One of Kagi's core principles seems to be that they don't try to guess what you want. Their "Personalized Results" settings just ask you to tell them which domains you like and which you're tired of seeing. It makes sense that they'd ask you for your locale rather than guessing it from your IP or asking for location access.
As someone who's sick and tired of the way Google tries and fails to guess what I want—to the point of now ignoring me when I try to tell it what I want with search operators—I appreciate this philosophy!
Announced a lot of unfunded tax cuts financed by borrowing - these have now been walked back on. The main issue was not really that she cut taxes, it's the unfunded borrowing to cover. Borrowing with the current high interest rates was always going to be risky and the market didn't have confidence that the cuts would lead to growth. This caused the value of the pound and of UK gov bonds (gilts) to plummet. Several large pension funds (which usually hold large numbers of gilts) were in danger of being margin called, which would cause them to have to sell gilts to cover the responsibility, which would drive down the price further, causing more sell offs. To prevent this the Bank of England (BoE) announced that they would be buying up to £65B of UK gilts - which calmed the markets and prevented a sell off (for now). But it has significantly worsened the economic outly for the country, buying your own bonds at a premium during a period of high inflation is a horrible position to be in.
The gov also declined to get the Office of Budget Responsibility (OBR) to check the impact of the plans. This is something the OBR does before every budget and it's very unusual that they didn't do this - even though it turns out they offered to before the budget was released. It didn't help that a lot of the taxes cut were targeted for high earners - It's hard to argue how cutting the top 45pc tax rate for earners over £150,000 and dropping a cap on bankers bonuses would help people in the short term (or dare. I say, the long), when the majority of people in the UK were struggling with the massively increased cost of living. It almost seemed as if the conservatives were trying to force through a list of long desired for tax cuts for the wealthy without the proper mandate (as Truss was only. elected by Conservative party members, rather than the general electorate) - and this made her gov monstrously unpopular.
A better question might be: Why is the private sector responsible for providing accurate health information? As this article shows, the incentives for people running medical websites and the people reading them are not aligned. I'd say the UK NHS website and symptoms/medications pages hit the nail on the head - https://www.nhs.uk/conditions/. It has no advertising and provides short, easily readable and actionable information on the majority of conditions and the correct way to use and take many different sorts of medication.
And crucially - if the information present is not sufficient, clear and obvious UI elements that direct the next best steps to get the help you need, whether that be ringing the non emergency helpline or immediately going to A&E. (It's been commented on before, but the new UK government sites are very consistently structured and open source their design systems https://service-manual.nhs.uk/design-system)
That's a nice page, and I'll definitely bookmark that one. But I don't see most of the public using something like that over WebMD.
WebMD is complete trash (I even block it in my Kagi search preferences), but it succeeds over sites like the NHS one because of blog SEO. WebMD is really a glorified blog with posts about every condition you might get paranoid over. I don't know how precisely they achieve this, but they're doing something right in an SEO sense if The Google continues to put them near the top of results after all these years.
Meanwhile, there are also sites like Merck Manuals, which is both a terrific resource and privately run, but I don't recall ever seeing it coming up for a search query like "what is that bump on the side of my neck."
The resources are out there. Whether The Google thinks the average person should read them is a different story. I don't believe The Google is going to ever filter out WebMD, so there must be a middle ground where sites like the ones you and I mentioned find a way to make themselves more WebMD-like without sacrificing their more academically-minded content they already have.
So there's a private option that's terrible (WebMD) and a private option that's terrific (Merck Manuals). And it's the terrible one that ranks well at Google.
Sounds like a Google problem and apparently only a Google problem.
That's where I continue to want to see what results in a search engine would look like that heavily punishes presence of advertisements in a result. All the SEO spam pages are ad-driven, so cutting out anything following that incentive should result in removal of all pages that follow that terrible SEO spam pattern that ruins search results.
Punishment/vengeance is a popular idea around here, but you have to also remember that a search engine is supposed to bring you the most relevant results.
Filtering out, say, Stack Overflow or Reddit because it has ads doesn't help you when it answers your question and is perhaps the only thing on the internet that truly does.
People seem to think there's this ad-less replica of the internet, sitting right behind our ad-riddled internet, where everything they want exists for free, it's just hidden. In reality, the websites making money are the ones providing the vast majority of things people are looking for.
Maybe instead of heavily punishing websites with ads, a search engine could instead punish heavily ad-driven websites. A lot of the SEO-exploiting blog mills are filled to the brim with ads where the goal is to get you to visit to view as many ads as possible, not provide good content that's funded by ads.
Does this site (in general, not just this page) have more than 5 advertisements per page? Between 2 and 4?
Does this site attempt to load 12 trackers? "Only" 4 trackers? Just 1?
