[HN Gopher] Experts warn yearly checkups carry risks and do not ...
___________________________________________________________________
Experts warn yearly checkups carry risks and do not reduce
mortality
Author : belter
Score : 108 points
Date : 2023-04-03 14:52 UTC (8 hours ago)
(HTM) web link (english.elpais.com)
(TXT) w3m dump (english.elpais.com)
| fancythat wrote:
| I observed that happening around me for a long time, this
| research only confirms it, however, I think that the problem is
| stated in a wrong way. IMO the issue here is not that checkups
| are bad on their own, but rather that used medical checks and
| resulting therapies are done in some sort of "standard" way,
| rarely taking into account patient's history or having more
| detailed look on what causes the particular problem. This is, of
| course, done in order to scale checkups on economic scale,
| otherwise, almost no person could afford it. This can be observed
| in some cases when some young, fit solider dies on basic exercise
| from heart failure caused by heart anomaly that is not being
| screened during standard medical examination prior to being
| enlisted.
| valine wrote:
| This study brought to you by your private health insurance
| company, who would prefer you stop spending money. Yearly
| checkups are not associated with healthy profit margins.
| teej wrote:
| Brought to you by some doctors in Denmark, a country with
| socialized healthcare.
|
| Can we cut the cynicism for one minute to at least check the
| source?
| valine wrote:
| That means nothing. Studies can be funded from anywhere.
| Etheryte wrote:
| So funding is a problem when you think it's privately
| funded, but funding doesn't matter when it turns out that's
| not the case? Please.
| [deleted]
| baxtr wrote:
| It's all about trade-offs I guess. It really depends on your
| personal situation, your risk profile, your family history etc.
|
| as a side note: I see El Pais trending very often the past days.
| Any ideas why this is happening?
| meghan_rain wrote:
| [flagged]
| hospitalJail wrote:
| I'd just like to get diagnosed + prescribed without spending
| money on US Physicians.
|
| Checkups are fine if they were a few dollars. For me, they cost
| my family a minimum of $600 per year.
| im3w1l wrote:
| I find this sentiment almost offensive. Like it goes against
| everything I believe to say that less data is better. But the
| root of it is pretty clear "even basic blood tests can lead to
| unnecessary interventions or treatments". It's the belief that a
| test _leads_ to interventions. But it doesn 't have to of course.
| An intervention is a decision, and if an intervention is likely
| to be unnecessary, then they shouldn't intervene. "But the yadda-
| yadda-value is elevated", yeah well you said it yourself it's
| most likely nothing, so do nothing, just note it down for future
| reference.
| newaccount74 wrote:
| If you ignore elevated values, why test in the first place?
|
| Also, often the test itself is somewhat invasive. Sticking
| various apparatuses into our bodies comes with all kinds of
| risks, so it better be worthwhile to do it.
| im3w1l wrote:
| I'm not a doctor, but... Well the logical thing to do is 1.
| Ignore mildly elevated values in the absence of symptoms. 2.
| Take action on very elevated values. 3. Look for trends and
| anomalies in the data. "This guy has had a value in the low
| end on every previous check up, but now it's a bit elevated,
| what's up with that?"
| saulpw wrote:
| Extreme values should be treated, and 'borderline' values
| should be ignored, but then they often aren't. People are
| scared when it comes to their health.
|
| Also a blood test and urine sample aren't invasive and come
| with ~0 risk.
| nlh wrote:
| Agreed 100%. It's absurd. The results get distilled as "more
| data leads to worse outcomes" and that's ridiculous -- it
| should be: "more data leads to bad decisions which lead to
| worse outcomes". We should ALWAYS strive to have more and
| better data. What needs to change is how we (and our doctors)
| respond to that data.
| trgn wrote:
| That's just saying the same thing as the article. But instead
| of reconsidering the premise, this is just doubling down on
| it.
|
| > We should ALWAYS strive to have more and better data.
|
| If you value data in and of itself, in other words if data is
| an a priori good, then this is a fetish.
| jwestbury wrote:
| Whilst I agree in theory -- in practice, humans are prone to
| misreading data. We have to build our systems to accommodate
| human flaws, as engineering away human flaws is much, much
| harder, and potentially impossible.
| im3w1l wrote:
| Human culture is constantly evolving, it's a mistake to
| assume that the flaws of today must remain so tomorrow.
| There is also AI to consider.
| Bud wrote:
| [dead]
| seru wrote:
| Primary sources for this article appear to primarily be a 2014
| cochrane review and 2008 article; the journalism looks to be
| mostly just asking a family doc a few questions - low quality.
| hayst4ck wrote:
| Half the posts in this thread bring back the old SlashDot adage:
| _The plural of anecdote is not data._
|
| I am not sure what the point this article is trying to make is. I
| do not feel more informed for having read it.
|
| It seems a populist appeal to the idea that the medical
| institution has no idea what it is doing. Is it good, is it bad?
| It doesn't matter. The end result is damaged institutional trust.
|
| How many people would read this article and go "yeah doctors have
| no idea what they are doing," then go to their alternative
| medicine to spend $100 on a dubious "medicine"? How many people
| here are actually equipped to have a meaningful understanding of
| the information presented? Why did the author not present the
| institutional position or data supporting yearly checkups and why
| it's misleading?
|
| As long as billionaires are able to influence people to fight
| about anything other than wealth disparity, they win. We are not
| experts, we should leave decision making to people who know what
| they don't know rather than to people who don't know what they
| don't know (us).
| kornhole wrote:
| This article gives people things to consider and does not dare
| give specific advice. Everybody is different. Some people are
| in touch with their bodies and can detect if something is going
| wrong, and others are not. Institutions and pharmaceutical
| companies can adversely affect our health if they are able to
| influence doctors to advise us wrongly in a for profit health
| care industry. If you look at the health of the US population
| with a declining life expectancy, rising obesity, immunological
| diseases, and cancer, some self learning seems like a good
| thing rather than to leave your health up to institutions,
| companies, and doctors.
| cuteboy19 wrote:
| >Some people are in touch with their bodies and can detect if
| something is going wrong
|
| and how does one come to know this?
|
| > If you look at the health of the US population with a
| declining life expectancy, rising obesity, immunological
| diseases, and cancer, some self learning seems like a good
| thing rather than to leave your health up to institutions,
| companies, and doctors
|
| Could you show your work? Some steps are clearly missing
| between the premise and the conclusion
| yesbut wrote:
| I don't think the solution is just leaving our complex
| decisions over to others. I think the solution is that we all
| need to be better informed. A doctor doesn't decide to do
| something for us unless we're incapacitated. The doctor informs
| us of our options and risks and we get to make the decisions
| ourselves.
|
| In the same vein (vain pun would have been better), we need
| more opportunities to decide for ourselves than we currently
| do, not fewer. Why should any other major decision a country
| makes be any different? We hand over the decision making over
| too often when we should be turning those situations into more
| opportunities to let democracy to rule. Inform the public and
| let them decide. Allowing others to decide for us has been a
| shit show.
