The Problem With Silicon Valley Medicine

[@MedlifeCrisis]

Facing a few challenges getting videos out at the moment. I sincerely appreciate your support in the form of just watching this one. There's also a way to get an awesome deal AND support the channel, get a year of CuriosityStream for $14.79 - a 26% discount - AND a year of Nebula too. Even more fun than a ketamine lozenge. Visit www.curiositystream.com/medlife (code 'medlife'). Thank you for dropping by! - Rohin

[@kilie1824]

No, thank YOU for going through those troubles to make your awesome videos for us, Dr. Rohin.

[@1234j]

You're back! (Despite challenges, too.) Thank you so much. Really appreciate your efforts, skills and insight.

[@michaelmayhem350]

Glad to see you're still around, I would sign up for the curiositystream bundle but it's super misleading. The discounted price is for 720p. For a more reasonable resolution it's $10 a month which is a huge jump from $15 a year.

[@JossWhittle]

Before watching, I was very much hoping you'd mention things like the ChestX-ray14 dataset and the controversies around the claims that major machine learning groups made about their ability to make diagnoses using their models that were in some cases literally impossible to make without actually examining the patients in person - but I can see you're going in a different direction with this video. Even so, thank you for using your platform to make people aware of issues like these in our fields. I hope that in time that medical datasets being used in ML settings is something you can weigh in on more. As we collect ever increasing volumes of increasingly high fidelity datasets the issues with dataset interpretation and collection biases are becoming more and more problematic. Radiologist Lauren Oakden-Rayner made a series of brilliant blogs about the ChestX-ray14 dataset back in 2017 that I think really highlighted the biases of the dataset and the claims being made that are still well worth a read. AI is not intelligent, it's curve fitting, albeit high dimensional curves. Biases in data collection, are biases that models encode. Incorrect claims about data origin or distribution, become incorrect interpretations of model confidence and correctness. "Explainable AI" as a field within ML, as a field within Computer Science, is still highly experimental and in flux.

[@donfalcon1495]

Brilliant video yet again! Educated and entertained in equal measure!

[@neurotransmissions]

I agree that stressing the body in moderation is healthy. I apply moderate stress every day to my lungs and immune system by waking up with a cat laying on my face.

[@MedlifeCrisis]

You joke but kids with cats do indeed have much lower rates of autoimmune and allergic disorders. And pets lower blood pressure!

[@1234j]

Cat volume, surface area and weight matter, plus length of application. That's MY contribution to science here.

[@johannesvahlkvist]

@@MedlifeCrisis tbf, an open wound lowers blood pressure too

[@gingeridot]

@@johannesvahlkvist now you're being unfair to cats―in addition to cats just tearing you open like a candy wrapper, they'd also generate the "normal" lowered blood pressure from 'having pets' ^^

[@mackieincsouthsea]

@@johannesvahlkvist best response and I adore my cats 😂

[@knarf_on_a_bike]

I had a bike collision a few months ago. They did a brain scan, as my helmeted head hit the pavement. Doctor said, "the scan shows a teeny little dot. It is so small, I can't tell if it's a blood drop, a pre-existing thing or maybe even just a digital remnant. You have no symptoms. You're good to go. If you have any unusual headaches or changes in vision in the next month or two, get to a doctor." I think I got good advice.

[@myscreen2urs]

It's probably pre-kidney stone🙃

[@beardiemom]

You also had a good indication to do the brain scan, having hit your head. It's not like the doctor just said during an unrelated appt: "While you're here, let's do a brain scan to make sure you don't have an anneurism."

[@mds8255]

You did get great advice. But let me actually say that even better was you trusting it and taking it! Honestly, hats off to you! I spend my days scanning patients that had similar advice and don’t listen…

[@knarf_on_a_bike]

@mds8255 A year later and I'm still here! 😀 No symptoms or indication of any issue whatsoever. So yeah, ~great~ advice!

[@randynovick7972]

I would never run a full-body scan on myself just for grins. I don't believe in that claptrap. Instead, I rely on the nightly body scan and colonoscopy I get from the aliens that abduct me while I'm asleep. The more you know, you know?

[@MedlifeCrisis]

Evidence-based aliens are TIGHT

[@Nightriser271828]

Those kind aliens are rendering free medical service to those who need it most. Bless those aliens!

[@abcdefvxyz4324]

@@MedlifeCrisis is that a Pitch Meeting reference? If yes, then well done, sir!

[@empty2757]

abducting you while sleeping was super easy barely an inconvenience

[@Call-me-Al]

I would love to be so rich I could regularly make full body scans, because one print of each scan added together chronologically would make a super cool flipbook, especially to disgust grandchildren with. "Did you see how Bob, Jimbo, and Benny the benign cysts kept wobbling around in my 30s as if they were dancing? So funny."

[@clared5812]

“You really don’t have to be that smart to be a doctor” as someone who has had some terrible experiences with doctors, truly, thank you. Instant subscribe just for that

[@warrenarnold]

semi solid state drive😆 i choked on my water

[@purplewine7362]

Did the doctor not approve you of being an antivaxxer? LMFAO

[@zvxcvxcz]

And if people think it's bad in the US... just wait till you see the people they let practice some other places. My first screening for a new doctor is if they are will to prescribe antibiotics for a cold (which is a virus). If they're willing to give you antibiotics for that, then get a new doctor right away.

[@ilona3630]

@@purplewine7362 some doctors are anti vaxxers themselves which proves that not all of them are smart

[@fluffynator6222]

I noticed this when my doctor was unsure what to do when I had a tonsillitis imperviable to regular antibiotics. Had to send me to a specialist.

[@KnowingBetter]

I'm going to be thinking about my pre-kidney stones all day. I can feel them rattling around in there.

[@MedlifeCrisis]

Can I interest you in a prophylactic cystoscopy? Don't look up what it is, just say yes. IT'S FOR YOUR HEALTH.

[@PsRohrbaugh]

@@MedlifeCrisis don't ever check out the subreddit "sounding"

[@NyanyiC]

I get where they are coming from though there is premenopause, prediabetes so it follows. I'm going to start screening for pre fibroids!

[@Camboo10]

@@MedlifeCrisis Naa do a ureteroscopy.

[@jhonbus]

@@Camboo10 Too far 😱😂

[@aaaarrmehearties]

I once had an otherwise healthy ICU young male patient who had a sinus arrhythmia. My consultant walked past and said "if you hooked up any of us, at least a handful of us would look like that. You might even have some WPW morphology" (I'm young and female). I immediately had Medlife Crisis in my head saying "THIS IS WHY WE DON'T SCAN FOR EVERYTHING"

[@Zeverinsen]

I guess the good thing about medical terminology, is that the patient probably wouldn't understand what the consultant said if he heard it 😂

[@aaaarrmehearties]

@@Zeverinsen he was in ICU; he wasn't awake 🙃

[@unknownentity7964]

@@aaaarrmehearties you say that like it's a given. It's not like 100 % of ICU patients will be asleep/sedated for the whole of their time in the ICU

[@the_expidition427]

@@unknownentity7964 It had been their patient I think they were well aware that their not awake

[@shamakuma1967]

Many of these pathology stuff which pops up on investigation will die with u and will not be the cause of your death.postmortem findings are enough proof to this.somehow people have been hospital shopping for long.they see it more like a shopping mall or a luxury hotel with ward girls cheering up and doctors as their choreographers.if this industry all other industries will fall down.thats how it's propped up.its survival is sort of parasitic or saprophytic.the show of joker doctors will continue because it's a jumbo circus orchestrated by and convened by all other circus jokers.

[@janmelantu7490]

It seems that the best medical advice is “eat healthy, exercise regularly, rest up, don’t smoke, and don’t worry about too much if it doesn’t hurt”.

[@MedlifeCrisis]

That’s pretty much it. But that doesn’t sell any books or buy instagram clout

[@janmelantu7490]

@@MedlifeCrisis I dare you to try to publish a 4 page book saying just that.

