14 replies to this topic

[calmcookie]

Dear MM,

You wrote:

I can analyze my patient's blood chemistry and finally offer her appropriate, educated, scientifically-proven, peer analyzed, legitamate treatment. Her life will be good. She will remain active and happy and productive and will live a long, fruitful life due to medicine.

My reply:

I am wondering ... EXACTLY WHAT, are you going to offer her that will make here life "good" so that she will remain "happy and productive" and "live a long, fruitful life." What is it, exactly, that you can offer?


I am sincerely curious, C.C.

[maineman]

CC, You know that If I answer that question as it is posed you will find every possible listed side effect of the treatments and rake me over the coals for poisoning her system. I suggest that first you do some homework and read current reviews of Rheumatoid Arthritis and refresh your knowledge of this devastating disease, how the immune system really works and the genetics involved. After that, review statistical analysis, as we are reuquired to do and required to do on an annual basis. Then we can discuss the risk/reward ratio and current concepts in Rheumatoid therapy. Then I 'll tell you what HER C3, C4, ANA and RF levels were, what her IgG, IgA and what her related serum chemistries were and I'll explain how I arrived at her treatment protocol. If you would like current medical references on RA, let me know. MM

[calmcookie]

Please ... your fancy terminology makes no impression on me. Quite the opposite. You are unable to explain what you have to "offer" because NO pill / surgery / high tech diagnostic machine or other medical "treatment" can give anyone, with chronic illness, the "long and fruitful life" that you're implying it can. Let us just agree to disagree. I rest my case. C.C.

[maineman]

Please ... your fancy terminology makes no impression on me. Quite the opposite. You are unable to explain what you have to "offer" because NO pill / surgery / high tech diagnostic machine or other medical "treatment" can give anyone, with chronic illness, the "long and fruitful life" that you're implying it can.

Let us just agree to disagree.

I rest my case. C.C.

Man oh man. "Fancy terminology?" This is what I do. This is what I've dedicated my whole life to. I am not trying to impress you, trust me. The trouble with "Faith based dieting" is that you cannot offer any proof. Your assumptions are presumptious and naive. And, when you are challenged, in a fair intellectual debate you retreat, call names and "call off" the discussion.

I have many lovely patients (people...) who are living long, healthy and fruitful lives as a result of diligent medical care and treatments. Due to many pills / surgeries / and high tech treatments.

It is okay to debate. Just show me the proof.

maineman

[calmcookie]

"Faith based dieting?" That is good. Love it!!!! LOL. (okay, so I fibbed about "resting my case" ha ha ha ha ha :-)

Edited by calmcookie, 13 February 2006 - 11:32 AM.

[OEXCHAOS]

I'm going to strongly advise that folks back off and carefully choose their words when dealing with each other's statements and professions. I have no dog in this hunt, other than to maintain a civil and thoughtful dialog. It's not happending right now. I just want to give some thoughts, however. Maineman, I know that you don't want to present your field as beyond reproach, do you? If so, I'd love an explanation for why I know folks who are being prescribed anti-depressants (long term) by their GP without any appreciable follow up, let alone any attempt at therapy? Or why folks with obvious trival viral infections (flu) are being given antibiotics that promote multi-drug resistance when they'd get well on their own? I don't think that you'd claim that's good medicine, but clearly those practices happen all the time. Your field, like mine, has systemic problems and is constrained by time, expediency, and the need to get on with more serious matters. Additionally, medicine deals with very complex issues with multiple inter-related factors that often be most misleading or contradictory. My point is that the medical establishment does screw up and like any establishment has blind spots. Considering the complexity, it's a miracle that it's not worse. My field is much simpler, in many ways and look how screwed up it is! The fact is that some things are looked at more more closely than others and those what pay somone big money are likely to get looked at better than those that don't (like nutrition and "alternative" approaches). E.g. the dearth of comprehensive and credible studies on the long-term effects (positive and negative) of the use of cannibis vs. the ample studies on the benefits of viagra. C.C. You're onto some interesting stuff and it has to be beneficial to anyone who cares about improving their health and wellness and preventing disease. That said, when you dismiss "peer reviewed research" you're dismissing the best that we have. Without that, you are left with anecdotal evidence and heresay and the rantings of crackpots and the beneficiaries of plecebos all given the same amount of ample credibility. In other words, without rigorous, peer reviewed science, you're left with something that's not a whole hell of a lot better than superstition. I'm not saying that peer reviewed science is infallible or not to be challenged. In fact, the basic presumption is that it is NOT infallible and that it SHOULD be challenged. There ARE limitations, and that's definitely where what you're doing is helpful, but to engage in handwaving dismissal of that which allows us to exist as well as we do (and is invaluable to our understanding of reality) is not beneficial. We've all got blind spots. Good science and an open mind are the only ways to get around them. The only way this forum can continue to be useful is if we carefully respond when there is deep disagreement (I direct this to all parties). Hurling inflammitory comments or using cynical debate tactics isn't going to get us anywhere and I will take actions to avoid it should it continue. What I'm saying is that just being nice to the person or acting like you would be isn't enough. One must show real respect for what they are saying and one's responses should be focused on the facts and not at the person. Am I getting through? Mark