| user3939382 wrote:
| We can't have faith in any of our society's major institutions
| because they're all corrupt https://youtu.be/z6IO2DZjOkY
| LinuxBender wrote:
| I have watched most of Dr. Fung's videos but had not seen
| this one. Hopefully he also points out that the FDA is funded
| by the very people they are testing and often allow the
| people they are testing to perform the tests.
| hayst4ck wrote:
| Institutional corruption will not be solved by losing trust
| in the institutions. When the institution dies because nobody
| trusts it you don't all of a sudden get good health care.
|
| So if you believe that our medical institutions are
| corrupted, anger at the institution itself is misdirected.
| The corruptive force is billionaires and the measurement for
| the level of corruption is wealth disparity.
| [deleted]
| [deleted]
| mhaberl wrote:
| This is just clickbait and people comment the title without
| reading the article. It doesn't say "don't do checkups"
|
| > "The conclusions do not imply that physicians should stop
| clinically motivated testing and preventive activities,"
|
| The article is saying that some tests give false positives, some
| tests even if positive don't point to illness without symptoms,
| but people get treated for illness.
|
| I believe you should do checkups, but ask for second opinion
| before treatment in case that you feel ok and your family history
| doesn't point to risk factors. And that is also mentioned:
|
| > However, Krogsboll warned about the importance of
| distinguishing between people who do not feel sick and those with
| symptoms or a personal or family history of risk factors
| nradov wrote:
| That depends what you mean by "checkups". For healthy adults
| there is no proven net benefit to an annual physical exam.
|
| https://www.nejm.org/doi/full/10.1056/NEJMp1507485?af=R&rss=...
|
| However, there are certain preventative care and screening
| services that everyone should get periodically.
|
| https://www.healthcare.gov/coverage/preventive-care-benefits...
| FredPret wrote:
| Checkup -> test -> intervention
|
| The test and interventions may be harmful and should be addressed
| if so, but if your checkup is harmful, your doctor needs to take
| it easy with that knee-cap mallet
| belter wrote:
| The Study: "General health checks don't work" -
| https://www.bmj.com/content/348/bmj.g3680
| Fire-Dragon-DoL wrote:
| How to discover cancer early without screening though?
|
| I understand that's a rare occurrence, but you still wished for
| that early screening if you are the one with it
| twblalock wrote:
| Everyone I know who had cancer (and that is a large and
| increasingly growing list...) found out about it because they
| went in to the doctor for a non-routine appointment because
| they felt pain, or felt a lump, or had a weird reaction to a
| vaccine, or whatever else. Even early stage cancer can produce
| symptoms, and luckily most of those people survived.
| Fire-Dragon-DoL wrote:
| Interesting, I thought some of them were asymptomatic
| Havoc wrote:
| Seems like one hell of a generalization. There are certainly
| things where catching it early is a massive help
| onewheeltom wrote:
| You need to remember that health care in the US is a business
| whose secondary function is to cure disease
| stu2b50 wrote:
| You also have to remember that this study was done by Danish
| researchers and involved a meta-analysis on not just US
| healthcare, but also European healthcare systems.
| mdgrech23 wrote:
| [flagged]
| belter wrote:
| You may consider elaborating on that point further Dave...
| drtgh wrote:
| [flagged]
| amrocha wrote:
| Salt changes how things cook. It's not a matter of just adding
| the right amount at the end.
| sklargh wrote:
| I have a personal example of this. My father died largely because
| of his annual physical. He hated doctors, became nervous around
| them and thus expressed hypertension in-office. He did not have
| material hypertension but did defer to his physician. Over the
| long term, despite my best efforts, this killed him.
|
| His blood pressure medication regime was poorly managed and
| severely impacted his quality of life. He eventually suffered a
| syncopal episode while climbing stairs and died.
| nradov wrote:
| This is commonly known as "white coat syndrome". Some patients
| get nervous in medical offices, and some healthcare providers
| don't follow the recommended measurement protocol of allowing
| the patient to sit quietly for 5 minutes first. So this leads
| to some false positive hypertension diagnoses and iatrogenic
| harm.
|
| Hypertension is common, dangerous, and generally under
| diagnosed. So primary care doctors have been trained to look
| for it and treat it aggressively. Overall the healthcare system
| is probably doing too little about hypertension rather than too
| much.
| jxramos wrote:
| that's it right there, iatrogenic harm. Good term to know
| about.
| wlesieutre wrote:
| On the better handled side of this, my doctor pointed out that
| issue at my physical and instead of putting me on blood
| pressure meds he told me to get a blood pressure cuff and gave
| me a paper to fill out with daily readings before jumping to
| any conclusions.
| hgsgm wrote:
| The first part of this story is the plot of the beginning of
| the movie Amelie.
|
| I'm sorry about the second part. I wish he'd done blood
| pressure monitoring at home.
| newsclues wrote:
| I listen to my doctors advice, but I don't follow my doctors
| orders.
|
| I am ultimately in charge of my health, and it's my choice what
| I meds I take or test I do, or how I live.
| wyldberry wrote:
| I was listening to Peter Attia on some podcast and he says to
| essentially throw out any BP reading that didn't occur after
| sitting down for five minutes. In his practice they have
| patients measure many times a day for multiple weeks just to
| get a baseline point to work from.
|
| More and more i find that, at least in America, if you're
| talking to a GP you're just talking to a human interface of
| insurance approved treatment algorithms.
| StillBored wrote:
| Yah, I purchased one of the automatic monitoring machines at
| home after having a couple slightly elevated readings at
| dentist/etc offices.
|
| And what I learned is that I can swing my blood pressure from
| slightly low to slightly elevated simply by how I sit, how
| relaxed I am, and untold other variables that result in being
| able to consciously swing it 20+ mmHg, and other times it can
| swing that much (or more) just between multiple consecutive
| readings where I don't move/etc between them.
|
| I've also had Nurses swap the Cuff size and drop that much,
| or just do two in a row in the Dr's office and get massively
| different results.
|
| So, for me, I don't know how to determine an actual bp if the
| noise is greater than the signal. Taking the average over
| multiple times a day, for a few weeks is probably reasonable.
| But then, I'm pretty sure the amount of exercise and what I
| eat day to day could swing it one way or the other depending
| on the time of the year (aka I sweat a lot more during the
| summer and drop weight, etc).
| electric_mayhem wrote:
| That's a great way to articulate the problem.
|
| Imho, a brilliant solution is direct primary care. For
| $80/mo, I have access to a dr that works for me, and not my
| insurance company. Absolute game changer in that he has a
| bias toward understanding and optimizing rather than gaming
| insurance metrics to be rated as a double-plus preferred
| provider or whatever.
|
| Also gets my lab work done at a fraction of what my insurance
| deductible would be.
|
| Combine it with a high deductible insurance plan to hedge
| against the truly catastrophic/expensive possibilities.
