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The Danger of Invisible Problems

14 [deleted] 06 November 2014 10:28PM

TL;DR: There is probably some costly problem in your life right now that you are not even aware of. It is not that you are procrastinating on solving it. Rather, this problem has gradually blended into your environment, sinking beneath your conscious awareness to the degree that you fail to recognize it as a problem in the first place.

This post is partially an elaboration on Ugh fields, but there are some decisive differences I want to develop. Let me begin with an anecdote:

For about two years I've had a periodic pain in my right thigh. Gradually, it became worse. At one point I actually had a sort of spasm. Then the pain went away for a few weeks, then it came back, and so forth. All the while I rationalized it as something harmless: "It will probably just go away soon," I would think, or "It only inhibits my mobility sometimes." Occasionally I would consider seeking medical help, but I couldn't muster the energy, as though some activation threshold wasn't being reached. In fact, the very promise that I could get medical help whenever convenient served to further diminish any sense of urgency. Even if the pain was sometimes debilitating, I did not perceive it as a problem needing to be solved. Gradually, I came to view it as just an unfortunate and inevitable part of existence.

Last Monday, after hardly being able to walk due to crippling pain, I finally became aware that "Wow, this really sucks and I should fix it." That evening I finally visited a chiropractor, who proceeded to get medieval on my femur (imagine having a sprained ankle, then imagine a grown man jumping on top of it). Had I classified this as a problem-needing-to-be-solved a few months earlier, my treatment period would probably be days instead of weeks.

Simply, I think this situation is of a more general form:

You have some inefficiency or agitation in your life. This could be solved very easily, but because it is perceived as harmless, no such attempt is made. Over time your tolerance for it increases, even if the problem is worsening (Bonus points for attempts at rationalizing it). This may be due to something like the peak-end rule, as the problem doesn't cause any dramatic peaks that stick out in your memory, just a dull pain underlying your experience. Even if the problem substantially lowers utility, your satisficing lizard brain remains apathetic, until the last moment, when the damage passes a certain threshold and you're jolted into action.

While similar to procrastination and akrasia, this does not involve you going against your better judgement. Instead, you don't have a better judgement, due to the blinding effects of the problem.

Possible Solutions:

I didn't solve my problem in a clever way, but I've begun employing some "early warning" techniques to prevent future incidents. The key is to become aware of the worsening inefficiency before you're forced to resort to damage control.

  • Do a daily/weekly/monthly reflection. Just for a few minutes, try writing out in plain text what you currently think of your life and how you're doing. This forces you to articulate your situation in a concrete way, bypassing the shadowy ambiguity of your thoughts. If you find yourself writing things about your life that you did not previously know, keep writing, as you could be uncovering something that you'd been flinching from acknowledging (e.g. "Obligation X isn't as rewarding as I thought it would be"). A more elaborate formulation of this practice can be found here.
  • I kind of feel that "mindfulness" has become a mangled buzzword, but the exercises associated with it are quite powerful when applied correctly. I've found that following my breath does indeed induce a certain clarity of mind, where acknowledging problems and shortcomings becomes easier. Using your own thought process as an object of meditation is another excellent method.
  • While the previous two examples have been personal activities, other people can also be a valuable resource due to their uncanny ability to be different from you, thus offering multiple perspectives. However, I doubt expensive talk-therapy is necessary; some of my most useful realizations have been from IRC chats.

Comments (55)

Comment author: Dustin 07 November 2014 03:35:51AM 14 points [-]

A chiropractor?

Am I delusional or am I correct in thinking chiropractors are practitioners of something a little above blood letting and way below actual modern medicine?

I mean, there's always the argument that you should do whatever it is that makes pain go away, but is there a reason to have a chiropractor do this rather than a medical professional?

I don't want to diss this post which seems quite good, I just wanted to highlight this point.

My first google result led me to this: http://www.sciencebasedmedicine.org/science-and-chiropractic/

However, I haven't done any real research on this subject. The idea that chiropractors are practicing sham medicine is just kind of background knowledge that I'm not really sure where I picked up.

Comment author: XiXiDu 07 November 2014 10:02:34AM *  4 points [-]

A chiropractor?

Am I delusional or am I correct in thinking chiropractors are practitioners of something a little above blood letting and way below actual modern medicine?

...

However, I haven't done any real research on this subject. The idea that chiropractors are practicing sham medicine is just kind of background knowledge that I'm not really sure where I picked up.

Same for me. I was a little bit shocked to read that someone on LessWrong goes to a chiropractor. But for me this attitude is also based on something I considered to be common knowledge, such as astrology being pseudoscience. And the Wikipedia article on chiropractic did not change this attitude much.

