I was an MIT educated neurosurgeon – now I'm alone in the mountains [video]

https://www.youtube.com/watch?v=25LUF8GmbFU

by carabiner • 2 years ago

125 78 2 years ago

youtube.com

hilbert422• 2 years ago

A remarkable video, I'm so glad I watched it. I can't explain why except to say you'll know after you watch it.

xtracto• 2 years ago

I got to half of it so far (will deffo watch it later).

One thing that struck me was the mention of what I call the "destructive" paradigm of medicine.

If we look at most current medical procedures, they are barbaric. Chopping stuff mainly.

How do you fix a fissure in the anus? LIS: Chop a bit of the sphincter and hope it heals back.

How do you fix GERD? Make a knot in the esophagus.

How do you fix Crohns? Chop the bowel and open a hole in the stomack .

Dont get me wrong, I applaud all the stuff current medicine helps with. And I'm far from a radical anti medicine . .

But those things make me think that in 500 years, people will turn back and see these sort of procedures the same way we see now how our ancestors treated bacterial infections: intentional bleeding, using leeches and other similar medieval procedures.

We as a society should start puahibg for more constructive or generative medicine. As the Guy in the video says, fixing the problem instead of alleviating the symptom.

etrautmann• 2 years ago

I haven’t watched yet but this seems highly selective. There’s so much creative building in medicine, from what’s done in orthopedics with rebuilding joints (often using a patients existing tissue with new hardware) or with reconstructive surgery, etc. if you consider medicine more broadly to include pharmacology or therapy then there’s more room for constructive creativity.

metabagel• 2 years ago

Reminds me of Star Trek IV where Bones cures a woman’s kidney disease in the 80s and rhetorically asks if it’s the “Dark Ages”.

https://youtu.be/_R_WbAhKyAk?si=KSnC6OYJArhnKe0W

rrsp• 2 years ago

How do you fix a fissure in the anus?

A: Rectal Glyceryl trinitrate

How do you fix GERD?

A: For the majority of people weight loss and dietary changes will do the job

How do you fix Crohns?

A: You don’t ’fix’ Crohn’s per se as there is no cure. But most people with Crohn’s can be have their disease managed well with -mab medications

In all those conditions you named surgical management is very much at the end of the list and for a minority of patients who do not respond to the above. The first line management in all of these conditions very much does look at ‘fixing the problem’ contrary to what your espousing.

hilbert422• 2 years ago

"If we look at most current medical procedures, they are barbaric. Chopping stuff mainly."

One has to agree with your view, at least partially. I've heard it said that surgeons are akin to carpenters—some are skilled craftsmen who craft fine furniture, others like builders whose skills are pretty much limited to joining bits of 2x4s but none of whom know the underlying mechanism of how trees grow or how they produce wood.

Nevertheless, with the fusion of modern chemistry, a refined understanding of biological processes, and advanced computing and specialist manufacturing techniques (micro sensors etc.) we're just now beginning to see the end of some of the 'chopping'—or at least how in the future we might end it.

I've been around for quite some decades so I'm unlikely to benefit from any new technique—they being too immature for deployment—but on current evidence those who are around in 50+ years are very likely to do so.

epicureanideal• 2 years ago

Not a fan of anywhere with that many mosquitos.

adamthegoalie• 2 years ago

Yeah that’s when I started questioning his life decision

ainiriand• 2 years ago

I am not sure what would happen to the ecosystem if we remove the mosquitos but god damn I am in favor of taking the risk.

aleph_naught• 2 years ago

I have some minor PTSD from prior insect bites, and the start of that video was giving me anxiety.

carabiner2• 2 years ago

I was pretty moved by this. It wasn't what I expected. It's his personal experience working as a neurosurgeon for 9 years, his critiques of US healthcare, his recognizance of burnout, and his escape from it all. What comes across most, especially on youtube, is his sincerity and lack of presentation or preaching. It's so personal and ends up kind of inspiring.

He talks slowly and you can watch at 1.5x.

Edit: Why is this flagged?

isoprophlex• 2 years ago

I vouched for it so it's temporarily back up, but I'm afraid it won't be for long.

Downvoters/flaggers, please explain yourself. I've found this very thoughtful and worthy of the front page... quite long though, I'll grant you that, but the guy has something honest and genuine to say

somenameforme2• 2 years ago

There's an oddly related video here. [1] It's an interview between two doctors and YouTubers, both named Mike. One is a practicing medical doctor, the other has a doctorate in sports science and provides generally provides excellent nutrition, lifting, and other advice related to body building. The reason it's relevant is because the medical doctor in that video also expresses similar views to the video from this article, yet the sports science Mike expresses radically different views. And his views are ones that even crop up on this site on occasion, so I expect it's a sort of bubble that you or I may not have even really been aware of.

