Textbook of medical physiology

What Hacker News says

1. UniverseHackerJan 2025
   You are completely misunderstanding me- I am not talking about rejecting things just because they come from an authority.

   I fundamentally reject that experts can make universal medical protocols that can be blindly applied by ignorant practitioners without high rates of really bad outcomes. It is done to execute cheap commodity medicine at scale, but it will never compare to having medical care from someone with deep understanding and individual context.

   These type of context-free ignorant protocols will frequently do things to patients that are wildly inappropriate and dangerous in a way that would be obvious to people that actually know what they are doing, but completely missed by the average doctor. For example, a patient with regular bloodwork where every single kidney function related lab result is on the very edge of the acceptable range, but they're all marked green by some official cutoff, so the doctor doesn't even notice the biological pattern being presented- and is blindsided when the patient comes back later on with serious nephropathy.

   Even worse- intelligent people that understand the evidence and the biology will self select out of even participating in developing such protocols- because the whole concept is nonsense. So these protocols are themselves mostly ignorant and outdated, and not developed by competent people.

   One cannot commodify technical knowledge into simple protocols, especially with something as complex and poorly understood as biology. The only time this is optimal is in something extremely routine with no impossible to anticipate exceptions, or in an emergency where there is no time for careful problem solving: e.g. as checklists are used in aviation. In medicine they are only appropriate for first aid type situations.

   Yes, when I have a health problem I generally read the scientific literature and understand it before accepting any treatment, unless it is an emergency where I am unable to. I do understand the mechanism of action for most of the OTC drugs (or as much as is known of them), and I am much more reluctant to administer OTC drugs to myself than most people are. For example, I would not take a Benadryl unless I was having a serious allergic reaction, because of the known risks of anticholinergics. I have a decades of training and scientific research experience in studying and modeling the biological mechanisms of drugs, and have patented drugs that are in clinical trial.

   The following quote sums up my opinion of medical protocols better than I can:

   "Knowledge isn’t a commodity, especially not a fungible commodity, as the medical business sees it. Consciousness and culture are part of the life process. It is exactly the commoditization of medical knowledge that makes it dangerous, and generally stupid. Doctors buy their knowledge, and then resell it over and over; it’s valuable as a commodity, so its value has to be protected by the equivalent of a copyright, the system of laws establishing the profession. Without its special status, its worthlessness would be quickly demonstrated. When A.C. Guyton wrote his textbook of medical physiology (the most widely used text in the world) in the 1950s, it was trash; as it was studied and applied by generations of physicians, it was still trash. The most compliant patients who bought their treatment from the most authoritative, Guytonesque, doctors were buying their own disability and death.

   Each time you learn something, your consciousness becomes something different, and the questions you ask will be different; you don’t know what the next appropriate question will be when you haven’t assimilated the earlier answers. Until you see something as the answer to an urgent question, you can’t see that it has any value. The unexpected can’t be a commodity. When people buy professional knowledge they get what they pay for, a commodity in a system that sustains ignorance." -Ray Peat, PhD

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2. aurareturnOct 2024
   I think this is where something like LLMs can help us find the source faster.

   Edit: GPT4o gave this answer when probed for the source:

   The estimate that a human’s blood vessels could stretch to about 100,000 kilometers comes primarily from anatomical studies and scaling measurements of microvascular networks, particularly capillaries, which are vast in number and length. The specific figures are generally derived from a combination of cadaver studies, statistical modeling, and anatomical measurements of blood vessels at various scales in the body.

   One influential source for this estimation includes physiological textbooks and studies such as Gray’s Anatomy and Textbook of Medical Physiology by Guyton and Hall, which both compile data from multiple studies across vascular biology. Additionally, scientific articles on the vascular network, especially those focused on microcirculation research, have informed these cumulative estimates by scaling up the capillary data across average human body sizes.

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3. UniverseHackerJan 2023
   They're not becoming stupider, the culture of following protocols rather than understanding is a pre-scientific one. It certainly has benefits- predictable consistency, limited liability for doctors. Unfortunately, Dr. House style deep thinking in widely available medicine is legally impossible, and only a tiny percentage of the population is able to think that way.

   I think this quote really sums up this issue, and it's history:

   Knowledge isn’t a commodity, especially not a fungible commodity, as the medical business sees it. Consciousness and culture are part of the life process. It is exactly the commoditization of medical knowledge that makes it dangerous, and generally stupid. Doctors buy their knowledge, and then resell it over and over; it’s valuable as a commodity, so its value has to be protected by the equivalent of a copyright, the system of laws establishing the profession. Without its special status, its worthlessness would be quickly demonstrated. When A.C. Guyton wrote his textbook of medical physiology (the most widely used text in the world) in the 1950s, it was trash; as it was studied and applied by generations of physicians, it was still trash. The most compliant patients who bought their treatment from the most authoritative, Guytonesque, doctors were buying their own disability and death.

   Each time you learn something, your consciousness becomes something different, and the questions you ask will be different; you don’t know what the next appropriate question will be when you haven’t assimilated the earlier answers. Until you see something as the answer to an urgent question, you can’t see that it has any value. The unexpected can’t be a commodity. When people buy professional knowledge they get what they pay for, a commodity in a system that sustains ignorance.

   -Ray Peat [1]

   [1] https://raypeatinsight.wordpress.com/2013/06/06/raypeat-inte...

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4. nawitusApr 2013
   Alcor FAQ states this:

       “We know that secondary memory does not depend on continued activity of the nervous system, because the brain can be totally inactivated by cooling, by general anesthesia, by hypoxia, by ischemia, or by any method, and yet secondary memories that have been previously stored are still retained when the brain becomes active once again. Therefore, secondary memory must result from some actual alterations of the synapses, either physical or chemical.” — Textbook of Medical Physiology by Arthur C. Guyton (W.B. Saunders Company, Philadelphia, 1986), page 658.
   
       “Procedural and declarative memories differ dramatically. They use a different logic (unconscious vs. conscious recall) and they are stored in different areas of the brain. Nevertheless, these two disparate memory processes share several molecular steps and an overall molecular logic. Both are created in at least two stages: one that does not require the synthesis of new proteins and one that does. In both, short-term memory involves covalent modification of preexisting proteins and changes in the strength of preexisting synaptic connections, whereas long-term memory requires the synthesis of new proteins and the growth of new connections. Moreover, both forms of memory use PKA, mitogen-activated protein kinase (MAPK), CREB-1, and CREB-2 signaling pathways to convert short-term to long-term memory. Finally, both forms appear to use morphological changes at synapses to stabilize long-term memory.” — “Synapses and Memory Storage” by Mayford M, Siegelbaum SA, and Kandel ER. Cold Spring Harbor Perspectives in Biology, April 10, 2012, page 10.

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