Does an AI text analysis of the first few paragraphs match on this nonsense?:
> Fixing your gadget is important. Many people find that their gadget sometimes breaks. Gadget helps us do action easier, and improves our lives. We all hate it when our Gadget doesn't work the way we expect it to. It can be frustrating. Read below for tips on how to fix your gadget. (Followed by 3 more paragraphs of filler before getting to regurgitated gems like "reboot it".
I'm sure we have the AI tech now to semantically see this bullshit and downrank it. Right? (Ok, maybe I overestimate how easy this would be. Forgive me, I'm just ranting here)
Do you mean the advertising company that runs a search engine should punish pages in the results that... show their ads? Or just when it's a "lot" of their ads? Or should they only do that if the pages are showing ads from their competitors?
I’m honestly surprised that Google thinks that a page with N ads deserves N times the CPM. The more ads, the less attention each ad can grab, no? I wonder whether just treating ads as zero sum (regardless of ad provider) — such that a page with 5 ads, 2 of which are Google ads, gets a payout of 2/5 the CPM of a page with one Google ad and no other ads — would basically drive all these SEO mills out of business. While also not really impacting honest ad-sponsored sites (like Reddit), that only tend to run one ad per page.
Or maybe the search engine shouldn't care about ads at all, and just figure out what is good content and what is bad content, and what actually answers queries well.
When I said "punish", I meant that the ranking algorithm should do that. It's not about vengeance, it's about filtering out SEO spam. The problem with filtering out SEO spam by detecting it as such is that it's by definition an arms race. That's why I propose to instead of looking for the symptom (SEO spam) pull it out at the wrong incentive structure that's causing it (ads).
"that heavily punishes presence of advertisements in a result." while that is pleasing to read at face value, it has two fundamental problems:
1. it's orthogonal to relevance of content (semi-solvable algorithmically I suspect)
2. it's antithetical to Google's core business model (a lot tougher nut to crack)
The entire point of my comment was that it's not orthogonal. The ads are what fuels the click bait and SEO-driven articles. Nobody for example would ever pay a subscription to a website that is just waffle filler. While stackoerflow has ads, it's much better in that regard to the SEO spam pages.
Aren't you contradicting yourself there? Stack Overflow is ad-supported, but is good. But you want search engines to penalize sites that have ads?
I hate ads, but I don't think we should be focusing on them here. Some sites that have ads have garbage content, and some sites that have ads have useful content. Just... find the useful content, and return it in search results. I know "just" is doing an awful lot of heavy lifting there, but I don't think "has/does not have ads" is as important a signal to a search engine's algorithm as you think it is.
I disagree. The way content is presented matters. Splitting an article into 4-6 pages and filling those pages with ads makes me not want to read that content. I'd much rather go somewhere that has the same text in a single page and only a few ads.
The ideal search engine would show me the ad-free page first given otherwise identical quality. Of course Google will never do anything like that. That's why I'm hoping for an alternative search engine to do so.
Imagine a world where the biggest search engine made its money from advertising. In that kind of a world, wouldn’t the search engine primarily be incentivized to show you the results pages with the most advertising, regardless of the quality of the content?
Anyone who wants attention is motivated to do SEO. Should engines downrank every site that has good SEO? That is, downrank every site that ranks highly?
They already look at things like clickthroughand dwell time and bounce back. If enough people dislike Example.com enough to avoid clicking on it or come back to search after visiting it, the engine learns that it is a bad result.
Maybe the problem is that most people like what you don't like.
No, they key is to differentiate SEO'd pages with useful content from SEO'd pages with useless content.
This is a game as old as search engines. In 2005, it meant filtering out sites that were just lists of keywords, not coherent sentences and paragraphs. It meant for giving extra points to articles with structure, such as header tags and paragraphs, as opposed to just blobs of text. It meant using PageRank to organically discover which pages real people thought were useful.
It's a much subtler and more difficult problem in 2022, but there are also better tools to do it (big NLG models). It just seems that Google lost interest in quality control at some point.
And I would guess they lost interest in quality control because of Chrome's market penetration. Chrome is a browser monopoly at this point, and with Google being the default search engine on Chrome, they no longer have to give quality results to maintain their search user base. On top of that, they control such a large share of the ad market that any SEO spam website is more likely than not to be using AdSense. Which means they have a financial incentive to deliver page views to SEO spam sites, which tend to have higher ad/content ratios.
That stuff definitely helps. That's also why do many now just search Reddit. However, wouldn't it be nice if the search engine could be smart enough to figure that out itself?
The problem is that people clicking+dwelling on something is not highly correlated with it serving their needs.
See: clickbait YouTube videos that show you something you really want to see in the thumbnail, then spend 10 minutes doing something else before showing it, and when you see it it’s a tiny aside with no more context than what you got in the thumbnail. If it’s even in the video at all.