They get into a topic about half way through on the future. Lifting Mike thinks that by the early 2030s medical science will have made breakthroughs such that basically every disease will be cured, people will be approaching living forever, and so on. This is paired alongside a general blind faith in all things tech - that the LLMs we have today will be imminently super-geniuses surpassing human intelligence with scales of exponential growth on the orders of magnitude, every other year, and so on.

Medical Mike is far more bearish on the future (and the present), though like a good host he doesn't really try to go to war with his guest, so much as just picking his brain and seeing how he responds to basic counter-points. And lifting Mike's responses are mostly to say "that's a very valid point" and then completely ignore them. In my opinion the singularity types are starting to gradually coalesce into something like a secular religion, because I don't think he really believes what he's saying, but he wants to believe it - because the thought of dying sucks.

And this video (from this topic) is yet another medical doctor speaking about the questionable path we're currently on and how not only are we not making this exponential progress many seem to want to believe we are, but that the motivations involved in a lot of things like medicine today are quite broken. This isn't going to be responded to well with people who have the faith that in a decade or two we're all going to be living forever.

----------

Okay, cripes this post ended up wayyyy longer than expected. But I also want to add that once you know about this sort of divide, it's almost enlightening to read threads like this [2] (currently on the front page: "Scientists discover a cause of lupus, possible way to reverse it") and watch how the views shape people's responses. There's [fortunately] no real signaling or whatever, but just people having extremely different views on what has happened in the past and present, and even more so about what will happen in the future.

[1] https://www.youtube.com/watch?v=UrzF-rhJtOs

[2] https://news.ycombinator.com/item?id=40931636

trealira• 2 years ago

It could be a mistake. I've accidentally flagged and downvoted comments before and then only realized it when looking at the list of comments I've flagged and downvoted. I'm more careful now, though.

rgrieselhuber• 2 years ago

Downvoters and flaggers generally don't explain themselves. They lack the ability to articulate their position and simply prefer the easy buttons.

threatofrain• 2 years ago

A dentist can fix cavities. But what was the root cause? Lifestyle. What can a dentist do about it? Largely nothing. Of course there's going to be advice to brush your teeth and avoid sugary drinks, but such advice is given to children many times over before a dentist sees a cavity.

So is it myopic for a dentist to focus on fixing cavities? Is the dentist missing something big? The dental industry also experiences a problem that if everyone started brushing well then the industry would largely crash. Does that stop dentists from telling people to brush? No.

leoh• 2 years ago

You are missing the forest for the trees here

anon-3988• 2 years ago

On the small scale, this might be true. But on the larger scale, there's much, much more money to be made from fixing the problem after the fact.

Edit: If dentistry as an industry cares, so, so much about dental care then why are they not lobbying for less sugar in our food? Is providing care and regular advice the most effective way to fix the problem?

narrator• 2 years ago

The root cause is Streptococcus mutans and other bacteria in the mouth. Dentists would be out of business, except for trauma injuries, if these bacteria were eliminated.

Mathnerd3142• 2 years ago

Ellie Phillips has this triple mouthwash system, in her book "Kiss your dentist goodbye". Apparently she hasn't had her teeth cleaned in 40 years. I have been using it and it seems to work, in that my dentist says I have the best teeth out of all his patients despite me brushing my teeth maybe once a week. The motivation for the mouthwash is simply that mechanical brushing isn't sufficient to kill the bacteria, whereas mouthwash is if you can disrupt all of the biofilms. And then the other two mouthwashes are for pH and fluoride.

dheera• 2 years ago

The fix is easy, stop giving kids so much goddamn sugar as a system.

We give adults way too much sugar as well. Every goddamn drink has shittons of sugar. Even a goddamn bread loaf has added sugar these days. A cup of many brands of flavored yogurt have half the sugar as a coke, and they try to pass yogurt off as the "healthy" alternative to ice cream. It's the same if it has the same amount of sugar. The coffee shop near my place sells 5 types of flavored lattes. They all have added sugar. The Japanese, Chinese, and western bakeries near me have added sugar in every pastry and every drink. It's fucking insane.