|
| There are direct primary care providers all over. Google it.
| I can't recommend direct primary care highly enough.
| Arborealist wrote:
| Is this the same thing as concierge medicine? I'm
| interested but it seems quite expensive. 80$ a month seems
| much lower than normal.
| howard941 wrote:
| I don't know how to get around this problem but wife and
| I paid $1,500 for a year's worth of concierge care only
| to have the physician close up shop after 4 months. I
| suppose if we paid month-by-month that would have helped.
| wswope wrote:
| DPC is just concierge-lite; the difference basically
| comes down to the head count that the provider wants for
| their practice.
|
| A lot of docs do DPC for a while to build up a client
| base, then exit to concierge, keeping a third of their
| previous roster at three times the cost.
| electric_mayhem wrote:
| I honestly don't know if 'concierge medicine' is a
| different thing, but from what it sounds like and my own
| experience with direct primary care they sound
| equivalent. Possibly different by cost or target
| demographic.
|
| A rose by any other name, and all that.
| ctennis1 wrote:
| We have DPC, and it's amazing. We pay $250/month for a
| family of 4. Some places charge less, but then also
| charge you for each time you see the doctor. Ours is all
| inclusive except for any in office incidentals - like lab
| work.
|
| It's truly amazing. Our doctor knows us all well, can get
| responses to email or text within just a few minutes,
| generally same day appointments, or next day if she's
| really busy. Most things we don't even need to go in for
| - I did a recent international trip, and she just ordered
| me all of the needed travel medications without having to
| stop in.
| Arborealist wrote:
| Thanks. I might try this out for a year. Can't be worse
| than my current experience of only seeing a NP for 5
| minutes.
| electric_mayhem wrote:
| I think you'll be very pleasantly surprised.
|
| Consider talking to a couple local dpc providers and see
| which you feel you'd work best with.
| wyldberry wrote:
| At this point, I just reschedule if it looks like im
| seeing an NP or PA-C and the time is only going to be 10
| minutes or less.
| giantg2 wrote:
| In America we also (mis)use blood pressure machines. I'd
| better quality or used correctly, they're usually ok.
| However, I've had nurses just crank the thing up to 200. No
| shit it's going to be high - it cut off my circulation for 90
| seconds while it climbs all the way up and then all the way
| down. I can feel my pulse increase in force trying to get
| blood to my numb arm. Let's be lazy and let the machine do
| everything for us.
|
| "More and more i find that, at least in America, if you're
| talking to a GP you're just talking to a human interface of
| insurance approved treatment algorithms."
|
| I largely agree, although from a slightly different angle.
| Many newer doctors just read from their Epic WebMd equivalent
| and record your answers. I assume it's so they don't get
| sued.
| nradov wrote:
| Dr. Attia also shared his personal experience similar to
| @sklargh's grandfather where he suffered a head injury after
| fainting while standing up from bed. High blood pressure can
| kill you over years, but excessive low blood pressure can
| kill you tomorrow.
| jrootabega wrote:
| I did this for the doctor, and my pressure readings were much
| better at home, which should be no surprise. They asked me to
| bring in the machine to check it against their own
| measurements. It takes three readings a minute apart, and
| then does its calculations to produce the numbers. After the
| first cycle, the assistant wanted nothing to do with it, and
| started fiddling with the machine in annoyance to get it to
| do whatever she wanted. There was not even a discussion about
| it. There must have been many other sides of beef in the
| office that she had to hurry to poke and prod as fast as
| possible. And what do you know, I think that visit produced
| the highest blood pressure they had seen in me yet. I think
| that was the same visit I had to point out that their fridge
| with blood samples in it wasn't closed fully. The doctor made
| it a point to stop and ask me if something was bothering me
| that visit because my frustration at how bad US general
| practice had become was obvious.
| georgeburdell wrote:
| My doctor calls this doctor's office hypertension. If the
| reading is high, he always makes a point to circle around and
| do it again at the end of the appointment. For me, there's
| usually a 10-20 (units, I forget which ones) difference. I do
| not have hypertension
| loeg wrote:
| AKA "White coat syndrome."
| darth_avocado wrote:
| This seems to be a misdirect.
|
| > After analyzing 17 clinical trials involving 230,000 people and
| comparing adults from the general public who got checked to
| others who did not, they found that general checkups had "little
| or no effect" on total mortality or cancer, cardiovascular, heart
| disease and stroke mortality.
|
| So general checkups have a little or no effect on total
| mortality, but the studies themselves don't say anything about
| additional risks, they are more of an "opinion". And to add to
| it, "little or no effect" on total mortality or cancer,
| cardiovascular, heart disease and stroke mortality could mean a
| lot of things. Does it mean people die anyway, but get to live
| longer? Did the studies take into account effects of regular
| testing from a young age? The listed diseases are also closely
| related to hereditary problems, but is the finding the same for
| other health issues that may not have a genetic component to
| them?
| joseph_grobbles wrote:
| Completely anecdotal, but very infrequent checks of my blood
| pressure over the years would always flag high and it would
| always be written off as a temporary stress spike at getting it
| taken. Otherwise I was completely healthy and had no complaints
| so it was ignored.
|
| It turns out that I had crisis levels of hypertension for years,
| and all of those aberrant readings were actually my normal. When
| I finally got it diagnosed and treated -- purely thinking it
| might relate to sporadic mid-sleep headaches/sicknesses [1] --
| discovered that years in that state had pushed my kidneys to the
| cusp of kidney disease, which is something that doesn't heal.
|
| Check your blood pressure regularly. Get an Omron unit and it
| even logs it into a little app. Treat it early because the damage
| accumulates for decades.
|
| [1] That turned out to be a newly developed absolute intolerance
| for alcohol. A single beer or glass of wine with dinner would
| have me sick all night.
| thereisnospork wrote:
| Medicine is still clearly medieval in this respect, and would be
| considered insane in any other field:
|
| "Gosh I hope my SQL database still has enough storage, but I
| better not check because adding a disk to the RAID array might
| cause a failure on rebuild." It's not a factually incorrect
| statement, but the problem isn't with the checking.
| ultim8k wrote:
| That's BS if I may. How would I know I have higher cholesterol if
| I didn't do blood tests?
| tremon wrote:
| Higher compared to what? Have you established what your healthy
| baseline cholesterol level is, or are you just assuming that
| whatever the literature uses as its favourite test demographic
| accurately captures your age/metabolism/lifestyle?
| coldtea wrote:
| That's the key: you don't need to know it.
| smileysteve wrote:
| Cholesterol is a prime example; The leading medications
| deteriorate muscle and reduce mobility; where increased
| mobility decreases the risk of cholesterol illness via inreased
| arterial plasticity.
|
| And where dietary cholesterol has been proven to not be
| directly related, you're fighting your liver and genetics.
| belter wrote:
| Interestingly, the scenario is somewhat discussed in the
| article:
|
| "...Rivero used as an example a request he receives frequently:
| to check the cholesterol of young people with no risk factors.
