Ask HN: Do you meditate and which system do you follow? - <AUTHOR> <comment><USER2> Yes. I meditate for 10-15 minutes daily after waking up in the morning. I use mindful meditation -- where I just observe my breath and if my thoughts starts wandering I just say "that's nice, but not right now" and let it go and focus back into my breathing. (Wrote a simple guide in my blog here, sorry for the plug: [http://www.enlight8.com/guide-to-mindful- meditation/](http://www.enlight8.com/guide-to-mindful-meditation/)). Sometimes I also just use a phrase like "I am" repeated over and over again so my mind won't wander, but it's really a practice to observing/focusing consciousness.

For learning meditation, using apps are great. Headspace is a great app that I highly recommend. Calm is also good (already mentioned).

</comment><comment><USER3> Does meditating on biblical truths count? I can't claim to do it day and night, but I did make a practice of regularly recalling biblical truths and reviewing scripture I have memorized when applicable to the situations I face throughout the day, especially with my kids. Very different from Eastern meditation.

"How blessed is the man who does not walk in the counsel of the wicked, Nor stand in the path of sinners, Nor sit in the seat of scoffers! But his delight is in the law of the LORD, And in His law he meditates day and night." Psalm 1:1-2

Great resources here: [http://www.desiringgod.org/messages/meditate-on-the- word-of-...](http://www.desiringgod.org/messages/meditate-on-the-word-of-the- lord-day-and-night)

</comment><comment><USER4> I don't meditate traditionally, but I think that motorcycle riding has a meditative effect; it draws my mind squarely into the present moment, giving me something intense enough to focus on that the noise around the edges of my brain just has to shut up for a while. It's a whole-body experience, too, especially when the road has some twists in it. I feel like I function better as a human being, generally, when I am using a motorcycle as my normal form of transportation.

Downhill skiing, bouldering, and sea kayaking are other activities which have offered enough of a rush to draw my enthusiastic participation, but which, once I'm in them, have tended to produce a calm, clear, present-focused mental state. I suppose that adrenaline functions as a pretty powerful "BE HERE NOW" signal.

Also, I've had experiences which felt like meditation in conjunction with psychedelics. At a campout last spring I remember spending most of an hour giggling to myself as I attempted to clear my mind of all words... I was just sitting there looking at the moon, "shoosh"ing my brain whenever words popped up, trying to just be in the moment, and see what "wordless thoughts" might feel like.

<comment><USER5> What you described above with motorcycle riding, skiing, bouldering, etc are known as "peak experiences" and associated with "flow". There's been a lot of study going into the benefits of these things which is pretty neat.

[https://en.wikipedia.org/wiki/Peak_experience](https://en.wikipedia.org/wiki/Peak_experience)

[https://en.wikipedia.org/wiki/Flow_(psychology)](https://en.wikipedia.org/wiki/Flow_\(psychology\))

</comment></comment><comment><USER6> Vipassana, which is a Theravada Buddhist tradition, via a 10-day intensive retreat. It's a remarkable practice for it's minimalism: there is no chanting, mantra, no imagination or visualization, no controlled breathing, etc. You are asked to observe the body and the breath "as it is". In so doing, you will experience various discomforts, which you learn to use to defeat the enemy of aversion, and pleasures, with which you learn to defeat the enemy of craving.

They ask students to practice 2 hours per day. I rarely do two hours, but find one hour in the evening to work. I also still drink alcohol on occasion, which means I will never qualify for the 20-day retreat. C'est la vie.

Check it out at [http://dhamma.org](http://dhamma.org)

<comment><USER7> In India everything has been commercialized perhaps except Vipassana at Dhamma. They now have centers all across the world. Being born and brought up in India, the land of yoga, meditation etc. , I have seen so much commercialization around that I never rely on the "gurus". Vipassana was a breath of fresh air. I went for a 10 days course. They are not about cult formation, conversion etc. This was perhaps the purest form of meditation teaching I saw. All the fooding and lodging was taken care by the Dhamma team and never for once did they even hinted us to offer money.

If you ever want to learn meditation, apply for a Vipassna retreat, take 10 days out of your schedule and see the difference. You can upvote me later.

<comment><USER6> Nice to see another Vipassana person around HN. I took my first course in 2002 in North Fork, CA, and have taken roughly one per year every since.

</comment></comment></comment><comment><USER8> Yes, a friend who has taken courses on meditation and put me on to this short book:

[https://www.amazon.com/Deep-Meditation-Pathway-Personal- Free...](https://www.amazon.com/Deep-Meditation-Pathway-Personal- Freedom/dp/097646554X)

I wake early to meditate for 20 minutes before I do anything else. The book describes the technique where you concentrate on a mantra, in this case 'I AM'. If your mind start on thoughts, you gently come back to the mantra but never fighting the thoughts.

The book is pretty short and is a good read for someone taking up meditation (I've never done it before and I found it to be a good primer).

Together with this meditation in the morning, I exercise immediately after. Been doing it for a few months now and I have found that my days get off to a really positive start. I have more energy and less likely to be easily agitated.

</comment><comment> wu-ikkyu There are various things I do which I consider to be forms of meditation:

-sitting down in a shower with the lights off

-going for a walk in the forest with no cell phone

-laying in a hammock by a river

-long distance running while focusing on my breathing and form

-rock climbing

Basically anything that enables me to cease compulsive thinking/worrying patterns and focus on the here and now

</comment><comment><USER9> I use an app called 'Calm'. It focuses on mindful breathing through 10-15 minute guided sessions. I have been using it daily for just over 3 weeks and have already noticed some differences in my ability to discern thought patterns that are not useful, and am often able to bring my mind back to the present. Not all the time - meditation isn't a fix-all for stress. But it has helped me thus far.

<comment><USER10> +1 for Calm

I am a very pragmatic meditator. I meditate around once a week whenever I feel stress building up. As someone with little technique, and little desire to wade through mostly esoteric resources, Calm manages to guide me through a very relaxing meditation.

Okay, I am not that crazy of a fanboy as that reads. I realize that its not THAT revolutionary, and it might be a bit expensive if you use it that little, but hey, it works for me.

</comment></comment><comment><USER11> My formal sitting (and walking) meditation practice is mostly _Shamatha- Vipassana_ oriented, including _Metta_ meditation.

I'll be happy to answer any specific questions that you may have about those practices.

<comment><USER12> Just saw this:

Long-term meditation fights age-related cognitive decline:

[http://www.memory-key.com/research/news/long-term- meditation...](http://www.memory-key.com/research/news/long-term-meditation- fights-age-related-cognitive-decline)

via this article:

Anapanasati:

[https://en.wikipedia.org/wiki/Anapanasati](https://en.wikipedia.org/wiki/Anapanasati)

[https://en.wikipedia.org/wiki/Anapanasati#cite_note-16](https://en.wikipedia.org/wiki/Anapanasati#cite_note-16)

Interesting.

</comment></comment><comment><USER13> I like to go back to the roots. The original Patanjali Yoga. Yama, Niyama, Asana, Pranayama, Pratyahara, Dhyana, Dharana, Samadhi. It has been a life long practice, but has worked quite well for me.

If you know Hindi the Patanjal Yoga Pradeep is the quintessential treatise on the subject, including a systematic reconciliation of the six systems of Indian Philosophy.

I've been studying the Pratyahara phase of yoga lately. The withdrawal of the senses inward away from external sensory stimuli. It is quite powerful, and opens you up to the ability to quite literally witness the formation of thoughts from subtle nothingness.

<comment><USER14> > opens you up to the ability to quite literally witness the formation of > thoughts from subtle nothingness.

I may not have been sufficiently charitable in reading this, but this appears to be either butchering the English language, or utter tripe.

<comment><USER15> Elaborate. Often ideas you are not ready for will seem like nonsense.

</comment></comment></comment><comment><USER16> I try and practice meditation in the vein of stoics like Seneca and Marcus Aurelius.

If I find myself distracted by a personal situation, I try and dissect it according to what values I hold dear, and how my current and past actions have done to further or detract from those values. This can involve some journaling or talking to myself, so I tend to save it for showers, late nights working, or long drives.

That being said I'm pretty amateur at this kind of stuff, but even the very basic level at which I practice some form of meditation really helps clear my head in the fast-paced and sometimes petty world of tech.

</comment><comment><USER17> I actually have some questions about this subject, as I'm still figuring out where/how to start with it. I think I'm beginning to grasp the varied benefits of actually making the effort so (finally) have some motivation to work with, but I've kind of drowned in the SnR of poor-quality information out there.

My interest in meditation is somewhat indirect; IIUC, it's an apparently- necessary stepping-stone to energy perception/study/work, becoming aware of the process of falling asleep, and trance states, three subjects I've been extremely interested in for some time, but which (like meditation) I have no idea where to start with. My attempts to figure and figure them out intuitively haven't really gone anywhere concrete either (...yet).

