Comment by seanp2k2 | Hacker News Reader

Comment by seanp2k2 | Hacker News Reader

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Thanks for your explanation. I know I like knowing /how/ drugs / medical treatments actually work, and I think many of the people on here also appreciate this.

Doctors, in the US at least, are a bit less than helpful when you ask about this kind of stuff, and I've had more than one actually act offended when asked about how/why what they're prescribing works. I know that in IT, if a client asks us how something works, I'm more than happy to explain, or at least point them in the right direction and link them to some documentation and/or how-to articles. With doctors, I typically get more of a "it just does" / "it's complicated and you wouldn't understand" / [very technical explanation, not even trying to make it make sense to laypersons].

It's a rare doctor that really knows -- in many cases, nobody really knows.

For example: How do SSRIs work? Statistically, they do "work," for certain values of work. We know that they result in more serotonin in the synapse. But we also know that that's not the reason they work, because that happens immediately but it usually takes a few weeks for the drug to actually work. Evidently they work by inducing some kind of structural change, but nobody knows what.. Nor do we need to know what to know that they're good drugs to prescribe in certain circumstances.

Meanwhile, many people want "reassurance" to be part of the product that they receive when they go to the doctor. If your doctor said, "these pill seem to sort of go with your symptoms in the massive table I have painstakingly memorized, nobody really knows what they do, try eating them", she would be providing a strictly worse product in many people's eyes than if she said "You have condition X. It happened because of Y. Take these pills and you'll be all right."

Not to mention treatment description apparently impacts efficacy. Here are two articles talking about this problem:

http://www.radiolab.org/2007/may/17/ http://www.wired.com/medtech/drugs/magazine/17-09/ff_placebo...

The curious will get labeled as doctor shoppers, then you will get nothing but an entry in their database. It's crazy, they treat the stats not the patient.

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