That medical advice may well fall into the questionable cause fallacy category: Are people healthy because they exercise regularly and rest up, or are healthy people more likely to exercise regularly and rest up precisely because they’re healthy? Similarly, do married people live longer because they’re married, or are healthy people more likely to get (and stay) married? And also, are dog owners more likely to be healthy because they live with a dog, or are healthy people more likely to undertake the extra effort of owning a dog?

[@wholeNwon]

Avail yourself of appropriate vaccines and BE HAPPY.

[@lach888c2]

@@MedlifeCrisis The motivation, time and effort to do these things comes down to mental health and social wellbeing. It seems like good advice but then in reality it’s just “be a better, more motivated person than you are”

[@MichiruEll]

I did my PhD in regenerative biology, and swear there's so much bs coming out of techbros interpretation of regenerative medicine. The worst, to me, is the whole "life extension" weirdness.

[@alakani]

Oh god jesus christ. I once had a "job interview" in San Leandro. It was in a random office building, they supposedly had heads and bodies frozen in the back. Like the entire interview was me trying to explain basic laws of physics and how you'd have to get FDA approval if you want to shoot cutting lasers into peoples eyes for no reason, thinking that would make a good VR HUD. I cut it short but they all gave me business cards. Turns out several of them were postdocs actively funded by obscure Berkeley departments. Parking lot filled with supercars. FML I can barely get funding for real shit and they can get millions for absolute bullshit. Ok I'm done, thanks for the opportunity to rant :p

[@canesugar911]

@@alakani love and light.

[@andy897221]

it really depends on what side of the "life extension" field you are referring to. I am not a PhD but I am currently also in postgraduate studies, and you know very well that in vivo reprogramming via transient and repeated expression is well regarded as a key technology for life extension supported by academia, e.g., Altos Lab (albeit iPSCs still yet passed clinical trials, but be hopeful)

[@alakani]

@@andy897221 I agree there's room for real research in that area, after all it took 20 years for anybody to think of 'hey what happens if we try to induce pluripotent stem cells, except actually look at them before the whole 50 days is done' and now there's a whole paper "Multi-omic rejuvenation of human cells by maturation phase transient reprogramming" - but that's not what was going on at that place... they're like Cave Johnson, but with worse ideas. I kinda still feel like I should maybe call up UCB and see if they're aware CREA was funding that place. I'm all about weird hypotheses and unexpected discoveries but this was bordering on unethical beyond the waste of money, especially if they were serious about storing bodies in the condition the place was in

[@johnk6757]

Weirdness? Cellular senescence is worse than every other disease combined by a factor of 50, it's amazing how few resources are put towards trying to solve it.

[@xouri8009]

Good video Rohin. I’m an engineer working with particle accelerators (cancer treatment) and just now me, a physicist and an oncology were just discussing this video of yours. When we realized, we had a couple radiotherapy technicians, a nurse and another oncologist listening and all discussing your video. We spend like an hour just around the growing phenomenon of patients asking for scans, and even later getting “preventive treatment” on dubious grounds, to the disappointment off the oncologists present. Seems crass to discuss in such a way, but they are currently treating a 92 year old with a small carcinoid tumor in his colon that was found during a scan from some unrelated health problem. The man had no symptoms and no issues at all, but still, he went from public health to private health to get treatment (radiation in this case). The oncologist was frustrated because having a 92y old man go trough radiotherapy for something that will not become an issue in his lifetime and doesn’t bother him at all is nonsensical. Basically he was frustrated with the higher ups and head oncologist willingness to do whatever patients are willing for some money. PS. I’m just an engineer making sure the accelerator keeps shooting its particles accurately 😆, so a lot of the medical jargon they used among themselves went completely over my head Anyway, just wanted to share, your video was discussed at length in a Spanish speaking country by even some people that don’t even speak English. Thank you

[@BronxGrrlX]

This is interesting because I agree that getting a scan "to check" or treating an "incidentaloma" is wasteful of medical resources and potentially harmful to boot. BUT I think a healthy 92 year old could easily live up to a decade longer. I don't know how advanced the colon carcinoma was, and they do tend to grow very slowly. But I'd have to give it a think myself if it was me and I was 92 and was healthy enough to get to 100.

[@Fragaut]

@@BronxGrrlX When you're 92, even your cancers think about retirement. They evolve extremely slowly at this age, so a simple yearly check-up is most likely the adequate answer.

[@patheddles4004]

@@BronxGrrlX That's a great demonstration of the issue here - carcinoid tumours are pretty common (~10% of men), and usually not harmful. Certainly not a strong reason for subjecting a 92-year-old to the harms and risks of radiation therapy.

[@fedyx1544]

@@BronxGrrlX radiotherapy isn't free on your body, especially if you're 90y/o. In this case it put him under unnecessary stress that might very well trigger some other disease

[@kiwiboy1999]

Beautiful how information permeates society such that people can discuss understand and build on ideas shared from a piece of media which if they had listened to it they would have understood almost nothing.

[@haleyw5677]

I really realized the issues with over screening when my sister got a false positive syphilis test when she had had no symptoms. she had been sexually assaulted a year prior and got tested for everything after, but syphilis can occasionally take longer than the two weeks she waited to show up especially since she was on antibiotics at the time. She went through a week of suffering and reliving all that trauma, and she got massive injections of penicillin just in case (they might have still been a good idea for her chronic strep). There was no reason for her doctor to think she had syphilis but the doctor just wanted to check for everything regularly, and it caused my sister so much pain. I can only imagine what people go through when they think they might have cancer.

[@XXXkazeXXX]

To be honest, I’d rather have a false positive than undiagnosed syphilis 🤷‍♀️ People go mad from that

[@timlawn1]

"I guess we've just figured out why he checks his genome so often" - I laughed so hard I think I passed a pre-kidney stone!

[@seetheanimal5867]

Bro my first time seeing this guy… he a real comedian 😂 👏🏽

[@surealivro6242]

@@seetheanimal5867 watch his cycling athletes heart video and the recent pig heart one

[@yeetyeet7070]

@@seetheanimal5867 also to be recommended is his video about how medicine defines death, and also go subscribe

[@Bimtavdesign]

Best comment

[@GotInterest]

I'm glad you brought up the apple watch heart rate monitor. My roommate who has terrible medical anxiety had to stop wearing their apple watch because the very fact that their heart rate was being monitored gave them anxiety that they were having heart problems- which would result in their heart rate going up- which fed into this feedback loop that resulted in them having anxiety attacks. If they didn't have that level of unnecessary monitoring of their body, they wouldn't have even thought about that. The mental health impact of this kind of hyper-vigilance just isn't considered or discussed.

[@shamakuma1967]

Sort of white coat hypertension can be the end result.when you r being measured your feel-good wave functional self collapses into a diseased person.

[@rembrandtklazinga4443]

"My sperm have been rendered as impotent as Boris Johnson's influence on Russian foreign policy" Never change, Rohin

[@Bimtavdesign]

The one liners are gold

[@leandrometfan]

@@Bimtavdesign Rohin is a one line machine, even in this unscripted videos.

[@tinycatfriend]

i'm medically complicated and have a lot of health anxiety, your videos have helped me a lot! they help me understand the decisions my doctors make, which lowers the anxiety significantly. i apply it when thinking of what to ask them, and whether i should ask for X test or not. i communicate clearly with my doctors, don't worry, you aren't dictating all of some stranger's medical decisions here! but your knowledge has helped me feel more confident and i can communicate my concerns better. i really appreciate that, thank you for doing what you do.

[@jhonbus]

I've had type 1 diabetes for over 30 years, and I now use one of these CGMs. As you say, it has been completely life changing for me. The idea that someone without diabetes would wear a CGM and obsess over their blood glucose when they don't have to is just baffling to me. There's not much I wouldn't give for my blood glucose to manage itself like yours, just let your body do its thing and be grateful it does!

[@lukasbhp]

I am a type 1 diabetic also, and I literally had the same thought. It's crazy that people would actually use (not to say pay for) CGM's.