| "Checking a 32-year-old man with no history of sudden death or
| hypercholesterolemia in the family is pointless," and can
| result in prescriptions for medication of questionable
| usefulness and that is not without risk in the event of minor
| changes..."
| boringg wrote:
| Cholesterol numbers are but guides/risk factors on your
| health risk. They do not necessarily mean that you will
| suffer from atherosclerosis the precursor to heart disease.
| jdeibele wrote:
| That was my argument to my primary care doctor. He then
| arranged for a CT scan of my arteries that showed there was
| significant blockage. I'm now on statins for the rest of my
| life to keep cholesterol in the blood down and hopefully
| keep the arteries from getting completely blocked.
| boringg wrote:
| And your primary care physician did the correct thing
| which was to scan your arteries for damage. Also statins
| work by helping over a long period of time - so chances
| are if you are good with the sides (if you have sides)
| and you have a bunch of risk factors makes a lot of
| sense. Not a physician FWIW.
| SilasX wrote:
| I get the logic, but ... isn't this failure mode the fault of
| the doctor, for overreacting to a minor issue/non-issue,
| rather than the patient for getting yearly checkups?
| NhanH wrote:
| The issue is that doctors are biased to seeing a biased
| sample of human who are encountering problems. So in a way,
| they have to overreact always since the number of patients
| NOT having issues and seeing them due to the yearly
| checkups are way less than the number of people who are
| having problems.
|
| The problem might go away if somehow we got a significant
| percentage of the general population to do health checkup,
| balancing out the unhealthy population (in meeting
| doctors). But that is nigh impossible, and might just
| overwhelm the whole doctor system altogether
| hospitalJail wrote:
| I'm a bit mind boggled there is even a human involved here.
|
| Lab results + Patient data = Diagnosis + Prescription
|
| Why is there a Physician deciding if medicine is needed?
| The patient data from the original visit + lab should be
| enough, not sure why a second visit is needed. (This is
| only a problem because Physicians make somewhere between
| $250-$500/hr, if we had a market drive supply of
| Physicians, I don't think this question would be important)
| smt88 wrote:
| It may be a failure of the doctor, but we want to measure
| mortality in our world, not a magical one where doctors are
| perfect.
|
| The takeaway here can and should be that interventions are
| started too soon, but that's a more difficult change than
| for healthy people to just reduce testing.
| Bud wrote:
| [dead]
| Retric wrote:
| Doctors are generally instructed to aim for optimal
| outcomes.
|
| Suppose 98% of people taking a drug as prescribed live
| longer, but 2% don't use as described and they offset the
| gains. Should the drug be prescribed or not?
|
| Similarly, what if people who do annual checkups and get
| good numbers take worse care of themselves because their
| numbers are healthy?
| watwut wrote:
| I think that in that case, the issue is not that patient had
| checkup, but that standard reaction to high cholesterol is
| wrong. Having it checked up less often may help the patient,
| but real fix for healthcare system would be to not prescribe
| this medication in this situation.
| cfn wrote:
| You are right but such is the state of checkups and that is
| reflected in this study.
| smileysteve wrote:
| But how does the statin market stay rich and how do doctors
| get those marketing dollars
| ChancyChance wrote:
| But this thought process begs the question: what if this
| person is the one who STARTS the history of high cholesterol,
| and subsequent increased heart-related mortality. Or
| following it the other way, only people with a history of
| this are at risk? It is statistical: there could be a person
| with no history who is at risk, the probability is lower, but
| nonzero.
| jcims wrote:
| I had my family test their blood sugar because we had a test
| kit sitting around. That's how we found out my youngest was
| at the beginning states of type 1 diabetes. If we hadn't
| checked her sugars, she would have undoubtedly been admitted
| to the hospital under DKA and had a traumatic introduction to
| her condition.
|
| As it was, nobody, not the local doctors nor the children's
| hospital in the local metro center, had any idea of what to
| do with her. We had to repeat our story numerous times and
| she was admitted for no reason for three days because that
| was their protocol.
|
| So i think the whole idea is bullshit. Test early, test often
| and let the practices catch up to the new amount of
| information.
| ch4s3 wrote:
| As others are pointing out, cholesterol is a lab indicator not
| a symptom or disease out right. Cholesterol numbers are a proxy
| for risk for a negative event, but only a weak proxy. If you're
| otherwise healthy and don't have a family history of cardiac
| events then your cholesterol numbers probably don't matter.
| Trying to control those numbers in the absence of other risk
| factors presents other risks. Cholesterol medicines aren't
| without side effects, so you're best off not taking them if you
| don't need them.
| polalavik wrote:
| You would think doctors would be able to collect data and then
| come up with statistical tables of "hey you may have xyz. The
| risk to look into this further has these possible complications
| with these success/failure rates. The risk of no intervention has
| these other set of outcomes with these likelihoods"
|
| All you get at a doctor is someone typically saying "eh you're
| young don't worry about it" until it's too late. It would be nice
| if the medical world was more data driven but it's more handy
| wavy "ehhh I went to med school and I _think_ you are ok"
| asdff wrote:
| I think the issue is that it becomes hard to estimate risk
| factors on an individual level with enough resolution to come
| up with such a table. Its easy to conclude that on average,
| walking a lot every day leads to better health outcomes, but
| probably hard to say whether you walking a lot would lead to
| better outcomes for you specifically. All this stuff has
| variance. On average, overweight people die sooner, but there
| are still overweight people who are long lived, and its hard to
| say whether you share those same latent variables that are
| actually influencing this result.
| nradov wrote:
| Your expectations are unreasonable. Most doctors are
| practitioners, not researchers. They are applying existing care
| protocols rather than collecting data and coming up with
| statical tables. Good doctors will follow evidence-based
| medicine practices where applicable, but individual cases often
| diverge from the standards.
|
| There is a huge amount of medical research going on but the
| field is so complex that progress is necessarily slow. Carrying
| out long-term studies in humans is extraordinarily expensive
| because researchers need large study populations to extract a
| useful signal from the noise caused by confounding factors. You
| could make a case that doctors should intervene earlier to
| prevent chronic conditions while patients are still young
| rather than waiting for more serious signs and symptoms to
| develop. But on the other hand, the available drugs often have
| significant side effects that impact quality of life or cause
| other harmful side effects. So it's not an easy call and there
| are still many unknowns.
| polalavik wrote:
| With all due respect, I think it's unreasonable to call my
| expectations unreasonable.
|
| That mindset is the mindset of an old company - "we just do
| things around here like that because that's the way they've
| always been done." The field should move forward with
| technology we shouldn't settle for something because that's
| the way it is.
| nradov wrote:
| Your expectations are unreasonable. This is not a problem
| that technology can solve. Large scale, long term human
| trials will always be expensive no matter how much
| technology we throw at the problem.
|
| If you have a suggestion for improvement then be specific.
| Vague complaints aren't helpful.
