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  #1   ^
Old Tue, Feb-28-17, 09:30
WereBear's Avatar
WereBear WereBear is offline
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Plan: Epi-Paleo/IF
Stats: 220/161/150 Female 67
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Location: USA
Default Doctors and Patients: stuck in a rut

The title says it all:

Quote:
When Evidence Says No, but Doctors Say Yes

Long after research contradicts common medical practices, patients continue to demand them and physicians continue to deliver. The result is an epidemic of unnecessary and unhelpful treatments.


Sounds familiar to all of us, I am sure. From "you aren't eating enough carbs" from a diabetes "educator" to pushing statins on everyone who walks through the door, we are in a situation where knowledge is accumulating faster than the medical profession can properly absorb it.

Quote:
While he was waiting in the emergency department, the executive took out his phone and searched “treatment of coronary artery disease.” He immediately found information from medical journals that said medications, like aspirin and blood-pressure-lowering drugs, should be the first line of treatment. The man was an unusually self-possessed patient, so he asked the cardiologist about what he had found. The cardiologist was dismissive and told the man to “do more research.” Unsatisfied, the man declined to have the angiogram and consulted his primary-care doctor.


The Internet strikes again!

Quote:
And so the executive sought yet another opinion. That’s when he found Dr. David L. Brown, a professor in the cardiovascular division of the Washington University School of Medicine in St. Louis. The executive told Brown that he’d felt pressured by the previous doctors and wanted more information. He was willing to try all manner of noninvasive treatments—from a strict diet to retiring from his stressful job—before having a stent implanted.

The executive had been very smart to seek more information, and now, by coming to Brown, he was very lucky, too. Brown is part of the RightCare Alliance, a collaboration between health-care professionals and community groups that seeks to counter a trend: increasing medical costs without increasing patient benefits. As Brown put it, RightCare is “bringing medicine back into balance, where everybody gets the treatment they need, and nobody gets the treatment they don’t need.” And the stent procedure was a classic example of the latter.


Despite all the stenting that is still going on:

Quote:
In general, Brown says, “nobody that’s not having a heart attack needs a stent.” (Brown added that stents may improve chest pain in some patients, albeit fleetingly.) Nonetheless, hundreds of thousands of stable patients receive stents annually, and one in 50 will suffer a serious complication or die as a result of the implantation procedure.


That's the big issue: such a procedure usually has a 2-5% chance of complications, right up to death. That's a big risk for zero payoff.

Read the whole thing: it includes one of the major downsides of this kind of outdated thinking.

And it's not like this situation is improving, either:

Quote:
... The 21st Century Cures Act—a rare bipartisan bill, pushed by more than 1,400 lobbyists and signed into law in December—lowers evidentiary standards for new uses of drugs and for marketing and approval of some medical devices. Furthermore, last month President Donald Trump scolded the FDA for what he characterized as withholding drugs from dying patients. He promised to slash regulations “big league. … It could even be up to 80 percent” of current FDA regulations, he said. To that end, one of the president’s top candidates to head the FDA, tech investor Jim O’Neill, has openly advocated for drugs to be approved before they’re shown to work. “Let people start using them at their own risk,” O’Neill has argued.


That's my bold and my italics because &(#*$&)#(*$&)#(~ the heck! I don't think they are motivated by helping their fellow humans, is all I'm saying. When it already takes about ten years for an outdated, disproved, treatment to stop being given to patients.

What makes the current pharmaceutical situation even more of a gamble is the mounting evidence that there is a much greater range of genetic diversity than we ever dreamed of. Which means that miracle drug for Patient X could turn out disastrous for Patient Y.

Quote:
According to Vinay Prasad, an oncologist and one of the authors of the Mayo Clinic Proceedings paper, medicine is quick to adopt practices based on shaky evidence but slow to drop them once they’ve been blown up by solid proof.


And that's just basic brain wiring: we see something "work" and then it's "pry it out of our hands."

Was pro-survival at one time. Now... not so much

Getting the book referenced in the article: Ending Medical Reversal.
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  #2   ^
Old Tue, Feb-28-17, 11:42
bkloots's Avatar
bkloots bkloots is offline
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Plan: Atkins/LCHF
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Quote:
To that end, one of the president’s top candidates to head the FDA, tech investor Jim O’Neill, has openly advocated for drugs to be approved before they’re shown to work. “Let people start using them at their own risk,” O’Neill has argued.
Whoa. I'd like to see the source and context of a shocking statement like this.

Already, overwhelmed doctors are in the position of saying, "Here, try this and see what happens." The subtext: The pharma rep came by and left a boatload of samples. Might as well clean out the storage closet.

Oh, I hope I'm just imagining this!!

Meanwhile, my doctor is "required" (based on the lab numbers, my age, and just a general hunch, I guess) to prescribe a statin for me. I always say, "Thank you, no." And he can scribble down that I'm a non-compliant patient.

Is this all wrong, or what?? Maybe we'd better take this over to the War Zone.
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  #3   ^
Old Wed, Mar-01-17, 07:02
WereBear's Avatar
WereBear WereBear is offline
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Plan: Epi-Paleo/IF
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Here's another article:

Quote:
Destroying the FDA to save it? No, more like just destroying it.

My jaw also dropped at this statement by O’Neill in the same talk:

"As a libertarian, I was inclined to believe that the regulatory costs that the FDA impose kill a lot of people and provide a lot of harm to the economy, and I don’t deny that … but one thing that surprised me is that the actual human beings at the Food and Drug Administration like science; they like curing disease and they actually like approving drugs and devices and biologics."

