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from the getting-sick-is-hazardous-to-your-health dept.
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: 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.