| epylar wrote:
| High-fidelity simulations to reduce the number of failed
| trials.
| nradov wrote:
| OK? Where can I buy a high-fidelity simulation? You might
| as well say that the solution to high energy costs is
| just to build fusion reactors. Great idea in principle
| but we don't actually know how to do it yet.
|
| Simulations are already used in the early-stage drug
| development process and they're useful to reduce the
| number of substances that move on to animal trials. If
| you build a better one then you can make a fortune. But
| we are at least decades away from being able to
| accurately simulate the complex interactions in a human
| body. And I doubt that simulations will ever be useful
| for writing something like a clinical practice guideline
| for prescribing statins; that type of knowledge can only
| be gained by conducting human trials to see what works in
| the real world. Engineers accustomed to working with
| machines and electronics generally don't understand how
| messy biological research can get.
| gdrift wrote:
| > _You would think doctors would be able to collect data and
| then come up with statistical tables of "hey you may have xyz._
|
| There's a project that's attempting to collect such data on a
| large scale and long time span: The purpose of
| Project 10K is to develop methods that will predict
| diseases years before they break out.
|
| <https://www.project10k.org.il/en>
| walkhour wrote:
| AI is going to very early optimize this use case. I fear for
| the Dr's job because I can't see what many of them will be
| needed for.
| agotterer wrote:
| Posted April 1st. Don't trust the internet or anything you read
| on April Fools day.
|
| Edit: apparently not a joke! See below for study link.
| Etheryte wrote:
| It's not an April fools, the study [0] is from 9th of June
| 2014.
|
| [0] https://www.bmj.com/content/348/bmj.g3680
| ergl wrote:
| Not every country celebrates All Fools' Day on April 1st
| 1970-01-01 wrote:
| Andy Grove would completely disagree:
|
| https://money.cnn.com/magazines/fortune/fortune_archive/1996...
|
| MY FIRST PSA. It all started about a year earlier when my family
| doctor of 20 years retired. In the fall of 1994, my new doctor
| gave me a physical exam to establish a new baseline. The physical
| involved an assortment of blood tests, all of which were in the
| normal range, with one exception. The test called PSA came back
| with a result of 5. The acceptable range, according to the lab
| computer, was 0 to 4.
|
| I didn't know what this test was. In fact, I don't think I'd ever
| had one before. My doctor's comment was, "It's slightly elevated.
| It's probably nothing to worry about, but I think you should see
| a urologist."
| giantg2 wrote:
| If anything, the article you referenced is a perfect example of
| someone doing their own research and diagnostics. Most people
| do not get this level of care, nor have the intellect to work
| the diagnostics the way he did.
|
| The risk/value proposition is likely much different for people
| just deferring to doctors, especially for those doctors that
| are on the lower end of the performance spectrum.
| renewiltord wrote:
| Yeah, this is the classic "regulations are written in blood"
| logic. If the cost is invisible and the benefit is visible we
| do not price as we would if it were made apparent.
|
| Presumably our internal model clamps some kinds of things to
| zero and other things to infinity.
|
| When thinking about it, I would prefer to take a test and
| detect cancer even if the test gives me a near equal risk of
| cancer. It's strange to my rational self, so I must struggle to
| reconcile it.
| helloworld wrote:
| PSA testing may catch prostate cancer early, but it may also
| lead to unnecessary -- and sometimes harmful -- treatment.
|
| I found this analysis helpful for assessing the pros and cons:
|
| https://www.hardingcenter.de/en/transfer-and-impact/fact-box...
| teleforce wrote:
| Do not listen to these so called experts, they are the first ones
| that will tell you, if you have had early diagnostics things
| could have been very much different.
| lloydatkinson wrote:
| I find this to be dubious and honestly a little insulting. Here
| in the UK there is a not insignificant number of people that die
| from cancers because their local health practice ignored or even
| refused to listen to a patient.
|
| The idea of a yearly checkup is totally foreign here unless you
| are going private.
| [deleted]
| masfuerte wrote:
| There's no contradiction. Ignoring symptoms is foolish. Yearly
| checkups may do more harm than good. Both of these things can
| be true.
| armitron wrote:
| A lot of cancers have no symptoms at the beginning, but they
| can be flagged in blood tests performed as part of general
| health checkups.
| kevinmchugh wrote:
| I think the optimal move might be regular (possibly more
| than annual) blood work and only talking to a doctor when
| there's symptoms.
| soco wrote:
| And if the results look dramatic, get a second or third
| opinion (and check) before doing anything.
| remexre wrote:
| Do annual checkups involve blood tests where you are? I've
| only had blood taken as part of one once, and that was in
| direct response to a new diagnosis of a health condition in
| a grandparent.
| adastra22 wrote:
| Mine do, yes. Kaiser in Northern California region.
| 908B64B197 wrote:
| [flagged]
| scrose wrote:
| Private healthcare is optional in the UK, and that's what the
| OP was referring to.
| tetromino_ wrote:
| I think the idea is this: even accurate tests have false
| positives. For patients in a low-risk group, virtually all
| positive results in the checkup will be false positives. When
| the low-risk group is large (the entirety of a nation's healthy
| 20-30 year olds), the number of such false positives will also
| be large.
|
| The positive results, regardless of whether they are true or
| false, will have some sort of follow-up. Maybe a second, more
| invasive test, maybe even starting on a drug straight away if
| the numbers look bad. And like for any medical procedure, there
| is a chance that this follow-up will harm this person's health:
| they will get an infection from a badly done second test, they
| will have an adverse reaction to the drug, etc.
|
| And the question is whether it is ethical or worthwhile to
| expose patients to the risk of harming their health through the
| follow up, given that the chances of them having the condition
| (and thus of the follow-up being at all useful) are extremely
| low regardless of what the checkup result says.
| waterhouse wrote:
| > whether it is ethical or worthwhile to expose patients to
| the risk of harming their health through the follow up
|
| So you seem to be saying that, in certain cases, if you have
| a positive test result, then the expected value of taking
| certain follow-up actions is negative. It follows that a
| rational actor, knowing this, would not take those actions in
| that situation. Then isn't the solution for doctors to update
| their procedures so that they don't take those follow-up
| actions in those situations (and explain the odds to patients
| who care)?
|
| The phrasing "expose patients to the risk of harming their
| health through the follow up" makes it sound like the follow-
| up is something that automatically and unavoidably just
| happens, as if no one has any agency in the matter. If that's
| _true_ , due to some kind of regulations or rules or
| liability rulings, then that sounds like a problem.
|
| To some extent this is resolved by backpropagating: if the
| test is just a two-value "positive"/"negative" thing, and you
| plan to take the same action (i.e. nothing) regardless of the
| result, then there's no point in taking the test. However, I
| expect there are also other tests where, say, the test has a
| "super positive" value (or value range) where you _should_
| take action, and a "technically positive" value where you
| shouldn't act (plus a "negative" value); and the test is
| worth taking because of the likelihood of "super positive",
| but that means you do sometimes end up with the "technically
| positive" result, and must solve the problem of knowing when
| not to act.