Comment author: shminux 07 November 2014 04:42:49AM 6 points [-]

A good chiropractic treatment provides an immediate, if short-term, relief for many joint issues. You can rarely get that from a physio and almost never from a physician without pain meds.

Comment author: kalium 07 November 2014 08:53:33AM 5 points [-]

They're plausibly pretty legit for some joint-related issues. However there's also a whole set of claims that they can treat totally unrelated issues, for example curing the flu by adjusting the spine. Not all chiropractors make this sort of claim, but enough do to make it background knowledge.

Comment author: Vaniver 07 November 2014 02:56:38PM 4 points [-]

Am I delusional or am I correct in thinking chiropractors are practitioners of something a little above blood letting and way below actual modern medicine?

Others have discussed the scientific evidence, but I'll flesh out shminux's comment with some anecdotal evidence. My father developed some lower back pain from his job as a pilot, and found that a chiropractor was immediately able to solve the problem; he recommends trying it out to people because a single session is low-risk but it should be obvious whether or not it's working.

In general, statistical analysis of medical treatments runs into the issue that it's easy to ask the question "did everyone given treatment X get better?" and difficult to ask the question "how can we tell who will get better and who won't given treatment X?", and the latter question is the one that tends to be practically useful.

Comment author: IlyaShpitser 07 November 2014 03:12:03PM *  6 points [-]

Indeed. They call this "effect modification" in epi. I guess in some sense, this is just another guise for the curse of dimensionality in the context of determining causal effects. Lots of covariates might be relevant for why [X] helps you, but trials aren't very large, and simple regression models people use probably aren't right very often. So it's hard to establish if E[Y | do(x), C] - E[Y | do(placebo), C] is appreciably different from 0 for a sufficiently multidimensional C.


edit: In case it is not clear, p(A | do(B=b), C) is defined to be p(A, C | do(B=b)) / p(C | do(B=b)) (under appropriate assumptions that preclude dividing by zero). This is one of the reasons I don't like the do(.) notation so much. In counterfactual notation, we can make a distinction about whether C is under the interventional regime or not, that is in general p(A(b) | C(b)) is not equal to p(A(b) | C) (but it is for any pretreatment covariate C, because then p(C | do(B=b)) = p(C(b)) = p(C). That is, the future cannot affect the past.

Comment author: hyporational 07 November 2014 04:44:01PM *  1 point [-]

In general, statistical analysis of medical treatments runs into the issue that it's easy to ask the question "did everyone given treatment X get better?" and difficult to ask the question "how can we tell who will get better and who won't given treatment X?", and the latter question is the one that tends to be practically useful.

Anecdotes don't answer the latter question any better. Not even if you're given a statistically effective treatment and happen to improve. I suspect placebo is stronger the more dramatic the treatment.

Comment author: Vaniver 07 November 2014 06:32:12PM 2 points [-]

Anecdotes don't answer the latter question any better. Not even if you're given a statistically effective treatment and happen to improve.

Agreed that anecdotes are single points of data with potentially unknown selection effects. Not sure if I agree about the second part; it seems like treatment successes vary in their obviousness and I suspect some component of that measurement will always be anecdotal.

When you can do statistics, of course, you should; Gendlin's Focusing seems like a good example of the benefit of trying to figure out whether or not therapeutic success could be predicted (it could, and then they could target the success factor directly).

Comment author: hyporational 07 November 2014 07:09:15PM 0 points [-]

Interesting thing about anecdotal data is I tend to hugely overestimate my effect in making people better. To bring myself back to earth I look at the puny effects many treatments have been demonstrated to have and conclude many patients get better regardless of treatment. I certainly underestimate my faults too, but that's a tougher nut to crack. I've also seen doctors overestimate other doctor's faults; of course the failure to intervene with a treatment shown to avoid a bad outcome by a few percentage points killed the patient!

Comment author: ChristianKl 07 November 2014 11:25:43AM 2 points [-]

Am I delusional or am I correct in thinking chiropractors are practitioners of something a little above blood letting and way below actual modern medicine?

The latest Cochrane review indicates that chiropractors do as well as conventional treatment for lower back pain.

It's a bit odd as the first choice of treatment but trying a bunch of different treatments till one solves an issue like this is useful.

Modern opposition to chiropractics is based on the foundation that chiropractors diagnose patients based on what they feel when they touch the patients and not based on X-ray. It's quite easy to do objective science based on X-rays. The moment where you diagnose based on subjective perception it becomes harder to do science.

Guesses about what Palmer, the founder of chiropractics thought he was doing turned out to be wrong and it took the chiropractic association till 1996 to update their definition of subluxation.

