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Seamus O'Mahony, a gastroenterologist from Cork, has written the most devastating critique of modern medicine since Ivan Illich in Medical Nemesis in 1975. O'Mahony cites Illich and argues that many of his warnings of the medicalisation of life and death; runaway costs; ever declining value; patients reduced to consumers; growing empires of doctors, other health workers, and researchers; and the industrialisation of healthcare have come true.
[...] Unlike Illich, who believed that modern medicine counterproductively created sickness, O'Mahony does see what he calls a golden age of medicine that began after the Second World War with the appearance of antibiotics, vaccines, a swathe of effective drugs, surgical innovations, better anaesthetics, and universal health coverage for most of those in rich countries. It ended in the late 1970s, meaning that O'Mahony, who graduated in 1983 and is still practising, enjoyed little of the golden age. We are now "in the age of unmet and unrealistic expectations, the age of disappointment."
[...] O'Mahony begins his dissection with medical research, "the intellectual motor of the medico-industrial complex." Governments see life sciences as a saviour of economies, and charities urge us to give more to cure every disease. Big Science, which appeared after the golden age, has provided jobs and status but "benefits to patients have been modest and unspectacular." A study of 101 basic science discoveries published in major journals and claiming a clinical application found that 20 years later only one had produced clinical benefit. Big Science is corrupted by "perverse incentives, careerism, and commercialisation."
[...] No disease is better marketed than cancer, and after Richard Nixon's War on Cancer, Barack Obama launched his Cancer Moonshot, which is now renamed Cancer Breakthroughs under Donald Trump. As O'Mahony writes, the language around cancer "is infected with a sort of hubristic oedema." For Big Science cancer is a blessing, leading to huge investments in molecular biology and genetics, but, as cancer researcher David Pye put it: "How can we know so much about the causes and progression of disease, yet do so little to prevent death and incapacity."
[...] "The medical profession," he writes, "has become the front-of-house sales team for the [drug] industry." He argues that "doctors' professional culture obliges them to do something—anything," but he is too easy on doctors, who could push back. Society, he says, displays "childishness" in going along with these expensive treatments: "we must have higher, and better, priorities than feeble, incremental and attritional extension of survival in patients with incurable cancer."
[...] The first thing that I ever had published in a medical journal was a letter to the Lancet in 1974 asking why there had been no response to an article in the journal by Ivan Illich describing in detail how modern medicine was a threat to health. (It would cost me $35.95 today to access the letter, about 50 cents a word from memory.) As a medical student I expected that the leaders of medicine would carefully dissect Illich's argument and with evidence show him to be wrong. But such a response never came. I was naive: I know now that it's easier simply to ignore cogent criticisms. I hope that O'Mahony's book, a Medical Nemesis for 2019, will not be ignored. It deserves to be taken very seriously.
(Score: 5, Interesting) by The Mighty Buzzard on Monday February 18 2019, @05:43AM (44 children)
He's not entirely wrong but he's significantly off the mark as well. We've all but cured HIV/AIDS, created the HPV vaccine, and there are cancer treatments in early testing that appear to be very nearly a safe and completely effective universal cure. So, it's clearly possible for us to still make serious advances in medicines. Mind you, we've also declared nearly every minor abnormality under the sun a disease so we can sell pills to treat but never cure it. That needs curtailed at the very least.
Me, I'd put conditions on drug patents demanding one cure for every four (or whatever ends up being the most efficient number) treatments patented or you can't patent anything else until you provide one. Or something along those lines. I'd also put an end to evergreening drug patents by putting two commonly paired medications together in a new pill and receiving a new patent as they're about to lose their original patents. Medical equipment patents also need looked into but I haven't given the matter much thought yet.
My rights don't end where your fear begins.
(Score: 1, Insightful) by Anonymous Coward on Monday February 18 2019, @05:46AM (9 children)
I would bet anything against this becoming true. There is just zero actual chance of this if you know what is actually going on. Source?
(Score: 0) by Anonymous Coward on Monday February 18 2019, @05:56AM
I mean really if I can find someone who really believes this I will bet everything I have on it not happening even without seeing the source.
A lawyer will need to be involved because I expect there may be an attempt to do it in some weasely way like redefining "cancer" or "cure". N.B. Medical researchers have a history of this, like how they redefined "we sequenced the complete human genome" to mean "we tried really hard to sequence the complete human genome but couldn't get that last 10%".