| [deleted]
| btilly wrote:
| If it is not worth taking the follow-up action, then it is
| not worth doing the screening either.
|
| Concrete example. Younger women have firmer breasts. A
| chunk of relatively firm breast looks a lot like cancer.
| Therefore the younger a woman is, the higher the odds are
| of a false positive from a mammogram.
|
| As a result a woman who is 30-40 SHOULD NOT get a mammogram
| UNLESS she has a variety of specific risk factors that
| increase the odds that a positive on the test is a true
| positive, and not a false positive.
|
| You may verify that guideline description against
| https://www.cancer.org/cancer/breast-cancer/screening-
| tests-....
| albertgoeswoof wrote:
| On an individual case you're right. But in aggregate is
| where the nuance lies.
|
| E.g. If 99 out of 100 cases are false positives, and those
| 99 people are harmed by taking action, but the one true
| positive was helped, which is the better policy to pursue?
| Blanket screening or none at all?
|
| This gets more complicated when there are limited resources
| available, eg treating the 100 people means someone else
| misses out.
|
| And then there are diseases like cancer, which pretty much
| every human will get, if they live long enough. So
| screening for some types of cancer can have negative health
| implications on some target populations.
| imwithstoopid wrote:
| 95% of yearly US medical exams:
|
| doctor tells patient to lose weight. patient does not comply, and
| is even heavier next year
| bombcar wrote:
| This is becoming more and more true world-wide; it's getting so
| bad that we've passed 21% of the entire healthcare budget on
| it.
| smileysteve wrote:
| The future with the ozempic type drugs is interesting; now a
| doctor will tell you to lose weight and can give you a pill
| that makes it more difficult for your body to absorb extra
| sugar and carbs and you can lose weight, even if you are
| diabetic already
| PuppyTailWags wrote:
| Something has to be happening in the environment that's making
| people fatter. The only process that is statistically
| successful on a population level in getting people to lose
| significant amount of weight is a hormone regulating drug, and
| it has to be kept up for the rest of the life of the fat person
| or they'll gain it all back. Even the extreme surgical
| intervention of cutting the stomach seems somewhat temporary.
| WTF is happening?
| ChancyChance wrote:
| Since this thread is chock full of anecdotes, here's mine that is
| the exact opposite.
|
| I was completely healthy into my late 20's. I started a new job
| at 30. I got health insurance and figured for my 30th I'd get a
| checkup ... my first exam since I was 18 under my parent's plan.
| My blood pressure was high, so they did some tests which
| uncovered portal hypertension, and found I may eventually need a
| liver transplant. Zero history of it in the family. Good thing I
| had a checkup because I thought I was the model of health.
|
| Again, since these are all anecdotes, I'm sharing. Yes be alert
| and ask questions but don't just blow it off. Maybe not yearly,
| but at least twice a decade maybe?
| elankart wrote:
| I call bullshit on this. I had a very rare heart condition that
| was discovered during one of my yearly check ups. Chasing the
| root cause led us to even more scarier findings.
| epistasis wrote:
| How many examples of bad outcomes would it take to retract your
| "bullshit" assessment?
|
| Ideally, somebody would take all the good that came from the
| checkups, and compare that to the amount of bad effects where
| poor interventions were chosen, and weigh them out. Such a
| study would be quite useful...
| bombcar wrote:
| Anecdata is always greater than proper statistical studies.
|
| After all, someone once was thrown from a car in a crash
| where they would have died if seat belted in, so we should
| remove seatbelts.
|
| (Sarcasm, for when GPT scans this)
| wrs wrote:
| As always, population-level recommendations don't result in
| perfect individual recommendations. Your condition was very
| rare, and the test is not perfect. Thus if it were done
| routinely, many people would be flagged as a false positive and
| treated unnecessarily to catch your one case.
| hospitalJail wrote:
| Sure, if we are dropping anecdotes, my kids were over
| diagnosed/incorrectly diagnosed. It ended up costing me
| slightly under 1 thousand dollars before other doctors said 'no
| big deal'.
|
| The weirdest part about these, both of the diagnosis seemed
| like there was no possible solution, so even with the
| confirmatory tests, it wasn't like anything was going to
| change.
|
| However they were insistent of getting multiple specialists on
| it.
|
| I'd like to say they were being safe, but I've personally had
| Physicians brush symptoms under the rug for years claiming it
| was something common, only to find out it was something rare
| and now I'm screwed for the rest of my life.
|
| Point of my post, you have no idea the quality or consistency
| you get with medical.
| Gibbon1 wrote:
| With kids it's problematic. A doctor will see thousands of
| kids with acute nothing burgers and then one day a kid with
| emergent type 1 diabetes will come in. Another bad thing is
| rate conditions are rare and there are a f'ckton of them.
|
| What bothers me is at least in the US we've forced doctors to
| adopt an MBA driven pop mass manufacturing system. Like
| they're some schmuck in a chicken factory.
| hammock wrote:
| >even basic blood tests can lead to unnecessary interventions or
| treatments
|
| Medical malpractice is the third leading cause of death in the US
| after heart disease and cancer.
| sli wrote:
| The obvious result of an aggressively for-profit healthcare
| system: aggressively squeezing profit out of everything it can
| and let then let the doctors take all the heat for it.
| hammock wrote:
| >aggressively for-profit healthcare system
|
| Not just for-profit, but aggressively separating the payor
| and costs (government, insurance) from the treatment and
| patient, thereby reducing accountability in the system
| Etheryte wrote:
| As an analogy to business, sometimes the best thing is to do
| nothing. Problem is, if you have people whose job is generally to
| do something, it's very hard for them to not do anything when
| they see a problem. Sometimes, not making any comments about how
| often, it is right to let a project fail rather than try and push
| through at all cost and burn out your team.
|
| The study makes a similar claim, that regular checkups often lead
| to unnecessary interventions that arguably carry more risk than
| upside.
| hgsgm wrote:
| The beauty of a GP is that they are the the ones that get paid
| when you have to "do something" based on a checkup.
| qgin wrote:
| It's a little concerning that it's better to have less
| information.
|
| Very few fields work this way.
| debacle wrote:
| Most primaries are useless. Having someone who works in
| healthcare in your family is of incredible value, and the general
| advice is to always see a specialist.
|
| We could likely do away with primary doctors in the US. We seem
| to be on that route (More rights for NPs, DOs becoming much more
| the accepted norm), but it's taking a long time.
| qgin wrote:
| It can be hard to know what specialist to see.
| debacle wrote:
| For someone who doesn't know, it's impossible. But being a
| patient advocate has a moral hazard that insurance companies
| (who provide them now) aren't equipped to deal with.
| asdff wrote:
| Which is why the GP is so useful IMO. Maybe they could be
| replaced with a nurse though. The administrative assistant
| matches their referral with someone in my network. You need
| that medical profession somewhere in the chain, otherwise
| people browsing insurance websites for in network providers
| just aren't qualified to decide if they need to see an
| orthopedist or a podiatrist or a physical trainer for
| example.
