Throwaway05
1d ago
There's a few layers of problems here.
First:
Yes I need to acknowledge that a lot of medicine is guess work and throwing up our hands and going "this makes sense" or "anecdotally this works." This is because proper research is extremely expensive, difficult, and is often unethical to do correctly (a lot of research in Peds is just not performed because nobody wants to test shit on kids). We do have things that we have really good quality research for, or know with a good deal of certainty. Medicine has some of the strongest validated research evidence and some of the weakest. It is totally a shit show and it's important to acknowledge that.
Second:
Again most medical care is centered around reducing mortality and morbidity. Optimization is considered less important and rewarding but it is what most people want since most people aren't actively dying at any given time.
Third:
Optimization is orders of magnitude more complicated. Individual genetics, lifestyle, life history, gut microbiome and so on radically impact the effect of these types of interventions. You'll see vegan or paleo diet advocates, touting the general wisdom of something that may have worked for that specific person. We don't have the research base and money for too much personalized medicine at this point which is a weakness of ours but any of this type of evangelism is fundamentally worse since people are bad at nuance and anyone involved in fad diets or whatever has a tendency to be extremely bad at "try it for a little bit and see if it works for you" type preaching instead of "behold, this is magic."
Fourth:
As alluded to above some people are capable of responsibly using this type of information, but by the numbers most people (or just enough) who get into "alternative medicine" (or however you want to label it) decide to abandon traditional medicine, and that includes the wealthy, intelligent, and educated. A common path is starting on a "fad" intervention and then just refusing mainstream medicine leading to future poor outcomes which can be extremely disturbing for the patient and care providers. This also makes most of us reflexively hate this shit which isn't productive but is the reality. Most people who are suffering are very willing to engage in black and white thinking and assume that mainstream medicine doesn't have much to offer them if this other plan helps with relief.
Vaccine refusal is a parallel - there's some nuanced discussion to be had on the COVID vaccines but any doctor who has seen a kid avoidably die from measles is going to want to put an anti vaxxer into a woodchipper because in their head it's the same crowd that is letting kids die.
Fifth:
One of the reasons for the difficulty in good research for this stuff is subjectivity vs objectivity. "I don't feel right" is a lot harder to chase, scale, and improve than "my blood pressure/sugar is elevated." This also means that the placebo effect and psychiatric impacts are extremely important and in all honestly might predominate.
People don't like to be told "this only works because you think it does" or "no there's nothing physically wrong with you it is a complicated psychiatric problem" but the reality is that many things are like this.
Unfortunately POTS is a good example, as is CFS/EDS/Long-COVID. People do appear to really have these diseases but the vast majority of people who say they have them, don't. This is magnified because of the importance of patient reviews and lack of time to actually speak to patients. Your doctor might be sitting in the back room going "yeah no way does this chick have POTS, but I don't have time for this fight so whatever I'll go along with it" and of course the fact that the physical and psychiatric side of things are tightly linked together doesn't help anything.
Ultimately almost all symptoms of these kinds of things (examples: tiredness, weakness, sleep problems, concentration problems) are equally or better explained by just depression/anxiety and are known to be symptoms of such. Treat the depression adequately and they go away, but identifying the issue as medical is more ego-syntonic and often impairs recovery.
You also see patients identifying as having ADHD because they can't concentrate and its really depression, bipolar, or personality and they refuse to acknowledge it but ADHD seems like a "better" disease to have and importantly has a clear treatment.
For a wildly different example: aging men demanding testosterone because they are feeling symptoms of aging or unhappy with their life course. It's not wise, but people refuse to not pursue it.
Fundamentally PEOPLE (all people) aren't really psychologically equipped to navigate these sorts of things in the modern world and it adds an enormous layer of complexity to the proceedings.
Sixth:
Assuming the previous point didn't turn you off the next layer is the assumptions of the math brain type person. If you've seen me post here before or on my previous account on Reddit you'll have seen me going at it with a bunch of hard science/math/finance people about how hard medicine is. People used to working in fields with way less ambiguity struggle to understand the realities of health and medicine (and research on the same). Your code runs or does not, the $$$ goes up or down. Why can't you turn medicine into an algorithm just like in our fields?