[@hkr667]

I had type 1 for 20 years and then it got cured. Even though my body now regulates it without any effort, it still feels like magic to me. I still had a sensor on and seeing that almost perfect flat line it one of the most emotional moments of my life. Seeking out that sugar level stress is baffling to me, I wanted nothing else but to get away from it.

[@Aurora8a]

@H Kr Did you receive a pancreatic transplant, or were you party of a stem cell clinical trial?

[@simonabunker]

CGM is even more amazing when paired with a smart insulin pump to form a closed loop. It is the closest thing we have to an artificial pancreas. And this has only been possible with computer simulation (in silico) research. But I do agree with the general point that you can watch the data too closely sometimes.

[@spiderwrist]

I came here to post something similar, type 1 for over 30 years and in love with the information I get from my CGM. I'm more annoyed than baffled at people who use one without a medical need for it but am more than a little horrified that they aren't bothering to learn how to use them properly. Like, they're going to fork out for the device but not learn how to correctly interpret the data it gives?

[@RenegadeContext]

As someone with a chronic illness I was already aware that "you don't have to be that smart to be a doctor"

[@ClifBratcher]

Worked on the tech-side of a healthcare company that had good intentions. Automatic reporting for doctors from diabetic and HBP patients. We would notify doctors if their patients results were irregular or they just weren't testing. We were unintentionally training patients to rely on doctor notifications. If we failed to notify, and the patient thought they were actively reporting, there was a very real chance someone could die. There are a lot of solutions out there searching for problems.

[@de_cokamer]

As a recently graduated doc, this channel is really what people needs right now. During my academic career I often ran into questions which can be answered so beautifully with these videos. I hope to build on my writing and speaking skills in the future so I can also inform patients/clients to this extent, rather than feeling the frustration of not knowing how I can convey how the medical/academic world works. Thanks for sharing these online!

[@zeideerskine3462]

As a central California resident I can assure you that we would be significantly better served if we could check in with a vet as large primate.

[@nicanornunez9787]

HAHAHA

[@y2kenh]

GENIUS! I'm buying a simian costume for my relatives

[@Anon26535]

Vets have more incentive to get it right. People say "oh, it was God's will" when grandma drops dead of a heart attack but they get angry when they lose a cow.

[@Banzybanz]

@@Anon26535 Grandma wasn't giving any milk though was she

[@preciousmourning8310]

@@Banzybanz Not for a long time.

[@-beee-]

I imagine it could be a touchy topic, but would be super interested to hear from you about diagnoses that are often delayed like for things like endometriosis. I sometimes struggle with knowing when to listen to my body, but unfortunately I don’t always feel like I can count on medical professionals to listen to me, which makes trust difficult. It’s also hard to know how anyone else feels (does everyone have pain like this and just deal? Are these things normal?). Not sure how you might explore this topic, but would definitely be interested to hear from you because I really value your perspective!

[@madzombiebaby]

I usually struggle with the opposite: not feeling healthy (being tired all the time, pain, feeling dizzy and other symptoms that aren't very threatening), but nothing coming up in blood work or anything. That can cause some anxiety, but I try to remind myself that we aren't machines, the human body isn't that consistent with its performance.

[@monkiram]

Same. A lot of this can actually be caused by anxiety. A lot of my non-specific symptoms like fatigue, muscle aches, headaches, dizziness, shortness of breath, heartburn, etc. stem from anxiety so both things cause each other. And then sometimes there's no explainable reason for symptoms and it just sucks

[@rayray2528]

Well u might have ADHD.

[@dr.suffuzz6383]

@@rayray2528 they haven’t mentioned any mental symptoms though?? people are way to quick to throw stuff like adhd out there smh

[@crazydragy4233]

The worst part is that there's plenty of people with "subtle" issues/disabilities that take decades to uncover (especially when smth like pain, exhaustion can be written off :/). It's just too easy to be anxious about your health x"d Wishing you all the best in leading the best and most comfortable live possible no matter what's up though!

[@OwlyFisher]

@@rayray2528 what does that have to do with anything

[@zachanikwano]

I'm so thankful that I've found your channel. You are literally giving peace of mind to a hypochondriac. It's like, I've been told this before by family but hearing from a professional really gives it weight and helps it settle in my mind.

[@ryang8934]

I've seen a lot of people who want MRIs yearly because they have health anxiety. Thought about this topic and how it would actually make it worse. I love what you're doing dishing out proffessional takes on stuff like this.

[@LongToad]

I think I'd rather be one of those people that always says "it's but a flesh wound" than one of those people that visits the doctor weekly over slight mood changes (I'd also much rather not be around those people either because they start to make me anxious). I know it's anecdotal but it seems like the oldest people I ever knew were always more laid-back, not really spending all their time worrying. Obviously it's not advisable in certain instances (like if you literally collapsed) but I feel that, "laid-backness", is actually far more beneficial to us than we think. -I haven't been to a doctor in over 20 years because I despise the entire for-profit aspect of the medical industry and feel I'd only ever go to the ER if I got shot or something (I live in the US).

[@kaitlyn__L]

@@LongToad yeah AFAIK chronic stress correlates with far stronger bad outcomes than lots of these things people stress out about. Obviously the ideal thing is to deal with them without stressing, but in a trolley problem where one can only eliminate one factor? Chronic stress seems to be the best choice.

[@Call-me-Al]

Yearly seems really cool for non-medical reasons, as an internal snapshot of what you were like at a certain year for fun reference later. (Definitely shouldn't be included in free healthcare though, because that's just a for fun thing.) It definitely can't be healthy for people who without grounds to be that are anxious about their health (e.g. if they have multiple relatives that developed a specific dangerous curable health issue at about their age) to constantly obsess about their body though.

[@timepasskale]

@@Call-me-Al Exactly. I feel like most of this self scanning business is fuelled by the desire for self measurement and idk, 'infotainment', for the lack of a better word. It's not hard for me to see a 'take a picture of your sigmoid every single day' trend on tiktok in the next 5 years /s (but not really).

[@lauramoore8823]

One of the strongest drivers of anxiety is checking on/calming our fears. We train our brains to continually throw up other scary scenarios that we can "fix". I genuinely think that our ability to know things has driven our ability to be afraid of things.

[@spde]

This is absolutely fantastic! I am a doctor, and I was dating a tech bro, and he would come to me with the most RIDICULOUS things... This "hack medicine" mentality was incompatible with a relationship, frankly. Thank you for using your platform for this. Honestly, if I may be permitted the conjecture, I suspect that a lot of the doctors who end up being bedfellows with tech bros probably enjoy the "hypermasculine" environment and thinking... I mean, becoming a doctor means being a bit of a nerd.

[@patheddles4004]

Tech bro as philosopher-king. I appreciate that connection.

[@HkFinn83]

Autism is certainly more commonly found in men if that’s what you mean by masculine.

[@yourstruly2983]

@@HkFinn83 more commonly *diagnosed in men. There are a hell of a lot of female adults suddenly receiving shiny new diagnoses (thanks in no small part to advancements in understanding the spectrum of Autism. Women and non-binary people may present differently to the ways men do.)

[@HkFinn83]

@@yourstruly2983 possible but highly unlikely. Men in general are diagnosed less frequently and later with almost every condition. If recorded cases are higher in men that’s almost certainly reflective of the reality of the matter.

[@monkiram]

​@@HkFinn83 On what basis do you say that? Certain conditions, particularly those where the diagnosis is heavily reliant on the history, are diagnosed a lot more in men because the classic stereotypical presentation is based on male patients. ADHD is another one where men are much more likely to be diagnosed because the presentation looks different in girls and health professionals, educators and parents tend to be less familiar with the way ADHD females tend to present. Even issues where the diagnosis is more reliant on objective measures, like heart attacks, are more likely to be misdiagnosed in women because they are more likely to have atypical presentations. Heart attacks are more common in men, but are still more likely to be missed in women.

[@rpx1979]

Spoken like a true NHS doctor who places patient outcomes above all else. Thanks for the great content!

