcare quality across EU countries (waiting lists are
| years long in my country) and no one can speak of Europe as
| a monolith and make much sense. People in my (EU) country
| who have serious illnesses often seek to go to the US for
| treatment because they have facilities and doctors that
| specialise in their illness and don't have a hope of
| survival otherwise.
|
| I see these comments all the time on Reddit and HN but
| never see the reverse from US posters. They just come
| across as insecure and snooty.
| asdff wrote:
| I think it depends on the context of the treatment and
| how specialized it needs to be. For example, I've had
| relatives from the U.S. who have gotten dental work done
| in Croatia because its cheap enough to the point where
| they can buy a transatlantic flight and spend some time
| visiting family members along with getting the root canal
| and crown done. A lot of people in southern California
| also opt to drive to Tijuana for dental work or other
| procedures. If its not some cutting edge thing or world
| renown surgeon, there is no point to paying the costs
| associated with a lot of treatment in the U.S. at least.
| For some stuff, yeah, the U.S. is best in class; Saudi
| princes fly out to Cleveland to get their heart work
| done.
| AlbertCory wrote:
| I'm reminded of that Simpsons episode (can't find it on
| YouTube easily) where they temporarily have to take in
| boarders: backpackers and so forth.
|
| Then the financial problem is fixed, and Homer carries
| one of them, all the while spouting about the European
| health system, to the garbage can. He says "Time to take
| out the Eurotrash."
| amyjess wrote:
| From my experience, other countries are _even worse_.
|
| I'm transgender, and everything the top-level poster said
| about incompetent doctors, gatekeeping, and having to read
| literature and teach yourself about your own medical
| condition absolutely 100% applies to me and nearly every
| other trans person I've talked to (I remember printing out
| the Endocrine Society guidelines and taking a highlighter
| to them in order to convince a doctor that what I'm asking
| for is standard practice). I also have friends who have
| other chronic medical conditions, and their experience with
| doctors is pretty much the same as my experience and the
| experiences of other trans people.
|
| And everything I've heard from people in Europe is that
| over there, _it 's even worse_. At least in the US it's
| possible to doctor-shop and find someone who knows what
| they're doing--or who at the very least is willing to
| listen--but in European countries with single-payer
| healthcare you are entirely at the mercy of whatever doctor
| gets assigned to your case (yes, this isn't as bad in
| multi-payer countries such as France as it is in single-
| payer countries like the Nordics). And in some cases, the
| barriers aren't even the competencies of your individual
| doctors but institutional requirements doctors are legally
| required to follow even if an individual doctor is
| competent. Mind you, there are some exceptions: in parts of
| Spain and in much of Southeast Asia, for example, a good
| amount of medications that are Rx-only in most other
| countries are available over-the-counter, so at least you
| can self-med if you've put in the exhausting effort to
| research your own condition and figure out what you need
| (and even then, good luck getting blood tests to confirm
| your dosage is appropriate).
|
| This isn't an endorsement of the US healthcare system, just
| an acknowledgement that the shit sandwich offered in the US
| has slightly less fecal content than the shit sandwiches
| offered in many other countries.
| cjbgkagh wrote:
| At least with socialist medicine doctors will gaslight you
| for free.
| AuryGlenz wrote:
| If you go to the Mayo Clinic in Minnesota you'll see people
| from all over the world for a reason. It feels like the UN,
| where everyone has some sort of debilitating disease.
|
| They have a system where you get evaluated by a general
| practitioner (or someone more relevant), and then they
| schedule you to see however many specialists you might need
| to see - all within a day or two.
|
| It's not perfect, and I've found it's still hard to get
| them to drill deep on anything not life threatening or
| obviously testable. That said, I very much doubt that
| system exists anywhere with socialized medicine. You don't
| need a referral or anything else to go. You just call and
| make an appointment.
| blakesterz wrote:
| I'll second the Mayo Clinic. I've (unfortunately) spent
| way too much time there, and it just can't be beat. I
| wish every hospital/doctor/system worked like this place.
| I doubt that's even possible, anywhere, but from my
| experience, it's how medicine should work.
| albrewer wrote:
| I recently had to make an emergency visit to a hospital
| in a major city, with a really weird presentation.
|
| Within 45 minutes of arrival they had figured out what
| was immediately wrong and had me hooked up to an IV drip
| of stuff to fix it. An hour later, a specialist for my
| issue came and talked to me about the problem and had an
| idea for a root cause. I was held overnight for
| observation and had several more tests run; by the time I
| left the next morning I had a root-cause diagnosis and a
| prescription to fix it.
| AlbertCory wrote:
| "IV drip" - that rang a bell. 25 years ago I was admitted
| to a hospital with severe abdominal pain. They had a
| surgeon who was preparing me, mentally, for a temporary
| colostomy. Fortunately, that IV drip fixed me up within
| half an hour.
|
| Those antibiotics, man. They work.
| csa wrote:
| > is this the supposedly high quality treatment that U.S.
| citizens get that is so much more expensive as opposed to
| the ,,socialized" insurance we get in Europe
|
| I am an American who has lived in several countries and had
| experience several medical systems.
|
| The US has the best care... if you have access to it. This
| access can be limited by geography, insurance, money,
| awareness of the specific doctor, etc.
|
| In a random provincial area with no university medical
| school nearby, the treatment will often be quite sketchy.
|
| In other countries I've lived in, the best medical care was
| still in the large cities, but the standard in provincial
| areas was to a much higher standard (imho) than in
| provincial areas in the US.
| albrewer wrote:
| In my experience the quality varies wildly, but every
| doctor has a base level of knowledge that is far deeper
| than a layperson. The quality of that knowledge is usually
| very high, and seems to be pretty well retained by most
| doctors I've met.
|
| The quality of the actual doctor varies on whether the
| doctor is a lifelong learner, a deep thinker, a good
| listener, is good at extracting information from people who
| are bad at introspecting how they feel, and communicating
| with people whose language skills and mental capacity are
| far below or above their own. They also leave out their
| personal biases about "what" the person they're treating
| might be (drug seeker, hypochondriac, malingerer, etc.).
|
| If you visit a doctor and they don't have the ability or
| time to execute those non-medical training qualities, then
| you get a bad doctor.
|
| The main issue is that the good doctors usually go to
| desirable places to live. This is often not in rural or
| even suburban areas of the country, and that's typically
| where the bad stories come from (adjusted for population
| density anyway - lots of stories from cities too but there
| are more people in cities).
