[jrpt]

There’s a lot of umbrella diagnoses that would benefit from more specific diagnostics first. What we call Alzheimer’s is probably actually caused by number of different causes depending on the person. This is true of a lot of things in medicine that get grouped together. That’s why testing a drug in mouse models with all the same characteristics sometimes works but fails to translate into humans who have more variety amongst each other.

The same is true of many diagnoses like pneumonia, cancer, alopecia, essential tremor: there’s multiple different groups that would benefit from different things, and if we had better ways to identify the groups, we’d give them what works for them instead of wasting their time with the wrong treatment. As an example, antibiotics won’t work for viral pneumonia and in addition to wasting the patient’s time, actually harm your microbiome. If you had a perfect way to know which is which, you’d always get the right treatment.

Precision medicine takes this even further.

[awesome_dude]

I recall a University of Washington (I think it was) where they were saying they had found Schizophrenia to be a bucket diagnosis, and had discovered that multiple sets of genes were working together in specific testable ways such that there were >4 sub types of Schizophrenia each with its own set of symptoms, and ability to respond to different medications.

The researcher did a follow-up study to confirm their thesis, but I've never seen anyone else follow up on those studies (family with Schizophrenia makes me acutely aware of developments in that field)

https://source.washu.edu/2014/09/schizophrenia-not-a-single-...

oh, would you look at that - a newer study https://biology.ucdavis.edu/news/discovery-hints-genetic-bas...

[nandomrumber]

You’re right, disease labels aren’t diagnostic.

Many disease labels just mean inflammation-of-a tissue / organ.

Worth noting that some viral inflections of the respiratory tract will have a bacterial secondary, where an either commensal bacteria has over proliferated or a pathogenic bacteria has started to get a hold, and treating the bacterial secondary can help the patient better fight the viral primary.

[storus]

It's quite terrible how the medical "debugging" works or rather doesn't. You run a bunch (at best) of tests then pick the most probable diagnosis and that's about it for 99.9% of cases. And then in a review you measure that the world's best performing doctor hit 45% accuracy whereas an average one hits ~33%.

[dimal]

As someone who has been debugging their own chronic illnesses for the past ten years (and doing better than my doctors), I wouldn’t consider the medical diagnostic process to be “debugging” at all. And that is exactly the problem. Doctors seem to be stuck thinking like bureaucrats following probabilistic flowcharts, and they’re incapable of actually thinking about a problem and debugging it.

The behavior seems to be so deeply ingrained in every single doctor I’ve seen that it seems impossible to change. I suspect they must have this drilled into them in school and residency, then it seems like every decision is constrained by insurance requirements. As far as I can tell, the situation is hopeless.

[djmips]

Always profile before you optimize.

[JumpCrisscross]

> Always profile before you optimize

Not necessarily. Often, treatment and testing can be done in parallel.

In many cases, the treatment is also a test. Every time you apply topical antibiotics to a cut, you’re testing for antibiotic resistance.

[awesome_dude]

I had read their comment as "accurately diagnose before treating"

It's not "House" where you guess something, provide a treatment, watch as things get worse, then change diagnosis in the real world is it?

[JumpCrisscross]

> read their comment as "accurately diagnose before treating"

Right. And I’m arguing that’s more of a fiction than House.

In most cases, waiting for a definitive test can be more harmful than treating when the preponderance of evidence points one way. (In some cases, the test is riskier than the treatment.)

Broadening out of medicine, it’s absolutely okay in many circumstances to try a fix before you’re sure you know what the problem is.

[gettingoverit]

> you’re testing for antibiotic resistance

...and also develop one.