[@cwmoo]

I am an engineer and programmer by training, but several in my family practice medicine. I did a lot of research and reading studies and watching interviews in longevity science, and some of it is exciting, but nothing is certain yet. The best advice right now seems to be: eat fruit and veg regularly, do some light exercise every day, and sleep on a regular schedule. That will get you 99% of the benefit and 0% of the snake oil. Don't buy expensive products or supplements, there is not enough information to back them up yet.

[@claudiadarling9441]

So much of it is just fear of death and getting older. They'd be better off spending their money on therapy.

[@sopyleecrypt6899]

I was particularly interested in the part about screening scans. Following a vestibular neuroma, my child has a screening MRI every year. I’m very grateful he has these, as it would alert us early to any new growth in the same location, or a tumour on the other side, something I’m particularly worried about, as if that happens, my child will become completely deaf. The last two scans have been “indeterminate”. So something looks a bit different, but radiologists and neurosurgeons can’t say for sure why. For a start my child doesn’t have a “normal-looking” vestibular system on the tumour side, because the site was subject to a lot of surgery. There is likely to be scarring and unusual contours. Also, the difference observed is within the margin of difference from scan to scan, so it could just be that his head was in a fractionally different position each time. So, at the moment, it’s Schrödinger’s vestibular system, we just don’t know whether there is new growth or not. We’ll see what this year’s scan shows. It’s stressful.

[@nedisahonkey]

Rohin I'm amazed you haven't hired an editor before! It's crazy that you're a full time doctor, father of young children and still manage to reguatgly upload some of the best on youtube. So please don't apologize for "gaps in uploads" you're doing great as always!

[@galandilvogler8577]

"But is anyone going to suggest that exercise gives people diabetes or hypertension? Of course not." Just you wait, Rohin, just you wait.

[@christafranken9170]

Well, exercise gives me hypotension Sometimes. Because I have a condition I see a cardiologist for. If exercise makes you feel faint and you classify standing still as cardio because your heart rate almost doubles and any exertion makes you feel terrible for days, see a doctor Edit: got confused between hypo and hyper

[@paniniarts1879]

I’ve seen the excercise = hypertension part before

[@BlueBockser]

19:20 Small nitpick: An enormous signal to noise ratio is actually the opposite of what you mean because it implies more signal than noise. You probably meant a tiny signal to noise ratio. But anyway, I really enjoyed the video - carry on!

[@RC32Smiths01]

Really appreciate your insight here. Eloquent and detailed as always.

[@devamjani9423]

Papa Flammy sends his regards!!

[@flossenking]

Diabeedus!

[@Pyriphlegeton]

Thank you. I'm a med student, fascinated with aging research and aspiring to join the field. But this is exactly what it needs. We have to trim bad reasoning, snake oil sales, pretend-experts, etc. away. Repairing certain processes of aging might provide many disease-free years and I do think it's promising but only if we focus on rigorous research, not hype.

[@x_abyss]

Excellent video as always Rohin. I've talked to those obsessed with longevity and go to great lengths to achieve it, including Aubrey de Grey. Although some of it sounds like a scam to profit off of people's genuine interest to live longer, most are trying to undo the damage of old age, or at least prolong the effects that come along with it. I agree that the message is thoroughly lost when it comes to the tech bros, who believe that they can solve aging problems by simply throwing money at it. Anyways, I largely agree with what you said, but I'm also encouraged by the active research on alleviating age-related illnesses.

[@MedlifeCrisis]

I'm planning a video with a friend who is an expert in the real, amazing research being done in the field. He's as aggrieved as anyone that longevity research often gets tarred with the same brush as the people I mention in this video. More to come!

[@gingeridot]

@@MedlifeCrisis ohh that sounds like something to look forward to! :D And maybe I'm running off into the wrong direction with this, but I've been thinking about aging and disability a bit (my flatmate has cerebral palsy) On the one hand, medicine should reduce pain/suffering as much as possible (obviously, hehe?), so if we can mitigate some of the side-effects of aging, that seems wonderful! But I believe at some point, we need to think about how society in many ways is inaccessible and doesn't make room for a lot of disabled people. If I remember correctly, most disabilities are not there from birth, but acquired throughout life, often from aging (although that shouldn't even matter, everyone deserves to partake). And just going out and saying one wants to 'eradicate' disability (and/or side-effects of aging) sounds icky at best, right? Of course, that doesn't mean that people shouldn't get treatment anymore! If someone needs glasses they're technically disabled, and getting their cornea lasered (or however that works) is a great improvement to their quality of life. But someone finally getting a wheelchair or a good cane is just as amazing, because they're getting accommodations! (Sorry for rambling!)

[@khazermashkes2316]

@@MedlifeCrisis I am looking forward to that video!

[@kaitlyn__L]

@@gingeridot hear hear

[@JavierMares]

@@MedlifeCrisis excited about that video thanks!

[@stevepoling]

I happen to be a victim of what I believe to be a Apple Watch AF false-positive. Relaxing Sunday evening over a jigsaw puzzle, I saw my Apple Watch declared an AF event. Felt fine--a bit anxious about the scary Apple Watch sound. Next day I called my doctor who ran a EKG and days later a cardiologist who did another EKG. No transient events. They gave me a monitor to glue to my chest for a fortnight. The monitor saw when I went running, but nothing untoward otherwise. No smoking, drinking, no stress, I walk 10,000 steps per day, and run two/three miles every other day. I have one cardio risk factor: I'm 68. Had I known the false positive rate of the Apple Watch beforehand, I'd have waited until my next checkup.

[@KitagumaIgen]

Obviously you have to test your genome once a year - at least! Otherwise you'll never know when you've changed your parents, this is obviously vitally important to catch!

[@derpherpblerp]

Damn, so much for hoping for a new + improved dad!

[@ooooneeee]

😂😂😂

[@vigilantcosmicpenguin8721]

In case you feel the need to really, really make sure he's the real father.

[@GT-tj1qg]

Bro this channel is fantastic. He's got an incredibly based perspective. His methodology is thorough and high quality. He is truly articulate - not pseudo-articulate like many KZbinrs. His voice is very listenable. And the occasional subtle but brilliant humour hits perfectly. Keep it up dude!

[@ref0522]

Hi Rohin. As an individual with the attention span of a goldfish, I really appreciate the subtitle work. Jokes aside, I think subtitles in videos full of medical and other technical words like this one help non-native speakers and non-medical personnel like me to understand this alien world a little better. Thank you!

[@gerardotelese5337]

As a borderline hypochondriac (probably because my father was a doctor and my brother is, but i'm an engineer, so i got MANY "half knowlage") to have this reminded to me is a breath of fresh air

[@koboldcatgirl]

oh god what's hypochondria do _I_ have it

[@somedragonbastard]

​@@koboldcatgirli gotta know are you asking genuinely or are you as im assuming making a hypochondriac joke

[@BFKate]

Great video, thank you. As a student nurse I recently got my first taste of sitting with radiologists reporting images, it was an education in how much of the diagnostic process depends on the skill of hedging probabilities, especially when there are no clear cut “eureka” moments on a scan.

[@KeithBoehler]

Something else to keep in mind is that data collected by any given device is not protected the way it might be if you were talking with your doctor. This data can also be sold to private health insurance companies to further raise your rates or deny you coverage.

[@WhatsSoGreatAboutThat]

The issue here is focusing on the corporeal rather than the higher pursuit of complete emotional efficiency, like my spreadsheet of every time I feel sad so I may one day eliminate the experience of any negative emotion. I call it my sad sack, patent pending. You wont find ME succumbing to the human condition!

[@MedlifeCrisis]

END PROGRAMME

[@pablopereyra7126]

Depression? NOT ME PAL

[@yardgrid]

Surely worrying about your longevity shortens your longevity.