(Score: 3, Interesting) by The Mighty Buzzard on Monday February 18 2019, @07:10AM (7 children)
Sources for this type of announcement pop up every year or so. Pick a search engine and look. The last one I saw was last fall out of Israel.
I'm not saying bet your life savings on it. I'm saying with this many people trying this many different approaches, it's going to happen sooner or later no matter what skeptics think.
My rights don't end where your fear begins.
(Score: 0) by Anonymous Coward on Monday February 18 2019, @07:17AM (4 children)
No, it is no more likely to happen than if a bunch of monks were praying and waiting for a heavenly revelation about what to do. You can keep adding more monks all you want, it's never gonna happen.
But I don't want you to believe me, I want to know how to bet against people like you who believe this stuff.
(Score: 2) by The Mighty Buzzard on Monday February 18 2019, @07:27AM (1 child)
I'm not saying the announcements are going to cause anything. I'm saying that many scientists looking into it eventually will no matter what you or I believe.
My rights don't end where your fear begins.
(Score: 0) by Anonymous Coward on Monday February 18 2019, @07:58AM
I'm saying I know the current state of cancer research and the idea they could accomplish what you are claiming (I assume based off the marketing materials universities are pumping out) is laughable.
There's not a chance in the world. Monks just making shit up would probably have a better chance since at least they are thinking rather than doing the bio equivalent of string of together a bunch of poorly run AB tests.
(Score: 0) by Anonymous Coward on Monday February 18 2019, @08:45AM (1 child)
None of those anouncements are about "cancer", they're about specific forms of cancer. Helpful to some people, but not many and who knows how many are every fully developed and actually create a tangible benefit?
(Score: 2) by HiThere on Monday February 18 2019, @05:49PM
To an extent you're definitely correct. Cancer is not a disease, it's a syndrome. A collection of similar symptoms that are called by a common name. So curing one variety doesn't necessarily, or even probably, cure the others. Another example of that is the common cold, which is sometimes one of a number of different viruses, and sometimes an allergy.
But curing one kind of cancer cures that kind of cancer, and then you can address the next kind. Some kinds are known to be "caused" by viruses. (It's not clear whether the virus actively causes the cancer, or whether it just acts as an initiating agent, but if you could eliminate the virus, you'd eliminate the cancer, or at least retard its initiation by decades. And again, don't assume all of the viral cancers are identical. For that matter there's a couple of animal cancers that are known to be directly contagious. A genital one in dogs and a facial one in Tasmanian Devils. So there may be human cancers that are also directly contagious.)
As a result, all this "War against Cancer" stuff is drastically oversimplified. Try to explain it in detail and people go to sleep on you, even though it's a matter of life and death. But the clear implication is that if you want to model it with a war, a closer model is a guerrilla war than one with formal armies. And even so it's a lousy model. But progress has been made, and is being made. And it's almost guaranteed to continue to not be better than incremental.
Javascript is what you use to allow unknown third parties to run software you have no idea about on your computer.
(Score: 2, Insightful) by Anonymous Coward on Monday February 18 2019, @08:51AM (1 child)
I'm not saying you're wrong, but I am saying that this type of breakthrough is nowhere near as close as it may appear if you read just the research announcements.
To put it into computer terms, today's biomedical/cancer research is basically trying to support legacy code, that is
* about 4 billion years of basically randomly generated spaghetti code with zero documentation
* operating in an environment that is quite different from what the code has (new chemicals unseen before, new types of radiation, new types of social and physical stresses, etc.)
* barely figured out.
In other words, we're trying to fix catastrophic (GPF/OS) crash bugs in a very complicated legacy Excel 97/VBA app, running in Wine or Windows 10 Home Basic, and our level of skill so far has only reached knowing how to open a hex editor and edit the binary code directly (no "source code" to speak of.) Oh, and one catastrophic crash means we can't practice on that install anymore, can't really debug what happened, and we have to start over on a completely separate, differently configured/corrupted install of the same app.
It may work sometimes, and this can feel very empowering and encouraging to someone who's never used a computer before, but it's nowhere near knowing what the fuck is going on and having a god-like power of full control/understanding that some specialists may give the impression of.