| ipaddr wrote:
| Most have knowledge of what they studied in college and
| what worked over the years and by worked they mean did
| not get sued, made the most money on and worked quickly.
|
| They are not paid by outcome they are paid by referrals,
| tests, drugs sold and consulting
| ironmagma wrote:
| Depends on which doctor you are going to. We have some of
| the world's best doctors but they might be in hospitals or
| doing a concierge service. You get what you pay for.
| Afforess wrote:
| > _You get what you pay for._
|
| But you don't... that's the whole problem with the
| American Healthcare industry!
| derefr wrote:
| No, with the American health system, you do _get what you
| pay for_ (i.e. more money = access to better medicine);
| but you _don't_ necessarily _pay (the right amount) for
| what you get_ (i.e. !(worse medicine = costs less)).
|
| Which is to say: standard-of-care treatments can cost far
| too much relative to other countries; but also, if you're
| willing to throw millions of dollars at private clinics,
| you can opt your own way into experimental treatments
| that don't exist anywhere else in the world.
| [deleted]
| ipaddr wrote:
| This is also Canada with even more socialized medicine
| compared to Europe.
| nick__m wrote:
| The Canadian system (well the one in Quebec anyway, each
| province manages it's own system so I cannot tell about
| the other province. Hell, I cannot even tell about the
| one in other administrative regions inside Quebec) has a
| big luck component.
|
| If your lucky enough to have an accessible primary care
| physician who personally knows specialist and lives where
| there is a University hospital center, the system is
| awesome. If you don't, the system appears to be a special
| kind of administrative hell.
| AussieWog93 wrote:
| >The rest of the American medical system? Gatekeepers that
| block access to potential treatment pathways until you can
| convince them it's worth a try.
|
| It's not just America. We have exactly the same issues here in
| Australia.
| DrBoring wrote:
| In my experience as a software developer, I've grouped my peers
| into a few different categories. This is just a rough estimate
| based a small sample set, there are probably various gradients
| in-between.
|
| 1. Super coders: These are the coders who write the algorithms
| that pave the way for coders below them.
|
| 2. Natural coders: Competent coders who take to the craft
| easily. Can easily learn new things, but probably won't be
| designing the next great video codec. (I fall here)
|
| 3. Amateur coders: that somehow got hired. These are the coders
| that you curse because you're always cleaning up after them.
|
| ...
|
| I have a theory that the same medical professionals have
| similar categories. This theory was first formed when I once
| saw a doctor who, on my first visit, regaled me with stories of
| taking Uber into the city for a night of drinking.
|
| I'd put this guy in the lowest category of medical
| professionals. He's there to make money by providing a service
| with little regard for the long term outcomes of his patients.
|
| There is more to the ranking than his crass unprofessional
| behavior. Upon leaving the appointment, I was given a card with
| a request that I rate him on some rate-my-doctor.com ... It had
| the same slimy feeling as one of those "give us 5 stars" cards
| found inside the box of many product sold on Amazon.
| awinter-py wrote:
| ugh yes re gatekeeping -- _maybe_ there 's an argument for
| requiring a prescription for some treatments, but at least in
| the US it's illegal for patients to self-order _diagnostic
| testing_. the new york AG sued a lab for doing walk-in blood
| tests without a prescription
|
| 'didn't accept insurance' is interesting -- in the econtalk
| episode with the surgery center of oklahoma, the guest claims
| that he's able to offer better medical outcomes by being out of
| the insurance system, and implies that billing things at a
| mainstream hospital has become so hard that it consumes more
| mental cycles than medicine
|
| it seems like the medical system as-is isn't the right service
| for people who are fighting the system to get a diagnosis; I
| wonder if there's a different model that would work better
|
| or tbh a specialized concierge doctor that just prescribes
| things that you ask for
| AuryGlenz wrote:
| For anyone reading this, I've found good success in printing
| out actual studies or other relevant literature and bringing it
| to the doctor. It lets them know that while you've done your
| own research, it wasn't stupid YouTube research.
| cupofpython wrote:
| >I can't count on doctors _at all_ to move the process forward.
|
| This has been my experience as well dealing with fatigue. I was
| 25 when I finally got diagnosed with sleep apnea, after over a
| decade of symptoms. How something so common could go unnoticed
| by the adults and professional doctors in my life astonishes me
| still today.
|
| Eventually, thanks to ego, I questioned the narrative that I
| was just normal and lazy. Without the internet, I might not
| have ever learned that sleep studies even exist.
|
| I was more than half-asleep for all of my schooling, college,
| and early professional years. I've spent the last 5+ years
| trying to catch up.
| jrockway wrote:
| I think the situation has improved there in the last couple
| years. I had a friend who I suspected of having sleep apnea.
| She called her doctor and asked for a sleep study. They gave
| her a device to wear while sleeping and the diagnosis of
| sleep apnea came the next day.
|
| Getting insurance to approve the CPAP, though... that is
| still an open problem. Weeks later, no treatment for
| diagnosed disease.
| cupofpython wrote:
| >I had a friend who I suspected of having sleep apnea. She
| called her doctor and asked for a sleep study
|
| It doesnt sound like the situation has improved. Without a
| friend like you, would she have received treatment?
|
| I think _the community_ has gotten better at addressing the
| undiagnosed sleep apnea epidemic. When I needed help, there
| were some discussions about it on forums that I could find
| with the right search terms. Now, it 's become much more
| common knowledge on the internet that people can spot it in
| others. which is fantastic.
|
| The Doctors still seem to suck at it. For starters, fatigue
| is possibly the single most common symptom of disease - and
| is not something proactively asked about by doctors (in my
| experience). Every doctor at every check in should be
| asking "How tired have you been?". The fact that you can
| notice apnea in your friend before trained professionals
| even suspect to ask about it is the problem.
|
| And the bigger problem is that even if we address this for
| apnea, how are we to know how many other issues are going
| around waiting for the patients to bring it up themselves?
| I certainly no longer trust that proactive diagnostic due
| diligence is being done on anything other than blood test
| result levels.
|
| Doctors rely on patient complaints to govern their
| behavior. full stop. Check-ins and physicals are way more
| superficial than most patients understand, imo. Still very
| helpful, but not nearly enough
| jrockway wrote:
| Yeah, you're right that doctors kind of missed this.