Those videos have both high clickthrough (thus “click bait”) and also high dwell time (from people waiting for the thing they wanted to see to show up.) They do also have high bounceback, but only from people who recognize what’s going on. “A new sucker’s born every minute”, and those suckers will click the video and watch it, because they don’t yet know the principle that this specific kind of enticing thumbnail+title format implies that they won’t find what they want here.
These metrics all measure, effectively, “wanting” rather than “having.” It’s like measuring food by how addictive it is, rather than by how satisfied it makes you. You’ll end up optimizing toward cheetos — literally flavoured air — rather than toward anything that fills your stomach. People might enjoy cheetos while they’re eating them, but if they’re genuinely hungry, cheetos won’t solve their problem — they’ll still be hungry afterward.
> Sounds like a Google problem and apparently only a Google problem.
I want something like webrings to become A Thing again. A user curated search engine. And the users doing the curated need to be vetted. I don't know if this is even possible, but I get tired of having to come to HN to get a human recommendation that is miles better than the algorithmic crap from the current search engines.
Unsolvable since it's a network of fallible humans we attempt to topologically score.
You can make decent attempts, such as academic peer review. Even this system perpetuates its own problems (beta amyloid) and has perverse incentives (publish or perish, falsified results), though.
Semantic web had some good ideas about this. Networks of signed FOAF data attached to articles and posts. You could form a side graph of trust information that you could revoke at any time.
You do. I imagine people or groups curating lists of pages or sites - they decide what to put on their lists, but you decide to include them in your personal search engine or not. Or you could fork their list and edit as you see fit.
It's a bit of a conundrum; on the one side, the NHS and (in a different area) MDN are better, more authoritative, etc sources, so Google should promote those. On the other, this would mean that Google can no longer cite neutrality or hide behind "the algorithm", as has been their legal defense against a ton of lawsuits where the suers said one websites should go higher or lower in the rankings.
What lawsuit? There is no legal basis for a lawsuit. As a private corporation, Google is free to rank search results however they like regardless of whether that's done by humans or algorithms.
So what? You haven't cited a successful lawsuit against Google on that issue, or even a plausible legal theory. Have you discussed this with an actual attorney?
Google chooses to rank "authoritative" sites based on its own notion of authoritativity (which they don't share, but they decide).
They implement it as agnostic tuning as much as possible, avoiding single human chery picking sites. They use panels of humans (mturk style) for quality ratings.
Could you imagine the outrage if Google said "The government is always the best source about everything?"
What even would be the point? Use the government search engine for that use case.
Google already does this. Searching for "YMYL" (Your Money or Your Life) should produce useful results:
> For pages about clear YMYL topics, we have very high Page Quality rating standards because low quality pages could potentially negatively impact a person’s health, financial stability, or safety, or the welfare or well-being of society.
I disagree. There is lots of useful information around the internet that is hard to find. A lot of content simply doesn't have the keywords it needs to be discovered.
For example, somebody could search for "best rewards credit card for married couple with normal lifestyle" and find some listicle full of referral links that's a few years old. But the best advice might be in a Reddit or Twitter discussion titled "what's a good card for my P2 with no AF, low MSR, and at least 2CPP" whose replies are terse comments like "CSP?" or "BofA Custom; select CNP transactions as the 3% category and order everything online. they give high CL if you want to AU instead". There's enough jargon and levels of understanding that Google can't find the best advice, only good keyword matches.
I recently had a similar issue when I searched for something well-phrased and generic ("how to stop wood joints from squeaking"). The results were lackluster, but after a few attempts, I found the most helpful results were actually under a specific application ("how to stop a bed frame from squeaking").
So what's my point? It's not Google's fault. They are trying their best of optimize text search, with some fancy word associations and other stuff to help. But it's going to take a lot of effort to make an efficient, scalable, general-purpose AI that can achieve near-human understanding of text and then find the most relevant articles related to that. This "super-Google" would have to comprehend every post and comment on the internet, contextualize the knowledge ("a squeaky bed is caused by squeaky wood joints or fasteners, so this advice is useful for any kind of squeaking wood furniture"), and quickly generate results for every query.
It's not WebMD's fault they have ad revenue that lets them hire writers to SEO their articles with the best keywords. Nor is it Merck's fault that they are using specific language that doesn't cover all the phrases that a person could search. Nor is it Google's for making a search engine without human comprehension. It's just a technological gap that can't be bridged in the present day.
Google can make or break any online business they want to. It is what it is... We let them get there... That being said, I haven't even tried to use Bing, and it's pretty much impossible to convince me that Microsoft Edge is worth a second look after all the years of MSIE, and how Windows has been slowly devolving over time.
If worst comes to worst, just add "reddit" to your search term, and then all you have to do is determine whether he answers you find look like they came from a human, a spammer, or a corporation.
I'd make the claim (without any real data), that the NHS has _such_ institutional power in the UK that it goes a long way to transcend any SEO shortfall it may have.