Big pharma also has a business model where they can outspend chiropractors by a huge margin when it comes to lobbying and PR to establish memes in society.

The fact that some chiropractors claim to be able to treat every disease while they probably can't also doesn't help.

Comment author: hyporational 07 November 2014 04:03:47PM *  2 points [-]

The latest Cochrane review indicates that chiropractors do as well as conventional treatment for lower back pain.

It's not clear from the summary whether the control interventions were conventional best practice or not. The authors also noted most of the trials had high risk of bias.

It's quite easy to do objective science based on X-rays. The moment where you diagnose based on subjective perception it becomes harder to do science.

Actually it should be quite easy to do science by comparing chiropractors' diagnostic accuracy to diagnoses done by radiologists. If you can see it on an x-ray in superficial anatomy a chiropractor should definitely feel it. Also if there's anything wrong with the positions of vertebrae that a chiropractor can feel an MRI would definitely show it. Do such trials exist?

Doctors do diagnostics manually too. The difference is they won't tell you their subjective methods are out of the reach of science. Same goes for physical therapists, wonder why big pharma isn't lobbying against them...

Comment author: ChristianKl 07 November 2014 10:10:07PM 2 points [-]

Actually it should be quite easy to do science by comparing chiropractors' diagnostic accuracy to diagnoses done by radiologists.

If it's about anatomy being wrong yes. If the chiropractor notices something that basically about motor neurons not firing in the patterns that they should fire given certain stimuli, then the X-ray doesn't necessarily show any evidence.

An fMRI gives you a static image. It tells you nothing about whether specific tissue reacts in the right way when there a little push. It also tells you little about fascia.

Same goes for physical therapists, wonder why big pharma isn't lobbying against them...

I know very little about how how societal attitudes about physical therapists formed and who's responsible for it but I wouldn't be very surprised if there isn't someone on the payroll of big pharma out there who's job it is to lobby for stronger standards of evidence for studies for interventions of physical therapists.

In practice many physical therapists also do a lot of things that aren't backed up by studies that show that they work for a specific condition.

Comment author: hyporational 08 November 2014 05:43:24AM *  0 points [-]

If it's about anatomy being wrong yes. If the chiropractor notices something that basically about motor neurons not firing in the patterns that they should fire given certain stimuli, then the X-ray doesn't necessarily show any evidence.

Point is if they can't notice anatomy being wrong they can hardly claim to have a clue about motor neurons being wrong. You could measure motor neuron problems with ENMG so they couldn't avoid science even in this area.

An fMRI gives you a static image. It tells you nothing about whether specific tissue reacts in the right way when there a little push. It also tells you little about fascia.

fMRI is a dynamic modality for imaging the brain which has nothing to do with what we're talking about. I was suggesting plain MRI, which is actually renowned for its accuracy in imaging soft tissues and not only bones.

In practice many physical therapists also do a lot of things that aren't backed up by studies that show that they work for a specific condition.

Possibly, but their interventions also have much less potential to be dangerous. There are numerous case reports of vertebral artery dissection with ischemic stroke following neck manipulations for example.

Comment author: ChristianKl 08 November 2014 11:42:16AM 1 point [-]

Point is if they can't notice anatomy being wrong they can hardly claim to have a clue about motor neurons being wrong. You could measure motor neuron problems with ENMG so they couldn't avoid science even in this area.

One approach is to say: "Hey, this location feels off. If I do technique X this location doesn't feel off anymore and the person feels better. They aren't in pain anymore and their symptoms disappear." It's another problem to figure out the underlying biology and be able to say exactly what's happening. That takes certain skills that usually don't go hand in hand with being able to perceive locations that are off.

It's also next to impossible to get funding for that kind of research. I know someone who does her PHD at using the kinect to do computer modeling of an proven physical intervention used by some physical therapists. There's little grand money available for that kind of research. Most of the grant money goes to cell biology and biochemistry. Universities have to seek external funding these days and big pharma has money to throw around. Some science that is in principle doable isn't done because there nobody to fund it.

Possibly, but their interventions also have much less potential to be dangerous. There are numerous case reports of vertebral artery dissection with ischemic stroke following neck manipulations for example.

I do think that risk of interventions is a concern but I don't think it's the driving force for mainstream beliefs about chiropractors. Given the inherent risk, it makes more sense to start with lower risk interventions.

As far as potential harm from interventions from physical therapists the risk is likely less, but I would be surprised if there's no physical therapists that messed someone up.