| Sometimes I wonder how many questions they ask
| (depression is what she was being treated for with little
| success) and how much is volunteered.
|
| I happen to enjoy reading NTSB accident reports in my
| spare time, and they're always sleep apnea, so it was at
| the top of mind when I heard things like "headache every
| morning" and "I randomly fall asleep on my couch". I
| didn't go to medical school so I'm not sure if those are
| anxiety/depression symptoms, but a sleep study sounded
| like it wouldn't hurt. You're absolutely right that
| doctors should at least be asking these questions ("how
| tired are you", there is even a scale with more specific
| questions).
| avgDev wrote:
| I'm not sure what your friends financial situation is but
| maybe try to collect some money for her and buy one? I
| googled that the average cost is just under $1k for a CPAP
| machine. If it could change her life then maybe should
| could even pay it back one day.
| cupofpython wrote:
| I second this. Absolutely pay out of pocket if insurance
| drags their feet. I spent $5k on a mouthpiece for my
| treatment and would do it again.
|
| It is far from an ideal solution, but in the 3 months it
| takes insurance to get their shit together - your friend
| could have the energy to work a side job to pay off
| whatever it costs and just be generally happier overall
| jrockway wrote:
| OK good advice, did not know that was an option.
| kromem wrote:
| On the other hand, I just had a lengthy conversation with my
| dad on why he shouldn't drink chlorine dioxide, and that a
| Bitchute video from a guy who got a "doctor's of philosophy of
| medicine" from a diploma mill who had a patent application on
| drinking it to cure COVID, was selling books and lectures on
| his crockpotery, and had charges brought against him for two
| deaths resulting from drinking the thing might not be the best
| authority on the topic.
|
| For people that are very good at research, self-advocacy and
| research is absolutely a night and day difference from just
| going in to the doctor for 15 minutes and being rushed through
| the system. If not for that in my own chronic health condition,
| I'd be on immune suppressants right now vs a much lighter
| treatment regimen in conjunction with generic/supplements
| supported in limited academic research abroad (the funding bias
| in research for patented vs generic/non-patentable treatments
| is its own topic).
|
| But that's not the majority of people, and far too many think
| that they are capable of "doing their own research" when they
| aren't equipped to do so at all.
|
| Particularly when it comes to medicine, that's a dangerous
| misconception, and Dunning-Kreuger is actively killing people
| who can't discern between snake oil and a meta-analysis.
|
| So many of the people doctors are dealing with that are
| Googling ARE idiots who endanger themselves with their
| 'research.' Which sucks for the people who are actually good
| researchers and dealing with biases towards self-research.
|
| Though in my experience, typically good doctors very quickly
| realize you're adequate at research and work with you as a
| treatment partner, and it's the people like my dad who will
| fight against actual research efforts in a quest for
| confirmation bias.
| jonhohle wrote:
| Are there any laws that treat medical providers as fiduciaries?
| That seems like a minimum bar that insurance companies would
| want to enforce (at least in the short term when premiums could
| remain high while treatment cost plummets).
| jmuguy wrote:
| Well theres the hippocratic oath, but maybe thats little
| comfort.
| ProjectArcturis wrote:
| You can sue them for malpractice, that's something, at least.
| But I can't imagine how bad a doctor would have to be before
| they were subject to criminal charges. Simply being awful at
| their job wouldn't do it.
| erikerikson wrote:
| Insurance companies in the U.S. are barred, I think
| universally and definitely broadly, by state law from being
| too profitable. The outcome you describe would result in
| returned premiums or other profit sinks.
| anotherman554 wrote:
| A doctor's job is to worry about your health, not not how
| wealthy you are.
|
| Quite literally. If a more expensive treatment has a better
| chance of saving your life, or a more expense test has a
| better chance of detecting a disease, the Doctor could be
| sued for malpractice for not ordering it if you die.
| rr808 wrote:
| I have noticed the same. My wife has some chronic problems. I
| figured going to a specialist would be able to give some good
| advice. For a few thousand in fees you'd think the hospital
| would be able to give you a book or at least a link to some
| reputable websites, instead we got a photocopied page and told
| to google it.
| the_only_law wrote:
| At what point can I just purchase old medical machinery on eBay
| and run my own blood tests and stuff.
| bsuvc wrote:
| No need to buy the machinery, unless you really want to.
|
| You can order your own tests right now from LabCorp and
| Quest, through sites like requestatest.
| andrem wrote:
| Does anyone know of EU based alternatives to the above?
| Dma54rhs wrote:
| What do you mean? There are always private places where
| to get tests done. Synlab is one of the biggest in
| Europe. Or you mean to take them at home?
| lmt55 wrote:
| Yes, social democracy and the welfare state.
| xeromal wrote:
| This isn't a helpful answer.
| xeromal wrote:
| Labcorp is fantastic. I do my own yearly checkups through
| them. You can pay 100-200$ and get a comprehensive panel
| done on you even checking your testosterone or estrogen
| levels. You can pay a few bucks and have a doc review your
| results too or you can give them to a teledoc to review
| that most insurance providers have.
|
| I hate going to the doctor's office to have them order a
| panel so that I can go to a labcorp and have the doc call
| me and say everything is good. It's all free but my time
| isn't.
|
| Going directly to labcorp bypasses everything and they give
| me the results to review myself.
| ydant wrote:
| LabCorp and Quest both have their own products for this,
| too:
|
| https://www.ondemand.labcorp.com/
| https://questdirect.questdiagnostics.com/
|
| Which are just a wrapper for asking one of their in-house
| doctors to prescribe you the test you requested, without a
| real review of your need or the actual potential benefit
| for you in doing so. So it technically meets the letter of
| the government requirements for medical tests, but not
| necessarily the intention behind restrictions around tests.
| gnu8 wrote:
| The cost and bureaucracy required to get one working will
| probably kill this idea. Those machines require consumables
| to run the tests, as well as for calibration and QA. The
| vendor might be willing to sell you the supplies and send a
| technician to get the machine set up to run a valid test, but
| it won't be cheap, and they might be unwilling if it's some
| guy trying to run the machine in his garage rather than a
| medical facility. Beyond that, there is a reason that the
| machine is on eBay and not being sold or donated. It could be
| obsolete and the supplies unobtainable, or simply beyond
| economic repair.