It does. Google treats gov.uk and nhs.uk sites as authoritative sources and ranks accordingly. We typically pay no consideration to SEO on non-campaign sites.
It doesn't stop ads from sneaking in above the results though. There's a whole industry of shady companies 'hijacking' and charging extra for free/cheap government services.
* transactional services - those that let a person do a task, like applying for a driving licence or registering a trademark
* information services - a collection of guidance on a subject, like maximum working hours or data protection responsibilities
There are some that don't really fall into either category and are there to advertise something. They aim to be informational and inspirational. Some examples:
The reason SEO is more important on these is that there's often competition. For example, if I search for 'teach in uk' the Get Into Teaching campaign site will be competing with lots of teacher training colleges and companies, job sites, etc.
The NHS definitely does rank highly in the UK. Not sure if it ranks above web md, but they’re usually both in the top 5 results if they have a relevant page.
It pretty much always ranks above WebMD in the UK. WebMD has a very low rank for me. Mayo Clinic is the site that I normally see tussling for the top spot with the NHS. Some examples randomly plucked from my brain:
1. Vitiligo: NHS: 1, Mayo Clinic: 2, WebMD: 7
2. Bronchiolitis: NHS 1, Mayo Clinic 2, WebMD: 9 (on the second page!)
3. Appendicitis: NHS 1, Mayo Clinic 2, WebMD: 3
4. Myopia: Mayo Clinic 1, WebMD 2, NHS: 3
5. Gastroenteritis: NHS Inform (never seen this before?) 1, WebMD: 2, Mayo Clinic 3, NHS: 4
6. Hodgkin's disease: Mayo Clinic 1, NHS: 2, WebMD: 5
I want to thank you for posting this. I was not aware of the Merck Manuals, and have often struggled to identify useful information on WebMD or Mayo Clinic sites.
Today my wife had a specific medical concern that we wanted supplementary information about, and because of your link we had incredibly helpful and credible insight that helped us and provided a deeper understanding of what her physician was saying.
Indeed. You mention it being SEO but I see the NHS website has a nice site hierarchy and even has schema.org data.
SEO in one sense is to 'help search engines understand a page', maybe the crossing point is where it outranks and appears too much. A site/page ranking well in Google says as much about Google as the site/page.
Google's problem is that it ranks pages, not sites.
It will much prefer a crappy site with a crappy page that is highly specific to your search query, instead of showing you a good site related to the idea you are looking for.
It puts far too much faith in its language parser, which doesn't comprehend.
I think this is giving way too much credit to Google. WebMD has existed in some form since 1996 and first went live as WebMD in 1999. They've been the web's most popular health information publisher from the beginning. This was before Google became the web's dominant search engine.
If Google has an issue here, it's that it tries to rank things based on a more or less mathematical look at its actual popularity at the time of indexing. It isn't aiming to promote sites based on quality in order to make them popular. If a site is where other sites are pointing and people are visiting, then Google is going to rank them highly (modulo whatever the hell other secret sauce goes into the algorithm - i.e. punishing slow load times), even if the information content is bad. WebMD was very much already the web's most popular source of health information well before they hit the top of any Google search.
This isn't even a problem specific to the web, let alone Google. Medical textbooks were available at the time Chicken Soup for the Soul was a best seller. Consumers quite often prefer shittier information to better.
> I don't know how precisely they achieve this, but they're doing something right in an SEO sense if The Google continues to put them near the top of results after all these years.
One hand washes the other. WebMD is chock full of google and other ads.
A fairly straightforward answer is that the government's goals are not necessarily aligned with your own. You, presumably, care very much about your own personal health. You also care about other people's health, but you really, really care about your own health, and probably don't want to die earlier than you need to.
The government, on the other hand, doesn't generally care about individuals, and is working on a statistical level. A good government wants the population overall to be in good health, and has a budget within which it must operate. It may make more sense for the government to ignore your rare disease if detection/treatment is expensive, and that money can be better used to save, say, 10 people with a more common disease.
Now, if the government was just providing health information, and individuals were on the hook for payment, this disconnect wouldn't really exist. But if the government is also providing the healthcare services "for free" to individuals, then there is an incentive to downplay testing for rare or expensive to treat diseases due to the cost/benefit ratio.
Is that supposed to be an advertisement for private healthcare? With insurances companies deciding based on profit margins? I'd say the government incentives are a lot more aligned to have their population healthy and productive, than the insurance company looking at how much you paid for your premium and how much the treatment is.
Pointing out a conflict of interest is not an advertisement for anything. It is what it is. You could also have publicly funded, 100% government provided healthcare which provided some base level of care but allowed individuals to pay for specific treatments if they wanted them and they weren't a part of the base level of care.
