Lame disclaimers:
1) not medical advice (I am a guy on the internet lol)
2) "don't go to the doctor" doesn't literally mean to never ever see a doctor under any circumstance. There are good ones and sometimes you need them. But as you'll see, you should be quite careful about it
I'm gonna break this down into roughly four sections:
1) General effectiveness (and risks) of medical intervention
2) Declining standards in medical education
3) Physician Conflict of Interest
4) What you should do
Part I: Effectiveness and Risks
In this section we're going to ask two questions:
1) When a doctor does something for their patients, is it usually helpful?
2) Do doctors harm their patients?
The answer to 1 is "sometimes", and the answer to 2 is "often"
The most important concept to understand in this section is that of "medical reversal". Medical reversal is when a treatment (a drug, surgery, anything) gets widely rolled out into medical practice, only to be shown to be either ineffective or harmful later.
Medical reversal is *extremely* common. In an analysis of every trial in the NEJM over 10 years, Prasad et. al found that over 40% (!) of trials testing an established medical practice found that practice to either be ineffective or harmful! [1]
You can of course quibble over the exact numbers and methodology, but it's quite clear that this is a very common occurrence. Reversal has happened for common and/or important practices.
Have any of your family members gotten a stent placed because of their stable coronary artery disease? It didn't help them! [2][3]
Beta blockers for hypertension? Didn't help! [4][5]
The carelessness with which physicians push their favorite pet interventions is shocking. Take, for example, the NELSON trial. The trial is simple: in current/former smokers, give them a CT scan to check for lung cancer. one group got the scans, the other didn't. [6]
Now, this one might seem like a no-brainer. Smokers get lung cancer, so you want to scan them and catch it early, right? If you read what the paper authors say, you'd certainly think so!
And look at that! The lung cancer mortality is lower in the screening group! The cancers were caught at much earlier stages! Better sign up for your cancer screening, right?
Of course, what they don't bother to discuss is the fact that the two groups had *the same* all-cause mortality. This means one of two things - either the earlier detection didn't help, or the extra tests and treatment harmed patients enough to offset the benefits.
Lest you think this is just a single random trial, this is one of the two pivotal trials that the USPSTF used to make its recommendation that smokers get screened! [7] (the NLST trial found a modest 6% reduction in overall mortality) [8]
I could do an entirely separate thread about the problems in life science research and why, despite the claims that "we're making breakthroughs every day", medical science is essentially stagnant. You can even see it in life expectancy, which has been nearly flat since 1990.
Part 2: Declining Standards in Medical Education
"Ok, so lots of things lots of doctors do are useless or harmful, I'll just find a good one!"
Good luck! The vast majority of doctors being trained today are not going to be able to
On an anecdotal level, I am at a slightly above average US MD school (we'll discuss DO schools later), and almost all of my classmates say they feel overwhelmed by the curriculum. Almost none of them are interested in doing research beyond what they need for residency matching.
You might be asking, "if they can barely handle the basics, and are not interested in the details of biomedical research, how will they be able to think independently and figure out what is really best for their patients?"
Good question! The answer is that they won't!
Almost all preclinical medical education is now pass/fail. As long as you score above a minimum level on your exams, usually ~60%, you will pass. If you do fail, the retake exam is often literally the same as the original
USMLE Step 1, the first licensing exam, is now pass/fail
Clerkships, the time in the third and fourth years when medical students are in the hospital to learn, are graded, but even students who do poorly graduate; 95% of US MD students match, and most who go unmatched do so because of a major red flag (crime, etc.) not mediocrity
(by "match" I mean match into a residency position)
The medical schools desperately try to ensure everyone graduates, regardless of their abilities, both because their accreditation body demands it, and because of "equity" concerns
The concern about lax standards just theoretical. In a 2007 survey of residency program directors, 30% said that their interns (first-year residents) struggle with "responsibility and reliability". One-third said they struggle with "organization" and "application of knowledge"!
Now, that survey was in 2007, and things have undoubtedly gotten worse. They will continue to get worse. The steps that are being taken to alleviate the "doctor shortage" are going to crater the average quality of physicians, especially in primary care
One of the reasons for this is that medical schools are expanding, fast. MD enrollment is up 37% since 2002, and there's no sign of this slowing down. This, however, is only part of the problem.
Right now the AAMC is pushing for an additional ~4000 residency spots. If almost all MDs already match, who will fill these spots? The answer: DOs from new schools and International Medical Graduates, mostly from the Caribbean. (getting cut off, will add rest of the thread soon)
Now, I won't clutter this thread with a full discussion of DO/Caribbean schools, but DO schools are mostly the same. Generally students with lower test scores and grades attend DO schools. This is mostly fine, but DO enrollment is exploding. There is even a for-profit DO school!
Caribbean schools (and similar ones in Europe) are generally attended by Americans who couldn't get into an MD or DO school. Since most MD and DO students match (95% and 80%), the thousands of new residency positions will mostly be filled by unmatched DOs and carribean grads.
It's hard to tell exactly what will happen with this, but expect it to be quite difficult to find good primary care doctors. The extra residency positions, when added, are going to be mostly primary care specialties, and a lot of them are specially earmarked for new schools
In summary, if you thought doctors were Very Smart, reconsider! If it was ever true, it certainly isn't true now, and won't be in the future!
Now for Part 3: Physician Conflicts of Interest
I'll keep this part short since this is already a ridiculously long thread, but let's say you find yourself a doctor who is not an idiot. Great! Unfortunately, they could be taking thousands from the pharmaceutical companies!
Conflicts of interest are pervasive in academic medicine. About 2/3 of US doctors receive personal payments from the pharmaceutical industry, and the total value of these payment is over $2 billion. This is not benign; it influences patient care directly:
Physicians who receive payments from industry are common among guideline-writers, conference speakers, and heads of departments, which means that even those physicians not taking the money are influenced by those that are.
This is only a small fraction of problems with the medical system; I haven't even mentioned cost, and a discussion of the pharmaceutical companies, FDA, and conflict of interest should be its own thread.
Now that we're through the blackpilling, what should you do?
Part 4: What to do
The main thing you really need to do is find a good primary care doctor. And by "find", I really mean go digging. Don't go do Dr. Dipshit that your neighbor told you about because they love him and he's "so thorough!"
You have to really make sure they know what they're talking about. Ask them about what the evidence is for what they want to do to you. If they give a bullshit answer because the real answer is "that's what my board prep said", get rid of them.
Next, you have to stay out of the hospital. I didn't include this in the original part, but hospitals are extremely dangerous places. Hundreds of thousands of patients die in hospitals due to medical errors [8].
Finally, and especially if you go to see a specialist, check to see if they have any conflicts of interest. There are two ways to do this, but neither are perfect. First, if you can find one of their papers or presentations, their conflicts will usually (but not always) be listed
Second, the CMS open payments database (
https://t.co/h0rrkn9661) documents industry payments to physicians, both personal and research. You would be surprised, I've seen personal payments on here upwards of $100,000/year
In conclusion, don't go to the doctor! Or, at least, find one good doctor and don't let any other dipshits do anything to you without running it by them first. Be careful out there! Good luck!
going to add my references shortly, also going to completely shamelessly tag
@MogTheUrbanite to find out if he deems this important enough to share with the people lmao