| sgerenser wrote:
| I hear you can get a good deal on "Edison" branded blood test
| machines. Questionable reliability though.
| xyzzy123 wrote:
| Yes but I heard they were invented by a genius so that's
| something!
| politician wrote:
| The gatekeeping these incompetent doctors do is infuriating.
| If I want a random blood test, why do I need to pay a doctor
| for to order the test from the third party lab. They add
| nothing to the process except frustration and expense.
| amyjess wrote:
| From my experience, in most states you can order whatever
| tests you want from Private MD Labs and just walk into any
| LabCorp location and get your blood taken and a PDF of your
| results emailed to you within 24 hours.
| mindslight wrote:
| I hate to be so negative, but it's likely that by the time
| you have significant medical conditions to worry about, you
| will no longer have the time/spirit to engage in such
| productive playing.
| TheRealDunkirk wrote:
| I have been struggling with what I have come to understand is a
| very rare neurological condition, which I've had for over a
| decade, but which became chronic just over a year ago. I liken
| my process over this last year to being a general contractor of
| my health, hiring migrants at the Home Depot parking lot for
| the day.
|
| I've been through 8 doctors now. I've had 4 specialists in
| different areas tell me that there was nothing they could do
| for me, and just leave me hanging, without even giving me an
| idea of what to look at next. The only reason I've been able to
| get any help was because my wife just happened to stumble on a
| couple of doctors (who work together) by researching my
| symptoms online. Luckily, the last two have identified my
| problem, confirmed the diagnosis, and one of them just operated
| on my back a week ago.
|
| During this year, I wasted time, health, and money on a surgery
| I didn't need, and which the specialist who performed it SHOULD
| have known wouldn't help. I can't help but think that he saw an
| opportunity to do a surgery, covered by my full-blown,
| "Cadillac" insurance plan, that _might_ have helped, and he
| took it.
|
| Now I've had an experimental surgery (i.e., uncovered by
| insurance), and two trips to California. I figure I'm running
| about $30,000 out of pocket on this whole fiasco. The good news
| is that the surgery seems to have been a success, but I won't
| know for sure for 3 to 6 months. Maybe even a year.
|
| > I can't count on doctors _at all_ to move the process
| forward.
|
| My feelings directly echo this. No one in this process is
| responsible for my overall HEALTH. I'm old enough to remember
| that it didn't feel like this. Your PCP would have been the
| "general contractor" several decades ago. Now, all anyone cares
| about is selling me a service, and then getting paid. And my
| PCP is notorious for trying to upsell me (per the FA) and get
| me to do tests and labs that I don't need.
| adolph wrote:
| > In reality, the doctor's responsibility is being pushed to
| the patient
|
| In reality, your choice is your responsibility. Even if one
| could delegate medical power of attorney to a health care
| provider, it would be unethical for them to hold a dual role.
|
| Chronic conditions that are not well characterized and
| addressed by medicine are awful and as you said are a combined
| burden: the condition in of itself and the effort necessary to
| address the condition. The science and practice cannot progress
| fast enough to address the long tail of rare disease.
|
| _Informed consent is a principle in medical ethics and medical
| law that a patient should have sufficient information before
| making their own free decisions about their medical care. A
| healthcare provider is often held to have a responsibility to
| ensure that the consent that a patient gives is informed, and
| informed consent can apply to a health care intervention on a
| person, conducting some form of research on a person, or for
| disclosing a person 's information. Informed consent is, in
| fact, a fundamental principle in the field of health
| protection, obviously wanting to mark the very close and
| unavoidable connection between the need for consent and the
| inviolability of the right to health._
|
| https://en.wikipedia.org/wiki/Informed_consent
| raxxorraxor wrote:
| If you have something exotic you are basically on your own.
| Maybe you live outside the city where a doctor knows every
| patient by name and is really invested in research or you find
| a clinical study that might align with your conditions, but
| chances for that latter are extremely low.
| brimble wrote:
| Can confirm. They paint people who google symptoms as kooks or
| as annoying, but you _have to_ if you ever want to get an
| actual diagnosis and treatment, because doctors and hospitals
| are, quite often, _worse than Google_ at figuring out WTF is
| wrong.
|
| Do your best not to end up in a hospital without an advocate
| (friend, relative) watching out for you. They'll fail to treat
| you at best, then discharge you with a shrug and a huge bill;
| and they'll kill you with mistakes, at worst.
| JKCalhoun wrote:
| I thought expert systems were supposed to replace diagnosis,
| like three decades ago.
| loup-vaillant wrote:
| In an April's fool story where Eliezer Yudkowsky was
| pretending to come from a rationalist parallel world (or
| outer planet), he suggested a medical system with a
| different way to specialize people.
|
| Most notably, he suggested we separate _diagnosticians_ and
| _prognosticators_ from _practicians_. The former do their
| best to guess what you have, send you to the right kind of
| practician, and estimate your possible outcomes (with
| probability distribution and Bayesian goodness and all).
| Then whatever practician you chose do their best to treat
| you.
|
| Separating prognosis from practice allows us to have a
| system where prognosticators are rewarded for their
| accuracy and calibration, and practicians are rewarded for
| their outcomes _relative to prognosis_. Being good doesn 't
| mean having better outcomes, being good means having better
| outcomes _than predicted_.
|
| I'm not sure how well this system would work in practice,
| and there may be a huge problem with eliminating the short
| feedback loops we can have between diagnosis and practice
| when they're the same person. What should be a nice
| separation of concern may turn into a communication
| nightmare.
|
| Nevertheless, it is possible that specialised
| diagnosticians may be better than any expert system.
| sharno wrote:
| This seems to make sense to me as a better medical
| system.
| thaumasiotes wrote:
| We have the same problem in education; we've stupidly
| combined certifications (diplomas) with instruction. This
| is a huge conflict of interest for the schools.
| cupofpython wrote:
| I only support this if I dont get charged for 2 visits
| rhexs wrote:
| The interesting part about this is that you'll also likely
| see a NP or physician's assistant, who, at best, "google"
| (uptodate) your symptoms if the case isn't obvious. Sometimes
| doctors will do the intake appointment and fail to tell you
| that any follow-ups are done with their "trained" NP.
|
| And then be billed 400-800$. Such an incredible system!
|
| I also gave up going to physicians with a chronic illness.