If anyone has any pointers on studying meditation to the above ends (and particularly if you have any ideas/advice about the things I've mentioned!) I'd love to hear whatever you have to say (email is cool, but I might take a while to respond).

I've actually wanted to ask this on HN for a little while now, but a thread for such topics would... well I don't think it'd be squarely kicked out, but it likely wouldn't be voted up too high.

</comment><comment><USER18> I am a Karate practitioner of an Okinawan traditional system and our main focus of study is kata, or form work. Once you have learned and become very familiar with the form where you don't have to think about the biomechanics, it can be a moving meditation with the same benefits.

In the monasteries and temples of China and India, where Karate can be traced back to, martial arts were practiced not only for self-defense but for therapeutic benefits as well.

If you have trouble sitting still, sometimes a moving meditation can help. This does not mean you have to go out and study a martial art for 4302842 years. It can be a simple exercise.

Think of a nice 30 minute walk that you enjoy taking and go out and walk. Try to be present and observe your own footsteps. Try to feel the weight shifting from one foot to the other. Notice if the sun is out. Can you feel it on your skin? Does it pick up your energy? Or does it make you tired? What kind of relationship do you have with the sun? Don't just think about it intellectually. Feel it out. Its happening right now (if you're on the walk). Bring yourself back to the shifting of your weight between your two legs.

Meditation is about being present. Its about tuning into yourself, without the filters of your mind. You don't need anything.

Another simple meditation exercise, which also helps to massage the organs with the breath: -Lay flat on your back -Place one hand on your belly and one hand on your chest -Can you make the hand on your belly rise up as you inhale, without making the hand on your chest move up. In other words, you're breathing into your belly and not your chest. This is a more natural, deeper breath. Repeat for ten minutes, or however long. Even after 10 breaths, you might notice a difference.

</comment><comment><USER19> I sit in the dark on a chair maintaining straight back and eyes closed for 20 minutes every morning and try to think about nothing. This is how I imagine meditating. I don't really understand all that other stuff like mindfulness or whatever they call it. My way does have a noticeable positive impact (on me at least) and that's good enough for me.

<comment><USER20> Pretty similar stuff - in "mindfulness" I think it's about focusing on the perception of your senses, how the chair feels behind your back, what sounds you're hearing and while you're doing that, you're not thinking.

<comment><USER21> I also do similar things, though not very often anymore. It's basically intentionally zoning out but I like to think of it as "mindlessness" now to contrast it. Techniques like focusing on body sensation can be part of mindfulness (I don't really do them except sometimes to help get into the mindless state -- I get comfy for my zoning out because I don't even want to be aware of my body if I can help it) but mindfulness is more about actually thinking. One of the times I tried a guided mindfulness session (from their website -- it's very corporate...) they said something like "think of a time you were talking with a friend, spouse, or therapist about an important situation in your life, and when the conversation was over you felt lighter, loved, and cared for." I couldn't think of such a time. Nor even imagine such a sequence of events happening ot me. Similar attempts done by company speakers randomly at all-hands meetings had similar guiding phrases that evoked no emotional memory in me at least. I don't work that way. If it was more general like "recall the feeling of being cared for", sure, I can muster something, but I don't think that's very helpful. Others' mileage may vary.

</comment></comment></comment><comment><USER22> I currently use two apps: Simple Habit and Oak by Kevin Rose. The latter is in public beta and should be generally available in a few weeks. Both apps take different approaches to meditation where Simple Habit is like "Netflix for meditation", Oak is more minimal.

Simple Habit - [https://www.simplehabit.com/](https://www.simplehabit.com/)

Oak - [https://www.facebook.com/groups/1673249232974412/](https://www.facebook.com/groups/1673249232974412/)

</comment><comment><USER23> Meditation is the simplest thing, yet people manage to overcomplicate it. And they need app for that :).

Guided meditation is maybe useful first time. They are distracting and they are disruptive for genuine meditation. I know some people like them.

I don't follow any systems, I like to use binaural waves, often created by myself, and just relax. Mind sometimes runs and it is OK to let it run for a while, then calm it down. Focus on body parts and progressively relax them for longer meditation.

While no sound is required, some background soundscape is good to insulate you from environment.

Sometimes my meditation is focused on emptying the mind, sometimes I enjoy thinking in deep states of relaxation about different things. Both work well. Once you are practiced enough, you can go to deep states without falling asleep. Even if you do, it is not a big deal.

</comment><comment><USER24> The 2 types of meditation that I practice I are mindfulness and concentration. Mindfulness practice has enabled me to become aware of the arising of unskillful compulsions, the habitual patterns of thought which give rise to them and to halt their progress. Concentration practice, on the other hand, builds the muscle of attention so that it becomes easier to stay focused and fully absorbed on whatever target you select. I have found that the combination of the 2 has enabled me rewire less skillful habitual patterns of thought and to replace them with more skillful patterns. I have found the instruction of Gil Fronsdal at the Insight Meditation Center in Redwood City to be the most valuable.

</comment><comment><AUTHOR> Thank you for your answers. I practice a heart based meditation [http://en- us.heartfulness.org](http://en-us.heartfulness.org) Wish you the best in your individual practices.

</comment><comment><USER25> Transcendental Meditation (TM) Maharishi, an advocate of Transcendental Meditation defines the purpose, "The goal of Transcendental Meditation is the state of enlightenment. This means we experience that inner calmness, that quiet state of least excitation, even when we are dynamically busy." In this Hindu tradition you sit in Lotus, internally chant a mantra, and focus on rising above the negativity.

However, to effectively learn how to practice this form of meditation, expert guidance is recommended. There is internet resources, classes, or even meditation retreats to better learn this form of meditation.

<comment><USER26> TM is a pretty terrible organization.

They used to officially believe all sorts of crazy things, like that their meditation could make you fly, or make you invisible, or that if the square root of 1% of a city meditated, then it would dramatically lower violent crime.

They charge huge amounts of money for very little value - a course to learn TM is something like $500, even though the whole technique could be described in 30 seconds.

They claim that you get a unique mantra based on your personality, and that the mantra is a powerful magical vibration energy word (or some such junk). In actuality, the mantra is chosen based on only your age (and sometimes gender).

The TM centers also sell snake oil - they have tons of teas, powders, supplements, etc, for cleansing your toxic energy.

Of course they have studies done by practitioners of TM that claim it is amazing, but there aren't really any unbiased studies about it.

The current leader of the movement, a former physicist, received the Ignobel Prize (like the Nobel prize but for stupidity) for his beliefs in the crazy parts of TM.

All of that being said, as a technique, it's not bad for meditation. It's just run by a shady organization that believes in magic and will charge you tons of money.

</comment></comment><comment><USER27> I use this app called Insight Timer on iOS. I use Bose noise cancelling headphones when I meditate as it helps cut any surrounding noise. I started with the free tunes that Insight Timer provided and meditated for 5 minutes in the morning. I have slowly increased it to about 15 minutes and purchased some of the other tunes via in app purchase on the app. Daily meditation definitely helps stay calm the rest of the day. I also use the same app after I get back home from work and use a different tune and it helps unwind.

</comment><comment><USER28> Yup, Zen Buddhist-style, breath awareness/pranayama, qi gong, and taiji.

(I also do a few of the things wi-ikkyu mentions, but I differentiate them from meditation, but acknowledge some of the similarities.)

</comment><comment><USER29> Yes, I'm using Headspace. I've been following it for just over a year. I either spend 15 mins at the start of my day or just after the daily standup which finishes at 11am my time.

</comment><comment><USER30> This is what I practice: [https://obcon.org/dharma/buddhism/the-eightfold- path/#8](https://obcon.org/dharma/buddhism/the-eightfold-path/#8).

> The form of meditation practiced in our Order is that of the Soto Zen > tradition. It is called "serene reflection meditation", which is a > translation of the Japanese terms "zazen" and "shikan-taza".

</comment><comment><USER31> Every morning for 20 minutes starting about 18 months ago, it's been very useful. I started with "The Mindful Geek" [https://www.amazon.com.au/Mindful- Geek-Mindfulness-Meditatio...](https://www.amazon.com.au/Mindful-Geek- Mindfulness-Meditation-Skeptics-ebook/dp/B0155FWYBW) and found it useful and secular.

</comment><comment><USER32> Maha Mantra Yoga...sound vibrarion is the current sync-practice for this time, Kali yuga. If you want to listen to the news you tune in to a radio signal. Similarly any Name of God repeated and concentrated listening upon such vibration is bhakti yoga. The practice is the goal since Absoluteness is simultaenously one and different. Vedic knowledge is our origins.

</comment><comment><USER33> I experimented with a few systems - headspace, calm, some mantra repeating similar to TM.