This should tell you a lot about Jim O’Neill. He had the attitude that those FDA scientists enjoyed shutting down innovation, preventing drug approval, and in general preventing industry from profiting. Of course, nothing could be further from the truth. FDA scientists are dedicated to promoting the health of the people of the US; they view their role as watchdogs to prevent ineffective and unsafe medicines from being approved as integral to that role, but they like approving effective new drugs.


There's a video at the link. Watch him saying all kinds of bizarre and disgusting things, and realise this is Trump's pick for FDA Commissioner.

The more you find out about this, the worse it gets. To approve more research money, Congress agreed to let pharmaceutical companies do anything they want.

And we all know what they will do, and what they want.

The thing that scares me the most, thanks to my research on hormones, is that drug companies are coming up with drugs which seem to create irreversible side effects.

Some people who took the baldness drug Propecia wind up with all their natural life functions damaged to the point of no libido, crushing depression, and a destroyed immune system.

Some people who took the acne drug Accutane have to have their intestines removed, risk blindness from perpetual dry eye syndrome, and develop a form of rapid aging.

It is known that 12% of the users of a certain anti-depressant have their sex drive destroyed as a result of being on it; while others report all kinds of damaged mood regulation from such common drugs as Prozac and Xanax.

And because these antidepressant patients reporting things that cannot be measured in blood tests and they have symptoms we associate with being mentally ill; they are not listened to.

Because even the current protocol is to gather a group of people for a test and first, eliminate anyone who experiences side-effects. Now that we know the great genetic diversity of the human population, this means a drug that won't harm person A will be a disaster for person B.

But we have no way of knowing who that person will be.

Last edited by WereBear : Wed, Mar-01-17 at 07:19.
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  #4   ^
Old Wed, Mar-01-17, 07:26
Karhys's Avatar
Karhys Karhys is offline
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Thank you for sharing this article. I feel both enlightened and aghast all at once, even though at least half of it was not new to me. (The half that was new to me was so terrifying.)

I visited a GP last year to ask her to get some blood tests done for me. While I was in there, I mentioned I'd been having trouble with my jaw popping and clicking, and some pain in my ears and surrounding areas.
Without even asking any further questions, she told me that it was almost certainly bruxism, and went into detail about the eventually therapies involved, including that you get botox injected into your face?! She never ONCE even asked if I grind my teeth or clench my jaw. I DON'T. Now, I've done enough reading to already know what bruxism is (and would've Googled it immediately if I hadn't) but someone less informed than me would have fallen for her crap and gotten treatment they didn't need that would have probably decreased their quality of life without fixing their problem.

Side note: when I finally found a good GP who started treating my chronic fatigue properly, the jaw and ear problems completely vanished. Yeah, not bruxism.

Honestly, after years of being treated like crap, these days I am so terrified of doctors. And this article really confirms for me that I would Google the HELL out of any treatment offered, even in an emergency situation.
My current GP is awesome, prescribes supplements over drugs, tells me to Google stuff and watch Youtube videos and to take notes, and he answers any questions I have about anything he gives me or any results we get. And I still Google the hell out of anything he suggests before I go ahead with it... because we have to in this day and age if we want to protect ourselves. And that is such a sad state of affairs. :/ We should all be so much healthier than we are.
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  #5   ^
Old Wed, Mar-01-17, 08:03
WereBear's Avatar
WereBear WereBear is offline
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Plan: Epi-Paleo/IF
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Default

Sadly, I am also in that same gotta-do-my-own-research boat. Had a terrible sinus issue and got antibiotics from an urgent care center. It wasn't until I had already taken one (these things, when I was sickest, had a tendency to get totally out of hand) that I found out it was one of those tendon-explody ones.

I dumped it and waited until my regular doctor was back from vacation. He gave me regular ol' antibiotics; there wasn't a reason in the world to give me the more expensive, more dangerous, one.
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  #6   ^
Old Wed, Mar-01-17, 08:52
GRB5111's Avatar
GRB5111 GRB5111 is offline
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Plan: Ketogenic (LCHFKD)
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Thanks for this information WereBear. This is more evidence that patients must advocate for themselves. Further, it is essential that we as patients research health issues to stay current with information to understand which physicians and medical practitioners are dispensing accurate advice. While many of us have taken this approach, it has become more critical today that we protect ourselves with knowledge and by being informed. To do otherwise could be deadly.

Last edited by GRB5111 : Wed, Mar-01-17 at 23:08.
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  #7   ^
Old Fri, Mar-03-17, 12:07
WereBear's Avatar
WereBear WereBear is offline
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Plan: Epi-Paleo/IF
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We live in stupid times.
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  #8   ^
Old Fri, Mar-03-17, 12:21
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cotonpal cotonpal is offline
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Plan: very low carb real food
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I had to figure out and solve my own health issues. It's an ongoing project. I am grateful to have the ability to do this and to not rely on misguided western medicine. We do live in stupid times. Have there ever been smart times?

Jean
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  #9   ^
Old Fri, Mar-03-17, 13:58
WereBear's Avatar
WereBear WereBear is offline
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Plan: Epi-Paleo/IF
Stats: 220/161/150 Female 67
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Progress: 84%
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We do seem to have that cholera thing calmed down

I was reading recently that the greatest advances to our health have come from public health measures like clean water, mass vaccination, and supplementation campaigns, like the iodine in salt and the B vitamins in processed flour.

In a way, it means our medical professionals are dealing with things they never had the chance to study or understand until a century or so ago; it is no wonder they seem so clueless about many things.
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