There is absolutely no need for this. It desensitizes everyone to sugar AND makes them addicted so that you can sell them more junk with even more sugar.

sethammons6• 2 years ago

Sugar is a problem. A hundred or so years ago, you may eat a pound or five of sugar over a year. We are now eating like 40lbs a year.

But sugar is not the only problem. Why do ancient skeletons all (mostly) have great, straight teeth and strong jaws? That is not sugar. I suspect it is soft foods.

Hnrobert42• 2 years ago

I have taken career breaks. I don't call myself unemployed. To me, unemployed means that you are not working but you want to be. It seems like the terms "unemployed" and "alone in the mountains" are just being used to dramatic effect. Am I wrong?

carabiner2• 2 years ago

On my sabbaticals I told people frankly that I was unemployed. Some people I know said they were "funemployed."

I don't think this semantic difference is something to get worked up over.

tasuki• 2 years ago

To me, unemployed means that you are not working but you want to be.

To me, it does not mean that. In the very same way that "unforgettable" does not mean "I remember but want to forget".

oskarkk• 2 years ago

To me, unemployed means that you are not working but you want to be.

In economics, exactly that is the definition of unemployment:

Unemployment, according to the OECD (Organisation for Economic Co-operation and Development), is people above a specified age (usually 15) not being in paid employment or self-employment but currently available for work during the reference period.

https://en.wikipedia.org/wiki/Unemployment

goethes_kind• 2 years ago

DISCLAIMER: If you have back/spine problems and you delay surgery because you hope the problem would go away on its own, with healthy living, you might end up with damaged/dead nerves which is irreparable damage, which even a delayed surgery cannot fix.

With regards to for-profit medicine, this is why I hate all market based health insurance systems. Even if you are rich and get treated like a king, you still have to question whether your doctor/surgeon is trying to sell you a procedure. The only system that does not suffer from this issue is the NHS (e.g. UK) where the incentive is lacking. The debate about health care systems tends to focus on availability and coverage, but this for-profit perverse incentive is orthogonal to all that.

throw734884• 2 years ago

The only system that does not suffer from this issue is the NHS (e.g. UK

Is that a joke? With NHS you have to wait to get GP appointments, wait several weeks for examination by specialists, more waiting in waiting list for surgery... The backlog for everything is huge!

In NHS you can literally wait years for non life threatening surgeries.

yungporko• 2 years ago

you also have to deal with every person at every step of the way trying to gatekeep healthcare from you instead of trying to help you.

damidekronik• 2 years ago

Parent comments is still correct, NHS is free from the Financial Incentive problem. I don't think anyone claims the system is good, just this one aspect is correct.

rickydroll2• 2 years ago

In the US, I am waiting 6 months for an eval appointment to redo an eval to see if a brain problem has progressed enough to put in a shunt.

how is this different from NHS?

sethammons6• 2 years ago

I have that gold plated US insurance that you pay a lot for. Just last week, I was rushed to the hospital due to my heart. We don't yet know what tried (or is actively trying) to kill me. The cardiologist ordered an emergency MRI.

Three weeks. I am told to wait three weeks. The doc wants it last week. We are having to call around and mess with coverage questions. Similar for my dad and a specialist. Waiting a month while having breathing issues.

People wait already for emergency medical situations, but we pay a premium. And I am still not sure what my 20% shared cost is gonna be for the ambulance and hospital stay. And yes, that factored into my decision to even be treated, which, had I stayed home, may have killed me.

Fuck our system. Medical should not be for profit. It should cost money to run because it should be a service.

tivert• 2 years ago

Is that a joke? With NHS you have to wait to get GP appointments, wait several weeks for examination by specialists, more waiting in waiting list for surgery... The backlog for everything is huge!

My experience of healthcare in capitalist America is exactly the same in that regard. I have a mole I want examined, and one of the dermatology practices I called (part of a major local health system) was taking appointments for March 2025! I usually have to wait 3 or 4 weeks to see my primary care doctor (though I suppose I could settle for a rando doctor with an opening or a nurse practitioner and be seen sooner, but whenever I've done that there have been other issues).

jimt1234• 2 years ago

I don't know about NHS, but I do know about Michael Jackson. He was a rich person and got treated like a king; and how did the for-profit health care system treat him? (It killed him.)

sethammons6• 2 years ago

A bed side and what appears to be an unethical doctor overdosed his meal ticket with a heavy duty medication to induce sleep. I don't think there is much to argue either way on for-profit medicine in that case.