What works for me is just to sit there at my computer seat, eyes closed, with jazz playing on my headphones. Breathe in, breathe out. I do it for at least half an hour before starting work.

When you get down to it, mediation is just about forcing your mind to run in subconscious, maintenance mode.

<comment><USER34>
      jazz playing on my headphones

Check out Bob James / Earl Klugh "One on One" and the original Pat Metheny Group album if you haven't already; they are ideal for this.

</comment></comment><comment><USER35> Yes, meditation is vital and a regular practice can bring serenity to your life, and the lives of those around you.

Many people have different systems and different ideas as to what constitutes meditation, but it is essentially investigation into the nature of being, or the nature of mind, or the nature of Reality. In close, attentive and relaxed examination, one's mind+body complex is gradually becoming more attuned to better information about the quality of direct experience.

When I first got into practicing, I started reading voraciously every book on Buddhism I could find. Still, one of my favorite resources is accesstoinsight.org/ which has a compiled index of all the preserved discourses of the Buddha (in English and other languages).

Nowadays, you may find Zazen strong and attractive, it is also a field of poetry / reflection / study / meditation / lifestyle that simplifies everything down to "Proper Meditation Posture = Enlightenment" which, with the older I get and the more experienced I become, seems more and more true (!) If you'd like a book recommendation, I highly praise "Zen Mind, Beginner's Mind" by Suzuki Roshi.

In a nutshell, there's calm-abiding meditation, which is almost as if one is training engagement-at-will of their parasympathetic nervous system; and then there's insight-meditation, which comes about spontaneously and happens more frequently the stronger one's study and contemplation is/are.

The mission is not "to create a new system in the imagination to grasp onto" \-- samadhi and the cultivation of wisdom is about de-patterning or un- patterning. So, the perfect "system" or morsel of contemplation unravels all on its own. Keep that in mind.

You may wonder what about Buddha's teaching really attracts me, and it is because Buddha taught causality (cause, condition, effect) and he relayed how experiences blossom and bloom in relation to our actions/deeds and intentions. There is no other tradition in the world that stresses so heavily causality and its undeniability. That appeals to me greatly, as there is no God to pray to or any sort of external force that must be appealed to. Although there are elements of that in many of the developed and culturally affluent adaptations, it is not something one needs to practice or progress.

Meditation becomes easier as one's attitude becomes more positive and relaxed, and this happens as one's motivation aligns itself with being of benefit to others. Our peak potential nature is purely altruistic. It is taught that the highest motivation is to be of benefit to all infinite sentient beings [including oneself], and cultivating that mentality over a long period of time with strong resolve and dedication is like a fast-path to freedom.

So you ask about Meditation, but really that question has many facets: your life and the actions you take must bend toward virtue, so that your resting mind will have the assurance that the rest is earned. It's really fascinating: the more good you do for others in the world, the easier your meditation will be, and the easier and more relaxed you are about your daily life, the happier the people around you are, and stronger and stronger we go.

So yeah, meditation is instantaneous investigation into this moment of reality and all its constituent sensory modalities, and it is also a way of abiding by uncovering more of what's already present beyond our ordinary attention.

Striving to bloom beyond the limits of conceptualization, rest in this very nodule of being.

By far the most profound practices in my life have been the practices of the Four Immeasurable States or Four Divine Abodes (The Brahma-Viharas) where actively, through repetition of phrases and skillful recollections, one cultivates Compassion, Lovingkindness, Empathic/Sympathetic Joy, and Equality/Equanimity. The fundamental notion being that these fields of awesomeness are naturally-existent potentials in everyone and can be activated, cultivated and deepened through practice and conscious effort (karuna, metta, mudita, upekkha are the sanskrit names of these 4 qualities respectively).

Be strong and loving and joyful, and may all incline toward Virtue! To meditate frequently with just a little bit of philosophy is much better than lots of study with no practice.

<comment><USER36> I was taken aback by how incredibly naive/amateurish most of the answers so far are, but I'd rather upvote and try to highlight this post instead which is excellent and very insightful.

An extra piece of advice for anyone serious about learning meditation:

1\. You'll need a teacher. Find your local Buddhist centre and chances are they'll have classes focused on teaching beginners. You simply won't learn by making something up yourself and calling it meditation, or reading stuff on the internet (including my answer) - you'll need both guidance and someone to look up to. I can't stress this enough: even the Buddha himself had teachers :)

2\. "Meditation" as a _technique_ is obviously found in countless religions and other secular systems, so that some people claim you can learn "mindfulness" as a stand-alone tool, without the Buddhist package that usually comes with it.

Although it might be possible to a certain extent, the understanding you'll have of the practice will be immensely impoverished. You don't have to _become_ a Buddhist to practice meditation, but without _some_ Buddhist context you'll limit yourself to an extremely diluted, dumbed-down version of the real thing. So I'd recommend you start there, and in time you'll carve your own path.

Best of luck, it's an incredible journey.

</comment></comment><comment><USER37> I've been using Autogenics to help with my really bad insomnia. I guess it is a form of mediation and it really works. I am surprised at how well and how quickly it helped.

[http://www.guidetopsychology.com/autogen.htm](http://www.guidetopsychology.com/autogen.htm)

</comment><comment><USER38> Yes, and I cannot recommend it enough. I follow the Theravada/Thai Forest tradition and practice several meditation techniques from it such as mindfulness of breathing (anapanasati), loving kindness meditation (metta), and death contemplation (asubha).

</comment><comment><USER39> 30 minutes a day, anapana sati

[http://www.accesstoinsight.org/lib/authors/ariyadhamma/bl115...](http://www.accesstoinsight.org/lib/authors/ariyadhamma/bl115.html)

</comment><comment><USER40> these UCLA online classes were fun and effective for me: [https://ccle.ucla.edu/course/index.php?categoryid=16](https://ccle.ucla.edu/course/index.php?categoryid=16)

</comment><comment><USER41> I've heard a lot about Transcendental Meditation but it makes my spidey senses tingle because it feels cult-ish.

At $500-$1,000 it also seems very expensive

[https://www.tm.org/](https://www.tm.org/)

<comment><USER26> Copy and pasting my earlier comment about TM - TLDR for it is that the org is terrible but the technique is not bad (it's pretty generic: sit comfortably, repeat your given mantra, allow other outside thoughts to rise up and pass through you. Don't fight them, just think them and then go back to your mantra. Repeat for 15-20 minutes twice a day).

TM is a pretty terrible organization.

They used to officially believe all sorts of crazy things, like that their meditation could make you fly, or make you invisible, or that if the square root of 1% of a city meditated, then it would dramatically lower violent crime.

They charge huge amounts of money for very little value - a course to learn TM is something like $500, even though the whole technique could be described in 30 seconds.

They claim that you get a unique mantra based on your personality, and that the mantra is a powerful magical vibration energy word (or some such junk). In actuality, the mantra is chosen based on only your age (and sometimes gender).

The TM centers also sell snake oil - they have tons of teas, powders, supplements, etc, for cleansing your toxic energy.

Of course they have studies done by practitioners of TM that claim it is amazing, but there aren't really any unbiased studies about it.

The current leader of the movement, a former physicist, received the Ignobel Prize (like the Nobel prize but for stupidity) for his beliefs in the crazy parts of TM.

All of that being said, as a technique, it's not bad for meditation. It's just run by a shady organization that believes in magic and will charge you tons of money.

</comment></comment><comment><USER42> I took the happiness course from Art of Living to learn Sudarshan Kriya. I don't have a regular practice, but when I'm feeling stressed I'll usually do it twice a day. When I wake up and before I fall asleep.

<comment><USER43> +1 Sudarshan Kriya is awesome I tried different methods, read books, but couldn't meditate until I did that. Been doing it for almost 20 years

</comment></comment><comment><USER44> I have been using the brain.fm app for over a year now. Has medication, focus and nap/sleep modules.

</comment><comment><USER45> Headspace. Just hit my second 30-day run. Easy, life-changing.

</comment><comment><USER46> I use the Headspace app, it's awesome

</comment><comment><USER47> Transcendental meditation

<comment><USER26> See my above comment - please don't pay them $1000 to learn this technique.

</comment></comment><comment><USER48> No.</comment>


Real-time dynamics of CRISPR visualized by high-speed atomic force microscopy - <AUTHOR> https://www.nature.com/articles/s41467-017-01466-8 <comment><AUTHOR> Here's a quick peek at the visualization tweeted by one of the authors:

[https://twitter.com/hnisimasu/status/928933260159197184](https://twitter.com/hnisimasu/status/928933260159197184)

And an article in The Atlantic that some may find more approachable than the original Nature Communications publication:

[https://www.theatlantic.com/science/archive/2017/11/crispr-v...](https://www.theatlantic.com/science/archive/2017/11/crispr- video-real-time/545603/)

<comment><USER3> There was also this in The Atlantic that overviews a different - <USER2> somewhat conflicting? - theory on genetics

[https://www.theatlantic.com/science/archive/2017/06/its- like...](https://www.theatlantic.com/science/archive/2017/06/its-like-all- connected-man/530532/)

</comment></comment><comment><USER4> Pretty cool visualization. Single molecule work like that is challenging to do properly - but when done properly gives a kind of visual proof to a hypothesis that is hard to controvert. Wild-type Cas9 cuts genomic DNA, and when it does, the strand can go flying - with repair a possibility rather than an inevitability.