Comment author: hyporational 08 November 2014 12:45:01PM *  0 points [-]

Your arguments against doing science in this case seem fully general to me. They could be used by anyone promoting their brand of alternative medicine no matter how bizarre their claims would be.

What are your suggestions for how to most reliably evaluate anecdotal data? Would it be possible to do some sort of meta-science on this topic? How would you evaluate placebo effects? (Note that I think utilizing placebo too is important.)

I understand many medical treatments aren't RCT based either but the fact that many are kind of makes me trust the mindset of health care professionals more.

Comment author: David_Gerard 09 November 2014 11:15:20PM 2 points [-]

Your arguments against doing science in this case seem fully general to me. They could be used by anyone promoting their brand of alternative medicine no matter how bizarre their claims would be.

And indeed it turns out they are: this is a pretty standard part of the alternative medicine anti-rationalist toolkit.

Comment author: ChristianKl 08 November 2014 04:57:55PM *  1 point [-]

I haven't made a simply argument against doing science in principle. I made arguments that you shouldn't assume that everything there is to know is discovered by science_2014.

How would you evaluate placebo effects? (Note that I think utilizing placebo too is important.)

Hypnosis is basically about utilizing suggestion in efficient ways. If you do it right then you can switch off any pain with it. How can argue that this is basically placebo but that doesn't change anything about the fact that the person isn't in pain anymore and the person wouldn't get the same effect if they would go to a person who's not skilled at using suggestion.

Furthermore any somatic intervention by definition targets someone's subjective experience. The notion of placebo's doesn't make any sense for somatics.

Instead of testing against placebo I would prefer testing against the Gold standard for treatment. A person who's in ill cares whether he gets healed better by treatment A or by treatment B. He doesn't care about placebos.

In some cases you can run additional trials with placebos to get additional knowledge, but comparison to Gold standards seems more important to me. Of course it's good for big pharma to have placebo blinding as the default standard. That way there less pressure to show that new drugs outperform old ones and treatments that aren't blinded as easily because they aren't pills or injections get shun.

I also think that the system that Eliezer proposed in his first april joke post, would work better than what we have.

The doctrine of blindness also shuts down a lot of phenomenological investigation that's important to understanding treatments.

Would it be possible to do some sort of meta-science on this topic?

Yes. I also care more for that then for chiropractors. I have no personal experience with chiropractic treatment nor know someone personally who has.

I'm not sure to what extend fascia is simply the latest buzzword or whether it a concept that yields a lot of new insight. The International Fascia Research Congress will be hold next year for the fourth time with makes it a pretty new field.

Somatics in general is possible to research by asking people to report their experience. It''s not straightforward. I took 2 1/2 years to understand a concept expressible in 21 words to the extend that I internalized it and could really use it. The little literature there is on somatics feels like it's making a bunch of trivial points but most of what matters is hidden in plain sight.

Standardizing that knowledge and structuring it in a way that's well communicated by a book is a hard project.

Last year I had the experience of trying out my newly found perception ability. I noticed a friend strangely interacting with grass and after asking him what he's doing he talked about it. I couldn't perceive anything special about the grass. Then he suggested tries because they are easier and it was an interesting experience.

WIth that new found experience I went to my somatics teacher and asked her about perceiving trees to check if my own perception matches with hers and she found what I'm doing a bit strange. If her tree at the balcony needs water than she gets a feeling that it needs water but she never goes out and actively trying to perceive a tree. I felt like a child playing with his new toy while the adults consider that playing and experimenting immature.

It still don't know whether I understand the full extend of the problem let alone the solution.

Comment author: David_Gerard 09 November 2014 11:13:53PM 0 points [-]

Big pharma also has a business model where they can outspend chiropractors by a huge margin when it comes to lobbying and PR to establish memes in society.

Big pharma versus big placebo: one of these is constrained by expectations of evidence, the other to people opposed to joined-up thinking.

Are you seriously claiming the medical opposition to chiropractic is a big pharma conspiracy? If so, do you have actual evidence rather than merely asserting it's possible?

Comment author: ChristianKl 10 November 2014 12:30:12AM 0 points [-]

Are you seriously claiming the medical opposition to chiropractic is a big pharma conspiracy?

I make a claim that's more complex than that.

Conspiracy assumes not being open. It has nothing to do with a university rather funding research that produces patents that a pharma company can use than the university doing research that's beneficial for individuals doing various kind of manual therapy.

As far as real conspiracy goes, there plenty of evidence of pharma companies having to pay huge fines because they bribe doctors in various ways to do what's good for the pharma company.

If a doctor gives his patients a drug from a big pharma company that company invites him to a fancy all-costs payed luxury vacation conference. It's not as bad as it used to be, but it was bad over decades and that made certain memes win memetic competition.