[@Tagmose89]

As Gilbert Welch teaches us - all cancers are either turtles (you’ll die with them), birds (they’ve already flown - you’ll die of them no matter how often you screen) or rabbits (if caught early it’ll potentially save your life) Seems like screening as a concept is great at finding turtles - rabbits not so much . And the pursuit of the evasive rabbit will make it very likely that’ll you’ll have to cash in the “patient citizenship” instead of the “healthy person citizenship” way too early (Iona Heath / Susan Sontag) In the end it all comes down to our relationship with uncertainty and mortality as individuals . But the scaremongering from Industry and patient organisations with “survivor” giving rise to a positive feedback loop (survivor paradox) about these things is such a tragedy and loss for society Thanks for talking about this important issue

[@MedlifeCrisis]

The fake disease video I made in 2020 that I mentioned in the video is very much inspired by Welch

[@BronxGrrlX]

Brilliant, great insight! ❤️

[@Secret_Moon]

@@MedlifeCrisis Francis, I understand and even agree with your point on overanalyzing cancer, blood sugar, cardiac rhythm and such. But may I ask, what about the case of hypertension? Because, a brain hemorrhage is caused by a broken vein in the brain, and by mechanism, a spike in blood pressure, even when very brief, can easily cause it. So shouldn't we watch out for every spike, however brief, in blood pressure? I ask because my father has occasionally had such brief spikes, and I'm really worried.

[@squamish4244]

@Luke Szweziuk For now. I had a 68-year-old friend go from Stage IV cancer to nothing in a matter of a short fever due to immunotherapy. It was experimental, but it worked.

[@bUwUmer1260]

@@squamish4244 TIL or CAR-T?

[@lenoraaronel8542]

I just found you a couple of days ago. This is very interesting. I am 60 years old and God to the doctors want to poke and prod me and screen me. I have absolutely no symptoms except my age I do actually just hide from everything and avoid all the testing and I really find your attitude refreshing.

[@KarlMarcus8468]

You sum it up pretty great at the end, people are so quick to point out the conflicts in doctors prescribing all kinds of treatments and drugs but sell out their family to join a essential oils MLM. Great video as always.

[@maythesciencebewithyou]

Often the patients themselves demand to have treatments and consider a doctor who won't give them the treatment they want a quack who doesn't know anything about medicine.

[@KarlMarcus8468]

@@maythesciencebewithyou lol yeah the "I demand ivermectin for my covid treatment that I'm not vaccinated from" people.

[@carlosreyesf19]

@@maythesciencebewithyou which is why quacks are even more dangerous, they interfere with real medicine by creating twisted expectations in patients.

[@PristinePerceptions]

6:00 I nearly spat my tea at your definition of "semi-solid-state drive" :D

[@normalmanbruh]

You are the only KZbin channel I can trust completely and watch without having the burden of always needing to wonder whether the guy in front of the camera is lying, or even unintentionally falling for a bias. I absolutely love your content, and I am going to keep watching it no matter your upload schedule.

[@OrWhatWeHave]

It's fascinating to me because he's so freaking balanced and unbiased that he comes across as less persuasive than the more popular voices in this space. It's such a shame that reasonable, well-rounded voices are less contagious than outrage.

[@cauchyschwarz3295]

I think an important point of these videos is that you should abandon that mindset of 'trust completely' altogether. Adopt a Bayesian mindset of relative trust. Where instead of the binary version you think of a degree of confidence.

[@NMS409]

Oh the irony, isn't his point that you should never trust 100%?

[@ThePhysicalReaction]

Excessive scans reminds me of the people who constantly check their watch in an effort to speed up time. It’s an anxiety response. It’s the confusion of motion with useful action.

[@mackieincsouthsea]

Very few things get me as excited as when you do a video on something that winds you up Rohin! 😂

[@MedlifeCrisis]

lol I like to think I only get wound up in a fairly chilled way 🙃

[@mackieincsouthsea]

@@MedlifeCrisis oh totally, you very much do, you should hear me on a work topic!! 😂 I love the word "incidentaloma" by the way, I really enjoyed your cancer video in the same vein. My mum went through breast cancer some years ago, which later returned and finally went into remission, longest op in Haslar hospital in gosport I believe (17.5 hours, double mastectomy) and got MRSI in the process. Through all of that, she ended up seeing a lot of people going through all this largely unnecessary poking and prodding and often wondered why you'd bother without any quite notable reason, she'd have killed to get out of there at the time as you can imagine! Sorry to blabber but I really love what you do on YT and truly appreciate your humble, funny, reasonable and logical views on it all.

[@Oliver-ob5og]

I just recently discovered your channel and watched some of your videos. I want to commend you for such valuable insights. What sets you apart is your very well narrated, non-sensationalist, reasonable and pleasant to listen to insights with yet a subtle humor here and there. Thank you for shedding light onto widely popularized, often entirely false or misconstrued concepts, hypes and half truths in the medical field. Great. I appreciate your videos.

[@KeppyKep]

"If you think about how different we look on the outside, why assume it's any different on the inside?" Woah, you just absolutely blew my mind. It's obvious when you put it that way, but it never occurred to me!

[@sk-sm9sh]

Move fast and break things no longer work in tech either - we have now created endless unfixable security holes in our software - and we're adding more and more software all around us - having all that software buggy and infested with security problems is already becoming a time sink.

[@patheddles4004]

Tech debt is only a problem if you're the one that has to repay it... (I'm a dev myself, but fortunately I get to move slow and build reliable stuff)

[@Anon26535]

Honestly, it was never the best way to do things. It's simply the way people with Cluster B personality disorders brains work. It's what Umberto Eco called "the cult of action for auction's sake".

[@bacicinvatteneaca]

@@Anon26535 and a large chunk of neurotypicals looking at cluster Bs and thinking "he's literally me"

[@user-yl7kl7sl1g]

I thought you were going to start talking trash about NAD Boosters or Senolytics, and went into this with skepticism but was pleasantly surprised when you instead brought up the downsides to excessive testing and scans, which cause stress and cancer.

[@rge9992]

Very interesting! I just learned in a medical lecture that in Germany, medical software has to be approved with the same studies used for medicine and technically isn’t even good practice to use calculators for scores (like Wells or NIHSS). I thought we were exaggerating regulation, but this video is certainly food for thought. Also, rare AF is both hilarious and great to memorise.

[@ghujdvbts]

The regulations for consumer technology to function as real medical apparatuses are very strict here in europe. However the general phenomenon of self diagnosis, over quantification and trivialization of the human condition doesn't seem to concern itself with certificates. All it needs as fuel is a trend of health-consciousness, a few sensors and some lucrative marketing.

[@rge9992]

@@ghujdvbts True. I've seen patients stressed over "not getting all possible test" before, even when they weren't clearly indicated. I've also witnessed doctors peddling useless tests to get money out of health-conscious patients. I just hope the tech-bro-y "hail data and computers" attitude won't make it into medicine itself. If people want to spend their hard-earned money on something, in the end all we can to is try to explain the scam, then let them make their own decisions.

[@christopherellis2663]

At 73, I am sure that I am getting younger, without any heroic interventions. Just food, exercise, sleep. The various things on offer keep falling off the table. I didn't get to live this long by taking things at face value. I expect to outlive some of these young enthusiasts. Good video. Thanks

[@Spanishproject123100]

Hey would you ever do a piece on TRT in young and middle aged men? I'd be really interested in your take as a cardiologist, and weighing quality of life increases and cardiovascular stress.

[@jeff2tc99]

We lost my 89 yo father who lived all his life with a heart leak. He was very healthy but convinced by a young specialist he needed a valve replacement. He barrelled through that trauma but as a result of the op he started to have fluid build up in lungs. That was the start of the 3 month slide to death. Good news, the leakage didn’t kill him. Unless you are ill , leave things alone.

[@rdizzy1]

Fluid in the lungs can happen due to an untreated "heart leak" as well. They tend to get worse and worse over time, especially over the age of 70, as tissues become far less flexible and tear more and more. He very likely could have ended up dying in a year anyway, even without this procedure.

[@jessica6735]

To be true, unless you are symptomatic, the best option is always to leave it alone.

[@DrAndrewSteele]

As someone excited by genuine longevity hype, I am not only annoyed at the techbro quantified self biohacker hype because it’s misleading, but because it dilutes and distracts from the real stuff, delaying which might do more medical harm in the long run. So I really enjoyed watching this video as I was transfused with young blood. Keep up the quack-busting!

