People are really bad at doing their own research and diagnosing themselves.

I'm much more medically knowledgeable than the average person. I'm reasonably smart, and interested in the subject. And then I married a doctor.

But even given all of those things, I'm very bad a diagnosing myself. I once swore that I had Giardia. I read dozens of papers and case studies. A close family member of mine was also having some similar GI symptoms at the time, and I even calculated the probability that our symptoms were independent.

After that was ruled out from testing and I kept having stomach pain, I did more research. I was pretty sure I had stomach cancer.

Eventually I got scoped--gastritis. Took a PPI for a little bit and it cleared right up. Gastritis wasn't even something that I had considered. It showed up in my search results, but because it wasn't a serious problem, I didn't focus on it.

My sister had an experience where she went to the doctor multiple times because she had felt something “off” about her health, fatigue, small aches in her chest.

Multiple times she was turned down for breast cancer screenings, she was told that she was too young (33 at the time). It was not until she had requested that the doctor write a note of their denial, along with reasoning, that they finally gave her some screenings.

It was stage 2(3?), it had affected several lymph-nodes, but she was lucky that she persisted and did not just say “oh ya it’s fatigue”. When I ask her about how she knew, it’s always the same response, that it was just a feeling, that she knew something was not normal.

Yeah it's definitely possible. And it's terrible if you or someone you love is in that situation. But for the vast majority of people feeling off, tired, and some small aches is going to be nothing.

There are costs to testing, financial and otherwise. For example you take someones family history, and other risk factors into account. There is a 1/100,000 chance that they have cancer. Then you add in the symptoms, fatigue, and minor aches and pains. That brings it to a 1/50,00 chance.

We don't have the money, technicians, or machines to run an MRI on everyone who shows up to the doctor with a problem that has a 1/50,000 chance of being cancer.

Then for many tests, with such a low prior probability, a positive test has a higher chance of being a false positive. So now you patients with massive anxiety out over a positive that has high chance of being a false positive. And you need to send them or further more invasive anymore expensive tests, that have real risks of harm.

> We don't have the money, technicians, or machines to run an MRI on everyone who shows up to the doctor with a problem that has a 1/50,000 chance of being cancer.

A guy launched a car into space; I think we have all this stuff but we — as a society — just don’t find the business case for “poor people being alive” very compelling.

There was a period where doctors would run every test on the list.. They stopped this because even if everything were free, each test has a false positive rate with a psychological cost to the patient. If anything the US has a problem with not accepting that everyone is going to die and asking them to go on to a road makes this more likely, (thus costing more than the value of the appointment.)

Being told that a doctor won’t do a test because it’s not worth it has a psychological cost that is higher than being told that the screening test came back positive and they need to run some more tests.

You are incorrectly calculating the “value of the appointment” from precisely the wrong viewpoint. Remember that healthcare is about the patient’s health, not the bill.

No, you're missing the point. Over treatment is a serious problem in healthcare. There is always some risk of iatrogenic harm, and for many tests the risks outweigh the benefits. Many tests don't even have a simple positive or negative result: often the outcome is inconclusive.

https://www.bloomsbury.com/us/price-we-pay-9781635575910/

This is such a wild non-sequitur! A single person doing a single wildly expensive thing is not comparable to hundreds of thousands or millions of people doing a far less expensive thing. The orders of magnitude don't cancel out; the 5-6 orders of magnitude in number of "people doing expensive thing" outweighs the 3-4 orders of magnitude difference between the costs of the things you are comparing.

It's also just so wildly irrelevant to the topic at hand

This is why proper differential diagnosis skills is important - something a layman would not understand. You must consider ALL possible conditions that your symptoms match, and then work your way from the most common to the most unlikely. AI is remarkably pretty decent at doing DDX.

A big challenge is that most doctors can't operate outside of the most common conditions and differential diagnoses of their specialty and have to punt patients.

Of course, to the doctor's defense, patients are not an easy population to work with, "Why can't I eat candy and cake 3 meals day and my diabetes is getting worse?"

There have been clinical decision support systems that were pretty decent at doing DDX for decades, well before the current crop of AI LLMs. The issue is getting relevant data about patient history, symptoms, signs, etc into the system and then convincing doctors to actually use it. For most simple cases, using any form of clinical decision support (whether it's based on AI or simpler deterministic algorithms) just slows them down and they don't have time to waste.

As someone also in a similar position to you, I think the challenge for the non-medical community is that medicine/health frames things in terms of some entity, instead of failures in a systemic set of interconnected processes.

"I HAVE cancer. I HAVE this autoimmune condition. I GOT a cold."

So people are in search of a label and the "thing" to get rid or fight, but imagine if all technology problems were labeled similarly. Rendering-itis. Memory-itis. PCI-Bus-itis. Imagine someone coming to a person going, "I think I have keyboard-itis, because when I type a key into the keyboard, it takes a couple seconds for the character to show up on the screen." When in reality, as the engineer, your intuition is that there's something amiss in the auto-complete microservice. Perhaps that service needs to be scaled up or something else is DOS'ing the service, Perhaps the autocomplete service is running across the country instead of the same datacenter, so you know which tests to run to isolate and solve the source of the problem. Medicine is basically that now.