Chiropractors don't have similar systems for paying doctors who refer clients kickbacks.

In the 20st century big corporations very often won conflicts because the have more power than a bunch of individual practitioners.

It also seems to me more and more silly to believe that the blind man sees more and that blinding in general is the key to knowledge gathering. It's one of those things, were a kid in a hundred years will have a hard time understanding history because the idea is just so silly. Just like we today have a hard time understanding what people in the middle ages used to believe.

It's also interesting that the ideal of blindness is so strong in the medical field and not as strong in any other domain.

A medical professor usually teaches the "evidence-based method" with teaching methods for which he as no evidence that they work. Somehow they succeed to do this without feeling weird. It's quite remarkable. I don't think you can solve the puzzle of why that double standard exists without acknowledging that well-funded parties have an interest in things being that way.

Nobody makes money based on a platform of "evidence-based teaching" so we don't have it in our society but we do have "evidence-based medicine" because a coalition lead by big pharma payed to establish that meme.

I think it's a defensible position to argue that everything should be evidence-based but I see no intellectual reason to have it concentrated into one domain. The best way to explain the status quo is through analyzing the interests of those in power for meme generation.

Comment author: Jiro 10 November 2014 03:06:07AM *  2 points [-]

1) You don't give any figures for how common it is for doctors to get invited to a conference that is an excuse for a vacation. And I suspect you don't have any.

2) Even if it's true, there is a limit to how you much you can influence a doctor with such things. You might get a doctor to adopt some new drug which isn't as good as it should be, but you can't, for instance, get the doctor to oppose vaccination or convince him that saturated fats are healthy. It would be impossible to get doctors to oppose chiropractic this way unless there was already obvious reason to believe it's pseudoscience.

Cigarette companies had plenty of money and tried to buy as many experts as they could. The best they could do was get an occasional scientist or doctor on their side; they came nowhere near convincing the whole medical profession that cigarette smoking is safe.

Comment author: Azathoth123 11 November 2014 01:45:20AM 1 point [-]

convince him that saturated fats are healthy

Well as we know now they are healthier than trans-unsaturated fats. Nevertheless, for decades doctors would advise their patients to switch from butter (saturated) to margarine (trans).

Comment author: hyporational 10 November 2014 04:52:09AM *  1 point [-]

It also seems to me more and more silly to believe that the blind man sees more and that blinding in general is the key to knowledge gathering. It's one of those things, were a kid in a hundred years will have a hard time understanding history because the idea is just so silly. Just like we today have a hard time understanding what people in the middle ages used to believe.

This is a straw man. Blinding is used where it can be used. It's not necessary for doing medical science, and nonblinded trials are definitely accepted by doctors as a weaker form of evidence in cases where blinding isn't possible. Many surgical procedures can't be blinded for example. Blinding doesn't mean not observing patients, it has a much more specific meaning than that. Because of your background in bioinformatics I think you know this, and are stretching the meaning on purpose.

A medical professor usually teaches the "evidence-based method" with teaching methods for which he as no evidence that they work.

You're making sweeping generalizations with nothing to back them up.

If a doctor gives his patients a drug from a big pharma company that company invites him to a fancy all-costs payed luxury vacation conference. It's not as bad as it used to be, but it was bad over decades and that made certain memes win memetic competition.

This is strictly illegal in many (most?) countries.

Comment author: ChristianKl 10 November 2014 01:04:33PM 1 point [-]

Blinding doesn't mean not observing patients, it has a much more specific meaning than that. Blinding is used where it can be used.

I can cross the street with a blindfold. That doesn't mean that's a good idea.

The general idea of blinding in medical science is that on average the human pattern matching ability produces more harm than good. Good medical treatment in the evidence-based paradigm is supposed to be treatment by the book.

People do things like putting box-plots in their scientific papers instead of providing plots of raw data to hide the messiness of real world data from their eyes. That happens in a culture that values blindness.

That culture of blindness leads to many unknowns unknowns that mess with your process in complex ways.

There are many assumption about how learning and how knowledge work that are just assumed to be true.

One example is measure lung function. I have seen papers on Asthma medication that use FEV1 as metric of success. I have measured FEV1 daily for over a year and one day before I got the flu I felt restricted breathing. My FEV1 was still at the normal value.

That's a reference experience that increases my knowledge about the subject. Involved interaction with the subject matter leads to knowledge. You don't get reference experiences by reading journal papers and text books. You usually also don't learn new phenomenological primitives that way.