[@devamjani9423]

Hey Andrew! Just wanted to say that I love your videos!!

[@DrAndrewSteele]

@@devamjani9423 Oh thank you! Very happy to see I have some subs in common with the doc!

[@PinataOblongata]

Hey, if it works in a couple of model rats, that has to be good enough for humans right away, right?!

[@DrAndrewSteele]

@@PinataOblongata For sure, I’ve always wanted to look like a model as I age

[@kindface]

The best goddamn KZbin I've watched today. Thanks a million!

[@drimachuck]

"Semi-solid state drive" is unappreciated and hilarious

[@enbycharlie6287]

11:59 My mum just recently went to hospital for chest pain (it ended up being referred pain from her stomach, but that's not the point) that seems like a major heart problem. She had a 24 hour monitor put on by doctors, but also had her apple watch. She kept doing ecg type scans using it, and they were going wild, but when paramedics arrived and did their own, it was perfectly fine. Yes, sometimes it could be helpful, but the number of false positives you could get. And the whacky graph made her more worried and made her pain worse and make the ecg crazier and it was a massive feedback loop, which I imagine could happen at any false positive these give (Edit for spelling/grammar)

[@jammies1431]

As someone in the tech field, I couldn't have put it better, myself. If you want to see an absolute disaster related to this- Elizabeth Holmes. Her company Theranos claimed a single drop of blood could be run for a multitude of tests. You could go to CVS and get blood tests whenever you wanted. People got false positives and false negatives which lead to passing on necessary care and unnecessary testing. Testing like this unnecessary for healthy individuals. Their machines consistently dirtied tests, including mixing multiple samples within the testing machine. Medical professionals and college professors told her over and over that this was impossible. She did not listen to experts. She also consistently ignored her own employees when they brought up their concerns with how faulty testing was. It took until whistleblowers came out for her and her partner to be caught. On top of this- these are data companies. Regardless of how pure their message is, it is highly unlikely that these tech companies are not selling your data. Money, money, money. Metrics, metrics, metrics. Ethics don't make money for shareholders nor does it help companies go public.

[@MedlifeCrisis]

Dropped a little clip of her at the start, the only reason I haven't made a whole video based on Bad Blood (excellent book) is because several other people such as Cold Fusion have already done it so well. In a way, and obviously I say this only in an abstract way as I know real people got affected by the Theranos scam, I am also kind of glad it happened - to demonstrate that often so much of the hype around medtech turns out to be not just hype, but falsehoods.

[@jammies1431]

@@MedlifeCrisis Totally understand. Thank you so much for throwing your hat into this conversation. I seriously hope that case stands as an example of how dangerous these companies can be. I completely understand wanting to make testing easier- just getting an appointment for blood testing can take a long time and prove to be expensive for many people, especially in the US- but there is a reason robots are not doctors. Even with the recent developments in predicting heart attacks with metrics, doctors are still involved in final decisions and prognosis for a reason. I can only imagine how hypochondriacs would be affected by simply being able to walk into a pharmacy and test as much as they wanted. They have enough anxiety as it is. Additional issues in the field are companies that claim to create aids for people with disabilities, but not actually working with people that have said disabilities for feedback. Tech companies completely ignoring advice from medical professionals or just flat out avoiding to reach out to medical professionals at all. It's incredibly worrisome.

[@MeltedMask]

I think there is future (heavy emphasis on future, not today) for rapid analysis, which won't require metric tons of blood. One drop maybe too optimistic, but with microfluid tech you can separate little blood to separate reaction chambers. I hope one bad tech apple won't taint whole basket, like its happened with fission energy.

[@jammies1431]

@@MeltedMask I'm optimistic for the future of medical technology. Really hoping the Holmes situation won't taint the waters and that ethics will be the highest priority of future innovation. We can only hope.

[@kaitlyn__L]

@@jammies1431 100%. “Disability aids” made purely from some engineer’s clueless idea (such as the “stair climbing wheelchair” idea you see a few times a year) of what they think someone would want, and not just failing to ask for feedback but actively ignoring feedback when it’s given, will never fail to infuriate me.

[@diablominero]

I feel better when I eat low-carb. All my organs feel cleaner, I function better on insufficient sleep, and my junk food cravings are milder. So I totally believe that knowing which foods increase your blood sugar variability and avoiding them can improve people's health.

[@J_Stronsky]

My doctor is a move fast and break things kind of guy, went in with a sprained wrist and now my leg is broken, but at least it happened quickly.

[@KrikitKaos]

My physio is the same, went in with a bad hip and shoulder, walked out with a messed up jaw.

[@J_Stronsky]

@@KrikitKaos sound like a savvy businessman - makes themselves a little bit of extra work so that you have to keep coming back ;)

[@ExplodingDarth]

I know plenty of other comments have said the same but I absolutely love the nuance that you employ in combating both quackery and over-zealous "science," it's really refreshing to see. I don't often "like" videos on KZbin but you just keep making quality videos (most with the attitude of a parent telling Jimmy his imaginary friend isn't proven yet, so stop following his advice).

[@heresjonny666]

I just wanna say I really appreciate your candid, blunt and entertaining videos on all of this medical stuff. It's confusing for we laymen to know where to draw lines sometimes, and you make sure you don't over egg the 'yeah science!' pudding, and are always realistic about what we know and don't. You're open minded without allowing good manners to prevent you from laying down truth bombs to people making outlandish claims. Hope you can keep posting these great vids!

[@DieButaSD]

Incidentalomas are so real and especially in med school the first one always scares you and then slowly you get used to them, the only one that's ever been clinically relevant in my year is someone finding out they only have one kidney but even that one was just something you call your gp about to have it noted

[@nyferox5637]

I recently took a class at Stanford Medical School during which I listened to a lecture by Dr. Michael Snyder, a Stanford Med professor who does a lot of research on wearable data in medicine. He would wear multiple different wearables all the time (fitbit, apple watch, etc) and has been keeping track of his personal health data for over a decade at this point. I remember him saying that he has over a petabyte of data on himself alone. He also runs long-term studies on health outcome predictions for other people with wearables. He made some really convincing arguments about the importance of individualized health data. For example, it makes healthcare much more personable. He showed a graph of average body temperatures for a bunch of people, and it ranged from around 96.5 degrees F to just over 100 degrees F. By knowing what the "normal" is for a specific person, not just assuming 98.6 F for everyone, doctors are able to better tell if someone is sick or something (like if someone with base temperature 97 is now reading 99.4, instead of just assuming the base in 98.6 now going to 99.4, that could be a meaningful change). He also talked a lot about being able to predict disease with wearables. He was able to prove the exact day he got Lyme disease thanks to his wearables (he showed a graph of a few different parameters and was able to diagnose himself before even getting to the hospital). He also has a Nature article about predicting Covid pre-symptomatic and asymptomatic patients with I think 80% success just from wearables. One thing that he stressed a lot that I remember was the readings from the wearables themselves don't matter that much, so like heartrate from the Apple watch, but large changes from the norm, especially ones that last for a few days, signify something is wrong. I am aware of all the issues of being overly concerned and taking drastic healthcare operations based on imprecise data alone. However, his argument was exceptionally strong, and I think data in healthcare will be immensely useful. He made very strong arguments on the overall benefits of preventive care. Have you heard of him or his work before? What are your thoughts on this?

[@BigHenFor]

Like most tools, it matters who's wielding it. The yahoos in Silicon Valley released software they knew could have deleterious effects on human psychology, just to profit from it. The ongoing effects have yet been to be fully documented, but negative effects on users' mental state have been observed. And you really trust these guys? As is, without effective regulation and privacy protection, I wouldn't want them to make a cup of tea.

[@michaelwing1501]

The change from baseline is indeed one of the most important aspects to determine a new pathology such as Lyme. He could have done this with how he felt (symptoms), or possibly slightly earlier with some form of wearable. Data will be useful, but not until we can understand it much better, as the video states.