| They're in and out in five minutes, and just ramble off the
| top two treatments from uptodate. If it's a surgeon, they'll
| try to sell you on surgery or a diagnostic procedure to "re-
| validate" the diagnosis (conveniently to generate a trivial
| 10K for the hospital in a few hours). If you want anything
| beyond that or to have a discussion, good luck.
| throwawayboise wrote:
| Yep, same.
|
| I only go to doctors for injuries or other clear, specific
| problems.
| chasd00 wrote:
| i never go under without someone there with me. My father was
| almost killed twice be incompetent nurses double dosing IVs
| and other things. My mother, an RN herself, watched him like
| a hawk every time he was in the hospital to keep the staff
| from killing him.
|
| Another anecdote, my sister worked at the front desk in some
| department ( she was an admin and not a nurse) and a patient
| coded but came back by themselves. Only afterwards did the
| nurses realize they were marked "do not resucicate" by
| mistake!
|
| i do not trust hospitals at all.
| majormajor wrote:
| A hospital isn't the place to be unless you have a specific,
| acute need to be there.
|
| They're looking to stabilize you and get you able to survive
| outside the hospital, not to solve a mystery.
|
| Great place to go if you need it, though. Got internal
| bleeding? Get that taken care of. The risk of a debilitating
| or fatal hospital error isn't that high, so absolutely go
| when the risk of not going is high.
|
| TV, though, has trained us to expect to get everything
| figured out and root causes solved too. Unfortunately, that's
| just not realistic _even if many of the complaints in this
| thread were solved_. There are a lot of nasty rare diseases
| and conditions, and strange manifestations of conditions,
| that will still be missed if they have 60 minutes with you
| instead of 8.
|
| You should also realize that doctor quality varies as much as
| any other skill. _SHOP AROUND._ I 've had better luck with
| second, third opinions than I have trying to pester an
| original doctor into changing their mind. There are doctors
| out there who _appreciate it_ if you bring up a written self-
| history of the condition, the strange aspects or other things
| that may or may not be related, what has or hasn 't worked so
| far, etc.
| [deleted]
| FollowingTheDao wrote:
| I was misdiagnosed with Bipolar Disorder for 30 years. Turns
| out it was Neuropsychiatric Lupus. Despite all my pleading to
| them to look further they never did. I had to teach myself
| biology and genetics while I was on disability. They missed
| all the common signs of Lupus; my skin, bad kidneys, etc.
|
| I am afraid all this technology is taking away all of our
| wisdom. Too easy to know things, very hard to understand
| them.
| nebulous_two wrote:
| Your fear is as old as time. The act of writing was
| considered a threat to human memory capacity and therefore
| wisdom too.
| throwamon wrote:
| This argument keeps being thrown around but it's pretty
| clear to me that this time it's actually different. Every
| new attention-grabbing invention is more potent than the
| last, and the Internet just might have crossed a
| threshold where it can actually break us on a large
| scale.
| FollowingTheDao wrote:
| You are assuming I believe that writing was not a threat
| as well, albeit a slower one. But here we are, because of
| all that reading and writing.
| AuryGlenz wrote:
| My dad almost died in the 90s because they couldn't
| diagnose his lupus.
| FollowingTheDao wrote:
| Sorry. Yeah, my mother suffered her whole life with it
| and never new it. She was in a wheelchair for the last 10
| years of her life with all kinds of issues. It was our
| kidney issues that tipped me off. That is the reason I
| went into the genetics, because she, and several other in
| my family have the same issues.
|
| If anyone is interested, it seems it is partly (mostly?)
| caused by a Purine nucleoside phosphorylase deficiency.
| (PNP gene)
|
| https://pubmed.ncbi.nlm.nih.gov/28859258/
| bryanlarsen wrote:
| Lupus is really hard to diagnose. There's a reason that
| ends up being the diagnosis on pretty much every episode
| of House M.D.
|
| Doctors generally see 6 patients an hour, and have 5-7
| minutes of paperwork per patient. The remaining 3 minutes
| gives enough time to diagnose the obvious, but not much
| else.
| FollowingTheDao wrote:
| It is not hard to diagnose once you eventually get to a
| person that can diagnose it. You said it yourself. It is
| not about difficultly, but time spent with the patient.
|
| But I literally showed my doctor the cutaneous lupus in
| my ear and she said "Oh, some people just get gunk in
| their ears" and would not send me to a rheumatologist.
|
| The slow diagnosis is because the specialists are so
| reluctant to see people. Right now I am on a six month
| wait to see a rheumatologist. Why? Capitalism.
|
| https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7255118/
| mmcdermott wrote:
| > The slow diagnosis is because the specialists are so
| reluctant to see people. Right now I am on a six month
| wait to see a rheumatologist. Why? Capitalism.
|
| This remark seems somewhat lacking in rigor. I know
| bagging on capitalism is a common reflex, particularly in
| medicine, but something more is almost certainly going
| on.
|
| The default thought process for a retailer is to move
| units. A lawyer wants to rack up billable hours. A
| subscription service wants more subscriptions.
|
| So why would a specialist look for fewer cases? There is
| almost certainly a perverse incentive involved, because a
| competitive market would usually prompt a service
| provider to accept business and grow with demand.
| leksak wrote:
| Specialists are hard to get a face-to-face with even with
| socialized medicine (personal anecdote from Sweden). I
| assume that one thing that transcends national borders is
| that unless your symptoms suggest anything life-
| threatening care will be administered in accordance with
| heuristics. The most probable diagnosis is set, and it is
| assumed that a patient will return if things does not
| improve.
|
| However, failing to communicate to a patient that a
| diagnosis is provisional might serve to undermine their
| faith in the healthcare system leading to periods of
| fatigue wherein one doesn't have the self-efficacy to
| continue seeking care if things haven't improved even if
| quality of life is severely impacted.
|
| From my limited understanding of the US healthcare system
| I'd imagine you don't want an excess of cases because
| each case
|
| 1. Is a responsibility, and thus a liability, and 2.
| every patient your staff needs to accommodate is draining
| (risk of overwork).
|
| If that would apply to a country with socialized medicine
| I imagine that Item 1. receives significantly less
| consideration but that Item 2. is still very much
| considered. If a unit isn't a first-line care-provider
| they can in theory be a bit more guarded about who they
| receive, while first-line just has to bear whatever comes
| through the doors.
|
| I feel as if I'm shifting to a different point of
| discussion but I still struggle not to mention the fact
| that a specialist may not be readily at hand depending on
| what city you are in.