Most public healthcare systems provide excellent treatments for the majority of the population. And, if you have some rare condition that can only be treated with some state-of-the-art cure that is only provided by some hospital out of the country, and you have several hundred thousand $$$ in your bank account, nobody will stop you from paying the treatment from your pocket.
It's best to know and understand each party's interests. Insurance companies want to keep you alive and paying premiums. Hospitals (government, for-profit, and non-profit) want you to receive a lot of treatment. The government treasury wants to keep you alive as long as your future tax payments exceed their healthcare and other expenditures. Government health departments have an extremely complicated set of incentives, dependent on exactly how they're organized.
> the government's goals are not necessarily aligned with your own.
as opposed to the private sector?
> But if the government is also providing the healthcare services "for free" to individuals, then there is an incentive to downplay testing for rare or expensive to treat diseases due to the cost/benefit ratio.
Which is what current private insurers often do. The government's incentives aren't just to cut costs and run more efficiently. It mostly cares about staying 'the government' and having people live long enough to pay taxes. I want to hear the same argument when you're talking about the government's incentives to be more cost effective when it comes to funding the armed forces.
I think the gist of it is that as an individual, in theory, you have leverage over the government via your votes or representatives. You have none of that when dealing with the private sector. So in this case, if I'm bothered by what the government publicizes about diseases and such, I have several tools at my disposal to deal with it (FOIA requests to track down who's responsible, town halls, writing to the representatives, lobby, voting etc..). If a private company does it, what am I going to do? Write a bad review?
The private sector will generally be happy to give you a service if you come with cash in hand. Which is why in the UK I can go get a brain MRI at a private clinic if I had a dream that I was developing MS, whereas I can't do that with the NHS.
That's not really what's happening at all. It's often cheaper to get an early diagnosis or catch a condition before it progresses too far.
The government doesn't actually hide information about diagnosing or treating diseases, even rare or expensive ones. They do, however, take into account the relative risk of false positives and resulting unnecessary treatments, which often outweigh any benefit of proactive testing for rare diseases.
It's counterintuitive, but if you have a 99% accurate test for something that means you're going to end up with 1 in 100 people getting false positives and undergoing potentially expensive (out of pocket) or dangerous diagnostics and treatments. When considering rare conditions that might only occur in 1 out of 100,000 patients each year, a 99% accurate test results in 1000 unnecessary false positives just to catch the 1 true positive. At scale, this can produce a lot of problems that can actually make life worse on average for the population rather than better.
I agree that there are valid statistical reasons to limit testing, but governments ration care and allow for long wait times when they are responsible for paying the costs. Faster testing and treatment is generally believed to be one of the best things you can do to improve patient outcomes, and government healthcare systems are notoriously bad at this (even worse than private healthcare).
Long wait times don't reduce the rate of false-positives, and false diagnoses. Long wait times deter people from seeking treatment, thus reducing costs.
> Here in reality, we are actually self-governing.
Given there is more to we than just me, "The Government" would refer to mostly other people and specifically other people with a particular proclivity toward involving themselves in the lives of others, to what effect is in the eye of the beholder.
> A good government wants the population overall to be in good health, and has a budget within which it must operate. It may make more sense for the government to ignore your rare disease if detection/treatment is expensive, and that money can be better used to save, say, 10 people with a more common disease.
That happens on the research funding side (e.g. it makes more sense to spend research money on cancer or heart disease than on an obscure disorder that only 10 people have).
However, it's not true that the government will provide misinformation or otherwise get in the way of diagnosing your rare disease to save money.
There are a lot of studies about the cost/benefit tradeoff of early diagnosis and preventative screenings. The goal isn't to reduce healthcare expenditure, it's to reduce problems and deaths from unnecessary procedures and treatments. We learned a lot from previous eras of over-treatment and over-testing that led to a lot of unnecessary treatments due to false positives. The risks of over-treating can actually outweigh any benefit of excessive testing, for example.
This is counterintuitive to individuals who want to order huge numbers of tests all the time just in case something might be wrong. The problem is that a lot of diseases may have occurrence rates on the order of 1 in 10,000 or 100,000 per person-year, while the tests may only be 98% to 99% accurate. This 1 to 2 in 100 will be misdiagnosed as false positives and potentially put on expensive medications or treatments that have negative health consequences. It's a very real problem that isn't obvious from the individual level but becomes very obvious at the population level when you start looking at the details.
But no, the government isn't actually hiding information about diseases or misleading people in an attempt to reduce costs. With many conditions it's actually much more expensive to be diagnosed later in the disease than it is to be diagnosed earlier when many conditions are more receptive to treatment.
I think the issue isn't data, its the "packaging". Going through the NHS website, it's useful if you already know what you have. I'll use myself as an example because I had an ingrown hair on my neck a few weeks back, went on google and I didn't search for "Ingrown Hair" because at that stage, I didn't know that it was an ingrown hair. I searched for "bumps on your neck" which led me to conclude that it was an ingrown hair (followed by a doc telling me the same thing).
