At least we know our established treatments generally do actually improve outcomes rather than worsen them. Establishing that as a criteria for adopting a new treatment was a real step forward.

Generally, sometimes. Medical research consistently has issues with independence and reproducibility.

One example of many:

https://www.bmj.com/content/360/bmj.k1073

It's not that the principle of peer review is wrong, it's just very hard to apply it fairly and objectively when money - huge sums of money - are involved.

I don't think that's really true. https://www.theatlantic.com/health/archive/2017/02/when-evid...

You do not think that established medical treatments generally improve outcomes?

What do you do if you think you have a medical problem? Where do you go for help? Obviously there are mistakes made and some unnecessary or counterproductive treatments are given in some cases. We’re talking about a massive endeavour involving millions of practitioners across the world. But claiming that in general this activity is not beneficial seems a big claim to make based on a single article on an issue with seemingly specific scope.

>You do not think that established medical treatments generally improve outcomes?

That's not what the linked article claims. The linked article claims that there are specific procedures that do not help in specific situations, yet these procedures continue to be done in those situations.

This is totally compatible with the claim that medical care improves outcomes on average.

I'm not quite clear what it is that you "don't think is really true", then.

I'm not the parent commenter. Ask him.

If you want to justify the claim, "future generations will look at modern medical procedure X and remark at how primitive and pointless X is," you don't need to show that all medical procedures are bunk.

Indeed, in Washington's time, not all medical procedures were bunk. Doctors helped people, sometimes. If doctors in Washinton's time never helped people, the average person would notice that, and stop calling for a doctor. Were some of those procedures harmful to patients? Sure, but not obviously so.

I was disagreeing with the idea that established treatments today are known to improve outcomes. It is very mixed, and really depends on what problem you are trying to solve. There has been a lot of progress in some areas, but there is also a lot of bad science out there, together with institutional, legal, and regulatory corruption, on top of plenty of plain old incomplete understanding of complex hard problems and the associated necessary accidental causing of harm in ignorance while doing the best we can. We do a lot of good. We have made some miraculous advances. But we also still treat some very common problems with methods known to cause harm. The way we treat type 2 diabetes, heart disease prevention, chronic high blood pressure and mental health are particularly suspect, and these are very common and widespread problems. And I don't call those out because I have read an article or done a survey of medicine - I call them out because as problems I have personally had, I have taken the time to learn about them and found the standard approaches to be shockingly poorly evidence based. I do not know enough to make a claim about the average case, but I do know that the reliability of the medical system in dealing with the particular problems I've had in the last decade or so has been surprisingly bad and dangerous. I've come through it okay, but I've also been given way more useless or harmful advice than I would have expected, and dodged way more bullets than I would have believed were out there.

The article I posted is the tip of the iceberg. A commonly recommended, unnecessary procedure, which kills or seriously injures one in fifty is a horrible scandal. Hundreds of thousands of deaths a year from errors in hospitals, a risk one avoids by staying home, is an awful scandal. Drugs prescribed long term to improve mental health issues based on short trials, now suspected to make them worse and induce dependence, are a terrifying prospect. Diabetes treatment protocols now absolutely known to kill people, in use for decades and probably still in use in plenty of cases. Suppression of dissent. Suppression of competition. Corrupt and motivated research.

I'm not saying don't go to the doctor. You should for a lot of things. I certainly do. I'm not saying doctors don't help - for a new issue I know nothing about, I'd generally expect them to be able to. But it is certainly true that if you exercise blind faith in the system, it is perfectly capable of cheerfully killing you. The best advice I have, and it is not very good advice, is to read absolutely everything. Review the basic science yourself for and serious condition you are dealing with, commit to no serious and life changing treatments without plenty of research and multiple opinions, DON'T TRUST THE STANDARD RECOMMENDATIONS TO BE SOLUD WITHOUT REVIEWING THE BASIC SCIENCE, and avoid unnecessary hospital trips and medication as much as possible. It is easy to scoff at the doctors of Washington's day - look at all the unnecessary and harmful crap they did! At least things are better now! Well... yes, a lot of things are better now, but we still do plenty of unnecessary and harmful crap.