Medicine is an art as much of a science, translating what patients are actually saying, interacting with patients, figuring out how to interpret p-hacked and clearly biased research, navigating legal environments and regulatory burden all make the field way more complicated and subjective than you'd expect from something that seems to so firmly abut hard science.
Epistemic certainty on the vaguer things is going to therefore be shitty as hell.
Seventh:
Okay so what does all of that boil down to?
I have no idea if what you are doing is working because you think it's working, because it's turning some corner psychologically, or because it is doing something biochemically useful for you. I have no idea how likely it is that it would work for you specifically and you just got lucky.
Nor do I really care, and perhaps you shouldn't either. If it makes you feel better than power to you!
You just have to be careful and have some insight. Still get regular medical care. Don't overdo it. Don't do it if your medical status changes in some way that makes it unsafe.
B-vitamins are pretty benign but lots of people end up overdosing on some supplements.
Is your improvement really for the reason you think it is? Probably not...but maybe? However because actually verifying that is nearly impossible it isn't something we can reasonably roll out as population level advice.
I'll leave you with one final example - one of the common ways to hack research studies for novel psychiatric drugs is to take advantage of improvement in an inpatient setting. Turns out that being checked in on and cared for every day, being surrounded by peers and social opportunities, and getting regular therapy makes people feel a lot better. Do these things and dump a new psych drug on them and they'll get better! But uh, not clear it really is the medicine doing it.
Throwaway05
1d ago
...you know that anecdote makes me wonder if another interpretation of the reality distortion is just nerds being shocked to interact with someone with actual charisma.
If you've ever met with someone high level (especially while young and impressionable) it can be quite stark, your ego gets totally consumed and you just go along with it (and for some people it's not even temporary).
Throwaway05
1d ago
Sure thing. Quick tl;dr about chiropractors is that I had one and just found another one that was around $40 for an adjustment, so to go from moving gingerly because back pain to just a little soreness and full range of motion when I need it is worth that and then some for me when I need it.
Just keep em away from your neck lol.
Jobs
Hmmm you make a good case.
I think the counter argument would be going all map vs. territory invalidation and then pointing out that their didn't seem to be much functional impairment, but that's to some extent luck given the way Apple went and the obvious retort is "avoidable cancer."
I guess he does pattern match to "tortured genius artist" types, and outside of obvious bipolars that's gotta be cluster-b.
Throwaway05
1d ago
RE: Chiropractors.
They can do some useful and real stuff but from everything I've seen everything they can do that is "real" is encompassed within the scope of practice of PTs and DOs doing OMM. And with much lower risk of random BS or ya know, sudden death.
RE: Jobs.
It's interesting you bring him up in that context, I was just thinking the other day about Trump and how he seems to exhibit a level of resiliency that is inconsistent with the way NPD seems to manifest itself. Obviously you could label him with some of the traits but everyone can get that accusation at times. So back to Jobs, the level of functional impairment in those two means they probably don't meet formal criteria...and then that makes me have a think about what kind of things pull people out of a formal disorder. In Jobs case maybe he that BPD brain but is absent the life history that manifests it in a clinically significant way? Or just that the visionary thought patterns and reality distortion stuff are correlated in some way?
This whole line of thinking isn't fully fleshed out but if you've got some thoughts, please share.
Throwaway05
2d ago
You did a great job!
You can google some "official rules" but given your location that has no culture for this I have two thoughts.
-
A big chunk of this is aesthetics. If it photographs well you did your job (and personally I think yours does, but it is subjective!). Nerdy optimizers aside most people are just going to take a photo, share it on social media, and then devour the thing.
-
Use what's available. Don't use low quality salami because that's all you have. It's pretty common to use some fruit and a jam or something. But you aren't going to have access to Harry and David pears so don't try.
In America most of the time we use more of a variety of cheese and crackers but again use what you got. I have no idea if you can find an Italian specialty store in India that has some real cured meats but if you can that is the way.
Throwaway05
2d ago
Same, I hear the way everyone talks about it and feel like I'm missing out on one of the great gaming experiences but.....I can't.
Throwaway05
2d ago
Yeah. Unfortunately all this is not a theoretical problem, or annoying but harmless - seeing people come in with completely avoidable but fatal disease because they were led astray by alternative medicine isn't every day, but it is extremely common.
