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johnlawrenceaspden comments on Thyroid Hormones, Chronic Fatigue and Fibromyalgia: A Hypothesis and a Proposed Experiment - Less Wrong
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I admit both charges. Where do I go from here?
Stop doing that?
No way! It doesn't matter how I came up with the idea.
The original mystery is sound. CFS/FMS/hypothyroidism are ridiculously similar. That needs explaining unless you believe in awesome coincidences.
One explanation would be: Something makes it so that hormones in the blood don't act on the cells.
That would explain a spectacular number of medical facts. There really is a mountain of evidence there. Did you know that doctors are trained to ignore the symptoms of endocrine diseases because they're everywhere? It's a major sin: Overdiagnosing Hypothyroidism. Learn what the symptoms are and go for a walk.
It would all be explained if we could find a something.
So it might be worth looking for a something. Cochran tells us where to look. And wow, here is one possibility. I bet there are loads once you start looking.
And here I am a couple of weeks later, trying my little experiment to fix chronic fatigue with tiny amounts of thyroid hormones, and the fatigue's gone, and been replaced by the manic state from manic-depression, which looks like one of the symptoms of hyperthyroidism? And the depressive state looks exactly like chronic fatigue. And I can balance in between by carefully titrating the dose?
It scared the shit out of me. I wasn't expecting that at all, despite having come up with an idea that strongly suggests it might happen not a week before.
What exactly is the difference between CFS/hypothyroidism/FMS/bipolar disorder? Are they all just words for the same thing? And the only difference is some stupid test that no one should ever have expected to work in the first place?
Aren't you even curious?!
Right now, you're saying "I use dodgy inferences" to deflect criticism, but then saying "all my inferences are great!" the rest of the time. That is not good rationality, and it is certainly not just "how I came up with the idea".
Your perception of similarity is based on dodgy inferences, and as such, I have no reason to care about it.
Evidence based on dodgy inferences is not evidence worth paying attention to.
That's a good point, and it's the heart of my argument (well, that and the TSH test).
So I propose a test for that. Ask a doctor you trust: "Can you tell CFS and hypothyroidism apart by clinical symptoms rather than by blood test?"
I have done this, and I think it's not possible. But you are right not to take my word for it.
If it is, I'd love to know, and it would be a great blow to this argument, which I am trying to defeat, so thank you both for the question and for the answer.
I have no idea if he could, but even assuming he can't, that wouldn't prove anything. "Have similar symptoms" isn't the same thing as "are similar". Many symptoms are produced by lots of different conditions.
Yes indeed! And if the only way to tell them apart is a blood test that shouldn't work, then....
I'm not sure why you think the blood test shouldn't work. If you mean that it shouldn't be able to tell apart two different conditions, of course it should--being able to tell apart two conditions is the whole point.
No, I mean that the blood test shouldn't be able to tell the difference between hypothyroidism (shows hypothyroid symptoms, gets better when given thyroid hormones) and not-hypothyroidism.
The TSH test measures one variable in a very complicated system full of feedback loops. It's a bit like if your aeroplane keeps crashing, and you take it to the mechanic and he says "The rudder wires are fine, so there's nothing wrong with it". And you say "But why do you think the rudder wire is all you need to test?", And he says, "Whenever an aeroplane is good, and doesn't crash, we check the rudder wires and they're always fine".
Except the TSH test isn't even that good! Because for forty years they've been arguing about what blood levels of TSH fine people have, and the latest answer is "such a narrow range that huge numbers of people who aren't ill are outside of the range".
So it diagnoses lots of people who seem perfectly healthy as ill, and it tells lots of people who are obviously ill that they're fine. I call bullshit!
But the real problem is that they never checked whether it worked or not. You're supposed to check these things. And they didn't.
Where is the evidence that (shows hypothyroid symptoms, gets better when given thyroid) is the same as (TSH in whatever the normal range is)?
Why did they ever believe that? Why did they not check to see whether it was true?
Rephrased a bit, this says "Healthy people have such a narrow range of TSH that huge numbers of healthy people are outside of this range". I trust you see the problem.
What do you mean by "worked"? As you yourself point out, it's just one variable in a complicated system with feedback loops. If you mean "necessary and sufficient to give a clinical diagnosis", then no, it never "worked". Doesn't mean the number is not useful.
Tests are Bayseian evidence. If people outside the range disproportionately have a condition, a test is evidence for that condition, even if not every person outside the range has the condition, and not every person with the condition is outside the range.
... maybe the reasoning that led you to the conclusion that the blood test "shouldn't work" was wrong.
g, see answer to Jiro above. I agree that I am probably wrong. I would like to see evidence that I am wrong.
That's a good point, and it's the heart of my argument (well, that and the TSH test).
So I propose a test for that. Ask a doctor you trust: "Can you tell CFS and hypothyroidism apart by clinical symptoms rather than by blood test?"
I have done this, and I think it's not possible. But you are right not to take my word for it.
If it is, I'd love to know, and it would be a great blow to this argument, which I am trying to defeat, so thank you both for the question and for the answer.