| throwawayboise wrote:
| Specialists are called that for a reason. They are not
| general practitioners and their time is extremely
| valuable. Access to them needs to be managed so that they
| do not waste their time on people who do not need their
| specialty.
|
| The way it's supposed to work is that the general
| practitioner rules out a bunch of stuff, and then starts
| referring to specialists who can diagnose/treat the rare
| things.
|
| In practice it's not quite perfect, but it's hard for me
| to think of a better way to deal with it.
| FollowingTheDao wrote:
| > The way it's supposed to work is that the general
| practitioner rules out a bunch of stuff, and then starts
| referring to specialists who can diagnose/treat the rare
| things.
|
| You missed a whole bunch in that progression. You forgot
| the insurance companies for one thing.
|
| And you are wrong about the diagnosis process for Lupus.
| My Primary Care gave me the worst test for diagnosis ANA
| levels for Lupus. It came up negative. Therefore, I could
| not see a rheumatologist even though I had documented
| (MRI) spinal arthritis, kidney problems, and all the
| other symptoms.
|
| When I found out it was a bad test I demanded they did
| the correct one it came up positive. So you see, when
| they do not know what is going on, the give up. They do
| not dig deeper. The process is a failure for people with
| chronic illnesses.
|
| The better way to deal with it is to have fewer
| specialist, get rid of insurance companies, and just have
| more doctors that can spend more time with their patients
| and learn more in the process. Primary care doctors need
| to know more and investigate more.
|
| And the only reason specialists time is extremely
| valuable is because they make sure there are not a lot of
| them.
| JamesBarney wrote:
| There are too many patients and not enough doctors. This
| isn't caused by capitalism, capitalism doesn't limit the
| # of doctors. Becoming socialist doesn't magically allow
| doctors to see patients for twice as long. If we had
| socialism more people could afford doctors(a good thing!)
| but it would make this specific problem worse, because
| there would be more patients. This is caused by the AMA
| lobbying to limit the supply of doctors in order to drive
| up salaries.
|
| It's why we have this.
|
| United States - $316,000 Germany - $183,000 United
| Kingdom - $138,000 France - $98,000 Italy - $70,000 Spain
| - $57,000 Brazil - $47,000 Mexico - $12,000
| FollowingTheDao wrote:
| It's funny you say this has nothing to do with capitalism
| but all the countries you listed have largely socialized
| medicine.
|
| Once capital gets power it uses a government to enforce
| that power.
| JamesBarney wrote:
| Roughly a third of our healthcare spending is socialized
| medicine, and Medicare and Medicaid have the same issues
| we do.
| FollowingTheDao wrote:
| 1/3 < 3/3.
|
| We do not have anything close to socialized medicine.
| Vecr wrote:
| I don't understand what you mean, not being universal
| does not have any bearing on that. The care is paid out
| of taxes.
| FollowingTheDao wrote:
| I am on Medicare. Because it is not universal means it is
| only partly socialized and still operating inside of a
| non-socialized system. Why does this matter? I cannot get
| any doctor I want, only the ones taking Medicare, which
| are fewer and fewer, because they would rather only take
| people on private insurance.
|
| In France for example you can walk into any doctor and
| they will see you.
| AussieWog93 wrote:
| I live in a country with (mostly) free health care and we
| have 6-month wait lists too. Same shit in the UK, who
| invented the NHS.
|
| Please stop blaming every problem on your ideological pet
| peeve. Society is too complex for every single issue to
| be caused by capitalism, financialisation, the patriarchy
| or systemic racism.
| thaumasiotes wrote:
| The book _M.D.: Doctors Talk About Themselves_ actually
| interviews someone who discusses this problem, and
| inadvertently illustrates a problem American policy ran
| into.
|
| The interviewee says that the Reagan administration tried
| to drive down the cost of health care by increasing (as
| opposed to, say, lifting) the quota on production of
| doctors, with the idea in mind that more supply of
| doctors would drive down costs. And he goes on to say
| that the idea backfired by _raising_ medical costs.
|
| In the interviewee's mind, the problem is that doctors
| can "make their own work" -- with more doctors around,
| more medical care can be performed than was possible with
| fewer doctors, and so the cost of health care went up
| instead of down, making the policy a mistake. That is the
| beginning and end of his analysis.
|
| No one asks whether the cost of particular treatments
| went up or down. If total national spending on health
| care went up, the policy is supposed to have been a
| failure.
| throw10920 wrote:
| > This is caused by the AMA lobbying to limit the supply
| of doctors in order to drive up salaries.
|
| This. _This_ is the problem - not the vague spectre of
| "capitalism" being waved around.
| FollowingTheDao wrote:
| Since when do salaries have nothing to do with
| capitalism?
| JamesBarney wrote:
| The Soviet Union had wages to, and far worse problems
| with shortages then capitalistic countries have ever had.
| [deleted]
| jacobr1 wrote:
| The presumption is that under a "free market" the demand
| would drive more production - more doctors. But that the
| rules of the current system artificially restrict the
| supply of doctors. Some of that we want - credentials
| clearly serve a purpose - yet are the rules more
| restrictive than they should be? Should there be more
| residencies? Should we have more "lower-level" providers
| like nurse-practitioners, PAs or pharmacists that can
| prescribe? There is limited ability for the market to
| innovate in such a regulated environment.
| WalterSear wrote:
| Since people refuse to see regulatory capture as an
| unavoidable feature of capitalism.
| bryanlarsen wrote:
| Lupus is a broad category of auto-immune diseases. Some
| are easier to diagnose than others. It sounds like yours
| was one of the easier ones. Easier, but not easy! Many
| Lupus diagnoses rely on differential diagnosis. AKA
| eliminate every other possible diagnosis and if they all
| are negative it must be lupus.
| tyrfing wrote:
| > Right now I am on a six month wait to see a
| rheumatologist. Why? Capitalism.
|
| Typically that's anti-capitalist: there are very strong
| government and regulatory limits on who can perform the
| services, and for self-serving reasons, they maintain
| shortages of supply. The free-market capitalist solution
| would be for prices to rise to a point where supply and
| demand are balanced, either by supply increasing (people
| switching fields), or reduced demand from prices rising.
