Comment by taxicabjesus | Hacker News Reader

Comment by taxicabjesus | Hacker News Reader

A 90's Aerosmith song goes, "There's something wrong with the world today, I don't know what it is..." I don't know either, but I've a few observations...

With regard to the "wellness" industry. Mostly it's a sham, but so too are many medical treatments. Women are particularly vulnerable to medical profiteering - I posted about this yesterday [1]...

[1] https://news.ycombinator.com/item?id=14708472

  There’s something grotesque about this 
  industry’s emerging at the moment when the most 
  basic health care is still being denied to so 
  many in America and is at risk of being 
  snatched away from millions more.

People are focused on Wellness because they're not getting it from their doctors. Sometimes a conventional medical practitioner's diagnosis is helpful, but usually they miss the big picture.

I took lots of people to & from their doctor appointments. Sometimes all a person really needed was to feel safe, but their doctors couldn't prescribe that. So they'd go from doctor to doctor to doctor looking for answers, but never finding them.

  But what’s perhaps most striking about 
  wellness’s ascendancy is that it’s happening  
  because, in our increasingly bifurcated world, 
  even those who do have access to pretty good 
  (and sometimes quite excellent, if quite 
  expensive) traditional health care are left 
  feeling, nonetheless, incredibly unwell.

This section reminds me of one passenger in particular... She wanted help, and had a few resources, but her doctors only made her condition worse. Sometimes doctors do good work, sometimes they don't know when to stop. "Wellness" is for those who've given up on conventional medicine.

"Wellness" is for those who've given up on conventional medicine.

You mean, given up on medicine.

All this other stuff? It's not medicine. It's snake oil. Chicanery. Placebo wrapped up in meaningless ritual to make it "feel" real. It's the new iteration of numerology, tarot, psychic reading.

The only thing that it, in some cases, brings to the mix is empathy, something frequently missing in our overburdened medical system. And in that respect it has value.

But medicine? That it is not, unless you define "medicine" as anything that makes you feel better, in which case you've basically robbed the term of its meaning.

You must have missed this ProPublica piece:

When Evidence Says No, but Doctors Say Yes - https://www.propublica.org/article/when-evidence-says-no-but...

There's a slander against "alternative medicine" that goes something like, "What do you call alternative medicine that works? Medicine. " The inference is that Medicine adopts what's useful. If a herb is actually useful, the pharmaceutical industry will figure out what the active ingredient is and figure out how to synthesize it, etc.

My corollary to the slander is the truism: "What do you call medicine that doesn't work? Medicine. " The ProPublica story linked above says that heart stents [are now known to not be] helpful for anyone that's not actively experiencing a heart attack, but thousands get inserted every year anyways.

[edit - clarification [] above]

Why do you care about what doesn't work? If the things that work are in the set "Medicine", that's the only set we need to be concerned with.

Sure, it's worthwhile to try and figure out which medicine doesn't work, but we know for sure that anything non-medicine does, by definition, not work.

Except the range of possibilities isn't ['works', 'doesn't work']. Rather, it's ['works', 'no effect', 'harmful', 'works and is harmful at the same time'].

A banal example: proton pump inhibitor drugs used to treat acid reflux will, over very long timeframes, cause nutrient malabsorption resulting in more brittle bones. They also have what's called a rebound effect, where dropping them cold turkey leads to a huge jump in stomach acid production and worsening of symptoms. So while effective to reduce stomach acidity, they also have long-term negative effects and a sort of withdrawal that makes the original problem worse. It's a weird and complicated situation, and certainly not the most intense example.

Okay, sure, but again, the things that have "no effect" are not worth even mentioning at all. That is what the debate is about, not whether medicine that works is also harmful.

They are worth mentioning, because they are often expensive and take a lot of time. They are often uncomfortable or painful. It is not neutral.

> we know for sure that anything non-medicine does, by definition, not work.

We don't actually know that. That something is proven to work to the satisfaction of the FDA and the doctor's lobbies is too high a bar to say that anything failing to meet it does not work.

Many treatments that "work" either can't adequately be double-blind tested or have a status such that the current US regulatory climate makes it too hard to get them approved as treatments. For instance, treatments that are "medicine" in other countries (China, Japan, Russia...) but not yet accepted here. Treatments that can't be patented so it doesn't make economic sense to get them approved here. Treatments that probably work but are legally or ethically problematic for other reasons (eg, ketamine for depression, alcohol for social anxiety, or cigarettes for weight loss).

That doesn't change my point.

If new evidence comes to light that now says a treatment is ineffective, and doctors are still applying that treatment, that isn't medicine either. At best it's, again, placebo. At worst it's fraud and/or profiteering.

I am surprised a comment this correct to be down voted down on hn. I thought this place tried to be evidence based...

> Placebo wrapped up in meaningless ritual to make it "feel" real.

Hey, don't rain on placebos, the remarkable quality of the "placebo effect" is how well it's known and been shown to actually work =)

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