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Can we trust the doctor's metrics as to what is healthy?

by (20787)
Updated about 12 hours ago
Created February 19, 2011 at 6:09 AM

I was recently reading one of Castle Grok's posts where he mentions he used to eat SAD and felt very sickly all the time, but when he went to the doctor, the doc said he had a nice low trig score and all healthy metrics and was pronounced to be 'as healthy as a horse.' But he knew he was not because he felt sick all the time. Because of that, he no longer trusts doctors to be the judge of his health.

Then there is the man who ate nothing but pototoes for 60 days. The end result was the doctors felt his blood metrics were much improved: http://20potatoesaday.com/index.html Is such a diet truly healthier? If you go just by the doctor's metrics, the answer is yes.

Then there is the guy who decided to eat 2/3rds of his caloric intake in the form of twinkies! Yes, he too lost weight, his triglycerides went down, 'bad' cholesterol went down and 'good' cholesterol went up. Was this guy healthier?
http://edition.cnn.com/2010/HEALTH/11/08/twinkie.diet.professor/index.html?hpt=T2

How reliable are the doctor's health metrics when it comes to determining health?

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1502 · February 24, 2011 at 4:17 PM

You might want to check out Stephen Guynet's (over on Whole Health Source) assessment of why the potato guy lost weight on that diet. One of his speculations is that potatoes get boring quickly so he simply ate fewer calories! And, of course, if he lost weight that would probably help his blood numbers in a variety of ways.

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2099 · February 20, 2011 at 2:58 AM

No, I haven't read *Arrowsmith*, but it sounds very interesting, and I'm going to see if I can get a copy if its in print, because that narrow educational focus is intensely interesting to me for several of reasons. Btw, PMing would be fine, but I don't see how to do it.

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762 · February 20, 2011 at 1:36 AM

@Helen: Given the length of these comments perhaps a PM is more appropriate. Nevertheless, have you ever read Arrowsmith by Sinclair Lewis? Although written at the turn of the last century, its dialog is scarily accurate (all the more so because people say those satirical lines seriously). My point is medicine's history doesn't differ much from its present. That said many student-doctors are ignorant of the history of their profession, perhaps because one chooses many college classes strategically to get into medical school not for learning on its own.

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2099 · February 19, 2011 at 11:48 PM

Its good to see your humanity, mac 389, really. But the problem is the *system*. Until we can conceive of another system...one much less brutal and power-and-profit-driven...things will remain as they are and *everyone*, patients and doctors alike, will suffer from it. That is why it is so important to know the "hidden" history of medicine...why it is like it is and how it got to be that way.

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2099 · February 19, 2011 at 11:18 PM

*I* know that they aren't infallible...I wish to god that more of *them* knew that, too, instead of being arrogant, callous butt-heads who put too much stock in tests and numbers instead of learning the subtle *art* of medicine.

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2099 · February 19, 2011 at 11:15 PM

p.s. I was young at the time, and trusted the doctor. Foolishly, as it turns out.

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762 · February 19, 2011 at 11:14 PM

@Helen: There is no excuse for what this physician did to you. But, physician aren't infallible. They are all too human. It's something they and the public must come to terms with. I have stayed up many nights wondering how many people I will inadvertently kill in residency. It is a sobering thought. But, how else to residents learn? Writ larger how else does medicine learn by mistake on humanity?

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2099 · February 19, 2011 at 11:09 PM

I certainly agree with you that doctors are inculcated with arrogance. It makes many of them callous. It also predisposes them to not listen to the patient because the doctor "knows better". I nearly died of an ectopic pregnancy. Although I told the dr that I felt pregnant and that I was in pain, the pregnancy test was negative. But instead of him investigating further, I was dismissed as a hysteric and told to use a laxative. But I was right, I had been pregnant, and I was bleeding internally from a ruptured tube. So please forgive me for being unable to be objective about this.

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436 · February 19, 2011 at 11:01 PM

"medical school curiculums ... bought and paid for by the drug companies" Helen, I object to the fallacious attack in your answer and your insulting comments directed at others here. While there are a myriad of significant & severe problems in medical education & practice, this is not the venue in which to vent your spleen. If you want to get involved, visit the Institute for Healthcare Improvement or ePatients (empowered). There are many forms of patient advocacy at all levels. With your passion and wisdom, surely you will find one that's a good fit and that will welcome your talents.