Gud• 2 years ago

Ok, and the NHS let Jimmy Saville molest possibly hundreds of children.

https://www.bbc.co.uk/news/uk-28021488.amp

Ey7NFZ3P0nzAe• 2 years ago

The only system that does not suffer from this issue is the NHS (e.g. UK) where the incentive is lacking.

Why not mentionning France? It's pretty awesome in that regard

trilbyglens2• 2 years ago

Classic anglophonic world view. Seems like people forget that literally all of Europe has universal healthcare, with many working far better than the NHS.

ulnarkressty• 2 years ago

This is not really true unless there's something _really_ wrong with your back. For run of the mill disk hernia the patient satisfaction scores at 1 year for surgery and conservative treatment are pretty much the same [0][1].

[0] https://bmjopen.bmj.com/content/6/12/e012938.short

[1] https://link.springer.com/article/10.1007/s00586-010-1603-7

wesapien• 2 years ago

I've dealt with lower back issues for a long time. The worst of it was long behind me and I've been diligent enough to not have crippling events. My lower back hasn't felt as good and pain free as of today.I don't know if it was all the walking I've been doing (vacation) and the bag on my back (weird right). The biggest change was the level of stress after vacation. I haven't been on one for over 7 years.

I feel much more relaxed these days but I can also tell that everyday this "stress bucket" is slowly getting filled by daily life and I have to dump it all out by doing something other than the ordinary. I'm not a super healthy eater but I'm conscientious about it. I'm not a gym goer or even home exerciser. Once in a while, I'd use my weights and do somebody weight exercises.I don't eat fruits and vegetables as much as one should. I also know that there is great variability in humans.

I'm also much more aware of my body and what it needs as far as physical therapy exercises. I've a lot of time watching videos on physical therapy and back pain. I spend the most of my time at home walking on a treadmill while watching something on the TV.

kehphin• 2 years ago

Very poignant and from the heart! Thank you for sharing. But oh man, when that mosquito was on his cheek, I got so anxious about whether or not he'd slap it away...

DataDive• 2 years ago

The channel contains 10-hour-long videos of natural sounds.

Maybe the post is less about what is right or wrong in medicine and more about the author having gone into the wrong field, which is opposite to what they enjoy in life.

Perhaps all along, the author misunderstood what modern medicine is about and how life really works. There is no miracle cure that would restore the neural system.

There is a miracle prevention however, be active, exercise, eat well, sleep well, enjoy life, contribute to society. That will help your back more than surgery once things go bad.

jpcookie2• 2 years ago

Yeah "positive thinking and going with the flow will fix disease". Tell me: why didn't everyone 1000 years ago live to be a hundred everywhere? Oh that's right: because it's not that simple.

sethammons6• 2 years ago

People long ago seem to all have great, straight teeth, and strong bones. Also a lot of them were killed by a rock to the head. Give and take, I guess

deepburner• 2 years ago

"Maybe this person who did this for 20 years did not know what they were doing" is such an HN take.

Narhem• 2 years ago

Super cool project.

spacetimeuser5• 2 years ago

He could have tried injecting senolytics into the weared disks to remove senescent inflammatory phenotypes, as there is some research in senolytics (dasatinib+quercetin) improving arthritic knee joints by removal of senescent inflammatory cells which allows the new cartilage to grow.

rozap• 2 years ago

I'm actually laughing quite hard at this. This may be the most HN take I think I've ever seen.

"20 year career in neurology, but there's this one weird trick that will fix everything"

zerof1l• 2 years ago

I suggest watching the whole video, I found it very interesting. Here's my attempt to summarize the key points.

An MIT-educated neurosurgeon quit his job after realizing surgeries weren’t addressing the root cause of patients’ problems. He observed that the outcome of surgeries would vary greatly: for some it would help, for others a bit and for others, it would not help at all even though he performed them perfectly every time. Some patients even called before the surgery to say that they were okay and no longer needed surgery.

So he started asking patients questions and after 9 years he concluded that patients who got better and healed did the following (at 19:42 in the video): low salt diet; mostly plant-based diet; did things that would cause sweat: exercise, sauna, or living in hot weather; did not smoke; drank little to no alcohol; had good social support: family, friends, etc; slept 8 hours a day; were not stressed or managed to release it back, e.g. meditate.

Then he talks about the moral dilemma. If he helps patients to truly heal by sharing what he has learned, he and the hospital would not make money.

omnimus• 2 years ago

So he concluded that we should destroy capitalism?

samiru• 2 years ago

No. The way we have built our healthcare system on top of private actors (at least here in Finland) has very little to do with capitalism.

