[grueful]

I think one of the major turning points in the future will be to trigger a "space race" which makes a grand project of developing substantive improvements to medical care and quality of life.

There have been significant improvements here motivated by e.g. battlefield medicine, and great results out of academic or humanitarian labs, but much of our current work is stuck in a loop between patents and the FDA approval process. Good intentions aside, the system acts to motivate certain patterns of action in order to stay profitable and continue growing year-to-year which aren't optimal for our long-range interests.

How one would go about motivating such a grand project - I have no idea. Perhaps it's a matter of continuing to make such small improvements as we can until the system is primed for one giant leap. The road of progress was never a well-paved or straight one except in hindsight.

I think that small teams and open sharing of knowledge are both key ingredients. The amount of resources currently in play in medicine is staggering, but social systems tend to lose efficiency very quickly as they scale. Perhaps startup culture will be a key piece in making this happen, but the timescales involved in speculative medical research tend to be beyond the scope of the typical VC-backed endeavor.

[ippisl]

At the academic level , there seems to be a "space race". Maybe it could be improved by making the NIH invest in more radical high risk stuff.

But the commercialization process sure sucks. Testing and verifying a drug is expensive, long and complex. But there seem to be some work going to improve that:

1. The FDA is becoming a bit more friendly[1]. 2. There are some new innovations in how to run clinical trials. One example is [2].They claim they might bring drugs 1-3 years faster to market. 3. Organs on a chip are starting to become available and this might be more accurate than the mouse models used today.

Since some of the new innovations in clinical trials do use web/mobile technology, i wonder what role startups can take in this area.

[1]http://www.xconomy.com/national/2012/09/10/the-fda-turns-fri... [2]http://disruptiveinnovationsinclinicaltrials.blogspot.co.il/...

[agumonkey]

I was just wondering if there was or were companies like google or spacex/tesla for medicine. One that do away with the status quo. Things like chuck pell opener http://www.youtube.com/watch?v=txVM07D4bbA . And aiming at a smaller 'time to market', practical effects.

[derleth]

> a "space race" which makes a grand project of developing substantive improvements to medical care and quality of life.

How about a "space race" to destroy destructive nonsense like homeopathy, anti-vaccine idiocy, reiki, and all of the other non-scientific crap people try to use instead of real medicine.

Getting rid of quackademic medicine would be a good first step.

http://en.wikipedia.org/wiki/Quackademic_medicine

http://www.sciencebasedmedicine.org/index.php/quackademic-me...

[grueful]

I'm all for that. The key problem is defining it. There exist historical examples of quackery which wasn't, e.g. hand washing.

Stricter rules about null hypothesis testing would be a start, but the bigger problem is one of education. We're still plagued by government that gives the nod to creationism and horrifically distorted sex ed in public schools.

I'd like to say we've become empirical enough about what practices we place belief in that we could just treat all cases of quackery as malicious fraud - but the very prevalence of such issues tends to support the opposite conclusion.

[derleth]

> I'd like to say we've become empirical enough about what practices we place belief in that we could just treat all cases of quackery as malicious fraud - but the very prevalence of such issues tends to support the opposite conclusion.

There are enough cognitive biases I can't support this conclusion. Confirmation bias alone accounts for a lot of this crap, I'm sure.

Fundamentally, though, there's a big difference between crap we know doesn't and can't work, like homeopathy, and therapies that are in the pipeline and might be accepted or rejected on their merits.

Homeopathy has had its turn and it failed. That goes for everything else I called quackery. Don't confuse that with something we haven't tried yet.

[grueful]

Failed according to you, me, and the prevailing majority of the medical community isn't equivalent to failed in the minds of the overwhelming majority of the public. The segment which believes or doesn't strongly disbelieve things like homeopathy is manifestly non-negligible.

Anti-vax nuts wouldn't be the public health threat that they are if there were two of them in a pool of hundreds of millions. The segment acting on these beliefs is manifestly large enough to enable outbreaks of diseases we otherwise could suppress almost totally.

[stfu]

For the sake of the argument let me try to defend Homeopathy for a moment. Sure, people can bash it all day long and it might have very little "measurable" effects. But as long as people believe in it, I expect that it leads to the same results as placebo effects.

Placebo effects have been proven in many cases extremely strong and a main obstacle for the pharmaceutic industry to prove the statistical significance of their products. And as long as people get better, even if it is just by the believe in the effect, it is in my view a legitimate approach.

[derleth]

> And as long as people get better, even if it is just by the believe in the effect, it is in my view a legitimate approach.

So fraud isn't really fraud if people are going to get better anyway?

[derleth]

> The segment which believes or doesn't strongly disbelieve things like homeopathy is manifestly non-negligible.