(Score: 0) by Anonymous Coward on Monday February 18 2019, @05:24PM
No, it is wrong. If you think there is any chance of this whatsoever tell me the odds and I will bet on it.
(Score: 3, Interesting) by c0lo on Monday February 18 2019, @06:12AM (9 children)
Wrong [wikipedia.org]: "HIV/AIDS has become a chronic rather than an acutely fatal disease in many areas of the world"
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But didn't eliminate yet the HPV infections or eradicate the virus and, based on the effectivity of the current vaccine alone [theconversation.com], we may never will
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That's wishful thinking, marketdroid speak and/or the brainwashing result of the latter.
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Theoretically, yes.
In practice, this is yet to happen.
https://www.youtube.com/watch?v=aoFiw2jMy-0 https://soylentnews.org/~MichaelDavidCrawford
(Score: 0) by Anonymous Coward on Monday February 18 2019, @06:19AM (3 children)
In other words, we've all but cured it! (and then some?)
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Please fund herpes cure. Make America Kiss Again.
(Score: 4, Informative) by c0lo on Monday February 18 2019, @06:23AM (2 children)
In other words, we made it almost non-lethal, provided that you take medication all your life. And no strong warranty offered:
https://www.youtube.com/watch?v=aoFiw2jMy-0 https://soylentnews.org/~MichaelDavidCrawford
(Score: 0) by Anonymous Coward on Monday February 18 2019, @12:01PM (1 child)
FTFY.
Like with cancer treatments, life expectancy flats out on HIV/AIDS. Some make it longer. Some don't. Averages under 10 years. Diet and other "healthy life style choices" barely add a couple of years over the average.
It's why they charge so much for the drugs: They're priced for how many years the insurance covers and how many years you'd last. So many dollars for so many years you're expected to last. Average dosage and presto.
(Score: 1) by shrewdsheep on Monday February 18 2019, @01:37PM
I think they are priced to maximize profit. With cancer drugs the societal pressure is high to re-reimburse these. There are cost-benefit calculations made and (in Europe) the acceptable cost seem to be around 50k Eur/yr. That's what the drug companies aim for no matter the actual cost (cost per QALY).
(Score: 3, Insightful) by The Mighty Buzzard on Monday February 18 2019, @07:05AM (2 children)
A study [hjf.org] ten years ago in Thailand had an HIV vaccine that managed a 32% success rate. That's still not good odds but you don't even get bad odds on something this complicated unless you're on to something.
And I expect you'll keep thinking that right up until we finally get one out of trials and being used regularly. You're a pessimist. Me, I'm happy that it's being looked at hard enough that we get false alarms so often. Eventually one of them will turn out not to be false.
My rights don't end where your fear begins.
(Score: 2) by c0lo on Monday February 18 2019, @08:35AM (1 child)
Cynical, to be more precise
'Pictures or it didn't happen. And, until someone shows pictures, it just won't happen'
Liitle chance to be negatively surprised with such a position.
https://www.youtube.com/watch?v=aoFiw2jMy-0 https://soylentnews.org/~MichaelDavidCrawford
(Score: 2) by The Mighty Buzzard on Monday February 18 2019, @09:45AM
I prefer hopeful but not expecting it to happen tomorrow. It'd be nice if it did but I'm good just as long as it eventually gets taken care of.
My rights don't end where your fear begins.
(Score: 0) by Anonymous Coward on Monday February 18 2019, @11:43AM (1 child)
There are 50+ strains of HPV. The vaccine is against 2.
(Score: 2) by HiThere on Monday February 18 2019, @05:56PM
Actually, with a virus, what counts as "a strain" is a bit artificial. And with the rate of mutation of the HIV virus, whatever definition you use there are probably strains you haven't noticed.
But that doesn't mean that working toward vaccines isn't a good idea.
Javascript is what you use to allow unknown third parties to run software you have no idea about on your computer.
(Score: 2) by exaeta on Monday February 18 2019, @06:58AM (14 children)
The Government is a Bird
(Score: 1, Troll) by The Mighty Buzzard on Monday February 18 2019, @07:11AM (13 children)
No need. Darwin cures those eventually if you allow him to.
My rights don't end where your fear begins.
(Score: 1, Informative) by Anonymous Coward on Monday February 18 2019, @08:01AM (9 children)
sorry, but you're wrong. there are two cases for genetic diseases:
1. death before reproduction: recessive genes will survive in the population, unless you activate a eugenics program. Darwin will not help.