Successful lobbying, if not straight corruption, would be closer to the current situation.

kazinator• 2 years ago

The combination of low salt intake and {exercise/sauna/hot weather} is poor advice.

If your salt intake is low, and you start sweating due to hot weather, exercise or a new-found interest in saunas, you probably need to bump that up.

careless_lisper• 2 years ago

Google tells me that Americans consume on average 3.5g of salt, while the recommended intake is 2.3g. Quite some room there to decrease salt consumption.

DoingIsLearning• 2 years ago

This part resonated:

".. When you let go of something you are holding too tightly, even though it's hurting you. When you let go of it, then you are able to pick up something else that is hopefully better for you."

Despite all the post-rationalization on the why's of medicine, it does feel like he is someone bouncing back from Burnout.

The risk being that he may fall into the opposite end of the pendulum swing. As the saying goes: "A ship in harbour is safe, but that is not what ships are built for."

In the end there is a balance to everything, I hope he finds his.

O1111OOO• 2 years ago

When he isn't talking about medicine, I get very strong Chris McCandless vibes. That need to be free, away from modern life, the demands, the unnecessary stress. Maybe get away from people too (which is harder to admit to... people directly).

I haven't come across a video yet but I'm sure he's better prepared for outdoor living than some others that have done similar. There's a large sub-community of Van Lifers doing similar. With a little planning and preparation, it's a great life. Especially for those that clearly need to get away from it all.

I can't imagine how difficult the decision was. He basically said that his entire 9 year career was emotionally difficult. That is a heavy burden to bear for so long. I'm certain that his upbringing, his years of preparation, the expectations of the world... made the decision to walk away (without a plan) seem overwhelming.

Still... he broke free from all of that!

Honestly... I feel so happy for him. To be able to make the decision and implement it. To be at a point where he can begin talking about it, freely. To be connected to civilization on his terms. To live his life in a way that makes him happy.

vehicles2b• 2 years ago

I'm wondering, does anyone know what are the chances for returning to neurosurgery after an extended hiatus? Person in the video practiced for a decade (edit: nearly a decade of practice, and two decades total including training), I'm sure burnout is common in the field, but I wonder if people that left ever make their way back.

moneywoes• 2 years ago

why not? isn't their a shortage

silverquiet2• 2 years ago

I'm more curious if he could re-specialize in a surgery that he finds more rewarding. I'd think orthopedics could provide very clear and quick resolutions for patients; hip replacement is known as the "surgery of the [previous] century" for having such clear quality of life improvement.

chubot• 2 years ago

Yeah that was partly my reaction too ... Why not steer your career -- i.e. accept a temporary setback -- instead of walking away from the whole thing?

But it sounds like he already did that once. The first part of the video talked about how he wanted to specialize in brain-machine interfaces, and then he came to the belief that the approach would never work.

It did feel like he had very high expectations for himself. Almost a bit of a hero complex.

But I don't think that's a bad thing. I think we need people like this to tell us the truth sometimes!

It's not the whole truth, but what he's saying is definitely part of the truth.

---

As a particular example, I have noticed that doctors and dentists don't talk to each other ... It's not overstating it to say "the system" essentially discourages that. But your body doesn't know anything about these divisions, and I agree with the observation that the mouth is one of the two main openings in the body and is central to health !!

i.e. the condition of your teeth are a good indicator of general health, not just dental health

This relates to the part of the video where he says: "if your body heals, it doesn't just heal the spine -- it heals everything"

It is comforting to know that people can see with what I think of as "blank mind" -- see and think from first principles -- rather than falling back on all the technical jargon that we use to justify ourselves and our jobs

2-3-7-43-1807• 2 years ago

netflix special ... when?

expertsturgeon• 2 years ago

I (non-US, non-neurosurgeon) work with a lot of neurosurgeons in my daily practice and here’s my two cents on this.

Dude is a neurosurgeon. There are lots of other options for neurosurgeon, and some of them are really rewarding. You don’t like spine surgery because of all the aforementioned reasons? Why not try neuro-vascular surgery, where you cure stroke? Or neurosurgical oncology, where you cure cancer? Or neurosurgical trauma, where you are literally putting people’s head back together.

Dude has a huge dysphoria problem with his job, probably burn-out or something, I don’t know, but throwing away years of educations is kinda wasteful.

I was an MIT educated neurosurgeon – now I'm alone in the mountains [video]

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