Cas9 (and similar proteins) have 2 basic functions:

1) to bind to specific DNA (by means of complementing a specifically-bound RNA)

2) to cut the DNA that is has bound.

Only one of these functions is actually desirable or unique to Cas9 - that of binding to a sequence-specific part of DNA. The 'cutting' function is how the CRISPR system naturally destroys foreign DNA in Cas9's normal environment, but is generally not desirable in these synthetic biology or therapeutic applications. For genetic engineering purposes we really have better tools than Cas9 to cut, modify, or otherwise affect DNA - but Cas9 is clearly a fantastic tool to _localize_ to particular sequences. That this paper so clearly demonstrates the terrifying damage that cleavage can do to genomic DNA only reinforces that Cas9 is a useful scaffold upon which to engineer further tools, but in its wild-type form is kind of scary.

Recent papers from the Liu lab at Harvard [1] (among many others) show how you can edit DNA using a modified Cas9 that has been modified to _not_ have that second cutting function, while retaining the ability to bind to a specific DNA sequence. The synthetic "BaseEditor" protein has been further modified to have more complicated DNA _modification_ capabilities, rather than whole-sale slicing of DNA [2]. Though this designed protein with Cas9 at its core is complicated, it should not cleave and let dangle genomic DNA as we see it here visualized. I'd be curious to see how the BaseEditors behave under a similar visualization.

[1] Kim et al. 2017: [https://www.nature.com/articles/nbt.3803](https://www.nature.com/articles/nbt.3803)

[2] BaseEditor v4: [https://serotiny.bio/notes/proteins/sabe4gam/](https://serotiny.bio/notes/proteins/sabe4gam/)

<comment><USER5> >"Wild-type Cas9 cuts genomic DNA, and when it does, the strand can go flying - with repair a possibility rather than an inevitability."

"Possibility" is too strong a term. Afaict, the best you can say about repair is that it is a "less than common occurrence," and even that may be too much.

>"Recent papers from the Liu lab at Harvard [1] (among many others) show how you can edit DNA using a modified Cas9 that has been modified to not have that second cutting function, while retaining the ability to bind to a specific DNA sequence."

Sorry but I could not find any comment/data about toxicity in this paper. This is basic info everyone wants to know: What percent of cells exposed to this stuff die? Maybe I missed it?

<comment><USER4> I understand your hypothesis that Cas9 only kills the cells that do not have the particular mutation and itself is a negative selection against the undesired genetic sequence. I do not believe the basic numbers and statistics of the rate of toxicity, size of genome, precision of mutation, etc. work out to permit that hypothesis, but it is a curious thought. As a hypothesis it is straightforward to test with a FACS-sorted population of cells expressing a fluorescent Cas9: does the fluorescent population die, or does the fluorescent population survive and contain the expected genetic mutation.

That experiment has been done and is actually written up here as a protocol to more effectively using Cas9. The paper clearly refutes the above hypothesis and demonstrates that modifications by Cas9 are generally proportional to the amount of expressed Cas9 up to the point of toxicity [1]. In it they tag Cas9 with a fluorophore, express the construct in cells and sort for those cells that express Cas9 (separating them from cells that do not), and binning the cells based on the level of Cas9 expression. Given your hypothesis, those fluorescent cells should die and not have the desired mutations, while the non-fluorescent cells will be enriched for particular mutations not found in the fluorescent cells. Some toxicity is shown at very high levels of Cas9 expression, but the on-target edits occur in cells expressing Cas9, and those cells live for a number of passages. See Figure 3 in the paper below:

> Cell population 1 displays GFP fluorescence intensities similar to those of > nontransfected cells (autofluorescence level), whereas populations 2–6 > display specific GFP levels ranging from low to high (varying ~500-fold). > (e) 20,000 cells were isolated from each of populations 1–6 in (d) and > cultured for 6 d, after which IDAA was used to determine indels at the KRAS > locus in an aliquot of the cells. Note that editing levels increase with > increasing GFP fluorescence level at the time of FACS and that almost > complete editing was obtained at submaximal fluorescence levels... [T]he > total number of live cells in each population analyzed in (e) was determined > by trypan blue exclusion and expressed as % of population 1.

[1] [https://www.nature.com/articles/nprot.2016.165](https://www.nature.com/articles/nprot.2016.165)

Given the above result, a _significant_ amount of research is being done _right now_ to preserve the useful properties of Cas9 - being able to home in on a particular genetic sequence - while engineering the protein to minimize and even prevent those deleterious cuts do DNA. And that research is finding steady success.

<comment><USER5> >"I understand your hypothesis that Cas9 only kills the cells that do not have the particular mutation"

The hypothesis is that it is more likely to kill those cells than the others, and does so at a high enough rate to select for cells missing the target site. Other things such as NHEJ/HDR happen too.

Anyway, the technique in the paper you linked is not supposed to be causing double strand breaks, which for a long time before CRISPR/Cas-9 were thought to result in Death >> NHEJ >> HDR. This is a totally different scenario, but it is quite odd they do not mention toxicity at all since that is a major concern of these technologies.

I'll check the Lonowski et al paper and get back to you.

EDIT:

> "Given your hypothesis, those fluorescent cells should die and not have the > desired mutations, while the non-fluorescent cells will be enriched for > particular mutations not found in the fluorescent cells"

Perhaps there is a typo here but this is exactly the opposite of what my hypothesis predicts. The surviving cells should contain cas-9 _and_ the mutation. Cas-9 damages the DNA of some cells less because the the mutation was already there. The cells with no cas-9 are noise because they were never treated.

<comment><USER4> > Cas-9 damages the DNA of some cells less because the the mutation was > already there. The cells with no cas-9 are noise because they were never > treated.

If the mutations were already there, then control in figure 7 in Lonowski et al. would not contain 0% "on-target" mutations. The presence of Cas9 is clearly _causing_ a genetic change that is not already present in the population, and those cells that are changed do not all die. It is clearly not the case that the cells with the desired mutations completely overlapped with the cells transfected.

<comment><USER5> >"Although exhibiting background fluorescence, population 1 expresses some nuclease, as evidenced by a low level of editing. [...] The 'shoulder' indicated by an asterisk is not an indel, as it is also present in the control sample; it is probably due to incomplete 3´ A nucleotide addition to the IDAA amplicon (see Table 3, Step 21)."

So they do see mutations in the control cells but decided to call it some kind of artefact. BTW, I also see a less shoulder in the left (on-target) site of the same figure.

The point is that these mutants pre-exist in low frequencies of 1/100 to 1/100,000 cells (depends on cell type, environment, etc), almost regardless of the target site. If you look at enough cells you are guaranteed to find one with an indel at any site. In those cases, just as cas-9 doesn't just keep re- editing the dna after the target sequence has been cut, the cells are relatively "immune" to it.

So for figure 7 they started with 50k cells, the questions are:

1) How many of those cells already contained a mutation at the target site?

2) What was the growth curve of the cells after treatment?

3) What is the division rate of these cells under these conditions?

4) What is the death rate of these cells under these conditions?

5) How many cells were there in the end for final analysis (sequencing, whatever)?

</comment></comment></comment></comment></comment></comment><comment><USER6> Does anyone know if there are also AFM videos of standard biological processes, e.g. molecular machines such as kinesin [1]?

EDIT: Found one here: [2].

[1] [https://en.wikipedia.org/wiki/Kinesin](https://en.wikipedia.org/wiki/Kinesin)

[2] [https://www.youtube.com/watch?v=1jt3AM5Kfqw](https://www.youtube.com/watch?v=1jt3AM5Kfqw)

</comment><comment><USER7> It's surprisingly slow process. Tens of seconds seem like ages in molecular physics. One could think an interaction between molecules should happen on a sub-nanosecond scale.

<comment><USER8> I was shocked the video was 20 seconds in real time as well. I wonder if there is a "numbers every programmer should know"[0] analog for chemical biologists.

