CipherThrowaway

It's easy to say "document what you can" when you leave "document", "what", and "can" loosely undefined. The article gives us a why and then leaves out the who, what, when, where and how.

If you observe people in their daily work, you will see there are many reasons why people do not document things. Time constraints, incentive structures, liability, general trade-offs and ambiguities. This is true not just in software/engineering but in any line of professional work.

There's plenty of grandstanding about the importance of documentation, but not much interest in understanding why people don't document in the first place.

So where is the "case for documentation"? The author provides no vision and no actionable recommendations. Documentation is not even mentioned until the end of the article.

Anyone can pat themselves on the back for pointing to the worlds problems and saying "this could be better!"

If you had to give a percent figure, what do you believe your mother's chances were of discovering a radical curative treatment for SCC and curing her own cancer?

I notice you've watered down your terminology from "cure" to "improvement on clinical best practice" which are pretty different things in the context of cancer treatment. However, I can respect the switch and I'll treat it as a sign you're starting to treat the subject a bit more seriously. It's more accurate to the outcome in the case study, too, since treatment was locoregional and neoadjuvant only. Full remission was only achieved with the traditional interventions of surgery and adjuvant targeted therapy.

> You're in the awkward position of arguing that an expert in a field doesn't understand what she is doing while citing evidence to support yourself that you (by construction) don't have.

No. I'm in the non-awkward position of arguing that non-experts should be careful about interpreting a single case study without context. Especially in a way that implies miracle cancer cures are sitting around in labs with no one paying any attention to them.

I don't think the average HN reader understands just how many wildly different treatments, drugs and therapies are being thrown at different cancers and how quickly medical oncology moves as a field. Cancers are an extremely complex family of diseases. Early results and case studies are correspondingly extremely difficult to interpret due to the variation in individual responses and disease course.

The existence of a "miracle" cancer treatment is almost ruled out from first principles. But if such a miracle treatment is sitting around in a lab, it would be non-trivial to tell it apart from the thousands of other promising candidate therapies that go on to pan out to nothing.

Exhausting all treatment options is not the same as having nothing to close.

There's no shortage of cancer patients at end-of-life stage undergoing aggressive treatments and/or experimental therapies in clinical trials for minimal to no survival benefit. For almost all of these patients, the best option for them and their loved ones will end up having been a palliative or best supportive care model.

> This virologist did believe that her colleagues were sitting around not rolling out something that would cure her.

And because her outcome was so unexpected and unusual it got published as a case study. What you don't see are all the cases where the experimental miracle cure treatment did not work. What you also won't see in headlines are all the trials where putative miracle cures and other promising treatments failed to demonstrate survival benefits in larger cohorts than 1.

One of the counterintuitive things about cancer is how badly individual cases and responses to treatment generalize to the broader patient population. If you didn't know any better, you could easily read a story like this and think "wow, this breast cancer cure was just stuck in a lab somewhere!" But to put a story like this into context, you need to understand just how many individual miracle remission stories there are, and how varied individual cancers and responses to treatment are.

There are potential miracle cures almost everywhere, and a large number of them are being aggressively researched, tested on cancer patients at any given time - often as part of combination therapies. Some of these promising technologies do become breakthrough cancer treatments that create durable remissions, such as checkpoint inhibitors. The rest fizzle out.

The development of PD-L1 expression was also interesting.

What doesn't make its way into case studies and HN headlines is all the stories of people who did get access to uncertain treatments and died anyway. Sometimes faster than they would have without the experimental treatment at all.

This isn't a case study about a breast cancer cure. This is a story about a single individual's cancer's response to an experimental treatment. For comparison, there are case studies of spontaneous remission in refractory cancers triggered by seasonal flu.

Virologists aren't sitting around waiting to develop cancer before they decide to roll out the miracle cancer cures. Oncolytic viruses have been researched, studied and tested on cancer patients for almost a century now.

This is a big simplification.

1. The interaction between oncolytic virotherapy and host immunity is complex. Consider that oncolytic viruses are also targeted by the immune system.

