> Why on earth would you conflate the profit motives of healthcare middlemen to imply that the science behind medicine isn't credible?

Because marketing often distorts the results or outright lies. It's not necessarily the science that is the problem, but the marketing and approach in pharmaceutical sales that will push this. This has been, on occasion, reflected in terms of studies, efficacy and results in terms of manipulation of data.

Personally, I feel that compulsory licensing models as part of a dual-sourcing (at least two manufacturers for any drug) would help resolve or reduce a lot of the issues surrounding this. As well as reverting to some prior legal and cultural issues in terms of how marketing of prescription medications is done. TV/Youtube/Dr.Office advertising has gotten pretty horrible, and does very little to actually help people.

I will reflect your outrage back to you now:

Why on earth would you NOT assume that institutionalized greed affects the results of medical science?

Who is funding the science? What are their financial motives? Who conducts the research? What are their financial motives? Are incentives aligned to produce quality medical research with the patient's best interests in mind, or the bottom lines of medical companies (pharma, medtech, even hospitals, etc.)?

I'm shocked and surprised at your shock and surprise. I don't think your arguments are irrational. I simply think they are naïve.

>Why on earth would you NOT assume that institutionalized greed affects the results of medical science?

Because I studied medical science and research for many years, have family in the medical field, and write medical software for a living.

Or rather, I understand very clearly how greed and the capitalist motivation affects health care, as it's literally my life. But with a realistic understanding comes the end of emotional histrionics and petty exaggeration.

AKA: I'm basically informed on this subject, unlike most of the commenters here.

>Who is funding the science? What are their financial motives? Who conducts the research? What are their financial motives? Are incentives aligned to produce quality medical research with the patient's best interests in mind, or the bottom lines of medical companies (pharma, medtech, even hospitals, etc.)?

What is GLP?

What is GMP?

What is a NME?

How many NME's does the FDA approve per year?

>I'm shocked and surprised at your shock and surprise. I don't think your arguments are irrational. I simply think they are naïve.

I'm not shocked or surprised at your response, it's a classic case of Dunning Kruger where you are so ignorant regarding medical science, the intense science based regulation of the FDA, and the business of creating drugs, biologics, devices etc, that you are inherently incapable of evaluating your or mine competency here. If you think I am naive, that is a real testament to the depth of your ignorance on this subject.

Back in university, we used this book to teach people the absolute and most basic fundamentals of this industry https://www.amazon.com/Drugs-Discovery-Approval-Rick-Ng/dp/0...

If you'd like me to answer your questions honestly, I'd be more than happy to take some time to source and answer your question from the perspective of someone who has studied this subject academically and participates in it professionally. But the book linked will discuss I believe every one of your ethical concerns.

I'm sure you're well read and educated. I won't ever be as knowledgeable on the subject as you.

I have the benefit, though, of not having my entire livelihood and career dependent on my faith in the systemic health of mainstream medicine.

Maybe you're right. Honestly based on the tone of your initial comment, I have written off your impartiality, and so have little desire to learn from you. I'm sure you feel the same towards me. So here's to coming to a stalemate while putting other people down on the Internet. Maybe that's the important learning point, for me.

Then you should be familiar with how generations were lied to and told that Fat caused heart disease and low-fat/high carb was the best way to eat.

Research funded by the Sugar Industry.

>Then you should be familiar with how generations were lied to and told that Fat caused heart disease and low-fat/high carb was the best way to eat.

I'm familiar enough with the FDA to know the difference of the Office of Food and Vet and the Office of Med Product and Tobacco.

Why don't you go research what CDER is, and try to determine whether or not diet guidance has anything at all to do with CDER and the actual topic of this thread.

"Research funded by the Sugar Industry."

Outrage porn funded for free, peddled by you.

Irrationalism? Err no.

Taleb expounds on his definition of the natural - anything that man has done for 100s of years without observing downside.

There is reasonable cause to believe that people are very interventionist in a lot of cases where all that is needed is letting the system sort itself out. Diabetes medication for instance (again - not in all cases): https://www.youtube.com/watch?v=da1vvigy5tQ

A lot of openness to low quality scientific work done in a lot of domains and our eagerness to think that anything with numbers slapped on it is better has given us wonderful gifts like high-fructose corn syrup, trans-fat, thalidomide (all within the last century).