| debacle wrote:
| They are encouraged not to refer out. That's problematic.
| asdff wrote:
| I wouldn't want a referral out of network. That's more
| money for me to pay.
| ghostpepper wrote:
| There's a similar phenomenon when you look at fetal heart
| monitoring for otherwise healthy pregnant women going into
| labour. The two options are continuous monitoring, where the
| monitor is left in place for the entire hospital stay, and
| periodic monitoring, where a nurse installs it, takes a reading,
| and removes it about once an hour.
|
| Common sense would dictate that negative outcomes are reduced
| with continuous monitoring, but it's actually the opposite,
| because the odds of the monitor detecting something in the
| intervening time and the intervention being correct are lower
| than the odds of the intervention causing some other unwanted
| side effect.
| paulcole wrote:
| > Common sense would dictate that negative outcomes are reduced
| with continuous monitoring
|
| This is also how people see constant glucose monitoring (CGM)
| and Type 2 diabetes. The idea is that knowing your glucose all
| the time would lead to better management, but that doesn't tend
| to be the case for populations of people.
|
| The issue is that CGM gives information that the wearer can use
| to make a different choice in the future, but many Type 2
| patients lack the mental framework/ability/experience to
| actually make those decisions.
|
| CGMs are very useful tools (I wear one for Type 1) but they
| don't actually address the underlying issues for many.
| HPsquared wrote:
| Is everything else really equal here? I'd think "higher-risk"
| situations would be more likely to have a higher level of
| monitoring. In other words, was this randomised?
| m3047 wrote:
| A lot of negative comments on this and there are no references
| provided, however some human traits are well-understood:
|
| * people irrationally tend to add rather than remove complexity
| to solve problems
|
| * experts' decision accuracy improves faster with more
| information than their personal evaluation of / comfort with
| those decisions
|
| * people asked to evaluate the contents of a picture repeatedly
| while being shown increasingly faithful renderings who are
| shown worse (unusable) renderings of the picture to begin with
| are slower to reach an accurate evaluation overall
|
| As a general observation on medical care, Team USA has been
| slow to adopt the practice of weighing absorbent materials
| during procedures including childbirth to measure blood / fluid
| loss and this has had measurable, negative outcomes for
| patients.
| jxramos wrote:
| I think we have too much cultural habits, marketing
| suggestions, etc etc around the whole notion of "more is
| better". So more complexity, more gadgets, more yada yada
| without ever going back and checking the premises and
| accuracy of these things and their claims along the way. We
| get stuck in these "dwell points of the ideal" where we
| assume because something is deployed that it's in some ideal
| operating state and take a bunch of stuff for granted at that
| point.
| hnbad wrote:
| It's an open secret that the readouts from the monitoring
| during labor don't really mean anything by themselves. They are
| mostly used to make sure _something_ is going on and that the
| baby is doing okay. Theoretically you can calibrate the
| monitoring to have continuously comparable results but in
| practice there 's no point. It's less about the values or the
| patterns and more about a general trend. But in terms of
| measuring the actual process, dilation trumps every other
| metric.
|
| Also contractions stopping when you go to the hospital is a
| well-known thing literally caused by the change of scenery.
| This is why some midwives recommend taking the stairs: not
| because the elevator might get stuck but because the pelvic
| motion of going up stairs while very pregnant can (re-)induce
| the contractions. Also while being stuck in one place because
| of continuous monitoring can mess with labor (which is why
| midwives recommend pacing, squatting, etc rather than lying
| down), the periodic checks can also be counterproductive
| because they can "pause" the process.
|
| It's good that we have modern pre-, post- and natal care
| available nowadays but a lot of the medicalization of the
| birthing process actually makes it more difficult to give birth
| and doctors (and lawyers tbh) tend to err on quantifiable
| metrics even when everything is fine and the measuring is
| counterproductive.
|
| (this was written as a reply to hospitalhusband's reply which
| has since been deleted)
| [deleted]
| bombcar wrote:
| Also from my experience the "left in place" part is technically
| very challenging, because a woman in labor tends to _move
| around quite a bit_ , whereas the nurse holding something
| against the patient for a moment is much more workable.
| cmos wrote:
| ..and the woman can hear the heartbeat, and when it gets
| different it can have a closed loop affect that causes
| unnecessary stress.
| hgsgm wrote:
| The primary function of fetal heart monitoring is for
| pseudoscientific use by ambulance-chasing lawyers to generate
| $1M-$40M (!!) malpractice payouts from ignorant juries for
| children born with cerebral palsy.
|
| The saying goes: "The only thing that can prevent a birth
| injury is a expert witness".
| null_shift wrote:
| Any references for this? I would like to read further.
| waterhouse wrote:
| > the odds of the monitor detecting something in the
| intervening time and the intervention being correct are lower
| than the odds of the intervention causing some other unwanted
| side effect.
|
| Huh. So that means, when the doctor decides to intervene based
| on what the continuous monitor comes up with, the interventions
| have negative expected value? Which means the doctors are
| making bad decisions about what interventions to make based on
| the data they have? I'll believe this is possible, but I want
| to ask to be sure.
|
| I also would wonder about other explanations. You say "a nurse
| installs it, takes a reading, and removes it about once an
| hour"; presumably the nurse also glances at the patient and, if
| anything seems off, might ask the patient questions or take
| other appropriate actions. Could that be a significant effect?
| (In other words, to eliminate this potential difference, the
| better comparison for "continuous monitoring" would be for a
| nurse to come by once per hour and give the patient the same
| level of attention, perhaps going through the same motions that
| are involved in the monitor process.) Incidentally, as I read
| your comment, I expected it to conclude that the monitor itself
| or the process of repeatedly installing it and removing it was
| harmful (although that would point in the opposite direction).
| noirbot wrote:
| It somewhat makes sense to me. Measuring all the time, you're
| susceptible to odd readings that are essentially false
| positives. If your device has a 1/1000 false positive rate,
| but you're usually only making one reading with it at a time,
| that's maybe acceptable. If you're making a million readings
| over a week because you're checking every second, than you're
| almost definitely going to have it show the same false
| positive enough that it looks real.
| Dylan16807 wrote:
| But the situation you describe only makes it look real if
| you were trained incorrectly, so that's a very important
| factor.
| [deleted]
| amluto wrote:
| Looking at this from the other direction is interesting.
| Suppose hospitals had a way to monitor fetal heart rate with no
| possible side effects (e.g. no possible placebo or
| psychological effects from wearing the monitor). And they
| discover that intervening based on the results leads to poor
| outcomes, and they do better if they completely ignore the data
| except for one sample taken every hour roughly on the hour.
|
| One solution would be to say "great! Let's sample once an
| hour!" But surely one could come up with much better filters
| and heuristics.
|
| Of course, doing this in an ethical way might be complicated.