For some reason these people have no liability and it's nearly enough to make me want to fedpost.
Throwaway05
2d ago
Haven't heard of him, but looking at it briefly looks like total quackery as per usual.
Here's why.
- Most of this stuff (and this is pattern matching accordingly) is not really "useful."
The advice "live a healthy life" is known to all, prescribed by doctors 100% of the time, totally ignored, and incredibly hard to intervene in. "You are missing some common sense lifestyle intervention X" is included within things like "eat a healthy diet for fucks sake." The few people who grab onto something (like thiamine or whatever) tend to ignore all else including extremely important medical intervention (fun fact: Steve Jobs died from one of the more survivable pancreatic cancers because he refused mainstream medicine). Outcomes in "healthstyle fad" type people tend to be incredibly bad, and then we see them avoidably dying in the hospital for no reasons with something preventable and demanding last second intervention.
- The medical industrial complex is a rapacious beast that will agressively steal anything of value from any form of medicine and put it to work (aspirin is basically repurposed willow bark). Sometimes if it can't be monetized you'll run into problems but these are generally edge cases and failing that someone will ruthlessly try and make a career out of it. It's hard to monetize Vitamin C but that doesn't change anything about the fact that we've had thirty years of people trying to make a career out of proving it's a sepsis intervention. If it worked they'd be able to prove it would be strongly incentivized to do so that they could get famous off of it.
Admittedly nutritional type interventions like OP's comment are a bit trickier because establishing evidence burden is hard, but that's not really what your link is getting at.
Throwaway05
2d ago
Regrettably I don't think your interaction would have been any less unsatisfying if it was in the U.S unless you were seeing a concierge or something like that. While the social pressures at play are pretty different in Japan it's also possible that you were getting a "saying you should try a little iron but not too much" without saying it type interaction, as you might here but it would be more easy to understand.
The problem is that you are more likely to catch someone who demands some form of intervention, any intervention and does so incautiously and then injures themselves than someone who actually has a personal biochemistry that is somewhat atypical and would benefit. Not saying you are one of those, but the majority of the global population is total morons so the practice of medicine has to be optimized around that (and smart people can also be morons when it comes to medicine).
Throwaway05
3d ago
I can only imagine how annoying that is as a patient but problems like that are unfortunately not what our system is optimized for.
If you recommend something that makes sense but isn't quite justified (because the labs are normal for instance) then you introduce a huge amount of liability if something goes wrong, and good luck getting it paid for if the patient doesn't meet whatever criteria.
Additionally, medical care is in general about preventing someone from dying, "minor inconveniences" (that nonetheless may be subjectively quite inconvenient) are generally not something we are equipped to manage (this being for a huge variety of reasons).
An extra level is the need to avoid fighting with patients unnecessarily.
In this specific case there are other significantly more likely causes of tiredness. Lifestyle habits (including diet, exercises, stress, substances, caffeine, sleep habits, etc etc), psychiatric issues, and boring things like aging are way more likely to be responsible.
I have no idea about you personally, but many patients are extremely resistant to having one of these pointed to.
Lastly there's a bunch of complicated stuff about reference ranges, additional studies, lab uncertainty, diagnostic nonsense... overworked primary care doctor is not going to bother.
Throwaway05
4d ago
As usual blah blah I don't agree with Scott on most aspects of doctoring.
Therapy works, and it works great, and has a great evidence base. The problem is that unlike medication management and general medical care, it's very hard to tell if you are getting good therapy, or the therapy that is good for you - not only is proficiency level variable, but the match between the therapist and patient is important and that can be hard to manage (classically: a good chunk of men are not going to respond well to the more ooey-gooey therapists)*.
Quality therapy also intends to end, it's not open ended or indefinite.
That said it sounds like you are skeptical, had a bad experience, and aren't necessarily the best type of patient for it (plus the expense).
But it is something to consider in the future if you are not satisfied with where you at or slide a bit.
Alternatively you can use the classic man-therapy type approaches. Sportsball! Teams! Friends! Woodworking! Blah blah.