| mindslight wrote:
| Doctors love to mockingly call this "Doctor Google" and
| reject anything mildly technical that you read on your own,
| even if you're just trying to have an open discussion and not
| push a diagnosis. I think the underlying dynamic is that
| doctors had one of the early monopolies on "knowledge work"
| and have never adapted their ways [0]. And so they're not
| used to having to engage with other's ideas, in stark
| contrast to the open collaboration we're used to in the
| engineering/scientific world.
|
| [0] srsly if I'm understanding some recent hospital records
| correctly, they still mostly work by verbally dictating at
| subordinates who transcribe for them. And they spend most of
| that dictation simply reciting the patient's known condition.
| Compare with programming where the working set is openly
| displayed on the screen (modulo scrolling), and then our
| contribution is only that of making changes.
| dillondoyle wrote:
| Feel this.
|
| Spent $500 for a pointless MRI.
|
| I have some specific domain knowledge on my injury (very
| sport specific) but obviously have not spent 10+ years in
| school studying hand surgery.
|
| But I did read and send AND tell/ask in my appoint real
| specifically relevant med publications saying the only way to
| see what I wanted was an ultra sound under stress.
|
| My PT also said this. But not a 'real md.'
|
| So I had to pay and sit through an uncomfortable MRI for
| nothing. And never got the ultrasound. Should have just said
| no thanks.
| asdff wrote:
| To be fair, the vast majority of patients they see who do
| bring in their own sources _are_ probably the kooks. Just
| look at the state of national discourse on any topic related
| to science. The number of people within the intersect of the
| venn diagram of "able to interperate the relevant
| literature", "has time to interperate the relevant
| literature", and "doesnt trust the doctors ability to
| interpretate the relevant literature" has to be remarkably
| small.
| arbitrage wrote:
| You experience is similar to mine. It goes even further than
| that, though. I have seen the relief in a specialists eyes when
| I present them with research and tell them the decision that
| they should make for me. I am essentially designing my own
| treatment and care plans. I am not a medical professional, nor
| have I any training, either.
|
| The United States' healthcare system is fundamentally broken.
| As it stands, it's probably completely irreparable, as well.
| refurb wrote:
| I live in a system where doctor's aren't questioned, everyone
| just assumes they get the best care. It's terrible because
| people get sub-optimal care.
|
| Patients who are proactive in their own treatment are a
| positive, not a negative.
| gravypod wrote:
| To add some more anecdata: I've been going to a local clinic by
| where I live (a very poor area) for a little while. Some time
| ago I had a full blood workup on intake and it turned out my
| liver enzymes were out of range by like 5% of the standard
| deviation. They were in range for what the NHS said was normal
| for someone in their 40s and I'm in my early 20s.
|
| I took this seriously and made some changes. I went back for a
| follow up I had scheduled for 6 months later. I met with a
| different doctor this time and she looked at my charts, asked
| why I was here, I explained I fasted over night and wanted to
| take a liver function test and I needed her to order one. She
| argued that "It's fine, you're not even that over the maximum!"
| and "Do you feel pain? If not you're fine."
|
| From my research there are both completely false statements
| when it comes to increase in this enzyme at my age range.
| Everyone said that if they see an increase in 6 months that's a
| sign of a larger issue and it's worth getting the test since
| your insurance would cover it (which mine did) just to be safe.
| After telling her I wasn't leaving until she ordered the test
| she opened her laptop to enter it into the EMR. I saw her open
| Google, copy "Hepatic" from "Hepatic Function Test" on my
| previous labs and then read the popup Google showed me out
| loud: "Liver.. ok good" and then order the test in the EMR
| again.
|
| Some doctors haven't got a clue. It's unpopular to say because
| it's a convenient fiction to think you will get good care from
| any qualified doctor but when one doesn't know what "Hepatic"
| means then I don't know what to think.
| Phrodo_00 wrote:
| > I can't count on doctors _at all_ to move the process
| forward. It's always me, reading articles on PubMed and coming
| up with ideas.
|
| This seems to be the case with most medicine. Doctors in the US
| don't seem comfortable making suggestions. I recently got
| appendicitis and at first they only offered an appendectomy as
| a thing I could do (or not do). I had to specifically ask for a
| recommendation to get someone actually recommend a path, and
| this probably is one of the most routine cases in an ER. Can't
| imagine having something more complex.
| vasco wrote:
| Even if a doctor spends a bunch of time on you, you should
| still do research. End of the day you're the person that cares
| most about your health in the whole world, why should you just
| leave it to a random expert with good intentions? If you spend
| time researching and come to them with detailed information
| about your symptoms, what you already ruled out and things
| you've tried, as well as a good understanding of your medical
| history, you'll get better treatment, either from a good or a
| bad doctor.
|
| I agree we should be able to rely on them more, but the point
| is to get a better outcome, and to do that, being an active
| participant in your treatment is a great option.
| rightbyte wrote:
| I care most about my car, house etc in the whole world too.
|
| The risk I guess is that being informed might make me want to
| overrule the experts. On a population scale the advice might
| be bad. Depends on how good the experts are.
| vasco wrote:
| So your opinion is that if research tells you that you
| should overrule a doctor's opinion, the right course of
| action is to not bring it up, not do the research in the
| first place, because the doctor "knows better"?
|
| In my opinion if you disagree or have doubts about
| treatment you should definitely bring those up with your
| doctor, see what they say about your reservations, and
| either get convinced or find some second opinion to
| increase trust in the expert opinion vs your own research.
| One thing I've learned from living with a doctor for
| several years is that an informed curious person on a very
| specific subject knows more than a doctor that has to know
| about a million things and probably isn't up on medical
| research papers. Your duty should be to bring up that
| research to your doctor and bring them up to speed. Once
| they read those they'll understand them better than you,
| but before... not a given.
|
| Discussion is always better than no discussion. Engineers
| get thing wrong all the time, but code reviews help. You
| should help your doctor to minimize mistakes rather than
| just accepting everything.
|
| Not only that, medical history is often wrong. I've often
| corrected previous notes to a new doctor - learning only
| then that the previous one hadn't actually understood what
| I had shared. There's a million ways in which your active
| involvement and care improve your outcomes.
|
| Another time I asked about several aberrations in an x-ray
| after a surgery, and the doctor admitted there had been a
| slight mistake during the surgery that chipped a bone, but
| that it wouldn't have negative consequences. He didn't
| bring it up until I asked.
