Not sure why the parent is upvoted so much. Trivial and rather useless advice, some platitudes, a few rather suspect google hits (paleohacks? really?), and a veiled insult "unless she doesn't like hard work".

she should estimate how likely it is that paid, reasonably savvy researchers can find something she's missed; and go for it if she feels it's over 50% likely.

No, it's much worse than that: "how likely it is that paid, reasonably savvy researchers can find something she's missed" AND it has a near certainty of helping. Current prior: nothing has helped so far, so the odds of something she missed ended up being useful is pretty low. If the estimate of helpfulness is, say, 1% (that's pretty optimistic), and the odds that MetaMed will find something new is 50%, then certain relief has to be worth $100k.

This is a new service and it has to interact with the existing medical system, so they are currently expensive, starting at $5,000 for a research report. (Keeping in mind that a basic report involves a lot of work by people who must be good at math.) If you have a sick friend who can afford it - especially if the regular system is failing them, and they want (or you want) their next step to be more science instead of "alternative medicine" or whatever - please do refer them to MetaMed immediately.

A friend of mine suffers from debilitating effects of fibromyalgia, to the degree that she had to quit her job. She has tried all possible conventional and alternative medicine, with little success. She would certainly be prepared to pay $5000 or more for a near-certain relief, but not for yet another literature search of undetermined benefit. I'm guessing she is not the target audience for MetaMed?

Moderate drinking can offer some health benefits. Plenty of sources, here's one.

Just because many abuse alcohol does not mean it cannot confer health benefits in controlled doses.

it seems a bit out of character for you to generalize so heavily

Seems to me that Yvain is slightly fed up with those on the site who display the LW superiority attitude (I also complain about it on occasion, and so do others). The generalization and all caps probably indicate a certain amount of bitter sarcasm.

He says that myth is often taught resident-to-student, but it isn’t actually backed up by any research.

Lorber B, Swenson RM. Bacteriology of aspiration pneumonia. A prospective study of community- and hospital-acquired cases Ann Intern Med. 1974 Sep;81(3):329-31.

Brook I, Finegold SM. Bacteriology of Aspiration Pneumonia In Children, Pediatrics. 1980 Jun;65(6):1115-20.

Finegold SM. Aspiration Pneumonia Rev Infect Dis. 1991 Jul-Aug;13 Suppl 9:S737-42.

Bartlett JG. Anaerobic bacterial infections of the lung and pleural space Clin Infect Dis. 1993;16 Suppl 4:S248.

Yamashita Y et al. Anaerobic respiratory infection--evaluation of methods of obtaining specimens. Kansenshogaku Zasshi. 1994;68(5):631.

El-Solh AA et al. Microbiology of severe aspiration pneumonia in institutionalized elderly. Am J Respir Crit Care Med. 2003 Jun 15;167(12):1650-4. Epub 2003 Apr 10.

The kicker - if the doctor would stop to think about it, it should jump out as unintuitive – it would take some serious changes inside the lung to make an anaerobic infection – an infection of bacteria that thrive in areas with no oxygen. In reality it takes frequent aspirations over a long period of time to block off an area of the lungs.

The normal flora of the skin, mouth, and upper respiratory tract contains anaerobic bacteria; this alone should be sufficient to disprove overly simplistic "But there's oxygen, you can't have anaerobic bacteria there!" theories. Anaerobes are actually more common than aerobes in the mucus membranes of the mouth and URT and in fact outnumber aerobes in saliva about 10:1. According to The Anaerobic Microflora of the Human Body:

It is not surprising that anaerobes are present in large numbers in the flora of the intestinal and geintourinary tracts because oxygen concentrations are low in these regions. However, it appears unusual that they are also prominent members of the flora of the skin, mouth, nose, and throat - regions that are continuously exposed to air. The presence of anaerobes in these areas is explained first by the activity of the aerobic and facultatively anaerobic components of the flora that reside in association with the anaerobes and consume oxygen in their metabolism and second, by the colonization of anaerobes of microhabitats protected from air.

I think the moral of this story all people, be they doctors or kindergarteners, don’t usually check facts they’re taught, especially when being taught by an authoritative teacher.

Okay, here's what actually happened. In the 1970s and 1980s, a lot of people worked really hard studying the microbiology of aspiration pneumonia and all of them found lots of anaerobes. In the late 1990s, some other people, especially a guy named Paul Marik, tried the same thing using more modern techniques and found very few anaerobes. They concluded that the old studies had been wrong.

Some other people objected that anaerobes are really hard to detect and that maybe Marik and his supporters had just screwed up and not been able to find them even though they were there. This seems to be the view of Rene et al, who claimed to have repeated Marik's experiments using better technique and found lots of anaerobes just like the old theories would have predicted. It was then counterclaimed that Marik's experiment had been unusually rigorous and well-conducted, plus it was also easy to screw up the other way - that sometimes samples might have been contaminated by anaerobes in the upper respiratory tract that weren't responsible for the pneumonia at all. Everyone had a nice big fight about it which as far as I know still has not been fully resolved. UpToDate, which I tend to trust on this sort of thing, pushes the pro-anaerobe line, but emedicine, which is also pretty good, pushes the anti-anaerobe line. I do get the feeling the anti-anaerobe people now have the upper hand.

The rationalist thing to do would be to let the microbiologists fight it out among themselves and just study which antibiotics are most effective against aspiration pneumonia. The answer to that is very complicated, but the oversimplified answer as given by UpToDate is clindamycin, an antibiotic known for its efficacy against anaerobes, which seems to maybe suggest there was some kind of anaerobic component after all - but I am reading between the lines here on a subject I'm not really qualified to read-between-lines on and am probably completely wrong about this.

I agree that many doctors don't know anything about this (I hadn't heard of it until you brought it up and I checked the literature). The average doctor just checks every so often to see what antibiotic is recommended for aspiration pneumonia and then prescribes that one. As far as I know the antibiotic recommendations are still correct. This seems like a pretty efficient system, given how many things doctors have to know.

Anyway, as far as I can tell the real moral of this story is that medicine is really really hard and complicated and, like all science, often changes as technology improves and better experiments become possible. This is a less fun narrative than "Doctors are incredibly stupid and just by knowing about this one study I can totally outdo all of them" (YES, EVERYONE ON LESS WRONG, I AM TALKING ABOUT YOU) but fun narratives are wrong suspiciously often and this one is no exception.

What, you didn't think doctors had medical myths too? Although Yvain seems to have voided your particular example, it should be pointed out that there are a ridiculous number of doctors in any first-world country, and based on what we know about the sanity waterline it seems absurd to assume anything other than, "Most of them are probably rather irrational."

Could you please give a precise definition of "values" in this context?

If I could, then the problem I'm trying to solve would already be solved. But I can try to clarify it a bit by saying that it's something like the last item on this list.

It may be interesting to note that this outline implies that when we discuss questions like "What's your utility function?" or "Do humans have utility functions?" we should be careful to distinguish what kind of utility function we are talking about. Examples:

• a utility function that represents my revealed preferences
• the utility function implied by my consequentialist moral principles
• the utility function that corresponds to my intuitions about the desirabilities of various specific outcomes
• the utility function I actually use when I engage in explicit consequentialist reasoning
• the utility function I actually use when I engage in subconscious model-based decision making
• the utility function I would eventually decide upon if I thought about it for a long time
• the utility function that best captures my intuitions about what "my real values" means
• the utility function that represents my real values (this may seem equivalent to the one above, except that I don't seem to have clear intuitions in the matter, what intuitions I do have seem subject to change, and maybe there is a fact of the matter about what my real values are beyond my intuitions about it?)