One idea I've had for a long time is the US Gov't (and all major governments) should have a large data gathering/distribution operation. This data would be things like medical research, and other data that would be in "the public interest" (basically all the data we have now, just in one place), everything from meeting notes, congressional bills, etc.
With a wealth of data from a single source, companies like WebMD could stop focusing on how to get the data, and shift their focus to how to "package" the data. A list of conditions with symptoms is nice, but lets repackage that into a "medical graph" that lets you explore related conditions through symptoms. Companies could then compete on the "packaging". You could go to FreeMD and get the same data as you could on WebMD, but WebMD has a much better search engine for X thing so they are worth the $4.99/month cost.
It would be expensive, and probably be a decade long multi billion dollar operation. But imagine the revolution in government services if there was a single source of truth for data.
There are arguments against this, mainly do you want a government to have that much power. But I think it could be done with some strict limits and checks. Data in this API would only be public government data, so IRS data and other private information is not on there.
NHS already offers a (fairly rudimentary, last I checked) diagnostic tool in the form of NHS 111, which as well as being a phone number that people in the UK can call to talk to someone, is also a website (https://111.nhs.uk/) where you can give your symptom(s) and get a suggestion if possible causes.
It may not yet be good enough in all cases, I'm not sure, but is that what you're asking for? I'm not quite sure as you dived into things like data licensing without being clear on your actual hoped end result.
(Of course, the 111 site is designed as part of the wider NHS system, so when in doubt it's more likely to give advice to speak to a GP / call to speak to a nurse / visit a hospital, than to say "not sure, here are all the conditions it could be". But as it gets better I expect it to be able to do both.)
Not to mention that the main NHS site also lets you search for symptoms in the main search bar, so you don't need to know the condition to use it to search for possible conditions. edit: as better pointed out by jjar here https://news.ycombinator.com/item?id=32650958
One issue with the NHS is that I get the impression the information they publish that strongly respects their goals and desires perhaps to the detriment of patients sometimes.
I’ve certainly noticed in the past big differences in advice. The NHS will downplay and not suggest investigations whereas another (non UK) site does the opposite.
The NHS advice surely is carefully crafted not to cause unnecessary (from their point of view) GP visits, tests etc.
I wouldn't necessarily assume that not suggesting investigations is detrimental to patient health. There is a continuing big debate in the UK medical profession about how over-investigation and over-medication/medicalising people can be a real problem in terms of patient health.
If you are seeing a disparity between UK and US in terms of advice about when something needs to be investigated, it could be that the US site is over-promoting investigations.
Keep in mind that the NHS puts a lot of work into prevention, into staying healthy without medication - it will quite often advise life-style changes, rather than popping pills - and that's for patient benefit.
The point is that they aren't neutral. They have a bias toward what they think is best, and they don't overcome it by acknowledging and advertising alternative views.
NHS is focused on the appropriate allocation of resources to the problem. It strikes an excellent balance of doing the right work when necessary and based on probabilities. If you have evidence that the process recommended by the nhs is failing patients in statistically significant numbers I would agree with you on them not doing enough tests but frankly, I think NHS would perform very well if it was adequately resourced (it’s currently starved of necessary funding).
The NHS follows a strict set of guidelines for the identification and treatment of illnesses. They do not act like medical businesses such as hospitals whose goal is to do as much testing as they can justify to get more money from insurers.
If you're not sick you should not be subjected to too much testing, because the risk is that you are diagnosed with a thing that will not harm you. And once you're diagnosed with it the tendency is to treat you for it. Treatment is not a neutral option, it carries risk.
Over-testing, over-diagnosis, and over-treatment all contribute to patient harm.
The argument was that the NHS does the exact correct amount of testing, diagnosis and treatment. That’s patently false.
The NHS regularly fails me, my friends, my family by refusing to do diagnostics while clearly sick. My GP refused to test me for Lyme disease even though I had lots of classic symptoms and had been in close contact with a deer (because he believed they’re not an issue in the area.)
I feel we’ve strayed quite far from my original point but that’s to be expected in any religious discussion.
> One issue with the NHS is that I get the impression the information they publish that strongly respects their goals and desires perhaps to the detriment of patients sometimes.
Do you have data that supports the NHS withholding or advising against necessary care that results in worse patient outcomes?
More utilization is not inherently better, and even in the systems like the NHS, everyone is incented heavily to keep patients healthy and out of the hospital system. The idea that they want you to be sicker rather than provide relatively cheap preventive care is, generally, absolute nonsense.
To extend this a bit, the ultimate solution is a quasi-government nonprofit organization along the lines of ICANN (or maybe part of ICANN) that operates a crawler and a database of crawled sites, plus an API for that data.