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762 · February 19, 2011 at 10:56 PM

@Helen: I do agree with your point that surgeons & physicians have a different European history, especially in England. I sympathize with the problem's physicians face in that the presentation and mechanisms of injury are more subtle.

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762 · February 19, 2011 at 10:54 PM

@Helen: Let's keep this civil. Your original answer states that drug companies fund and direct medical school curricula. It doesn't mention seminars for licensed doctors. There are egomaniacs and power junkies everywhere, cf. the "masters of the universe". So why out of hand reject all doctors? The GPs who go to Appalachia, Doctors without Borders?

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2099 · February 19, 2011 at 10:52 PM

and p.s. It was RG73 who failed to see that I distinguished between medical school and pharma-run "education" seminars and surgeons. I *did not* tar surgeons with the same brush as the physician-shills as RG73 said I did.

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762 · February 19, 2011 at 10:51 PM

@Helen: One shouldn't confuse the limits of medicine with malevolence. A doctor who passionately advocates SAD may just be doing the best with what he was taught. How to educate doctors whom the system inculcates with arrogance is more the issue. The same qualities that make one confident in clinically uncertain situations make one unreceptive to knowledge at other times. Medical researchers may have more vested interests. But, let's not open that can of worms.

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2099 · February 19, 2011 at 10:45 PM

sorry about the goof-up in my last comment when I quoted mac389. My own comment is "If you read my original answer, you will see that is *exactly* what I did."

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2099 · February 19, 2011 at 10:43 PM

@mac389: you should distinguish between medical school and pharma-run "education" seminars. If you read my original answer, you will see that is *exactly* what I did!

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2099 · February 19, 2011 at 10:41 PM

Being a doctor is also about being able to wield power over others. Alot of doctors are power junkies and egomaniacs...their staffs are afraid of them, and they intimidate their patients. This, too, is common knowlege.

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762 · February 19, 2011 at 10:40 PM

@Helen: Many aspects of medical education are designed to make doctors-to-be act the part. All medical schools have a class where they grade you on how'doctor-like' you act with fake patients. Still, the uniformity in medicine doesn't appear to go to the core. There are many historical antecedents to the modern doctor. Physicians and surgeons are different, for example. As RG73 noted, you should distinguish between medical school and pharma-run "education" seminars.

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2099 · February 19, 2011 at 10:36 PM

Well, if I am, Kamal, then I am harming only myself. But when medical professionals are influenced by pharmaceutical money *plus their own logical fallacies*...like "cholesterol causes heart disease", just to use one example, then they end up killing people by the hundreds of thousands of every year. I have been brutalized by the medical profession enough times in my life to have come to heartily loath it. I distrust doctors on principle.

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24523 · February 19, 2011 at 10:16 PM

Even if RG73 is being influenced by pharmaceutical money, I do believe Helen is being influenced by a multitude of logical fallacies.

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2099 · February 19, 2011 at 9:16 PM

...a doctor is clearly about more than money. Its an *identity*. When a person's identity is at stake, they will fight tooth-and-nail to defend it. Prior investment is about making sure that you become identified with the system, and mistake it's interests for your own. It is also about putting the welfare of the system above the welfare of the patients. It is also about peer pressure and the fear of bucking the system, since the system controls the livelyhood of the doctor. So in a very real way, it is about you.

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2099 · February 19, 2011 at 9:12 PM

Can you possibly deny that medicine, as it is currently practiced, isn't *drug based*? How do you think it got to be that way? The apple doesn't fall far from the tree, you know. It has to do with you because whether you like or not, and whether you want it to happen or not, you are being influenced by drug company money. One of the reasons, although not the only one, that tuition is so expensive is called "prior investment". By the very act of investing so much time, money and effort into the system, a person is that much more likely to support that system no matter what. Being...

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3184 · February 19, 2011 at 8:30 PM

Helen who is the ignorant and arrogant one here? You're the one who presumes to know my worldview and my beliefs. You don't know anything about me, my worldview, my beliefs, my experiences, or my medical school for that matter. I read that NYT piece a while ago. I'm not sure what that has to do with me. So tell me Helen, what do you know about me other than I go to one of the many medical schools in the world? How much funding does my particular school get from pharmaceutical companies? And how much money control do pharma companies have over USLME and COMLEX? Don't presume to know me.

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2099 · February 19, 2011 at 7:46 PM

...is hidden by your own beliefs about it. It is hidden from you by your ignorance and arrogance and by your need to believe in the system that you are investing yourself in.