2. death after reproduction: Darwin will not help, unless you activate a eugenic program for it.
(Score: 2) by The Mighty Buzzard on Monday February 18 2019, @09:48AM
That was a what those of us with a sense of humor like to call a "joke". Gallows humor [wikipedia.org] to be specific.
My rights don't end where your fear begins.
(Score: 1) by shrewdsheep on Monday February 18 2019, @01:44PM (5 children)
1. You are wrong in this case. A recessive allele will have negative fitness meaning it disappears from the population (look up fitness).
2. This is debatable and probably wrong. Why are we not dying directly after leaving reproductive age? There is cross-generational care, transfer of knowledge and other interactions in many-generation groups. This again means, that early death leads to negative fitness and elimination of alleles (look up group-selection, inclusive fitness).
(Score: 2) by c0lo on Monday February 18 2019, @10:43PM (4 children)
Blue eyes is recessive, with the brown eyes dominant. Not seeing any sign that the blue eyed humans will disappear soon.
Point: what is negative fitness in one env may be a survival advantage in others. Case at point, one of the hypotheses [abc.net.au] is that blue eyes allow a better perception of blue light, with advantages in being more resistant to "seasonal affective disorder, a major depressive illness that occurs when there are long periods of low light."
https://www.youtube.com/watch?v=aoFiw2jMy-0 https://soylentnews.org/~MichaelDavidCrawford
(Score: 1) by shrewdsheep on Tuesday February 19 2019, @09:19AM (3 children)
Sure thing. We were talking about disease alleles. The point was about the misunderstanding that a recessive allele can somehow escape selection. It is important to stress that there is another nuance. Alleles present in the population for longer times cannot have negative fitness (otherwise they would have disappeared). They convey a disadvantage in certain situations (let's say the homozygous state) but do convey an advantage in other ones (e.g. hemoglobin mutation vs. malaria).
(Score: 2) by c0lo on Tuesday February 19 2019, @09:40AM (2 children)
Sure, but it does not mean a negative-fitness allele is guarantee to disappear during evolution.
Being recessive, they can carry negative fitness for long time. And the reason is exactly what you pointed: they manifests only in homozygous state (and eliminate the individual), while in heterozygous state their activity is suppressed by the dominant and it can be passed to the new generation.
I wonder if the communism could have got a hold in Russia if not for the royal disease [wikipedia.org] (tangent: maybe a recessive can be deadly to millions of otherwise healthy individuals)
https://www.youtube.com/watch?v=aoFiw2jMy-0 https://soylentnews.org/~MichaelDavidCrawford
(Score: 1) by shrewdsheep on Tuesday February 19 2019, @10:05AM (1 child)
Depends on how you define "long time". Under the assumption of no heterozygous advantage even a small fitness disadvantage leads to quick loss of allele, say 1000 generations (do .99^1000).
(Score: 2) by c0lo on Tuesday February 19 2019, @12:57PM
How about 0^1000? 'Cause the very definition of recessive alleles is that they do not show effects unless homozygous.
The cases in which an allele show effects in heterozygous situation:
1. is dominant
2. is codominant (e.g. the AB blood type)
3. is recessive but the other allele is incomplete dominant - does not completely suppress the activity of the recessive
In the case of pure dominant/recessive heterozygous combination, no matter how deadly the recessive, its activity is absolutely null.
Besides, even with a negative fitness homozygous combination, there exist cases in which the individual suffer the effects past the reproduction age - thus the negative fitness allele is passed into future generations (Becker's muscular dystrophy sufferers can live to old age, while the onset of distal muscular dystrophy is between 20 and 60 yo [wikipedia.org]).
https://www.youtube.com/watch?v=aoFiw2jMy-0 https://soylentnews.org/~MichaelDavidCrawford
(Score: 2) by HiThere on Monday February 18 2019, @06:01PM (1 child)
You misunderstand evolution. Even the late appearing genetic diseases generally count as disadvantageous. They just aren't as strongly selected against. But among humans disadvantaging the grandparents usually disadvantages the current children.
And you missed a few classes of genetic diseases that are actively maintained by evolution. The classic example is sickle cell anemia, but it's only one of several. And I'm not sure how you would count blood types, which slightly protect against one disease while making you slightly more susceptible to another.