This would not be a search engine per se but a neutral backend that anybody could build a search engine on top of. Want to build a search engine and sell ads? Fine. Want to build a search engine specializing in health information subsidized by the drug companies? Fine. Want to build one as a neutral nonprofit and charge subscriptions? Fine. The same backend database works for them all. Even Google could build a frontend on top of it.
Yes it would be expensive. The government would have to pay for all the backend infrastructure (whether the government buys it or rents it from Amazon, Google, Microsoft, etc.), and Cloudflare and robots.txt would have to allow "icanncrawler" to access sites without friction. But it would finally allow the creation of neutral search engines not beholden to advertisers. It's a piece of infrastructure the modern Internet sorely needs.
In the US, the CDC has been really bad at providing health information, and the FDA has been really bad at providing food safety info. They also don’t have incentive alignment (incentives are mostly to grow the bureaucracy and serve careers).
I’d expect private enterprise to eventually converge on better info… eventually consumers will choose services that provide the best info amidst competition.
Check out the National Library of Medicine’s MedlinePlus resource for an equivalent to the NHS’s consumer-oriented health info portal: https://medlineplus.gov/
It's my first time seeing it, but it seems like yes.
I have a relatively new mole that I thought looked a bit funny, so I awhile ago now I looked up what malignant ones look like, thankfully it doesn't seem to be.
Interesting! But the first link you gave is just a list of conditions, which requires that I already know what my problem is. Is there a page that goes from symptoms to likely causes and what to do, like WebMD?
I'd say if I were to suggest improvements the symptom search could definitely be better and more prominently placed. In the UK I personally (and I'd imagine most people) get to the NHS website directly from Google, which is better at finding more relevant pages.
That doesn’t really help. It just vomits a list of articles that mention coughs. The “killer” (rescuer?) feature of WebMD is being able to start from a symptom and narrow down through clarifying questions. You implied the NHS does this better, when it doesn’t attempt that feature at all.
I’m not sure this is the prime “UX done well for symptoms->cause” example you cited it as. Though I agree UK government sites follow much better UX patterns!
The information there a couple of years ago helped me losing a lot of weight and adapt a healthier overall lifestyle.
The information is dry, concise and easy to understand for a layperson. I cannot judge how well it is aligned with recent science, but I trust the site much more than most others, because their incentives after all is public health (I'm sure some politics play a role as well), not selling you books and courses with unrealistic expectations.
I also prefer information from the NHS even though I live in the US. Here medical information online is all about making money from ads and who knows what else they sell. There is actually little money to make from providing relevant information, unlike a national heath care system (which despite its terrible current state politically in the UK, where it seems they want to move to the US model) has an incentive to provide good information.
I don't know about the NHS, but we can't trust the information vended by the CDC -- they have proven willfully incompetent over the past two years. I will give just one example: they initially told us masks were ineffective against COVID, which they knew at the time was inaccurate. They said it because they didn't want a run on PPE required by medical workers. Result: there was a shortage anyway and they damaged their reputation irreparably. Great job everyone.
Mistakes to correct statements, yes. Those balance out. The opposite of being right is being wrong, the proportion of these two is their score.
Lies though, where we find out they knowingly said something they knew was wrong when they said it, don't balance out. The opposite of lying to someone to manipulate them is respecting them enough to let them make their own choices. They need to acknowledge that and start purely providing facts again - even at the cost of some political narratives, before they'll regain trust.
Corruption is bad, lying with good intentions is context dependent bad, mistakes are OK. But if one is going to throw out the baby with the bath water at every instance of corruption/lying/mistake, you are not going to be left with much other than chaos.
Humans are fallible creatures, we have to work and improve with what we have.
The exceptionalism of the USA is the fact that most of its organization are open to criticism and repair. The FDA/CDC/USDA/DoT/EPA/etc and many other non governmental orgs are far from perfect, but they are pretty awesome compared to the alternatives around the world.
If the “government” becomes the only source of truth, that source of truth is necessarily political. The oft-mentioned NHS — do they not have an incentive to lower health care expenditures? Would providing medical information to the public that prescribes a suggested course of action incentivize the course of action that is least expensive to the government but not necessarily the best treatment? Is there any potential for a conflict of interest there? Of course there is. If some condition is best treated with an expensive procedure, would the NHS be incentivized to recommend a cheaper, but less effective approach? Of course they would. The NHS routinely denies or delays life-changing surgeries over cost despite such denials not being in the best interests of the patient. (Try getting an NHS knee replacement.) There are treatments NHS won’t recommend because a person is too old. Not because they can’t handle the procedure but because the expense isn’t worth the amount of lifespan remaining in the patient.
Medical information provided by governments is often centered around what’s best for “populations” and not necessarily the individual. Covid is a prime example: masking kids was bad for the kids but allegedly “good” for the population. Damaging to the individual for the alleged benefit of the so-called greater good. Despite all the kid masking “science” turning out to be garbage. Covid vax for kids is another example: the government right now in the US promotes vaccinating even toddlers despite their individual risk of serious illness being statistically zero.