| [deleted]
| rightbyte wrote:
| It easier to judge if someone sings good than to sing
| your self. I get your point.
| ryandrake wrote:
| Everyone's using that word in this thread: research.
| Watching a bunch of YouTube videos is not research.
| Browsing medical web sites and choosing "treatments" that
| are cleverly and subtly marketed to you is not research.
| Matching your symptoms with a TV ad is not research. We
| saw what two years of "dO yOuR oWn ReSeArCh!" left us
| with during a deadly pandemic.
|
| We're all dunking on doctors in this thread, but look at
| it from their perspective: They're probably sick and
| tired of patients coming in to their office saying "The
| TV told me: Ask your doctor about Provalanix!" And
| patients who googled "How to get your doctor to proscribe
| SSRI medication". And patients who insist they should go
| with their aunt's Healing Crystal Therapy. And patients
| who asked HN for medical advice[1] !! If you want to
| really do research, go get a medical degree and then do
| actual research in an actual academic institution.
|
| Yes, have a discussion with your doctor. Yes, ask him or
| her if you have concerns. Maybe even get a second opinion
| (from another real doctor). But don't think your keyboard
| is going to bring you to The Truth That Doctors Dont Want
| You To Know.
|
| 1: https://news.ycombinator.com/item?id=31098263
|
| EDIT: Right, the comment is not directed in particular
| towards its immediate parent, more in general at the
| entire thread.
| vasco wrote:
| Maybe you should reply to those comments instead. I
| mentioned:
|
| - reading medical research papers
|
| - bringing detailed information about your symptoms
|
| - mentioning things you ruled out and things you've tried
|
| - having a good understanding of your medical history
|
| I didn't mention ads on tv, youtube videos or HN
| comments. Perhaps you should reserve your outrage for the
| proper place.
| ipaddr wrote:
| The internet with the latest and most information
| available to mankind can be ignored?
|
| If someone gets information from video format they should
| be ignored?
|
| If someone came in and wanted to have a conversation
| about a medical product they recently heard about they
| shouldn't go to their doctor with questions?
|
| Sounds like someone is close to retirement or leaving the
| field with that attitude. Those are all valid concerns
| the general public may have. That's your job as a gp (to
| schedule appointments while patients tell you things you
| suggest your ideas).
| [deleted]
| toolz wrote:
| Sure, but if a professional breaks your car or house
| irreparably then they have insurance to buy you something
| equivalent or better.
|
| If a doctor breaks your body irreparably, it would seem
| there's a high probability that you have no recourse other
| than in rare situations you might get a settlement for some
| cash. Cash that won't fix your problem.
|
| My main point is that the risks aren't comparable at all.
| gtirloni wrote:
| _> being an active participant in your treatment is a great
| option._
|
| It's not a great but a necessary option, unfortunately.
|
| Better would be if they gave you a % of their salary in that
| case.
| ProjectArcturis wrote:
| Exactly. Your health is too important to be left to the
| doctors.
| petesergeant wrote:
| > Laser bacterial reduction (LBR) is just one example of the many
| high-stakes medical decisions
|
| Whether or not to drop $400 is not a "high-stakes medical
| decision". Also, expecting Google to give you high-quality
| medical advice when your actual, licensed, trained dental
| hygienest is not is asking a lot of a search engine.
|
| Personally I've found sticking "examine.com" on the end of most
| results to be very useful for anything supplement-related, and
| "reddit.com" as a suffix pretty good for anything else.
| acheron wrote:
| > Also, expecting Google to give you high-quality medical
| advice when your actual, licensed, trained dental hygienest is
| not is asking a lot of a search engine.
|
| This is true.
|
| > and "reddit.com" as a suffix pretty good for anything else.
|
| LOL. Our definitions of "high quality" are apparently
| different.
| elcomet wrote:
| high quality here means "genuine", ie discusions made by real
| humans and not corporate advertising.
| cyberlurker wrote:
| Unfortunately Reddit discussions can be made to look
| genuine when they are really corporate advertising.
| darknavi wrote:
| Certainly, although I find subject-based subreddits are a
| lot less tolerant of a lot of that BS.
| cyberlurker wrote:
| I don't have a source off hand but I definitely read an
| article about how Mods are routinely contacted by
| advertisers. I'm not saying every subreddit is a bunch of
| corporate shills but we are basically trusting unpaid
| volunteers to not take payments to look the other way.
| notamy wrote:
| > Whether or not to drop $400 is not a "high-stakes medical
| decision".
|
| This just feels out-of-touch. $400 on a medical decision is a
| MASSIVE choice for many people -- it could be the difference
| between whether not they eat.
| jcranberry wrote:
| It could be a high stakes decision but perhaps not
| necessarily a high stakes medical decision?
| Karawebnetwork wrote:
| It's still a laser focused at your gums based on limited
| studies. What if this ends up creating health issues?
| Looking at some studies on risks for that procedure,
| there's small issues like itching sensations that last for
| days but also more serious issues like badly fitted eye
| protection that could potentially end up causing blindness.
|
| All medical decisions are high stakes, even if they don't
| end up working. Even without effects and side effects, the
| confidence from the laser could mean the author stops
| flossing for example.
|
| Think sugar pills and homeopathy. If you end up trusting
| that the useless pill prevents cancer, you might stop going
| to your cancer screening appointments.
|
| It can also become very costly if the procedure is then
| added to all other appointments. In an economy 64% of the
| population lives paycheck to paycheck, this can open a can
| of worms when presented as a mandatory (or strongly
| encouraged) procedure.
| gumby wrote:
| The point is that by framing it as a medical decision they
| change the calculation, pushing it ahead of other important
| things the patient might spend on.
| petesergeant wrote:
| I guess I tend to consider "high-stakes" in the context of
| medicine to mean life-or-death, and not prophylactic pre-
| gingivitis treatments.
| mort96 wrote:
| Ok it's not life or death so it's not high-stakes to you,
| but it's about whether to get treatment to prevent your
| teeth from falling out. Whether or not to ignore your
| doctor's suggested treatment for that is certainly
| something I'd consider high stakes.
| mannykannot wrote:
| A one-time, or even recurring, payment of $400 may not be a
| high-stakes _financial_ decision (though for too many people it
| is), but there is quite a lot at stake _medically_ in choosing
| dental and periodontal care and treatment.
|
| I appreciate your suggestions for improving search results.
| oversocialized wrote:
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