It doesn't matter. Science doesn't work by popular acclaim.

[Alex3917]

"There exist historical examples of quackery which wasn't, e.g. hand washing."

And homeopathy, which even James Randi admits was more effective than western medicine in the 1800s. (In the video that was submitted to HN recently.)

[carbocation]

That's very misleading without providing proper context.

In Hahneman's time, medicine was actively harmful and virtually never actively helpful. The risk benefit analysis would not come out in favor of getting treatment.

In contrast, homeopathy does nothing. It's placebo. And giving placebo, it turns out, is safer than actively sticking dirty instruments into your patient's bloodstream and giving them bacteremia.

In that context, the statement makes sense, but is still obviously tongue in cheek. Homeopathy never worked, but medicine at the time actively harmed.

[Alex3917]

"In contrast, homeopathy does nothing. It's placebo."

Well, yes and no. It is a placebo, but the research seems to show that placebos do significantly more than nothing, at least for some diseases (pain, depression, etc.).

The comment I was replying to was asking for examples of where things that were once believed to be quackery were later vindicated. At the time homeopathy was believed to be quackery. In fact the reason the AMA was launched was to combat homeopathy because it was cutting into their profits; one of their first acts was to launch a 'propaganda department' to scare people off of homeopathy. (Essentially the AMA was founded to kill people. They knew they were less effective than homeopathy at the time and they knew they were killing people, but they just didn't care because they wanted the money.)

The point is though that at the time homeopathy was actually significantly better than western medicine. Now if the definition of something not being quackery is if it's the best treatment available to us at the time, then homeopathy couldn't have been quackery by definition, since it was in fact the most scientifically advanced (or however you'd phrase it) form of medicine available at the time.

[carbocation]

> Now if the definition of something not being quackery is if it's the best treatment available to us at the time,

I do not believe that to be the common definition of quackery.

>then homeopathy couldn't have been quackery by definition, since it was in fact the most scientifically advanced (or however you'd phrase it) form of medicine available at the time.

Again, this is misleading. Homeopathy was and still is completely scientifically bogus. It was never and is not now advanced. It is misleading to say that a field that unintentionally had no effect was scientifically advanced. It's simply the (undisputed) truth that their outcomes were better because of their lack of real intervention, not because of any scientific merit whatsoever.

[Alex3917]

@carbocation

You can call it whatever you want, but the fact remains that if homeopathy was quackery then western medicine was the whole duck.

Also, it's not really fair to say that homeopathy was better merely by accident or that it wasn't scientific, since they're the ones who pioneered evidence based medicine. It might have been completely wrong, but it was scientific. They at least tested their ideas empirically unlike western medicine at the time, which by any reasonable definition must make it more scientifically advanced than the alternative.

[aswanson]

Saying homeopathy was more advanced than regular medicine at the time is akin to saying rain dancing was more advanced than irrigation of crops from a polluted water source. At least the latter method is based on the assumption of certain evidenced-backed empirical principles. The former method has no correlation or effect on reality under any assumption beyond pleasing the rain gods and associated bullshit.

[Alex3917]

@Derleth

Read the book Homeopathy: The Academic Years. Even the AMA admits that this is true, and they give the book a very favorable review on their website. (And also the AMA talks about their propaganda department on their own timeline of their history.)

[derleth]

> At the time homeopathy was believed to be quackery.

It still is believed to be quackery, because it still is quackery.

> In fact the reason the AMA was launched was to combat homeopathy because it was cutting into their profits; one of their first acts was to launch a 'propaganda department' to scare people off of homeopathy. (Essentially the AMA was founded to kill people. They knew they were less effective than homeopathy at the time and they knew they were killing people, but they just didn't care because they wanted the money.)

This sounds like conspiracist nonsense. Do you have a single cite for any of it?

[frobozz]

Homeopathy was more effective in the 1800s because the patient was only under threat from their ailments, rather than having to worry about the doctor killing them as well.

Early medicine was in a large portion, quackery. Some of it was actively harmful. Something that has no effect whatsoever will be more effective than something that harms and doesn't cure.

[TillE]

The placebo effect is remarkably powerful. But there's nothing special about homeopathy.

[derleth]

> homeopathy, which even James Randi admits was more effective than western medicine in the 1800s

I hope you realize how worthless this statement is in a discussion of modern medicine.

Also, it's incredibly racist to call 'medicine that works' 'Western medicine'. Do you also call 'math that works' 'Western mathematics'?

[Alex3917]

"Also, it's incredibly racist to call 'medicine that works' 'Western medicine'."

I assure you that's not how I'm using the phrase.

[derleth]

> I assure you that's not how I'm using the phrase.

Except it is. Medicine can be practiced by anyone who knows how, not just people with the right-colored skin.