Medicine has developed to the point where they have several hammers where if bloodwork == X || symptoms == Y, then A or B or C drug/procedure. So doctors are mostly the level 1 engineer after the level 1 tech support rep on a script.

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Most medicine is merely a collections of latin labels, and unless the conditions map to well-known treatments, most doctors are in the dark. You were lucky that you responded to PPIs.

Gastritis is "inflammation of the GI lining" and the use of a PPI, is similar to a common second-line option like "reset the software settings" after the first suggestion of "reboot your computer." They scoped you, because they had no clue what was up. Scoping is basically like lighting up the debugger. They go in with a camera, and basically found nothing but inflammation, thus came the PPIs. They were mostly ruling out cancer or growths or other weird things like outside items. (ie ate a non-digestible item).

Basically, doctors are relying on pharmaceuticals to help out for a couple days/weeks, while the body addresses things on their own such that they don't become necessary anymore. That's probably most medicine. As most pharmaceuticals are symptom management, doctors really only have tools to help someone manage symptoms or alleviate the pain. They are just practiced in that troubleshooting process, the way tech folks get deep into the stack of the architecture of computing, networks, etc and can troubleshoot issues in the tech stack.

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The way that there's only a handful of the most brilliant engineers who deeply understand the stack top to bottom in such a way that they can thread their way to "that's a problem in this specific subsystem and the latest change now makes the datastructures exceed the L3 cache size of that node and that's causing an additional 10 millis degradation." There's really only a handful of doctors who are intimate enough with the all the subsystems of the body to be able to drill into what's going on with a person, otherwise most operate on rules and mentally null pointer when they run into something that doesn't fit into their flow chart.

Outside of very specific genetic conditions, incredible amounts of sickness out there could be alleviated by supporting the biochemistry (limiting reagents) of the body, so its processes can keep it in tip-top shape.

IMHO, the REAL problem is not the individual doctors, it's the system we seem to have implemented to dole out "health care" as if it's a product that has to be rationed according to some metric.

I've met doctors that are passionate, but are hamstrung by "the process". The hospital has policies, the insurance company has policies, local health departmen thas policies, whatever it is. I hate that "some process" needs to be in place to keep things in check, lest we end up with patients abusing things, or doctors abusing things (SURGERY ALL THE THINGS, for example).

I think it's "the process" we have lost trust in. Individual people really do want to do good things for each other. But "the process" sadly has an awful lot of inertia, and doesn't make it easy to change.

Precisely right. The corporate takeover of medicine is dangerous. Private equity firms are buying up hospitals and then illegally shutting them down to cash out. (Yes, I’ve seen this happen first hand. I’ve also read about other cases.) Another example of small local governments getting railroaded by corporations that have more money and lawyers.

How does shutting down a hospital allow a PE firm to "cash out"? Let's see some actual numbers on that, not vague claims about tax write-offs. Sometimes PE firms take on too much debt as part of acquiring a hospital and paying out a special dividend to shareholders. But if the hospital later fails due to being unable to make debt payments then the PE firm takes a loss on their remaining equity stake; they would always prefer to keep it running as a going concern so that they can sell it for an additional profit later.

There is a legitimate issue with concentrated ownership of provider organizations in some regions. More antitrust enforcement is needed to protect consumers but unfortunately that seems unlikely.

I would say in your toy example the hospital has been shutdown due to the PE firm "cashing out" excessively

> How does shutting down a hospital allow a PE firm to "cash out"?

https://www.theatlantic.com/ideas/archive/2023/05/private-eq...

https://www.ineteconomics.org/perspectives/blog/private-equi...

What would you propose as an alternative? All healthcare systems have to ration care because resources are limited and demand is effectively infinite. We can discuss the process used for rationing but it has to be done on some reasonably objective basis.

I had a conversation with my friend. "Look at this new, incredible CPU cooler tech! It's sooo good at removing heat."

"What if you didn't generate the heat in the first place?"

Personally, I have a hypothesis that there are systemic areas we need to address in our food supply to lower healthcare demand. This will sound kooky, but if we can get more sulfur and trace minerals into the food supply, we could improve the general well-being of massive amounts of the population. We really need to look at doing more research into additionally fortifying our foods.

Here's a nature article on the reduction of sulfur from the food supply: https://www.nature.com/articles/s43247-021-00172-0

NPK farming has ensured that the food supply doesn't have a rich set of additional minerals outside of (N)itrogen, (P)hosphorous and (K)potassium.

Then when looking at sulfur-containing molecules, the research on them tends to herald them as miracle-health molecules: MSM Taurine, B1, NAC. All bring sulfur into the body.

Then there's companies like Buoy drops that offer 87 different trace minerals and folks are swearing by the effects of them. Asian countries consume things like seaweed and get trace minerals like this from the the sea water, but a the standard american diet is really lacking in a lot of additional nutrition that would be productive to health.