[0]: [https://gist.github.com/jboner/2841832](https://gist.github.com/jboner/2841832)</comment></comment>


Royal Society's Philosophical Transactions Accessible Online - <AUTHOR> http://rstl.royalsocietypublishing.org/ <comment><AUTHOR> Related BBC News article: <http://www.bbc.co.uk/news/magazine-15445507></comment>


Bell Labs and CSP Threads - <AUTHOR> http://swtch.com/~rsc/thread/

<comment><USER2> Promela, the language interpreted by Holzmann's Spin, is worth a fling. If you can dig up a copy of "Design and Implementation of Computer Protocols", you can get a bunch of good ideas and experience from messing around with Spin.</comment>


Ask HN: How Do You Keep PostGres in Sync with Elastic Search? - <AUTHOR> So, here is the deal. We've users interacting with our API. Objects change, the elastic search goes out of sync. Has anyone ever found a way to keep it in sync? Please share, thanks. <comment><USER2> Yes, there is:

[https://www.postgresql.org/docs/current/static/logicaldecodi...](https://www.postgresql.org/docs/current/static/logicaldecoding.html)

I know a couple companies that feed elastic search via it. Don't think they've publicized the glue though.</comment>


Show HN: Go# – go-like concurrency aspects in C# - <AUTHOR> https://github.com/kpocza/GoSharp <comment><AUTHOR> Just a quick note. This is a small library for .NET/C# that implements the most important concurrency elements of go like channels, selects, timers, tickers. Don't hesitate to tell your opinion if you have suggestions, comments, ideas, etc. Thanks.

</comment><comment><USER2> I need to know if this is something I can use in production.

\- What are recommended minimum C# / CLR versions?

\- Do you plan on implementing first-class support for the full .NET framework?

I would like to know how much thought you've invested in future direction.

\- Do you have a plan for incorporating the C# 7.2 Span stuff?

[https://news.ycombinator.com/item?id=15731233](https://news.ycombinator.com/item?id=15731233)

<comment><AUTHOR> There are no specific requirements for the C# version, the library was written in v7. Go# compiles to three targets: .NET Standard 1.2, .NET Standard 2.0, and the full .NET Framework 4.5.2+. The same three are available in the NuGet package published to nuget.org.

There are not so many allocations in the library where Span would help still it's already quite performant at the moment. If you have any production feature requests please don't hesitate to file an issue on GitHub or send a pull request.

<comment><USER2> Thanks! You should flesh out some of this usability info in the README.

</comment></comment></comment><comment><USER3> how does this compare to tpl dataflow on performance? is a go channel kinda like c# bufferblock? are channels thread safe for multiple producers and multiple consumers writing to and taking from the same queue? i like the code sample.. very clean.

<comment><AUTHOR> I haven't compared it to TPL Dataflow however made some pure performance measurements. The results are at the end of this: [https://github.com/kpocza/GoSharp/blob/master/src/GoSharp.Pe...](https://github.com/kpocza/GoSharp/blob/master/src/GoSharp.PerfTest/TaskRunner.cs)

Basically Go# can pass millions of messages in a second.

And yes, a Go#/Go channel is similar to something like BufferBlock however both are designed to fit into different "ecosystem" and way of thinking.

Go# channels are thread safe and have been designed to operate in parallel environment.</comment></comment>


Why Some Doctors Purposely Misdiagnose Patients - <AUTHOR> https://www.theatlantic.com/health/archive/2019/08/when-doctors-purposely-misdiagnose-patients/596068/ <comment><USER2> This problem is the biggest in dentistry.

Most dentists are perfectly capable of providing the correct diagnosis. Unfortunately, even if and when they are, there are obstacles:

\- Weak incentives to provide an accurate diagnosis

\- Strong incentives to provide a particular inaccurate diagnosis

Giving a correct diagnosis often means investing more resources, as well as continuously investing in education and tooling. If the patient doesn't see the difference between a correct diagnosis and "probably correct diagnosis" then they will react the same in both cases.

This situation where every diagnosis is perceived as the same, an examination is one of the least profitable services provided by dentists and, naturally, falls into the problem of "adverse selection."

Some dentists recognise the opportunity of giving the wrong diagnosis to get a higher benefit. Be it by keeping or winning over the patient or by leaving room for the ability to recommend costly treatments.

The results of this are:

\- Patients on average get a less correct diagnosis

\- Dentists earn little to nothing for their diagnostic work

<comment><USER3> Specific example I came across (may have even been a scientific study). Memory is a bit hazy, but roughly:

Dentists routinely recommended the more-expensive ceramic teeth replacements for teeth in the back, even though ceramic is less durable than the metal counterparts. Even though you basically can never see the hind teeth, so cosmetic reasons shouldn't have applied as they do for front teeth.

<comment><USER4> > Even though you basically can never see the hind teeth

I notice metal in peoples hind teeth all the time. This is still a cosmetic need.

Food for thought. If teeth are constantly grinding against each other, is it good for the opposing teeth to constantly be grinding against a hard material like metal?

<comment><USER5> I agree with your point about regularly noticing metal crowns but note that dental ceramics are way harder than metal. Dental ceramic is a 7 on the Mohs scale while gold and silver are in the 2.5 to 3 range.

<comment><USER4> Interesting. And tooth enamel apparently ranks a 5.

<comment><USER6> It's not just about hardness. It's about biocompatibility.

</comment></comment></comment></comment></comment></comment><comment><USER7> In Germany there is a strange policy for hospitals. If you do not do a minimal amount of operations of a certain kind (e.g. hip replacements), you loose the admittance to do any further surgeries of the same kind.

The incentive was probably to focus competency to certain hospitals, but you can imagine how this plays out in reality.

Especially people not familiar about medical necessities should always get a second opinion. Otherwise you might end up with an extra hip or something like that.

At least it begins to be common knowledge that hospitals do operate too often.

Still, with all its problems, and there are many, I certainly would prefer to be operated in any country of the EU compared to the US. Not because of capabilities of doctors, but to me it seems US health care as a example how private business can be worse than governmental services. Common market mechanisms don't work if your life depends on it. It is just about extracting the most amount of money from suffering and this article describes a problem to which there is no solution in my opinion.

<comment><USER8> The US's healthcare is hardly an example of private businesses going awry. The US's healthcare is by far the most heavily regulated in the country with a near majority of spending by the various governments. We have the worst of both worlds, some kind of Frankenstein's monster of regulatory capture, government incompetence, and age old corruption. 20% of Medicare billing has been fraudulent for decades and now the government can't fix it because so many parts of the industry rely on straight up theft.

So yes the US health care system needs a push to be more socialized or less regulated, but it's not some prime example of a free market gone awry.

<comment><USER9> "so many parts of the industry rely on straight up theft."

This will be a big issue in any kind of health care reform in the US. if they want to get costs even remotely in line with other countries a lot of people will either lose their job or make much less money. That won't happen without a lot of resistance.

<comment><USER10> yep, health care reform to single payer will basically guarantee a recession - a huge percentage of GDP/jobs will evaporate over the course of the transition.

there is no such thing as having this cake and eating it too: there will be immense pain for a sizable part of the economy whenever this gets tackled.

<comment><USER11> While those who are negatively affected by the reform would suffer, that money doesn't evaporate. It goes elsewhere, so it wouldn't cause a recession on a macro scale. Look into the Broken Window Fallacy in Economics in One Lesson. its a great book.

<comment><USER12> The money doesn't evaporate, but it very likely would result in less total money spent. And people spending less money is the textbook cause of recessions.

<comment><USER11> if its not spent, its saved somewhere. Very few people put substantial amounts of cash in their mattress. Most goes in the bank, which helps set the rate if interest rates for loans. So, even unspent money goes somewhere and gets spent. Still not a recession.

<comment><USER12> The problem is near term interest rates are near 0, so the casual pathway of money saved -> lower interest rates -> more investment isn't as effective. This is why quantitative easing has so little impact.

And a saved dollar is spent less than a spent dollar.

<comment><USER11> low interest rates are supposed to provide information regarding the value of money spent vs. money saved. However that function isn't allowed to work. Further quantitative easing add(s|ed) further noise to the flow of money from investment to spending.

</comment></comment></comment></comment></comment></comment></comment></comment></comment><comment><USER13> I had much more success researching my own health problems than by visiting any doctor (and have seen a lot, unfortunately). As a bonus, I learned a lot about the body and the mind.

I see misdiagnosis happening at a very high rate but I also understand they don't have the time and/or energy to dig very deep into each patient and they do fine (money and respect-wise) by doing the bare minimum so many don't try to fight it by e.g. setting up their own consultation and trying to do better (not necessarily making less money).

Of course, a bunch of exceptions can be found and they do shine a lot, but the average doctor isn't going to be helpful after the very typical and simple checks don't yield anything and they'll happily prescribe things that won't actually help you. That's been my experience in at least couple european countries.

Edit: typo

<comment><USER14> I think it's very important for people to be proactive about their out health and care, but I think listening and working with your primary care doctor is just as important. If you don't think your doctor is helpful or listening then you probably need to find a new doctor.

<comment><USER15> > be proactive about their out health and care

My mother did this on my behalf when I was an infant, just a few weeks old.