Between the emergence of resistant bacterial strains and growing understanding of internal microbiomes, the future will not look kindly on our use of antibiotics. And of course, you don't need to go into the future to find people who look dimly on the state of the art in nutrition.

While overprescription of antibiotics to human patients has been a problem, I think that the antibiotics usage that the future will really look back on unkindly is the massive use of antibiotics in the livestock industry. Wastewater from that is a major contribution to bacterial resistance.

You don't even have to go into the future to find unkind looks here. Operators making the decision to use ABX the way they're used in livestock are morally guilty of negligent homicide whether or not it meets a legal standard. It's unconscionable at this point to treat them as just another industrial input.

A family friend, who's a farmer, made the decision not to use antibiotics in feed.

He then went bankrupt. He claims that was why.

Whether or not it is, in his specific case, this is a coordination problem. Using antibiotics this way has to be outlawed, because any farmer who unilaterally chooses not to use it is leaving money on the table. In an efficient market, that leads to bankruptcy.

> the future will not look kindly on our use of antibiotics

It's entirely likely that we use too many antibiotics, but antibiotics have also saved all of us from unbelievable levels of pain and suffering.

I had an ear infection once, and the pain was unbearable. I went to the doctor, who quipped, "if we leave it alone, eventually it'll just burst the eardrum and drain out." And then she prescribed me some antibiotics. And that's not even the worst situation that calls for antibiotics. It's not like my life was in danger.

Won’t look too kindly?

The alternative to antibiotics in a lot of these cases is death.

Not sure anyone would look at that “unkindly”.

I believe the parent was thinking of our using antibiotics for things like increasing growth rates in livestock, hand soap marketing, and viral infections; but maybe your incredibly uncharitable interpretation is correct ...

Sure, those specific cases are justified. A lot of others aren't. I guess in the context of blood-letting it wasn't clear I meant they would look unkindly on our policy as a whole, rather than on using them at all.

In 20 years time it will seem barbaric that doctors used to treat us without even looking at our DNA.

That’s a bit like saying it’s barbaric that in the 18th century doctors never ever sent blood off to be tested (or looked at under a microscope).

We can’t really expect doctors to do things that aren’t really very possible (yes dna sequencing is somewhat possible today but the results aren’t necessarily very useful and far too little is known about the interaction of different genes with each other and medicine for it to be useful)

I am sure that's exactly the point the GP is making.

200 years? How about in 50 years? Heart attacks and cancers will be detected early and easily treatable. The idea of chemotherapy will seem barbaric.

To be fair chemotherapy does sound barbaric already today, but it's one of the few things we know that kind of works

Otto Warburg figured out a lot about cancer. Unfortunately he was a jew in Nazi Germany, and his insights were mostly forgotten when the “bad genes” theory of cancer took hold of the medical profession. There was a semi-recent NY Times article about the resurgence of Warburg’s metabolic theory of cancer.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4493566/#!po=5....

> but it's one of the few things we know that kind of works

Chemotherapy as a treatment for cancer is one of many pseudo-scientific medical practices commonly used by conventional medical practitioners.

Edit: link to NY Times article on Warburg: https://www.nytimes.com/2016/05/15/magazine/warburg-effect-a...

Chemotherapy sucks, but it works and is scientifically sound.

Works short term but wrecks your immune system long term, which means you will get sick from something else and no one can be blamed. Have you actually seen someone on chemo? Scientifically sound is not the first thing that comes into my mind. There's even a decent amount of objective research out there these days showing exactly this so there are really no excuses for clinging to these delusions any more.

> Have you actually seen someone on chemo?

I have. Chemo is horrible. It really wrecks a person. But you know who looks even worse? Someone who died of untreated cancer.

The same as someone who died from a second round of untreatable cancer after having their system wrecked?

Look, I get it; cancer is no fun. But when the cure is worse than the disease, it doesn't make sense any more.

Except if you profit from disease and suffering, I guess.

> McCoy: What’s the matter with you?

> Patient: Kidney... dialysis.

> McCoy: Dialysis?! What is this? The Dark Ages? Here! You swallow that and if you have any more problems, just call me!

Star Trek had just the right amount of childish optimism to work well as critique of the current state of affairs.