Thread by @then_there_was

The medical industry has a major problem.

They treat health solutions as if they only have first-order effects.

Let's take heel pain as an example.

Heel pain is a consequence of having weak foot muscles.

Wearing shoes with soft soles can cause it.

Over time other muscles will compensate.

Those muscles weren't designed to support the extra burden though.

Eventually they're maxed out and pain sets in.

Doctors recommend ibuprofen and soft shoes to alleviate the pain.

Then cortisol shots, and after some time, surgery

This approach completely misses second-order effects.

The patient has heel pain because the foot is weak.

You need to recommend barefoot walking and shoes with no soles—the complete opposite of what doctors recommend.

Why?

Doctors aren't stupid. So why are they wrong?

It's because they have no skin in the game.

Specifically there is no mechanism giving them feedback on their dumbass advice.

They only see a patient for a problem, but don't track the problem over time effectively.

In other words, they give advice but don't see the outcome.

This problem is rampant. I've done more to solve my mothers ear infection, carpal tunnel, and blood pressure than any doctor she's seen.

And she's seen a lot.

There's something fucked up happening here.

The system is not self-correcting.

There are known solutions to many problems.

And they're easy to implement.

But doctors are not updating their models. They're not integrating these new solutions.

Part of the issue is the sheer overwhelming around of knowledge you'd need to provide solutions.

To be confident in your approach to acne, you'd need an understanding of nutrition, endocrinology, and the antibacterial properties of UV light.

That's a really odd mixture of knowledge.

But the knowledge is out there, on islands separated by oceans of ignorance.

This doesn't just happen with doctors.

Joe Rogan's physical therapist didn't know how to cure tendinitis with a Thera-Band. It's basically a big rubber stick you rotate. Simple but effective.

They simply recommended ibuprofen and ice.

My mothers doctor thought she had arthritis.

She had carparl tunnel.

She convinced the doctor it was carpal tunnel.

Doctor wanted to do cortisol shots.

All she needed to do was massage her thumb for 3 weeks.

Pain is gone.

My dermatologist recommended Retin-A and cleansers. Everyone on Reddit did too.

Not one person realized UV light could kill acne.

Everybody recommended sunscreen to protect your face.

Notice how most of the solutions cost money.

Financial incentives mean the products that cost the most money will make themselves known.

It's why when people think of carpal tunnel they think of surgery, why when they think of acne they think of moisturizers.

The free solutions don't get ad time.

I think that's absolutely fucked.

I think in 2018, when we literally have computational power far in excess of what billions of humans can do...why in the hell should we be left stumbling in the dark, trying to Sherlock Holmes our way to solutions that already exist?

I could understand if these were solutions nobody else knew about.

Nobody knows how to cure certain cancers. I get that.

But when you have 4-5 doctors unaware of basic problems and their simple solutions, scorn is the only appropriate response.

And by the way, the health app technologies are shit too.

All these entrepreneurs lack the courage to make something useful.

They're either finding ways to make doctors more efficient (20 Ibuprofen bottles per hour vs 78.6 per hour) or giving patients another way to track pills

Essentially to be a great doctor you gotta be able to play 20 questions.

"Where's the pain?"

My back

"Do you sit often?"

No

"Do you exercise?"

No

"Do you carrry a wallet in your back pocket?"

Yes

"Switch it to the front. That'll cause hip displacement and pain."

There's no app that's collecting useful data about your health and building a profile, comparing it to other people and observing trends to come up with useful solutions.

Instead they just record super obscure measurements that don't measure shit.

"My calcium was at 4 today"

When you go to the doctors office, the most advanced thing he uses to diagnose you is the stethoscope.

Think about that.

That tool is more than 200 years old and in that time nobody has figured out a better way to quickly diagnose you.

When's the last time you had a checkup, the doctor listened to your heart and he was like,"Oh shit, you have cancer."

I can listen to my heartbeat myself.

I can literally feel it. The fuck is that dude spending years of medical school for?

I'll end it with this.

Jeff Bezos has done more to help people solve their health problems than any doctors in history.

The ability to buy obscure books about any topic gave people the ability to teach themselves.

Can't say the same for medical schools.