"Nothing is staying down. Always throwing up. Not gaining wait."

"Oh yea yea sure new mother. You'll get the hang of it. Come back next month see you then. Naturally under weight since birth it's normal for the kid. Thanks bye."

Rinse and repeat until some doctor got bloody tired of the repeat visits. "Fine, come on in and I'll take a look." A few minutes later it was "oh fuck" and I was on a gurney being wheeled into surgery.

So now that it's decades after I didn't starve to death thanks to a procedure that didn't exist before 1912 [official diagnostic criteria at 1888] ... yea. Maybe sometimes you should bother your doctor(s). Sure, humour them and leave a lot of the time but when you know it's Not Good ... make them stop humouring you.

And yes, "I have the scar to prove it".

<comment><USER16> Nowadays is the baby isn't gaining weight after the first week the standard is to hospitalize.

</comment></comment></comment></comment><comment><USER17> I think some "industries" shouldn't work as a normal business, health, education, law / police. They just don't work as a business and will end up corrupt because money.

<comment><USER18> Education hasn't gone well publicly so far in America. I'm not sure completely private is the answer but something needs to change. Government funding has led to massive amounts of money being spent for negligible results. Agree on health, law / police though

<comment><USER19> But isn't the problem with public schools in the US that the funding comes from taxes in the school district itself, so ppor districts will get a underfunded school while rich districts get a well funded school?

Anyway, the school system should be changed dramatically everywhere. The current paradigm is hurting children and should be abolished.

<comment><USER20> In Michigan, where I grew up, Detroit public schools got about 50% more funding than the public school I attended. Want to guess which schools had better outcomes?

<comment><USER21> I would expect schools in impoverished, troubled neighborhoods would cost QUITE a bit more than schools in wealthy neighborhoods in order to get the same results.

The students are more likely to be facing food insecurity and odd parental schedules at home. The school may need to spend more keeping their student body safe. And one kid with a violent parent who reacts by being violent in turn can wreck havoc on the rest of the classroom. That kind of person might need an education that is more therapy than academic.

</comment></comment></comment></comment></comment><comment><USER22> It's orthogonal to the linked story, but I attended a dinner the other night where the presentation was on advances in MS research.

The speaker, an MS researcher and clinician, noted among other things that we've been really really wrong about how many folks in the US have multiple sclerosis - like, by a factor of 2. There are lots of reasons for this, but it's not JUST the lack of easy diagnostic tests.

Until relatively recently, there were NO real therapies for MS, so doctors were hesitant to make the pronouncement. Add to this that a diagnosis of MS would qualify as a pre-existing condition, and would prevent the patient from getting health insurance (pre-Obamacare, anyway), and would absolutely put the kibosh on life insurance.

So there were real world consequences, and they were therefore hesitant.

<comment><USER23> I think part of it, but also not the entire story.

Take cancer, for example. The treatment is so toxic (potentially deadly) that we want to make sure that our diagnosis is as close to 100% as possible. To the point where if you want to transfer where you get your chemotherapy, the new place will insist that you bring not just the biopsy report that shows that you have cancer, but the actual 'slides', the actual biopsy tissue for them to independently evaluate.

Contrast this with MS where there is virtually no therapy (until recently), the tests themselves are very expensive (multiple MRIs over time) and the tests aren't even that much better than just talking to the patient and examining them. But, both the MRIs and the clinical exams/interviews require multiple visits, sometimes with years of monitoring in between to _truly_ make the diagnosis.

The system just doesn't incent this type of care and certainly doesn't reimburse it very well. Patients want answers and answers now. Doctors are hurried. Insurances change so you have to change networks, etc, etc, etc.

<comment><USER24> > The treatment is so toxic (potentially deadly) that we want to make sure > that our diagnosis is as close to 100% as possible.

I think you're ignoring how obscure some symptoms of cancer are, though. My cousin went back and forth with the doctor about a recurring cough, for 3 or 4 years. It turned out to be bowel cancer, and while they did treat it, it was too late by the time anyone in the medical system thought of that. The only indication that would point them towards bowel cancer, was the medical history of her family, her grandmother had it too. She was rather young as well, late 20s/early 30s, so they just didn't consider it.

</comment></comment></comment><comment><USER25> Many focus on the doctor, and surely his moral compass was off. But from a birds eye perspective the primary problem here is companies paying doctors to recommend certain pills and procedures.

This can make a doctor which was semi-decent and quickly turn him into a greedy immoral person.

I don't think it should be legal for companies to pay doctors to promote their products. Do anyone disagree?

<comment><USER26> My wife is a resident. She used to intern at PCP clinics and was invited by her supervisor (a physician) to one of the dinners hosted by pharma companies (Sanofi, if I remember correctly). The dinner was a feast. The doc invited everyone in her clinic and their immediate family members. We had Shirmps, Lobster, Wagyu beef (I know it's a redundant word, but that's how it's known in the US), lamb to our fill. Sanofi rep footed the bill (and asked us to sign our names on a sheet when we arrived).

Experiencing that dinner and seeing my host family mom (a practicing psychiatrist in the US for a private psychiatry hospital) getting food every week from pharma reps, makes me feel disgusted about the connection between doctors and pharma companies in the US.

<comment><USER27> I have MDs in the family too, their continuing education classes are sponsored (free) and with feasts provided as well.

Lawyers have to pay for our required continuing education classes. Sponsored courses and retreats are clearly a conflict of interest for MDs.

Also, as lawyer, I remain shocked and saddened to see how US medical providers have abandoned patient privacy in the wake of the US opioid crisis. Patients prescribed any controlled substance are now put on registers that almost any state actor (or local police) can review at will.

US MDs have thrown their patients under the bus because they (or their colleagues) were (lazily/blindly/greedily) writing too many opioid prescriptions.

<comment><USER28> How are doctors responsible for laws passed by state legislators (who tend to be lawyers) requiring doctors to use PDMPs?

<comment><USER27> Ask the AMA. Docs should have stood fast or at least forced more patient privacy protection. As it is, some health providers require patients to sign broad privacy waivers before issuing prescriptions for controlled substances (including ADHD meds).

My GP didn't even think it was an issue -- here sign this. I couldn't believe what I was reading. I refused and didn't get the meds I needed -- resulting in harm to put it mildly. I am lucky that I am not suicidal because it got pretty dark for me, after a few weeks I had to crawl back to get the meds I need.

</comment></comment></comment></comment></comment><comment><USER29> I was keeping an open mind about this doctor, until I read that two other doctors were willing to testify they had thought he was misdiagnosing patients. Its notoriously hard to get doctors to testify against each other at a malpractice case and the fact that doctors who worked with him were Ing to come in on their own accord is damming

</comment><comment><USER30> The medical industry has the biggest conflict of interest I have seen in any industry. It's actually bad for doctors if preventive healthcare takes off the way it should, we all eat healthy, balanced diets and exercise to take care of our bodies and mind.

That coupled with genetic diversity, ignorance of their customers and relative ignorance of the practitioners itself (we still don't know more than we know) could truly be a recipe for disaster.

My celiac was misdiagnosed for pharyngitis for long, and since I've stopped taking any doctor very seriously. I read A LOT, visit a bunch of doctors (preferably leading to specialists) and ask a lot of questions before deciding what course of action I want to take.

Luckily, in India, doctors don't charge as much (~$20-40) per session.

<comment><USER31> > The medical industry has the biggest conflict of interest I have seen in any > industry. It's actually bad for doctors if preventive healthcare takes off > the way it should, we all eat healthy, balanced diets and exercise to take > care of our bodies and mind.

Not in countries with a national health system, where the government is incentivized to keep people healthy in order to reduce cost.

<comment><USER32> > Not in countries with a national health system, where the government is > incentivized to keep people healthy in order to reduce cost.

It's hard to see how this can be true, since government operations are infamous for excessive cost.

<comment><USER33> We have a pretty lean system in the UK, possibly too lean. The private system in the US however seems a poster child for excessive cost.

<comment><USER34> And in the UK you also have horror stories with patients with cancer who need an urgent surgery and have to wait months to get it.

<comment><USER35> Outliers or tabloid stories, while in the US people do not get treatment because they cannot afford it.

<comment><USER36> Those US stories are outliers as well.

If a lot of people in the US can't afford treatment, then why does the US lead the world in several cancer outcomes? If people were just dying for lack of treatment, that would make outcomes far worse.

</comment></comment></comment></comment></comment></comment></comment><comment><USER37> Your typical case of measuring a doctor's success by the number of EGGs and the likes that his patients do!

Wrong incentives = unexpected outcomes!

<comment><USER38> Seems similar (or the same as) the cobra effect

[https://en.wikipedia.org/wiki/Cobra_effect](https://en.wikipedia.org/wiki/Cobra_effect)

</comment></comment><comment><USER39> I for one cannot wait for my ai primary physician.