2. Oncolytic viruses that directly destroy cancer cells may not depend on a host immune response at all for therapeutic effectiveness.

3. There are many common chemotherapy agents that enhance anti-tumor immunity. For example, 5FU is understood to enhance anti-tumor response and activate the p53 pathway.

4. Immunosuppressive chemotherapies can still enhance anti-tumor immunity by changing the tumor microenvironment. This is one of the principles behind combined chemo-immunotherapy regimes in treatment of solid tumors.

5. Some immune cells promote tumor growth and suppress anti-tumor immunity. Tumor associated myeloid cells are one example of an immune cell suppressed by chemotherapy that promote tumor survival.

This is just scratching the surface of some of the complexities here. In general, cancer and cancer treatment are incredibly complex with massive variation not just between types of cancer but within individual cancers themselves. Oncology does not lend itself to simplistic thinking.

> He's not wrong though.

It's more of a "not even wrong" statement. It's the kind of useless and reductive analysis poor leaders trot out from a position of personal frustration after failing to surmount the challenges involved in steering a complex, messy, human institution towards success.

It's incredible how consistently this maladaptive "everyone just work harder!!" mentality crops up among failed leadership in institutions of all kinds and sizes. In this respect, Schmidt is no different to the average frustrated restaurant owner, blaming his business failures on his staff's work ethic, "no one wants to work hard these days" and other copes.

Let's say we go ahead and assume that long grinds and 100% in-office attendance is the only way a successful and highly engaged team can look. Getting to that point would still require leadership to perform the actual hard work of creating the right conditions and incentives for that successful, engaged work to emerge. Shaking your fists at the air and saying "work harder people! we need to win!" doesn't cut it.

If Schmidt allowed himself to look more closely and reflect more deeply, he would realize that Google is and was full of extremely hard workers. But their "hard work" more likely took the form of navigating Google's political structures and chasing up internal promotions and prestige.

Moonshot or no, these incremental improvements in surgery do translate into cured patients and saved lives. Surgery is the initial intervention in many cancers and the course of disease is highly sensitive to it.

Dietary advice is one thing. Woo peddling and fringe medicine is another. The original question didn't even ask about rheumatoid arthritis.

I'm not overreacting. There are many people who will read my comment and know exactly what I'm talking about. This is simply a "you get it or you don't" situation where you're currently on the "doesn't get it" side.

I know this is well-intentioned, but please keep this stuff out of health threads about serious health conditions. This kind of material lacks rigor, dramatically misrepresents the state of scientific and medical thought, cherry picks studies, overstates the effect sizes and passes off speculation and easily digestible explanations (for laypeople) as emerging medical truths.

Long-term sufferers of RA - and the people in their support networks - know first-hand that RA is a complex and progressive condition that requires some pretty hardcore medical interventions to manage. Like other auto-immune diseases, different people will experience different disease courses. A very small few will be lucky enough that their disease goes into remission for no clear reason. Others will try everything under the sun only to see their disease become worse and worse. The reality for sufferers is that there aren't quick fixes and simple triggers.

It's reasonable to expect that general lifestyle interventions such as healthier diet and the right type of exercise regime may improve symptoms within the margins permitted by the underlying disease process. But promoting content that centers the role of "lifestyle" once RA has already developed only trivializes the disease and widens the empathy gap that sufferers already face.

"AI assistants are bad" isn't the take. The thing making people feel icky/uncomfortable about Her - and about the 4o demos - is not the idea of Samantha but the idea of Theodore. It's about nerds' idealized AI versions of womanhood. Tirelessly flirty, giggly servants who they can interrupt and talk over as they please, that come without the inconvenient features of personhood.

This is the thing that is so wild to me. Outside of tech, everyone I encounter in day-to-day life intuitively understands that tech dudes inventing AI voices to flirt with them is not awesome or cool.

At this point, I have to assume that being out-of-touch is deliberate branding from OpenAI. Maybe to appeal to equally out-of-touch investors.