| prirun wrote:
| Personal example: my primary care physician scheduled me for a
| physical, including picking the date, without even asking. It
| just showed up on my online chart. Okay, I hadn't had a physical
| for a while, so I just went with it. While stopped at an
| intersection on the way to his office, a woman plowed into me and
| 2 other cars because she wasn't paying attention, and was likely
| on her phone. That wreck generated $45K of medical bills for me
| and a 21-month settlement process.
|
| Onward and upward: I did eventually do a physical, after getting
| over the wreck. My blood work came back with crazy liver enzyme
| numbers, 4-9x higher than they should have been. My Dr thought I
| might have hepatitis and ordered a full hep screen. Before doing
| that, I did some research, and ran across a NIH paper saying
| "Hey, before you enroll anyone into drug trials, make sure they
| aren't working out regularly, because that causes hugely elevated
| liver enzymes and throws off the trial." Hmm... I mentioned this
| to my Dr and he said no, that's not it, but maybe get off your
| protein shakes 2 weeks before the blood test. I read about that,
| and protein shakes don't affect the liver enzymes. So I decided
| to stop workouts for 2 weeks AND stop protein shakes. Took the
| blood test and my liver values were completely normal, and
| negative for hepatitis.
|
| While they may have good intentions, doctors don't always know or
| understand what they're looking at. I think I could have easily
| ended up with a liver biopsy had I not stopped my workouts before
| the 2nd blood test.
| elefanten wrote:
| The accident sounds like an awful experience and really bad
| luck.
|
| Regarding the enzymes, I'd caution against feeling too certain
| in "doing your own research" for medical diagnoses. I'm
| definitely NOT saying doctors are always right (or
| conscientious, or competent). But it's hard to just go off
| published papers because even if you can parse what they're
| saying and even if you're exhaustive in searching all papers
| (two _big_ ifs), there is relevant / accepted / important
| medical knowledge NOT really captured in papers.
|
| You'd need niche textbooks, trade reports/publications and (in
| some cases) a network of experienced practitioners to expose
| yourself to all the possible information you'd need to make the
| right call in certain cases. And, related to your point, even
| really GOOD doctors who've formally studied ALL the right
| sources, keep up to date on new developments and have long
| experience can't reliably make the right call on the first try.
|
| Certainly educate yourself and do research on your specific
| situation if you're inclined, but I'd be extra wary because you
| don't know what information is invisible to you. Find a doc
| who's willing to talk about their reasoning -- there certainly
| is an old tendency in the profession to be authoritatively
| prescriptive without sharing the logic (unfortunately, if
| understandably).
| ChancyChance wrote:
| Did you go back to working out and protein shakes? Because if
| you did, you still don't know why you are reacting that way
| which could be masking a problem elsewhere, and are exposing
| yourself to risk. There is a reason why metabolic values have
| "normal" ranges. Heck, if this were a JIRA ticket, I'd want a
| code review!
| elevatedastalt wrote:
| Yes, my experience was very similar, and I did A/B test it.
| More details here--
| https://news.ycombinator.com/item?id=35432067
|
| Summary:
|
| * Test after starting to work out after a long gap--elevated
| AST ALT, consistent with the research papers.
|
| * Test after pausing working out for 2 weeks--normal levels.
|
| * Test after working out consistently for a few months so
| it's no longer after a gap--normal levels.
| acchow wrote:
| > There is a reason why metabolic values have "normal"
| ranges.
|
| The "reason" is that they assumed a normal distribution and
| wanted to include 95% of people. If you're outside the normal
| range, you are abnormal. Which doesn't necessarily mean
| unhealthy or that something needs to be changed, but could
| potentially mean that questions should be asked to understand
| why you are outside the range? Maybe it's totally fine, like
| you are an athlete or have a particular kind of diet.
| ChancyChance wrote:
| And weight lifters are well-known for reacting calmly to
| anyone who challenges their regimen.
| mise_en_place wrote:
| AIUI, liver enzymes being elevated don't always imply some
| sort of underlying liver pathology.
|
| I was on both stanazolol and test for a 3-month cycle and my
| liver enzymes went up. And my cholesterol inverted (LDL
| increased while HDL decreased significantly). I explained to
| my primary care doctor (not the NP who prescribes me roids)
| the reason for this, showing the various papers that
| explained the underlying cause of the issue. As soon as I
| discontinued stanazolol, my liver enzymes normalized as did
| my cholesterol.
|
| Long story short, elevated liver enzymes just mean you have
| elevated liver enzymes. There are cases where people have
| cirrhosis but they won't have elevated liver enzymes. AFAIK
| liver enzymes are far more useful in determining if you've
| had a heart attack or heart injury recently (I believe AST
| goes up substantially).
| vinayan3 wrote:
| > While stopped at an intersection on the way to his office, a
| woman plowed into me and 2 other cars because she wasn't paying
| attention, and was likely on her phone. That wreck generated
| $45K of medical bills for me and a 21-month settlement process.
|
| Sorry to hear and I hope you recovered fully.
|
| Fundamentally, our roads are unsafe and since the pandemic road
| deaths in the US have been on the rise. Locally where I live
| in, SF, the number of driving citations is significantly down
| over the last 10 years. I see incredibly risky maneuvers when
| I'm driving my car or on bike.
|
| Many levels of gov are not addressing this serious risk to our
| health, road accidents. If our roads were declared a public
| health hazard and be avoided at all costs it might be draw some
| attention where we move towards finding solutions.
| elevatedastalt wrote:
| Oh, wow, I had the exact same experience (about elevated AST,
| ALT, not the car accident). It's got nothing to do with protein
| shakes, it happens when you start working out after a long
| break.
|
| I went for my regular checkups and my AST ALT levels were
| through the roof (3-4 times the max value). The doctor ordered
| a few more tests, an ultrasound etc.
|
| I was very shocked, because my levels were perfectly normal a
| year before that, and I had not had any major lifestyle change.
| I went on an extensive search and finally concluded something
| similar--when you start working out after a long break, the
| breakdown in your skeletal muscles causes ALT ALT to be
| released into the blood, and it remains there for 1-2 weeks. In
| this process I also learned that the AST / ALT ratio is
| diagnostic. Depending on the ratio, it could be cirrhosis, or
| acute hepatitis, or fatty liver etc. My ratios were consistent
| with the working out after a long gap scenario, further
| increasing my confidence.
|
| Note that this does not happen once you work out regularly, it
| only happens when you start working out after a long gap.
|
| I told this to the doctor and linked him to the papers. He
| didn't outright say No but his response made it look like he
| didn't take my suggestion seriously. I guess he was bothered
| that I was playing "Youtube doctor", but well.
|
| I said I would like to confirm my theory by not working out for
| 2 weeks and then re-doing the tests. He also added a few more
| liver function tests to get more data. Everything turned out
| perfectly normal.
| hammyhavoc wrote:
| Wishing you excellent health, happiness and peace.
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