*Yeah I really don't know what Scott is going on about here. There are absolutely the type of patients who therapy isn't likely to work for but DBT for BPD is well validated, and every therapist I've ever dated (pro-tip: don't date therapists) will endorse patients with radical improvement or development, even if it's just catching a college student who needed to grow up. If Scott isn't ever seeing it work something about his catchment is fucked or he is exaggerating in an unhelpful way.
Throwaway05
4d ago
Two thoughts:
-
Your presentation seems pretty biochemical - rapid response to an therapeutic dose (5 is too low), somatic symptoms, a significant amount of side effects (the stomach is common and usually self limited and associated with specifically the initiation of medication and changes of doses). You should keep that in mind and inform your doctor if you need to make changes or you get a new one.
-
This advice will may mean less to you if your presentation is in fact pretty biochemical, but therapy and medication is superior to either alone. Our best guess for how SSRIs work (and you may not actually be one of these it sounds) is that they make your cognitive structure more flexible and allow good decisions and therapy to stick better. If you feel like you could do more to be better, get a reputable therapist.
Additional thoughts - also sounds like you have a decent chance of being the kind of person whose brain isn't good at listening to their brain or body, so you get random ass symptoms as your brain flails around in confusion. In those situations it may be wise to reach outside yourself to try and figure out if you are doing okay/how well you are doing. Of note it's not uncommon for successful people to be like this because they establish patterns of just puttering along and getting it done and burn themselves in the process.
Throwaway05
5d ago
I wtf and turtle-up at the thought of fucking in front of one’s own child.
Which is interesting!
While it's obviously taboo today (and for good reason in my mind), that's probably the one most present historically since large families and a lack of space meant that parents had to make do with little boundary from their kids.
Throwaway05
6d ago
ah, makes sense
Throwaway05
6d ago
Women spend their entire lives being hit on by men constantly, they then have to decide who and when to reject vs. accept and have significant training in establishing their boundaries for these things.
Many men spend their entire lives without being hit on without them initiating to the point that they will continue to flirt when it isn't acceptable to do so (because they are in a relationship, old, power dynamics and so on) because they don't expect it go anywhere.
If it does get reciprocated or it comes out of nowhere ....they don't know what to do and have little familiarity with saying no.
This is the flip side of the power dynamic - men may use power and prestige when they shouldn't to get laid, but women can also take advantage of men's weakness and this is seldom acknowledge or commented on.
I don't really recommend it but it's an interesting experience, just like everyone has a plan until they get punched in the mouth every guy with a reason not to feels like they can reject a pretty woman coming onto them...but many fail in that moment.
Throwaway05
6d ago
Huh. That's fascinating.
I wonder behind the psychology of that - wanting to stare death in the eyes?
Throwaway05
6d ago
Right, I think it works well for firing squads but as soon as you have ten people pushing buttons and only one of them work.....it just kind of looks stupid. Since the whole issue here is optics I'm not sure how to make that shake out.
Throwaway05
6d ago
It's this.
Anesthesiologists know exactly how to kill someone reasonably cheaply and in a painless and not distressing way, it's why they have such a high suicide rate.
But finding people to sell the stuff required (and getting requisite professional staff to assist) is hard.
Then you add on the "finger on the trigger" problem (who wants to be the specific person who killed someone on purpose? Nobody you want doing it).
All this adds up to the weird dance we have.
Throwaway05
9d ago
meth fueled
Thank god it isn't PCP...
Throwaway05
10d ago
Officially added to the (not long at all cough cough) list.
Throwaway05
10d ago
Ar'Kendrithyst is a more central example
Great rec for our specific community (assuming the reader is someone who can get past a slow start).
Throwaway05
10d ago
I need a better elevator pitch for it. Any thoughts?
Every time I try I sound like that Always Sunny conspiracy board meme.
Throwaway05
10d ago
Reverend Insanity
Goddamnit. Isn't it unfinished due to CCP fuckery though?
Also where would you rec I read it?
Throwaway05
10d ago
I loved WtC but come on, DCC is on another level (for example: hilarious and not 110% ratfic).
Yeah you made do with what you had which was wise, but next time you are in a country where you can get a real one do so!
Cold cuts have a surprisingly high quality ceiling, and cheese is something that can taste incredibly different depending on what you got.
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