Oscar Wilde wrote: "Nothing that is worth knowing can be taught." "Nothing" might be an exaggeration but certain knowledge is just really really hard to transfer. But you can set up conditions that are conductive to learning.

You're making sweeping generalizations with nothing to back them up.

Are you arguing that professors are using teaching methods for whom they have published evidence that those teaching methods work?

This is strictly illegal in many (most?) countries.

Today yes. 20 years ago no. Today Big Pharma can't bribe as much doctors anymore, their business model is in crisis and they have to lay of a lot of workers. Of course it might just be correlation and no causation between the separate observations.

Comment author: Jiro 10 November 2014 05:16:02PM 1 point [-]

I have seen papers on Asthma medication that use FEV1 as metric of success. I have measured FEV1 daily for over a year and one day before I got the flu I felt restricted breathing. My FEV1 was still at the normal value.

A measure that is wrong in one particular case may still be the best measure available on a statistical level. I highly doubt that doctors would get better ideas of which therapies are good if they discarded this measure and instead used "does the patient claim to feel restricted breathing".

Furthermore, you haven't convinced me the measure was wrong even in your case. Measurements are rarely yes or no things; most measurements fall within a range and there is not a sharp cutoff between healthy and unhealthy on the end of the range. You could have been at some point that was far enough within the range to be considered okay, yet still not be 100% okay.

Comment author: ChristianKl 10 November 2014 05:47:37PM *  0 points [-]

You could have been at some point that was far enough within the range to be considered okay, yet still not be 100% okay.

It's a measurement I did every day I know how the value fluctuates and it was in the middle of the normal range.

A measure that is wrong in one particular case may still be the best measure available on a statistical level. I highly doubt that doctors would get better ideas of which therapies are good if they discarded this measure and instead used "does the patient claim to feel restricted breathing".

I don't claim that doctors should just replace FEV1 with "does the patient claim to feel restricted breathing". That's the kind of thing that doesn't need any reference experiences and is easily communicable via text.

I claim that the actual experience of interacting with a measurement in a involved way is important to train your intuition to be able to understand a measurement. If you don't have that understanding you are going to make mistakes.

If someone would give me a million dollars I might also produce a device that measures something better than FEV1 but that's not the main point of the argument. But that would be me wearing a bioinformatics hat and that's not the main hat I'm wearing in this discussion.

Comment author: hyporational 07 November 2014 11:22:54AM *  1 point [-]

I see two problems with a chiropractor even if they could be of real help which I'm not too sure about.

  1. A bad chiropractor can do a lot of damage.
  2. Temporary relief, real or placebo, will delay diagnosis if there's an underlying medical problem.
Comment author: ChristianKl 07 November 2014 11:55:37AM 2 points [-]

A bad doctor that operates you based on a misdiagnosis can also do a lot of damage.

Giving pain killers is a quite standard approach of doctors to deal with people who complain about pain and not very well targeted to solve underlying problems either.

Comment author: drethelin 09 November 2014 08:46:15AM 2 points [-]

the average practice of chiropractic is a lot closer to operating than the average doctoral practice. They do spinal adjustments as a matter of course.

Comment author: ChristianKl 09 November 2014 02:03:21PM 0 points [-]

That depends a lot of how you measure "closeness to operating". A bad doctor can hit a nerve when he gives you an injection via a syringe.

A lot of drugs can have quite nasty side effects.

Comment author: hyporational 07 November 2014 03:29:12PM *  3 points [-]

There's vastly more quality control in medicine than in alternative medicine, which is the context in which I meant my comment to be read.

There are lazy doctors, yes, but I'm a bit tired of you painting all of them with the same brush. Also NSAIDs are the most effective treatment known for many problems which understandably bores patients who are anxious to get all kinds of bells and whistles on their first visit.

Comment author: Gunnar_Zarncke 07 November 2014 03:33:27PM 5 points [-]

I see a comparable effect at work in the software industry esp. in teams dealing with aging software. Team members or whole teams can get used to flaws or 'minor' inconveniences in the software, esp. the build and development process until the process slows down to a level where any change takes ages because all steps of the development process have accumulated enough of these invisible problems to hinder any real progress. And the developers not feeling any real pain and have plausibly sounding excuses ("the build just takes that long to compile our large application", "the deployment just requires these manual copy steps", "we have to first create/update/close all the bugtracker entries"...). For the code-base itself there is the concept of Technical Debt, but this problem seems to go deeper because it becomes an indeed invisible part of the organizational process. It is comparable to the problem of Uniformly Slow Code where no simple hot spots can be cured either.

Comment author: Emile 07 November 2014 01:24:23PM 3 points [-]

I was expecting you to write about another kind of invisible problem, one that you just don't know exists, such as "I have really bad breath". That kind of problem is harder to detect!