[maineman]

Great answer/comment Mark. You hit the nail on the head. The overuse of medications by some doctors is inexusable. That is why we have a peer review process. I was chief of medicine for 7 years at a large local hosipital. We scrutinize every admission, challenge each other in department meetings, sanction those who practice wrong or insist that they justify their diagnosis and treatment. In the modern world of medicine where there are a lot of HMO-style insurers we are now even able to begin looking into office practice. Doctors who prescribe anti depressants have to justify to a review board why, and what follow up they offer, just as you describe. We "flag" overuse of antibiotics. We monitor how physicians prescribe drugs, treatments, tests. etc. Why? Because the public expects us to be honest and we are commited to doing the best that we can. Is it perfect? Far from it. Are there doctors who shouldn't be allowed to practice? Of course. We're working on it. But to denigrate all of medicine is inappropriate. As you have so eloquently stated. Personally, I have long been into what I believe is healthy eating. But it is not my place professionally to "prescribe" or even tout unproven remedies, even if those remedies "feel" right, or seem to have comfortable stories behind them. When a patient comes to me I have to uphold the Hippocratic Oath. If they want to chat with me after work about my "beliefs" well, we can go for a beer and share our "opinions". You know me by now: I like to challenge people to really think about what they are doing, whether in trading or in medicine. maineman

[calmcookie]

Thank you Mark. FWIW ... I agree with you. I do not wish to offend, anyone. It's true that I have strong views on the subject, because of all the avoidable suffering I've witnessed. It is tragic. But, I have never denigrated "all of medicine." Nor is that my view. Alas, written communication has limitations and can be interpreted in various ways ... despite the best intentions and the use of emoticons. I regret any arguing tone that may have occurred ... I, however, am not the one who is angry, C.C.

Edited by calmcookie, 13 February 2006 - 12:34 PM.

[maineman]

Well, I am angry and I admit it. As a physician I am challenged every day by patients who want to know about diet, vitamins and other alternative therapies. Professionally I have to tell them what we know. I have to analyze data and interpret that data for them. I have to tell them the truth or I have to tell them that we do not yet know the answer. I also have an obligation to keep them safe. From unproven therapies or the improper use of treatments that have NOT been subjected to the scientific process. Why am I angry? Because those who tout unproven therapies are NOT subject to this same kind of peer scrutiny and are able to hoodwink the masses to the tune of billions of dollars a year. And people who are vulnerable fall prey and are put at risk. I mentioned the Hippocratic oath earlier: FIRST DO NO HARM. I see enormous suffering from naive people who thought they could manage thier health through potions, diets, etc. only to come to us late in the game, suffering, sad and feeling GUILTY, thinking that perhaps they didn't eat the right food or take the right vitamin or herb. What has got many of us fired up was the recent death of Correta King in a "clinic" of "alternate therapy" in Mexico. That clinic was run by an American chiropractor who had lost his license to work in the US, so he touted his herbs and vitamins to the cash customers and lied to them. He lied to the King family. (no, not all Chiropractors are bad...) Protest too much? We don't protest enough. Honesty, integrity. Truth. We are talking about life and death here. People. People's lives. Don't mess with that, please. maineman

[calmcookie]

Mainman, As I once wrote to Dr. Echo ... if we met in person, you might find that we have some things in common. I agree that there are a boat load of crazy alternative health scams out there. Naive people spend a lot of money on things that don't work. I understand that you have no way of assessing my intentions or qualifications. I could list them, but doing so is inappropriate. I DO respect the amount of work it takes to become a physician ... and I have worked with several wonderful doctors (endocrinologists) in Australia, Canada and the U.S. I do not wish to attack you or anyone else ... really ... I only feel frustration with the system of incentives. Doctors are human beings, like everyone else ... they are governed by the same rules of human behaviour. Most work within a system that rewards writing prescriptions and /or recommending surgery ... not spending two hours educating someone about how to quit smoking or adopt reasonable exercise habits, or give up coca cola. That said, I understand that you and other doctors may attempt to counsel patients on these issues ... but the financial incentives to really work at this are simply not present. I did not intend to make you angry ... that is of no value to anyone. C.C.

Edited by calmcookie, 13 February 2006 - 02:54 PM.