The majority of healthcare spending goes to chronic diseases primarily caused by lifestyle issues. Collectively we are a nation of obese, sedentary substance abusers. If we could do better on prevention and delay the onset of chronic diseases like type-2 diabetes, hypertension, and heart failure then that would largely fix the demand problem and leave a lot more resources available for patients who randomly get cancer or multiple sclerosis or whatever. But this is a policy issue that goes way beyond the healthcare system and no one has a practical solution. Everyone loves to give health and nutrition advice to others, but we're all undisciplined and do unhealthy stuff even when we know we shouldn't.

https://peterattiamd.com/outlive/

As for the food supply, I have no doubt that many people are impacted by subclinical micronutrient deficiencies, whether it's sulphur or zinc or D3 or something else. But the evidence indicates that's less important than excess macronutrients for most people.

I'm a big fan of Attia and familiar with his work. That's fair that excess calories is among the major contributors to Healthcare and addressing that would probably be among the largest impact items we ought to tackle.

I wonder though if with the advent of GLP1 drugs, if obesity may already be a solved problem, but merely a matter of time?

I imagine, as with anything, perfect doesn't need to be the enemy of good enough. A huge multifaceted issue like obesity could be addressed from many angles.

What's actually interesting is that there exists a model for solving obesity. Mostly it's a matter of having the will and prioritization to solve such a problem.

Japan has an obesity rate of 4%. By law they require every school to employ a professional nutritionist, which requires 3 years of additional training on top of their education degrees. In a particular example of 1000 kids, not a single child is overweight. Every nutritionist is required to design the school's food curriculum such that all meals are made from fresh foods and to be balanced according to all the food groups, and they forbid even the use of processed pastes. All meals are made from fresh foods on-site.

Then the kids are then taught how to eat well and to fully cover their nutritional needs from 6-18. This would be the non-ozempic way to influence a nation to eat well.

Americans already consume more healthcare than anyone in human history by a huge margin. A large proportion of that healthcare isn't really healthcare at all, because it does more harm than good.

If you're paying out of pocket, you have the right to demand as many tests and as many treatments as you can afford. If you're relying on an insurer to foot the bill, then that insurer has two choices - refuse to pay for some treatments, or watch costs (and premiums) trend towards infinity.

> I think a lot of people have lost trust in doctors.

Do you have any source to back this up? I very much trust my doctors to provide a treatment correct for me versus googling my way to horse de-wormer or similar

I mean a lot of people have lost trust in doctors, but then again a lot of people have decided that vaccines are created by Bill Gates to mind control them.

That one will come back to bite your head off, mark my words.

Bully didn't suddenly turn into a nice person who wants to save the world, that never happens.

More likely, he's still doing everything he can to maximize power and profits, without any regard whatsoever for other people.

Very true. My guinea worm used to tap out a valid Windows product registration key in morse code on demand. Then Bill went and shut him up :(

You still can't see it, can you?

Africa is where all the resources are, we just have to get rid of all the pesky people standing in the way.

I think there is a movement against science, largely from the COVID epidemic, but I would like to see numbers. I also believe for science, there are a lot of bad actors out on the internet publishing inaccurate information (ivermectin, flat earth, etc).

I am going to disagree. 'Do your research' doesn't mean you will be well-informed. How many patients can understand publications on the literature and the jargon involved? Do they know what p=/C.I/RR means? Or how about the differences between a retro and obs study?

Anecdotally, a colleague had a patient bring him a printed PubMed article about something. The patient demanded the treatment in that PubMed article.

I looked at the article, and it was from a trash journal, with huge amounts of red flags (eg: C.I was all over the place, self-reporting, no blood work. Diagnosis was suspect from the start, and the authors had a financial interest in the treatment)

The patient didn't want to her any.

A lot of it is just that:

a) The knowledge is democratized on the internet (albeit often without proper context, and with somewhat limited accuracy)

b) You just care a lot more about your own, or a loved one's health/life and are willing to put a lot more effort than a doctor can or an insurance company is willing to pay for.

You may not have a medical degree, but if you're willing to put in 40 hours doing research and your condition is even somewhat unusual, you can probably exceed the knowledge of your doctor about your specific condition.

Regarding b) there's a term "advocating for one's health" and yes, doctors are fully aware of it.

>> you can probably exceed the knowledge of your doctor about your specific condition.

It depends on the doctor. That's why in the US patients first see a general practitioner, then are referred to a specialist. I've met some less knowledgeable doctors for my condition, but I don't discredit them for it. It's a difficult profession.

Plus "doing research on your own" is not a bad idea, but if one deep dives and starts believing ivermectin cures everything, well, I'd say they did poor research, and poor research can be worse than listening to a doctor.

"Do your own research" has turned into codeword for "Open yourself up to quackery." Nobody uses it to mean do actual research. It really means: Go onto YouTube or search and find all the various Herbal-this and Natural-that and Abc-Oils and Xyz-Supplements that confirm your suspicions that doctors are lying, and that managed to SEO their way to the top. Or, more recently, go onto your favorite political echo chamber and trust medical advice from pundits.

When I need my car fixed, I don't go to the local psychic or consult Fox News. I go to a mechanic.