<comment><USER40> Great! Let me hook you up with the latest medical AI technology. Actually, let me hook you up with __all __of the latest medical AIs, throw your symptoms at them and let them treat all you ailments. And add to that, all the latest medical robotics, and we 'll take the surgeons and intensivists, interns, and nurses away.

Good luck with that, I'm sure you will be much happier and healthier when the current AI tries to decide whether you are acutely dying of hypercalcaemia or a cardiac tamponade and Marshalls the robots to save you.

\s

For all the faults and failings of doctors (read: humans), I find many Hacker Newsers __vastly __oversimplify what doctors do and __vastly __overinflate what AI is able to do now, or will be able to do in the next ten, twenty, or even 30 years.

It's great that we not have some AI that can diagnose a stroke better than a radiologist on a CT scan. But it can't tell you the scan also shows a space occupying lesion. Or hydroencephaly. Or an extra dural haematoma. Or any other intracranial pathology. And that's about the state of the art.

I welcome new diagnostic aids as I think most clinicians do, but I would take the fleshy system we have of human healthcare providers and suspect that will be the case for a good while yet.

Disclaimer: am doctor and engineer

<comment><USER39> >It's great that we not have some AI that can diagnose a stroke better than a radiologist on a CT scan. But it can't tell you the scan also shows a space occupying lesion. Or hydroencephaly. Or an extra dural haematoma. Or any other intracranial pathology. And that's about the state of the art.

Why couldn't a model report all discernable co-morbidities?

I don't see any form of objective data analysis remaining optimally in the hands of humans for long.

Double checked by humans, in the short term, sure.

There's arguably zero 'creativity' in diagnostics. It'll be automated within a decade or two IMO.

<comment><USER41> There's a lot of nuance in diagnostics, and information can be scattered about, especially with relatively rare disorders.

</comment></comment></comment></comment><comment><USER42> A benefit of "socialized medicine", provided the government is not corrupt, is that medical practice can be evidence driven. E.g. compare rates for wisdom teeth extraction and tonsillectomy between the US and UK.

</comment><comment><USER43> The other side of the coin is that there are lot of (or at least some) doctors who will "misdiagnose" a patient to get them appropriate treatments that insurance would otherwise not pay for.

Personally, I had a number of _very_ large lipomas on my body that no insurance would normally ever cover the removal of as they were cosmetic and socially stigmatizing and not dangerous to my health. My doctor filled out all the necessary forms with the proper magic language and my insurance paid the bill. These are simple, 10 minute, outpatient medical procedures that require a knife and $.25 of numbing agent. I could have done it myself if I could buy something OTC to numb myself.

Not all doctors are just looking to pad their billables.

</comment><comment><USER44> In order to counter these risks, we prefer going to doctors and hospitals that are so busy (and highly regarded) they don't have time for bullshit.

Of course it helps being in a large city with many options and excellent insurance. Without this, I'd probably be getting g second and third opinions constantly.

<comment><USER45> Don't you worry that very busy hospitals will treat you more anonymously and/or make more mistakes?

</comment></comment><comment><USER46> This actually sounds like an honest (mis?)diagnosis. Confusing migraine and temporal lobe epilepsy is not a particularly egregious mistake, and the two conditions often occur together. A number of anti-seizure medications are prescribed to prevent migraines.

</comment><comment><USER3> Q: "Is it Worth Getting an Annual Physical Exam?"

A: "No"

[https://nutritionfacts.org/video/is-it-worth-getting-an- annu...](https://nutritionfacts.org/video/is-it-worth-getting-an-annual- physical-exam/)

</comment><comment><USER47> Jesus. How corrupted people are becoming. And if there's one type of people that absolutely can get corrupted are doctors. They're dealing with lives after all. The implications can result in death or at least a lot of suffering;

</comment><comment><USER48> Our medical system is completely wrong. Doctors should get payed for the time their patients are healthy. As soon as they fall ill, payment should stop until they are well again.

<comment><USER49> What about people who consciously (or unconsciously) live extremely unhealthy lifestyles?

<comment><USER50> They get to pay an "unhealthy lifestyle tax".

<comment><USER49> What about the corporations that push addictive and poisonous food with massive multi hundred million dollar marketing campaigns targeting children?

<comment><USER48> Maybe the "free market" isn't such a good idea after all...

</comment></comment></comment></comment></comment><comment><USER51> Ah, good old Dr Knock[0]

[0]: [https://en.wikipedia.org/wiki/Knock_(play)](https://en.wikipedia.org/wiki/Knock_\(play\))

</comment><comment><USER52> This is getting very common in India

</comment><comment><USER53> Just like mechanics of vehicles.

</comment><comment><USER54> didn't they give the hippocratic oath? doesn't that count for anything?

</comment><comment><USER55> TLDR; Money

</comment><comment><USER56> Could we add "in the US" to the medical news that may not be that relevant in other countries?

<comment><USER57> > Could we add "in the US" to the medical news that may not be that relevant > in other countries?

The incentives are misaligned in many other countries, including Germany and the UK. This article focuses on examples in the US, but as noted elsewhere in these comments, there are plenty of articles that show examples of similar perverse treatment incentives in other countries.

<comment><USER25> Except nowhere are the incentives as screwed up as in the US. Sure a doctor does have a financial incentive to not always do what is best for you anywhere in the world. But in most places this concern competes strongly with a sense of moral duty.

In the US you have companies which have no scrupulous because they don't see or know the patients they screw over, actively push and incentives doctors to work against the interests of their patients.

The prevalence of companies paying doctors to prescribe certain pills or suggest certain procedures seem to me more of an American problem. At least in my home country I highly doubt such an arrangment would even be legal.

I mean this just fits in with the opioid crisis in the US. Where medical companies would basically send young prostitutes to doctors to try to persuade them to push their drugs. Yes this is a fact. These companies hired young pretty women, which frequently slept with the doctors they were supposed to influence. The companies made billions while patients died left and right from their drugs.

I cannot think of anywhere in the developed world where anything remotely as horrible has been going on in the health care sector. While everybody has challenges in their health care sector, everything pales compared to what is going on in the US. Greed as completely taken over.

</comment></comment></comment><comment><USER58> A: $</comment>


A $277 million navigational error - <AUTHOR> http://www.nytimes.com/2013/02/01/world/asia/us-navy-to-scrap-vessel-stuck-on-philippine-reef.html

<comment><AUTHOR> _[US Navy Rear Adm. Jonathan] White's message states, "initial review of navigation data indicates an error in the location of Tubbataha Reef" on the digital map._

<http://www.navy.mil/submit/display.asp?story_id=71553></comment>


Ask HN: App ideas? - <AUTHOR>

Web and/or mobile.
Two of my ideas:
1. "I Want..." It'd be like fml or textsfromlastnight. There'd be text that says "I Want..." and then a form right next to it that let's the user complete the sentence. Submissions would be ranked via votes or likes. (I'd pay someone who could quickly build this.)
2. Something that aggregates the 10 most interesting news stories of the day and provides (aggregates) thoughtful analysis on those topics from several sources. I don't follow a lot of news online because it changes so fast, but I'd at least like to know a lot of details about a few things each day. <comment><USER2> I want an app where I can update my profile picture on all networks, without having to individual update it on Twitter, Facebook, Buzz, etc.

</comment><comment><USER3> We're building something called The Spark Foundry over at Sparkmuse that I think addresses #1. The basic premise is this:

1\. A person enters their idea and commits to it.

2\. That person can then spread the word via Twitter, Facebook, etc to get others to commit.

3\. There are multiple levels of commitment, the user can commit to try a solution out, pre-register for a beta, answer a survey, or buy it. Each commitment puts their email on a list.

4\. Founders at Sparkmuse can see how popular ideas become. The more commitments one has, the more validated it becomes. They can choose to build a solution for the given wish and then have access to a large mailing list of potential users (we don't give them the emails).

5\. Thus, user has an incentive to spread the word on their idea as it can create an opportunity an entrepreneur wouldn't want to pass up.

We'll be releasing our first stab at this to the public in the next week. The premise is essentially a "Kickstarter for social capital." Right now it's on demo inside of Sparkmuse. If you'd like to check it out, please drop me a line. We're always looking for more people to join our mission.

<comment><AUTHOR> What I'm thinking of is much simpler than that.

</comment></comment><comment><USER4> here are some ideas I had a few years ago. There are people working on them but no one has it the main stream yet: 1) anonymous peer to peer micropay. Ability to pay someone anonymously without a 3rd party intermediary 2) real time traffic - use tracking data from cell phone gps, GM onStar (this may be the best) or from GPS (garmin etc) to determine real time traffic data on all roads

3) automatic/real time insertion of product placement into videos (i.e. you tube videos). You tube videos can specify types of products and then blue screen those products (like a can of soda) so that google can insert them real time into the video.