Javascript is what you use to allow unknown third parties to run software you have no idea about on your computer.
(Score: 0) by Anonymous Coward on Tuesday February 19 2019, @08:17AM
The trouble is that many of the late appearing diseases are outcomes of young advantages. Burn fast, leave lots of kids, and die young can be a successful evolutionary strategy.
(Score: 0) by Anonymous Coward on Monday February 18 2019, @12:44PM (2 children)
Not quite. As long as it is a recessive gene (and they all are, or else they "cure" themselves out) , it will always be there, as only up to 25% of population would be "cured", in absence of means of treatment, while of the remaining rest, up to two thirds will be carriers of the faulty gene.
(Score: 2) by The Mighty Buzzard on Monday February 18 2019, @02:59PM
See above re: joke. It'd take a much bigger asshole than I am to advocate eugenics.
My rights don't end where your fear begins.
(Score: 2) by HiThere on Monday February 18 2019, @06:09PM
Sorry, but even at low frequency levels there's continued pressure against disadvantageous genes even if they are recessive. It's just a lot lower, and keeps getting lower as the frequency decreases until it's swamped by the noise level.
OTOH, many disadvantageous genes are actually advantageous in certain circumstances, especially in the heterozygous form. And in that case the question may turn out to be "how often does the advantageous circumstance present itself" as well as "how helpful?" and "how harmful?". And do you think a population should eliminate a gene which is sometimes helpful just because the condition under which it was helpful has become rare? So some people are hairier than others, despite that giving aid and comfort to body lice, because it sometimes gets really cold for a few centuries. (OK, the attribution of insight to the evolutionary process is wrong. But it's the effect that would be seen if there were insight, being achieved through partial dominance and weak selection pressure.)
Javascript is what you use to allow unknown third parties to run software you have no idea about on your computer.
(Score: 2) by loonycyborg on Monday February 18 2019, @09:01AM
Doctors prescribing cures just for bribes from patent holders or based on patient's ignorance(antibiotics for flu etc) violate the Hippocratic Oath. There aren't any more regulations needed here. If they refuse to honor even foundational ethical principles of medicine then they'll ignore any regulation too.
(Score: 2) by Runaway1956 on Monday February 18 2019, @09:15AM (1 child)
Damn, you're harsh. Just think about all those kids who might go hungry if the snake oil salesmen are put out of work!
(Score: 3, Touché) by The Mighty Buzzard on Monday February 18 2019, @09:49AM
Think of all the snakes having to slither around with dry skin due to lack of oiling too.
My rights don't end where your fear begins.
(Score: 2) by physicsmajor on Monday February 18 2019, @11:50AM (3 children)
If by all but cured you mean be on a lifetime cocktail of expensive medications with significant side effects, then sure.
We haven't cured HIV. It's not an imminent death sentence, quality of life with the disease can be improved, but it's still very bad.
(Score: 2) by The Mighty Buzzard on Monday February 18 2019, @03:01PM (2 children)
I was thinking that as well as there being some very good work being done, if slowly, on bringing a vaccine up to useful effectiveness.
My rights don't end where your fear begins.
(Score: 2) by deimtee on Tuesday February 19 2019, @08:23AM (1 child)
I knew a guy on the AIDS pill regime. They worked, but the side effects were so bad that after a couple of years he took the option to stop taking them and die.
If you cough while drinking cheap red wine it really cleans out your sinuses.
(Score: 2) by The Mighty Buzzard on Wednesday February 20 2019, @06:10AM
That's up to him. I won't ever shout anyone down for saying they've had enough. The vaccine should make that a non-issue within my lifetime though.
My rights don't end where your fear begins.
(Score: 2) by SpockLogic on Monday February 18 2019, @01:30PM (1 child)
Continuing treatment = constant corporate income stream (the MBA wet dream) = Capitalism. One shot cure = OMG, Socialism !!!!!
Glory, glory, hallelujah ! TMB has seen the light.
;-)
Overreacting is one thing, sticking your head up your ass hoping the problem goes away is another - edIII
(Score: 2) by The Mighty Buzzard on Monday February 18 2019, @03:03PM
Nope, capitalism still. Government granted monopolies (patents, copyright, etc...) work against capitalism and need reform badly.
My rights don't end where your fear begins.