[@SomeoneBeginingWithI]

I completely agree that knowing what is the normal baseline for each person can be useful for things like body temperature. Maybe what some of the tech bros are getting caught up in is an interest in the absolute numbers, like watching their glucose go up after eating and worrying it's too high. Generally the shape of the graph is probably more important than the absolute numbers. It's normal for glucose to go up and down, the significance is if it stays high or low for a long time and doesn't self-correct. Thinking about patterns and feedback loops is usually the kind of thinking you need in ecology, which is my background. I wonder if maybe tech people tend to be more interested in, or used to thinking about, precise numbers and statistics, rather than patterns and shapes of graphs.

[@BronxGrrlX]

I think there is a cost\benefit analysis that could be done here. For most people, collecting and interpreting this much data in onerous, and also may incline people towards becoming obsessed with their own data. I also note that, right now, physicians do not listen if you tell them, for example, "I know my normal temperature is 96 so 98 is a 2 degree temperature for me". They simply do not listen. But you don't need all the data or baseline measurements for that, you just need physicians to begin to listen to patients. People know their own bodies better than anyone else, even without technology.

[@SomeoneBeginingWithI]

@@BronxGrrlX Yes, I have had exactly that experience with doctors not listening to that kind of information. I don't know whether having real data you can show them would help. The core problem is with the doctor's attitude and the way they're trained.

[@Sarah-re7cg]

I’m a comp sci and philosophy major and I’ve observed this really narrowed focus on both diagnosis of and solution for problems where the field someone works in really colors how they perceive and make sense of the world. I think one way to describe this phenomenon is a cognitive bias called “the law of the instrument” which is where if you only have or become over-familiar with one tool, let’s say a hammer, then every problem you come across will start to look like a nail. In the medical Silicon Valley world, they’re working from a limited computer science framework. Weird, it’s almost like it’s really important to have a well-rounded, holistic education where you’re able to spot your own biases and see how unknown puzzle pieces are puzzle pieces in themselves.

[@vidhoard]

This is a really important video. I need to listen to this advice, I genuinely have changed my thoughts about screenings and constant monitoring of my body's stats thanks to this. I really appreciate you bringing all this up. I didn't know I needed it. The health anxiety caused by these tech bros is real.

[@MazHem]

Thanks for the concept of "antifragile" I really think we need to stop protecting ourselves from various things to get more used to them - such as keeping people at the same temperature all year round should be for the aged who can't adjust their internal temperature. We can do with more temperature variation in general.

[@a14409]

As a Machine Learning scientist, I want to point out that the only way we could develop and improve our model is train and test them with lots of data. So it is nice to collect a huge amount of information of our body in many different dimension. I believe the video argue around the "risk analysis" of test and treatment which is also a very "machine learning" type problem. I am sure there are some researcher working on this kind of problem now.

[@laaaliiiluuu]

Yes. It all depends on what we do with the data. I like to go with the Pareto principle here. At some point the extra data one COULD collect is just not worth the effort that is needed for it to be collected and the result that would be achieved with it. I rather die 5 years earlier than forcing myself into ridiculous over-scanning of my body. One must be really paranoid to want to squeeze out every little detail that nobody would ever really notice anyway. I feel the fear of dying younger reduces your lifespan more than eating a cookie once in a while anyway.

[@k.e.1760]

@@laaaliiiluuu other people might prefer those extra 5 years.

[@laaaliiiluuu]

@@k.e.1760 And in return waste your time with scans and body checkups all the time? What kind of life is that?

[@k.e.1760]

@@laaaliiiluuu well, that's for them to decide not us. We should let people live however they want.

[@Call-me-Al]

@@k.e.1760 as someone with a lot of health issues of which most haven't been diagnosed yet: Annual scans would be great and not stressful for me, especially as I'm at risk of cancer once I hit my 50s and I've had too damn many health issues since I was a kid that didn't kill me so I wouldn't stress out even if they found tumors. Because it's only the late stages that would be the issue to me, I have the time for the doctors to figure out whether the tumors are benign or not. For me it's more like outsourcing having to pay attention to my body, which is an annoying cognitive load I'm happy to delegate. Plus it would be really cool to get to see how my different broken bones have healed. For instance I only have an X-ray of the ankle that healed wrong (parental medical neglect), would be really cool to see it in full 3D.

[@joemck85]

As for the Apple Watch afib monitor thing: As someone who's closer to a tech bro than a doctor, I think the way to proceed should be to have a large study. Get a bunch of people, like Framingham Heart Study numbers, and get them to use various wearable monitors for years. Document how often the devices record atrial fibrillation, and correlate it with whether the patient has any symptoms, is eventually diagnosed with afib, and whether they require any treatment. I suspect there will be some correlation, but that the devices would do well not to alert the user until several episodes happen, and probably try to filter out patterns of episodes that suggest suggest a false positive. And if a smart device I was wearing alerted me of afib, I think my response would be to wait and see if it happened again. If it was a frequent thing, I'd want to see whether I could capture it on something capable of showing a proper ECG graph and not just a notification. It would certainly trigger health anxiety though.

[@aim-at-me]

As someone in tech - although I understand your very real message, this whole video had me laughing. Thanks so much for your time and humour Rohin!

[@stefanschneider3681]

I am a pediatrician and just stumbled over your channel - and I love it! I've worked in primary care for 20 years now and just a few days ago I looked back and thought to myself: Nothing really REALLY new has come along in my field over this period of time! Of course some new vaccines against diseases that are quite rare and need A LOT of vaccined children to save a life, asthma-medications are a bit more refined and easier to apply for example, but apart of that it's more of a less: We use less antibiotics because often it's not necessary, we usually don't recommend cough medication because (see above), less fever-medication (again: see above), less i.V.-rehydration and so on. Get me right: I vaccinate all day, it's been one of the game changers in children's medicine and I strongly recommend the basic vaccines. Protection in car accidents has made huge strides and what's been accomplished in specialized fields like oncology is huge. But for the everyday child not much has changed and that's fine! We are doing alright, let's strive to keep this level! And talking about checkups: I really hesitate to put in words what's my opinion is on alle these regular well child visits I do half the day ... if you apply the generally applied criteria for the use of a screening method they would fail miserably ... Keep it up please!

[@MegaAdeny]

The blood glucose thing is particularly baffling to me. Is it not the literal consequence of how the body utilizes carbohydrates...? Breaks them down into the simplest sugar and transports it around...?

[@SomeoneBeginingWithI]

yeah, it's like they've forgotten that the purpose of the blood is to transport stuff

[@Aetherian1]

@@Hope4all2 "I had to remind my doctor that a strong marker for negative cardiovascular outcomes is actually fine when you're doing a biohacking diet nobody was doing until 10 years ago" I'm not surprised you had to remind him, he's probably never seen a patient that so rigorously eats such a strange diet for so long that his blood has that kind of makeup without some sort of metabolic derangement - except you absolutely do because your LDL is high and that's bad. Furthermore LDL doesn't carry ketones, it carries fats. Ketones aren't fats, they're water soluble. Keto diets are supposed to lower LDL for this reason - fat is broken down into ketones. For people who have high LDL on a keto diet, most medical sources will tell you to stop the diet. LDL doesn't invent a new function in people undergoing ketosis. Also how in the hell is this at all related to the OP and why are you stating LDL are non sticky particles when that's 100% absolutely not the case.

[@ng.tr.s.p.1254]

@@Aetherian1 Some people are just completely disconnected from reality, sadly.

[@Aetherian1]

@@ng.tr.s.p.1254 It's bizarre. Really is true that sometimes people have ideas, other times ideas have people.

[@toomanymarys7355]

Glucose is reasonably tightly regulated in metabolically healthy people. It rises but doesn't spike very high because insulin increases to balance it. If it does really increase, that is because you are metabolically unhealthy. Some of that unhealthiness is almost unavoidable with age. Others are due to behaviors. I think he is rather misrepresenting what people are doing.