Comment author: Fluttershy 06 November 2014 11:24:01PM *  3 points [-]

To extend on what has been said in the "possible solutions" part of the thread:

  • I think that having unimportant-seeming health problems checked out by a medical professional within a reasonable amount of time of them first occurring (from immediately for serious problems, such as chest pain, to perhaps a week or two for things like general aches and pains) is a ridiculously good heuristic to have in general.

  • Actively cultivating friends who are conscientious, intelligent, and sane enough to repeatedly tell you that you are rationalizing away an actual problem in your life is a good habit to have. Acknowledging the severity of any given large, easily fixable problem in your life does not follow automatically from noticing that such a problem exists, and having sane friends can help to alleviate this failure mode.

Comment author: gwillen 07 November 2014 01:13:50AM 3 points [-]

I have had bad luck getting doctors to take any kind of mild aches or problems seriously, because I am young (I guess.) And they always turn out to be nothing, so my heuristic is that, "if something feels slightly off with my body, it's nothing, and a doctor will make fun of me if I ask about it."

I realize that this heuristic is bad and will get worse as I age...

Comment author: hyporational 07 November 2014 02:36:57AM *  1 point [-]

How many visits does always mean? How many fruitless visits would be worthwhile to you to make for that one visit where something bad is found? How much do you value not being worried?

Then again, if a person goes to the doctor for minor aches when they sit all day, don't exercise, are overweight or have a terrible diet medicine won't be of much help.

Comment author: gwillen 07 November 2014 06:14:29AM 3 points [-]

Your second paragraph seems like a pretty uncharitable hypothetical, and I'm doing my best to read your second person as generic, and not directed at me personally.

Comment author: hyporational 07 November 2014 10:27:13AM *  1 point [-]

Generic is how I meant it to be. Sorry for the ambiquity. I'll edit it.

I once had a patient who was severely obese, had congestive heart failure, asthma, COPD and her most acute problem was pneumonia with exacerbated asthma/COPD. She still tried to smoke through a window while having oxygen tubes in her nose and thought her biggest problem was that she had to take too many pills every day. Needless to say she didn't survive. I hope this perspective helps to deal with your frustration if you encounter sceptical doctors. They've seen it all.

Comment author: Fluttershy 07 November 2014 03:05:41AM *  2 points [-]

How many fruitless visits would it be worthwhile to you to make for that one visit where something bad is found?

The negative utility generated by going to a public health clinic and gaining absolutely no useful information is, for me, on the order of 50 USD, assuming an average copay of around $30, and that my time is worth around $20.

If I want to simply model the expected utility of going to a clinic by assuming that I either will or will not gain useful information from going to the doctor, I might subtract:

[$50 x p(fruitless visit)]

from

[(monetary value of information gained from a helpful visit-$20) x (1-p(fruitless visit))].

where the -$20 in the second equation is to account for the value of my time in the event of a fruitful visit.

Comment author: ChristianKl 07 November 2014 11:27:11AM 1 point [-]

How many visits does always mean? How many fruitless visits would be worthwhile to you to make for that one visit where something bad is found? How much do you value not being worried?

If you have recurring pain and a doctors tells you that he can't diagnose anything that's no reason for not worrying.

Comment author: hyporational 07 November 2014 11:36:34AM *  0 points [-]

That depends on a lot of things, like what kind of a basis they have for saying so, and how much you like worrying about things that can't be helped. Point of the quote was you should probably worry less with each fruitless visit.

Comment author: ChristianKl 07 November 2014 11:56:15AM 0 points [-]

like what kind of a basis they have for saying so

The basis is usually that the doctor doesn't know a solution for the problem.

The category of things doctors can't help me with and the category of things nobody can help me with aren't the same.

Comment author: hyporational 07 November 2014 12:39:30PM *  0 points [-]

The basis is usually that the doctor doesn't know a solution for the problem.

True and it probably also means that you're not in serious danger if they did competent investigations which should limit your worrying. If you've leg pain and you visit both a competent orthopedic surgeon and a physiatric doctor and they can't help you, good luck with your leg pain, generally. Note that solving the problem doesn't automatically mean knowing what the problem is or even knowing how to solve it, and misunderstanding this is why people love their placebo healers.

The category of things doctors can't help me with and the category of things nobody can help me with aren't the same.

That's obvious, but there's significant overlap if we're talking about problems with the body, which is also obvious.