Covid information is another example: the government was wrong on multiple occasions throughout the pandemic. Yet when “official sources” are the only approved source of information, the public gets mislead. The marketplace of ideas is a real idea and it should be embraced. We need more private sector competition for information, not less.
If WebMD is bad, the solution isn’t government, it’s a competitor.
Of course the NHS has an incentive to lower costs, it's in their interest for doctors to prescribe the most cost effective treatment as patients rarely stop coming back as a result of ineffective treatment. Does this mean that objectively good preventative treatment (like physio) and quality of life elective surgery get pushed to the back of the triage queue, and that individual needs are occasionally failed? Absolutely, and in these cases where the NHS falls short there's always the option of going private, which just highlights that healthcare is always political.
In a purely private healthcare system (which doesn't exist in the developed world) the politics are firstly whether you can pay and secondly how much you can pay. No point offering free dieting and lifestyle advice when risky weight loss surgery (which has a notoriously low success rate) offers instant success, got a bad back or knee? Try out this risk free* (*not actually risk free) surgery! It wasn't that long ago in the US that getting cancer without health insurance was a death sentence, and that again is a political choice, one that the US government reneged on.
> If WebMD is bad, the solution isn’t government, it’s a competitor.
And how to decide who to trust? Still unsolved. The general public loves being lied to, as long as they like who is lying to them (same political party, religion, or just making impossible promises).
What would be better if basic stuff like this was part of our public education system. We need the equivalent of "shop" class but for basic medical needs. Wilderness First Aid would be a good start
>>Why is the private sector responsible for providing accurate health information? As this article shows, the incentives for people running medical websites <in the private sector> and the people reading them are not aligned.>>
I don't know that the cause of this particular misalignment is "private sector". But no doubt the current implementations by the private sector exhibit this misalignment.
>>I'd say the UK NHS website <which is public sector> and symptoms/medications pages hit the nail on the head>>
I assume this implies that the NHS website does not exhibit the previously noted misalignment. Why is that? Obviously this site's sole funding is not from advertising. I assume it's from taxes collected by the government. So what is incentivizing those that build this site and maintain its content to make it so good?
I'm wondering why my question got downvoted. I've had this happen before when asking questions. Could it be a matter of a couple of readers not assuming benign intent? As in, someone thinks I'm not actually asking a question but making a statement and they don't agree with the statement. Either way it's interesting.
Perhaps the more likely to be read as benign version would be this: We all agree site A is bad because it's misaligned (which I think all agree is due to being driven by ads). Then we propose that site B is good - but there's no indication about WHY site B is good. We know why site A is bad, but why is site B good. And more specifically since we're describing the value in terms of alignment, what alignment is there in site B that drives the goodness?
It's a common conflict for info publishers, the only solution is really to get rid of advertising. WebMD relies too much on industry advertisers and on companies selling pharmaceuticals and it corrupts their ability to objectively provide health advice. Advertisers pressure publishers for prime placement, and for editorial influence when they have weight to them, and it corrupts the tone of what a site can publish by nature.
The same is happening with many doctors that need to pay their overhead, many offices turn into "pill mills" because that is what keeps the lights on. We're at a very weird time in history, where people are more profitable as unhealthy individuals, so certain actors in health care peddle fear, confusion, and paranoia to sell medications as well as the valid issues and panaceas to them, and even minor and completely minute afflictions normally have commercials running non-stop on TV. WebMD is a tiny blip when you consider that people type their affliction into Google first.
Perhaps for them, and as the online ad economy melts itself down, contracting with the government to provide official information on a non-ad funded site with a far less cluttered UI might be a better long-term profit model.
> We're at a very weird time in history, where people are more profitable as unhealthy individuals
The thing is that to wider economy and society at large, people are vastly more profitable if they are healthy. This is one of the top reasons why countries spend so much on healthcare: healthy citizens are productive citizens.
The entire problem is one of externalized costs and misaligned incentives.
That graphic shows ~44k HNWI emigrating, and ~20k HNWI immigrating. I skimmed the underlying text and didn't see an explanation, so are we to assume the other ~24k HNWI immigrated to the rest of the world's countries in relatively low numbers per country?
I suppose another answer might be that it's easier to track HNWI leaving countries than it is to track them entering other countries?
While funny, California as a whole has (according to Wiki) 8.5% of million dollar net worth families. There are almost 10million of them in the US. That's on the order 1 in 10 people belonging to a family in that bracket in the US and thus a whole bunch of people. So that's not really just some tech bro's in the valley...
But I think when you extend the sample to the spectrum of all humanity (as the infographic does), $1 million USD becomes quite clearly a fitting benchmark of wealth.