[@VuLamDang]

This is something we computational biologist struggle with the most. I distinctively remember when asking my old professor if our work could be applied as it (We work with genome wide association study), he basically said "I sure hope not"

[@chickensalad3535]

Why?

[@MarcPaganCohen]

Bravo and thank you from the USA. ...I had to stop the video due to falling off my chair from laughing at "Semi-solid state drive" with reference to poo, and its alleged memory capacity. Ah, the other sciency stuff in the video ain't bad either :) FYI, while a full time Flight Instructor in Florida many moons ago, I conducted a check-out of Peter Diamandis. A check-out is required of any first time aircraft renter, or one who has not rented within the prior 90 days. Very nice fellow. He proved himself to be a safe and proficient pilot in oral and flight exams.

[@mecmeuf4528]

14:12 good points abt diet and nutrient tracking. understanding limits of raw data outside of a scientific study. balance is key

[@gabrieldarce1991]

just finished reading taleb's other book "skin in the game" today and kept thinking the first half of the video was very similar to antifragile!loved this video what a coincidence!

[@TesterAnimal1]

He’s a loon.

[@TheTonySRich]

I'm 60 and have had knee pain for some time I had both knees scoped and scraped in my 50's but they're playing up again so I went to my GP who ordered an MRI and referred me to a surgeon The surgeon said that the MRI indicated that I was a candidate for a total knee replacement but ordered x-ray's on both knees anyway After seeing the x-rays he decided that I wouldn't need the procedure for a while yet as he explained that too much detail can be misleading

[@Electric-Gal]

I’m seeing all of these thoughtful comments about the technical and social commentary- but I’m just informing you that I appreciate your jokes about men’s egos, radiation, and Boris Johnson.

[@eliterun6214]

I am so jaded by the health system that I've vowed never see a doctor unless it's an emergency or an obviously very deleterious health condition. Preventative care is easy enough to do yourself.

[@ssmith6963]

This was an amazing video. I loved the information on the Apple watch and even had a disagreement with a doctor about the necessity to monitor for afib in a younger population which is the demographic of the typical buyer of the watch. I also had a spine surgeon that is diabetic and she constantly monitors her blood sugars and posts them on her twitter page and she tries to put all of her patients on Keto. I ran away from her office (it did my back wonders 😁). She is a spine surgeon and not a registered dietician. Thank you for the critical look at data. Those pre-kidney stones will bring you to your knees.

[@michaelb1761]

Excellent points. When you mentioned the blood glucose monitors, I immediately thought of exercise. Not exactly in how you pointed out its effect on glucose levels, but as in when engaged in exercise like a 5k climb on a bike ride. I want high glucose when I'm engaged in a high energy activity like that.

[@henryginn7490]

Just under 1 in 7 people liked this video, that's one of the highest proportions I've ever seen. I'm not surprised though, Rohin reliably produces some of the highest quality content on the platform

[@Laogeodritt]

I was for a time involved in the engineering of new ECG sensors intended for a project involving 24/7 ECG monitoring. I thought this project was rather exciting-not because long-term continuous monitoring had any immediate clinical benefit, with the knowledge we have now, but because the roadmap included a goal (among others) to eventually conduct research to classify long-term 24/7 ECG monitoring data with respect to clinical diagnoses and outcomes, in order to better understand what kind of anomalies are clinically significant in this kind of long-term monitoring. I'm not medically trained so I'm not in any position to make any firsthand claims, but those goals seemed in the right direction for developing new technologies that would be clinically useful-as you said, doing actual research!

[@NyanyiC]

Thanks for this. I'm a medical doctor now working within digital health and I am horiffied by what goes down in this industry. How does the concept of Minimum viable product apply in health care systems

[@n3v3rg01ngback]

We did an exercise in my veterinary nursing class in which we interpreted blood work. On one of the profiles, my group kept throwing out all these diagnoses to explain the slightly elevated eosinophils. Then it hit me. The patient was normal. There was nothing to diagnose.

[@Unsensitive]

incidentaloma.. great phrase. I built our whole body MRI protocol, and we have a few clear indications for our MRI techs. All other indications require a our medical director to sign off on, which usually means a cancelled study. There are places who will gladly take your money for a whole body MRI, regardless of the benefit to you, but we are not one of them.

[@WilliamChan]

I feel like of all the people in the healthspan/longevity space, Peter Attia represents the most thoughtful and reasonable. From what I know, he's never advocated for any specific diet or health plan for people across the board, let alone strict ketosis. He does stress the importance of CGM data, but in one of his podcasts did go through some compelling all-cause-mortality data relating to blood glucose excursions (both magnitude and frequency). But for sure, no matter which doctor you follow, you always gotta ask the right questions.

[@auwtomoton]

Thank you so much for exploring this topic!! Please talk more about the Harvard and Stanford professors who are also internet personalities and who profit from associated supplements and testing services. I am genuinely curious to know your perspective on their claims

[@MedlifeCrisis]

Huberman and Sinclair? Absolutely the people I was referring to in this vid.

[@auwtomoton]

@@MedlifeCrisis yes exactly. I have been watching their videos (because I just do whatever youtube tells me to do apparently) and it's been freaking me out a bit about how I should be cold plunging and doing all these health things...because they are such authorities, and then the conflicts of interest are huge and that gives me a really bad feeling about using them as my source for health information :/ Thank you so much for responding and doing this I appreciate it so much!

[@auwtomoton]

@@MedlifeCrisis Sinclair says we should all be on some diabetes medication that makes it harder to exercise but we live longer?? Ugh it's stressful to imagine myself in the future looking back from my deathbed like, "damn I should have listened to Sinclair" but at the same time the conflict of interest and big money he and huberman are making from scaring me and convincing so many to buy his supplements and testing services ugh! It doesn't sit right. Thanks again for talking about it and please talk more about it all often af✨

[@slash196]

This gues has got to be the first doctor I've ever seen just straight up say what many of us have either suspected or had to learn the hard way: unnecessary involvement with the medical system is not just wasteful, but can actually be DANGEROUS TO YOUR HEALTH.

[@palomasofiaalcalde382]

My mom is a doctor, she does appointments in the private sector and step-down unit in a public hospital, and she's always complaining about how ppl in her appointments who don't have absolutely anything bad in their health pressure her into ordering analysis and check ups on super complicated things they searched on Google (and the private sector enables without question). She thinks ppl are like anxious about wanting to find some kind of pathology or sth. I mean knowledge is always good but sometimes I feel that the obsession for data on the regular ppl is kind of backfiring their mental health.

[@debmary2999]

I’m glad you mentioned Peter Attia who I had followed for years but now think he’s pretty much out for the $. He probably now has a guru like following who are obsessed with all these investigations. Keep on making videos- they are of such high quality and super important to med students and nurses etc. also hilarious of course. 👏🏻🙏🏻

[@Skittenmeow]

Gotta say I've been offered free full body MRIs by a radiographer relative. I was tempted but said no, in some ways I don't want to know. I have had so many weird body things happen due to being "a zebra" (Ehlers-danlos syndrome). I did have a 2020 incidentaloma found during an abdominal scan. Big liver lesion, as in 6cm ball. Luckily it was quite obviously an FNH which are benign, because of its location a biopsy would have been really dangerous. Anyway I have had a few ultrasounds to check and it's been continuously shrinking which is cool. But l don't want the free MRI yet!

[@fran21159_]

I love your videos, I love your humor and ones like this that show support for a practical, as necessary, approach to medicine rather than the hypochondriac idea of having medical care being a regular part of everyday life. Thanks for making these

[@PSPMHaestros]

Great, now I can't even have my crystal meth and a whopper breakfast without judgement

[@M.E.M.O.10-50]

OMG I so needed this. I find EVERY contact with drs results in prolonged worry trying to prove I'm NOT dying of something completely unlikely. This is probably at least partly because I'm old, but I think medicine has devolved into the "GP" being simply a referral engine. I think I'll go back to saying "Until there's proof that something's wrong, leave me alone."

[@lolno4384]

"Referral engine" is a great way to put it lol, I was thinking the same thing the other day