The Taleb metric is just that a lot of systems don't respond in a linear fashion to random input. High levels of consumption of a substance only materialize with a delay of a few decades in horrible ways and the negative result can undo all the positives over the duration of the use of said substance. Thus is it important to err on the side of those things that have been (i) well tested over centuries and (ii) strong evidence doesn't exist that said substance is actually dangerous (tobacco for instance).

Note that thalidomide is still used as a medicine; it is a very effective drug when other drugs don't work. The issue was that it was given to pregnant women, when it was known that it shouldn't have been.

I think it was only a stereoisomer that caused trouble.

not exactly, the story is really complicated.

I think some nuance here is needed. My understanding of "natural" primarily comes from an understanding of evolutionary history. If humans have been doing something for millions of years, it is likely to be more "natural" and therefore not cause harm compared to recently invented things. But it is not a black and white thing, but rather a spectrum.

Some examples: Trans fats were invented because they thought saturated fat, which was consumed by humans for a long time, were not healthy, and this new thing was supposed to be better. Then it was found to cause all kinds of problems and are now banned in many places. Here I think it was pretty cut and dry.

An anecdote I've found others corroborate: I used to have foot pain. Some people suggested orthotic insoles, but I also found the barefoot shoe proponents saying that shoes without any padding at all (more "natural") work better. Five years later I never have any foot pain. The Vivobarefoot or Vibram Fivefingers shoes are definitely not something that was around a million years ago, but the principle is the same.

In healthcare, an example in the book is how many people are prescribed statin drugs if their cholesterol is too high, even if there is no other visibly problematic symptoms. Taleb would argue the far better solution is to improve the person's diet, or just wait and see if something happens, than to start taking a drug that isn't.

The author once strained his back lifting weights. The doctor suggested an expensive and invasive surgery. Instead he just rested for a while and the problem went away. On the other hand, my mom recently had neck surgery to replace several vertebrae. She'd been in pain for years and nothing could fix it. So in this case I think Taleb would agree that the risk of a dangerous surgery might be worth it in that case.

An extreme example from the book: in the early 20th century children were given doses of radiation to treat acne. We obviously look at this and scoff, but it is the same idea.

> Why on earth would you conflate the profit motives of healthcare middlemen to imply that the science behind medicine isn't credible?

I'm looking at the profit motives to see where I should be cautious. I feel like this very site is where I've read many articles about how scientific studies had bias because of funding from the companies invested in a certain answer. From what I can see, if you follow the money, you can explain a great deal of the behavior of large institutions.

So I'm not at all advocating ludditeism or against science. Rather I'm against scientism (I think the word he uses in the book) - the belief that science has all the answers and that newer things are inherently better than older things just because they are. They may in fact be better, but not always. Sometimes atheists I meet are just as close-minded as the religious.

So you're saying, if an anecdote fits your theory, it's proof, and forget searching too hard for anything that runs contrary to your beliefs?

I think science works a bit better than this, and I put my faith in that.

A good hypothesis can be used to make predictions. I'm just saying with my foot issues that the heuristic of "subtractive medicine is better than additive medicine" was able to predict that removing padding from my shoes would make my problem go away. And it did. That does not prove anything but it worked here.

Say that the padding had worked, you might have rationalised it to to be that it's unnatural to walk on hard surfaces ("our ancestors never walked on concrete").

There are also probably many instances in your life where this hasn't worked, but you've cherry picked the example that does.

It's very likely that your body healed itself regardless of the padding. You might have just needed time. You've figured that it's removing the padding but it might not be a factor. It's why studies need decent sample sizes to make strong conclusions.

That's fair enough, but also why I looked for other people who had similar experiences. I'm definitely not always right, that is true. I am not a doctor, lawyer, or accountant.

I'm pretty sure the early hydrogenated oils were created (Crisco, 1911) because they had similar and in some cases superior properties to animal fats and butter, but were cheaper and had a longer shelf life. The idea they were healthier came later.