Comment author: ChristianKl 07 November 2014 01:23:38PM *  0 points [-]

Note that solving the problem doesn't automatically mean knowing what the problem is or even knowing how to solve it

Of course. On the other hand similar things go for doctors. Just because a clinical trial has shown that given certain patients a certain drug helps those patients, you don't know why it helps them.

I plausible that some psychopharmaca work by reducing inflammation in the gut.

In addition most doctors who diagnose a problem as a misplaced vertebrae don't look at why the vertebrae got misplaced in the first place. A misplaced vertebrae is visible on an X-ray. The underlying problem isn't.

If you've leg pain and you visit both a competent orthopedic surgeon and a physiatric doctor and they can't help you, good luck with your leg pain, generally.

If pain is your only problem and you score decently on hypnotic suggestibility a good hypnotist can remove it. In general that's often no good solution because pain is a signal and you would want a fix for the underlying problem but simply removing pain can improving someone's well being.

The human mind is capable of simply shutting of a pain signal.

That's obvious, but there's significant overlap if we're talking about problems with the body, which is also obvious.

Doctors are essentially trained to be blind and not trained to perceive what goes on inside a body. That has advantages because the can give you treatments that work in blinded trials but it also has it's issues.

My own primary physician can't distinguish whether I tense up or relax in a conversation and she's a Yoga teacher on the side, so probably more kinesthetic than average.

The night I stopped being a bioinformatic student I thought "beliefs have to pay rent" as far as my nonstandard beliefs go. I went and fixed one of those problems doctors have told me I have to live for the rest of my life because I didn't feel as bound anymore to the scientific way of doing things.

Comment author: Vaniver 07 November 2014 03:04:15PM 2 points [-]

I think that having unimportant-seeming health problems checked out by a medical professional within a reasonable amount of time of them first occurring (from immediately for serious problems, such as chest pain, to perhaps a week or two for things like general aches and pains) is a ridiculously good heuristic to have in general.

One of the things I've done for this is keep a list in Workflowy of minor medical issues. It still doesn't feel worth the hassle to go to the doctor for one thing--"hey I've got this tiny lump on my finger, what's up with that"--but it does feel worth it to say "hey, these are the five things I've noticed in the last six months, can you spend 2 minutes checking each of them out?" If four of them turn out to be harmless cysts and one of them is an actionable issue, the appointment still feels like a success.

I also don't have a very good intuitive sense of the past, with things basically getting lumped into "the last week" or "before the last week," and so I've found it very helpful to be able to say "hmm, this lump that I noticed 'recently' has actually been there for eight months. Maybe I should treat it as permanent instead of temporary" because it's on a list with a date that I noticed it.

Comment author: Fluttershy 07 November 2014 07:14:34PM 1 point [-]

keep a list in Workflowy of minor medical issues. It still doesn't feel worth the hassle to go to the doctor for one thing...

That seems like a great idea!

I have found that compiling written notes of one's medical history (including not only observations about how you feel on given days, but also notes you have taken during doctor's visits), can be another helpful thing to do. At least for me, this is largely true because it can be hard to remember the particulars of why a particular diagnosis or treatment was given to me five or more years after the fact.

Comment author: John_Maxwell_IV 08 November 2014 02:53:37AM 2 points [-]

If you have chronic muscle pain I highly recommend this book: http://saveyourself.ca/tutorials/trigger-points.php

Comment author: Gunnar_Zarncke 06 November 2014 11:37:25PM 1 point [-]

The human ability to adapt to changing circumstances is high. And especially the ancestral environment allowed little to do about such things. Clearly exhibiting such 'failures' (and calling for help constitutes this) probably reduced your reproductive fitness (I can't give references for this but I vaguely remember that birds show outward signs of illness only prior to it being deadly).

Comment author: bramflakes 07 November 2014 01:54:15PM *  2 points [-]

This hypothesis makes some interesting predictions, such as being more willing to display failures to close family than to extended family - if the problem is due to an infectious disease then alerting your close relatives will increase your inclusive fitness more because they can shield themselves from you, while the benefits to displaying it to extended family will be less likely to outweigh the downside of shunning.

Comment author: bbleeker 07 November 2014 09:25:55AM 2 points [-]

I've noticed cats are the same way, they only show signs of something being wrong when they're very sick.

Comment author: Metus 07 November 2014 12:34:43AM 1 point [-]

I feel like this is something that has to be well researched already. Or there has to be a list somewhere already.

Comment author: Gunnar_Zarncke 06 November 2014 11:31:56PM 1 point [-]

I considered doing a whole body self assessment checklist a while back to monitor my own health progress but didn't deem it worth the ffort in the end. I had thought about it more out of curiosity (quantified-self-wise) but now I will reconsider this. Seriously.