RyanCarey comments on A Medical Mystery: Thyroid Hormones, Chronic Fatigue and Fibromyalgia - Less Wrong
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Excellent - thanks for responding to this so positively. I wouldn't say you're necessarily trolling, rather than just arguing a little more forcefully than someone else might.
I basically think that this is the absurd conclusion that demonstrates your chain of reasoning to be false. This is far wronger than the idea that Fibromyalgia could have an endocrine cause. And I think you've identified this problem with your argument even more acutely that I had.
I think there are a lot of useful ways you can reason from here, such as: 1 - It has never been the case previously that almost all unexplained human ailments have shared a single simple explanation 2 - Many conditions that we discovered a long time ago had simpler 'single pathogen' explanations, whereas many newer ones are quite complex. 3 - Although many of these conditions will eventually be explained, the explanations are not likely to be visible to a non-expert. 4 - If they all shared an explanation, there's no major reason why it should lie in the endocrine system. An alternative 'catch-all' explanation for these would be 'psycho-neuro-immunology', another somewhat overambitious school of mostly scientific thinking that could potentially claim these conditions more credibly.
My alternative explanation that collects this thinking is that most 'unexplained human ailments' are likely to be multifactorial. This is also the common wisdom. As to where to read and learn about this, by far the best place is www.uptodate.com. This is very popular but also potentially expensive. So if you really must, you could instead look through medical textbooks like Harrison's or Kumar and Clarke, focussing specifically on unexplained conditions. I would warn that reading about conditions unexplained by medical science via textbooks of medical science might be a bit like pulling teeth, but truly it should be one way to abstract away the knowledge of these conditions.
Another approach might be to learn more about the scores of "medically unexplained physical symptoms", "diagnoses of exclusion" and "functional disorders". Likewise some "functional symptoms" and some "ideopathic" or "cryptogenic" conditions. "functional", "ideopathic" and "cryptogenic" can be used interchangeably here, as in the sentence "we can't explain your problem, but as a concession, let's meet halfway and conceal our ignorance with this Latinate (or Greek) name. On my hypothesis, most such conditions will be about halfway heritable (as are most traits in behavioural genetics). They'll be correlated with each other, and with mental health conditions. They'll often be helped by SSRIs and by psychotherapy.
I guess you just have to learn a lot about these conditions with an open mind and see where you end up. If you gain a detailed knowledge and still think that some have an endocrine explanation, then write up your findings in a google doc, send it around to some other smart people who share that knowledge, and see what they say.
Ryan, thank you again. Your concerns are my concerns, I am grateful to you for them.
And I apologise. You have been talking to a raving lunatic, by the ICD10 diagnostic criteria as applied by my attorney and myself. See the exchange with buybuydandavis for details. I am apparently recovered now, in the opinion of one who should know.
I am painfully aware that I have reasoned myself into a place where I prove too much.
I am in the position of a philosopher who started out with a little detail, and is now claiming 'It is at least marginally possible that here is the light and the sacred cup'. Knowing that he is wrong.
I was carefully and expensively trained to speak with certainty when and only when I was certain. The Lord knows I was never very good at it.
I have used plausible reasoning where I only trust classical logic.
I am forced to seek the Grail.
But I cannot shake the suspicion that I might be right. And I know that my hopeless hardware will not let me find the reason why I am wrong.
It has. The germ theory.
I am claiming that the great killers of the past may have left their shadows in our genes, and those shadows still plague us today.
I am claiming that the great changes we have made in our environment may have hurt us worse than we know.
Here I stand, naked to the world. Afraid. I can do no other in good conscience. I do not believe my own conclusion.
I hope that when I am shown to be wrong, I can retreat with no more than huge embarrassment, resolving to fail better next time.
And it all depends on the TSH test. If I am wrong about that, I am just wrong.
If the TSH test is flawed, then all our statistics are confounded, and we have some thinking to do.
Still Crocker's Rules though! Let this cup pass from me!
Forget about being proved wrong and facing huge embarassment.
Short-circuit that by getting some background domain knowledge then making claims that in light of that knowledge are reasonable.
OK, type 2 diabetics, suffering from a mysterious condition that prevents insulin (an endocrine hormone) acting on their cells, can achieve very good blood sugar control by overwhelming the resistance with exogenous insulin.
And yet they still suffer horrible complications. Which look awfully like hypothyroidism.
The simplest explanation is that this mysterious condition is interfering with other endocrine hormones as well.
Desiccated thyroid, containing excessive T3, will overwhelm the hormone resistance, and clear up the complications of diabetes.
T4 alone will not change the amount of T3 in the blood significantly, since it is subject to the body's T4->T3 conversion mechanism, which defends T3 levels.
Therefore T4 will not help diabetics, but T4/T3 combinations will.
Broda Barnes observed this empirically in the sixties. I predicted it independently before I read his book.
Find a diabetic colleague, and explain this to him. I predict that he will suddenly take the idea very seriously indeed.