</comment><comment><USER5> 1\. Re-open <http://www.lazyweb.org/>

</comment><comment><USER6> How much would you pay for 1?</comment>


Ask HN: Which programming language you prefer for starting a new SaaS product? - <AUTHOR> <comment><USER2> Less about language, more about the business and selecting tools / frameworks from there.

If you provide some context into the business, you can get better recommendations.

If it's a new idea, you probably don't need to write code yet anyhow. There are lower barrier ways to validate your idea.</comment>


Tolkien Snubs a German Publisher Asking for Proof of His "Aryan Descent" (1938) - <AUTHOR> http://www.openculture.com/2014/04/j-r-r-tolkien-snubs-a-german-publisher.html <comment><USER2> It seems we're often confronted with the job of separating the artist from their work, because of distasteful personal failings of the artist.

It's awfully nice when it's not necessary, and the artist turns out to be a decent human being.

<comment><USER3> Do you need to separate Tolkien from his work? I like consuming Tolkien- related media as much as anyone on HN, but there's little denying its racist and sexist overtones.

<comment><USER4> You should try reading Robert E Howard. His writings can be uncomfortable, at times.

</comment></comment></comment><comment><USER5> I wish people still wrote so eloquently in their everyday correspondence. It seems like the further you go back in time the more beautiful the language used to be. Some of the letters back and forth during the American Revolution were very nice, like between John and Abigail Adams. Going back further the letters between Erasmus and Thomas Moore were also very nicely written. Now it's all emoticons and lol.

<comment><USER6> Language was also less ambiguous because they didn't leave out important punctuation or relative pronouns. I expected Tolkien to be a on Hitler's side because I interpreted the title as "Tolkien Snubs a German Publisher, Asking for Proof of His "Aryan Descent", but the author means "Tolkien Snubs a German Publisher Who Asked for Proof of His "Aryan Descent". Writing ain't what it used to be, even if only the clergy and royalty could do it!

<comment><USER7> It's a headline. Take a look at some newspaper headlines from 1938:

[https://www.google.ca/search?q=1938+newspaper+headlines&espv...](https://www.google.ca/search?q=1938+newspaper+headlines&espv=2&es_sm=91&tbm=isch&tbo=u&source=univ&sa=X&ei=6YxeU9HTIM2RyASwuoDoDQ&ved=0CCkQsAQ&biw=1916&bih=881)

Not really any different.

<comment><USER8> I have a clipping from a small regional daily newspaper from the 60s. The headline reads, "U.S., Canada Rear Warning Staveal Sites of Radtions" which sounds ominous indeed. It took me several tries to realize that someone most have dropped the line of type, breaking it, and reassembling it in the wrong order. It _should_ have read, "U.S., Canada Reveal Sites of Radar Warning Stations"

</comment></comment></comment></comment><comment><USER9> My favorite part of this letter is where Tolkien pretends to not understand what the Germans mean by "Aryan", and initially answers as if they are referring to what we now call the Indo-Iranian language family[1]. Obviously he knows quite well what they really are asking, as the rest of his letter makes clear.

[1] [https://en.wikipedia.org/wiki/Indo- Iranian_languages](https://en.wikipedia.org/wiki/Indo-Iranian_languages)

<comment><USER10> Tolkien: "Let's get one thing clear, I'm the smartest guy in the room".

<comment><USER11> Tolkien was a professor and student of linguistics, so I think he's allowed a little fluffing of his tails feathers here :)

</comment></comment></comment><comment><USER10> Somewhat related, my favorite letter from Kurt Vonnegut:

[http://www.lettersofnote.com/2012/03/i-am-very- real.html](http://www.lettersofnote.com/2012/03/i-am-very-real.html)

<comment><USER12> That's a beautiful letter. I found a bit more information about the event here: [http://www.minotdailynews.com/page/content.detail/id/519549....](http://www.minotdailynews.com/page/content.detail/id/519549.html?nav=5576)

What the English teacher said about the matter can be read there and it is also a nice sentiment. It seems in the end the school allowed the books to be read and the teacher (whom I believe was forced to resign) was given $5000 as a settlement.

I always find it very peculiar how people can be so offended by curse words and at the same time have such an under-developed sense of morality with regards to things like censorship or war.

</comment></comment><comment><USER13> Nice.

"The author drafted two replies, the less civil of which reads as follows:"

So, which one did he actually send, if either, then?

<comment><USER14> Consensus is that his publisher sent the other one. As far as I'm aware it has never been published (and probably was lost long ago).

</comment></comment><comment><USER15> As someone commented last time I saw this posted: 'Dude can't even say Fuck Off in fewer than 200 words'.

</comment><comment><USER16> I had interview with an american company recently, and they asked for my racial profile as well.

<comment><USER17> They can ask, but it is not required for you to give. It is used for hitting affirmative action requirements.

</comment></comment><comment><USER18> Of course; Tolkien would only care if the author was male!

</comment><comment><USER19> That's pretty cool I guess.

</comment><comment><USER20> Would you be so kind as to change the title, which is ambiguous now I come to read it again, rather than misleading, to something like

      Tolkien verbally pistol-whips Nazi publisher who wanted
      proof of Tolkien's Aryan ancestry before publishing `The
      Hobbit`.

The thing that worries me, and that Tolkien conceded, is that these were probably not bad people, just people obeying the law. Problem was they were not good people, willing to disobey the law.

<comment><USER21> Or they were good people who didn't think that the deaths of their families was a fair price to pay to get a book published. It's easy to demand heroism from the comfort of your home, but by 1938 there were plenty of examples of what happened to people who tried to stand up to the Nazis in Germany.

<comment><USER22> The only thing necessary for the triumph of evil is that good men do nothing.

<comment><USER23> It's not clear if a corollary of this is that good people who do nothing cease to be good people.

<comment><USER20> yes they (we) do.</comment></comment></comment></comment></comment>


Ask HN: Where do you host your side projects? - <AUTHOR> <comment><USER2> Heroku, Firebase and Netlify usually. I'm using Firebase and Netlify for [https://www.checkbot.io/](https://www.checkbot.io/) at the moment (it's a Chrome extension that tells you how to improve your website). Minimal hosting costs and I don't have to worry about what happens when traffic picks up.

</comment><comment><USER3> Most of my stuff is at Linode; but for the last new project I spun up, I moved to Hetzner just because the pricing is so much better.

<comment><USER4> How are speeds compared to Linode? I currently use them, and have gotten a fairly consistent 1Gbps. I'm also curious about their management functionality. Linode is very good there; I particularly appreciate the lish console for if I lock myself out. Any such equivalent there?

<comment><USER3> _How are speeds compared to Linode?_

Too early to tell here. The site hasn't been promoted yet and is in "private beta" mode, so the traffic is trivial. Subjectively, when I visit for testing and admin stuff, it feels fine, even though the servers are in Europe and I'm on the US East Coast.

 _I 'm also curious about their management functionality._

I find Linode's stuff to be a little better from a UX perspective, but I have no particular complaints about Hetzner so far. But keep in mind, I'm running one app there that I stood up a month ago, which has no paying customers yet. So I can't exactly offer the most in-depth critique ever.

<comment><USER4> Yeah, not a fan of the whole european server thing. Needless lag when no non- American will use it. Also, not a fan of European regulations. Having a European server might make me subject to GDPR (?) (or other regs I don't know about), a risk I don't want to take.

</comment></comment></comment></comment><comment><USER4> I self-host some, with the rest at Linode. Self-hosting is a little hard for me as I don't have much hardware; I'm hosting various services on Raspberry Pis and old laptops with one rpi as a reverse proxy for all. Though I don't recommend it to everyone, as there's a serious security risk if you don't know what you're doing.

<comment><AUTHOR> Yes, that's risky indeed unless you know what you're doing.

How do you do it?

<comment><USER4> I close down everything on the home gateway box but one publickey from one ip (hardened cloud server) with secure ciphers and protocol 2 only. Non-standard port. Cloud server acts as a jump box, only allowing login from lan ips (requiring vpn first). This is, in no small part, because of the awful quality of most isp-issued router/firewall combos.

</comment></comment></comment><comment> 52-6F-62 I've been happy with Digital Ocean. It's versatile, and so far reliable for mainly small to kid-sized projects. YMMV. From what I understand they've improved over the years.

</comment><comment><USER5> Digital Ocean: Reliable, flexible location choice (US, EU, SG), simple, good pricing for what I need (mainly, small instances, one instance dedicated for one project).

</comment><comment><USER6> Either Hetzner or DigitalOcean. Both have handy API's which makes deploying new nodes easy (ansible, terraform, ...).

</comment><comment><USER7> Digital Ocean and AWS. More on AWS recently because I also want to try some new services (e.g. AI) it provides</comment>