1acc4ee9381d9a8d998b59915b3f997e
2099 · February 19, 2011 at 7:44 PM

http://www.nytimes.com/2009/03/03/business/03medschool.html http://jama.ama-assn.org/content/285/15/2009.extract http://www.sntp.net/fda/piper_griffin.htm http://www.themurielsmillerfoundation.org/conspiracy.htm http://www4.dr-rath-foundation.org/open_letters/pharma_laws_history.html The nerve I hit is the one that causes the person to reflexively reject all facts that contradict his world-view, in order to save himself from examining his beliefs. At any rate, the links I have found should get you started...you can find plenty more from there. The history of your chosen profession...

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3184 · February 19, 2011 at 4:56 PM

I need to look into the "hidden" history of my profession? If it is hidden, I can't, by definition, find it. So please, why don't you enlighten me? And with all your medical knowledge, do tell, what nerve did you hit?

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2099 · February 19, 2011 at 3:43 PM

Btw, I seem to have hit a nerve :P

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2099 · February 19, 2011 at 3:11 PM

You guys need to look into the hidden history and workings of your chosen profession. But then, you might lose your illusions...never a pleasant thing to experience.

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762 · February 19, 2011 at 12:19 PM

@Helen: Still, I understand your sentiment that like a social worker the doctor treating chronic illnesses, inasmuch as the doctor is profit-minded, an incentive to no do too much good exists. But, not all doctors treat chronic illnesses (e.g. trauma surgeon, an ER doc sometimes) and there will always be enough sick people.

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762 · February 19, 2011 at 12:17 PM

Medical school curriculums are nationally set, inasmuch as they must prepare people for the boards. Drug companies have little to do with that. Drug companies do heavily influence the medications private practice physicians prescribe when those doctors are choosing among drugs they were taught are equally effective.

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20787 · February 19, 2011 at 8:45 AM

I was not saying I think this guy was healthier. I was saying that by the commonly used doctors' metrics, they might be tempted to say he is healthier. Hence can these metrics really be trusted? People post here all the time worrying about their metrics or proud of them. But maybe these numbers don't mean quite so much after all. By the way, the twinkie guy agrees that such a diet is surely not healthy. It was done as an experiment only.

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24523 · February 19, 2011 at 8:23 AM

Also, obese does not depend on age, gender, or activity level. Just height and weight.

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24523 · February 19, 2011 at 8:03 AM

Why did you only put his lean mass loss? That's a little misleading. Especially because his DEXA results put him at a lean loss of 6 pounds (meaning water, glycogen, and muscle loss) and his fat loss at 25.3 pounds. That is about the same ratio as a bodybuilder cutting for a contest, which is unexpected and sort of incredible. And he got his bodyfat to just under "overweight" not "obese", which is a big difference (e.g. I am lean and technically overweight). Regardless of our collective skepticism of lab tests, we shouldn't pick and choose facts.

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2759 · February 19, 2011 at 7:55 AM

Dr. K - I imagine that part of the problem is that many people don't want to *have* to learn that much. For those of us who do, though, what do you recommend we ask our PCPs to help us choose the right one?

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3184 · February 19, 2011 at 7:43 AM

Umm, medical school curriculums are bought and paid for by the drug companies? I wish, then I wouldn't be taking out ridiculous amounts of money in loans. I haven't seen a drug company rep yet at our school. All the pharmacology lectures have done is convinced me that I want to save drugs for rare cases where they are actually needed because the side effects usually suck. I wouldn't doubt that there are some schools more tainted by drug company money, but don't tar all of us with that brush. There are a few Paleo adherents in my class even. Have hope, the good docs are on the way.

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25467 · February 19, 2011 at 6:40 AM

as a physician the landscape for a patient is caveat emptor. You need to assess us as much as we assess you. The tools are there but the info is lacking sadly.

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4e40d2b9e1a762949a25b958762aa10d
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762 · February 19, 2011 at 12:33 PM

Hi Eva,

You raise a very interesting question that I've never experienced discussed in medical school except for superficial discussions of sensitivity and specificity. However, to my knowledge, it is something that technicians, the more diagnostic specialties, and researchers in industry often grapple with.

The punch line is that these tests only show how different you are from a group of people whom the government thinks are normal. There is something called the Harvard-MGH death: the patient dies with perfect labs.

All lab values are compared to a normal range and the person establishing the test, who usually isn't the doctor, must apply his test to a reference population. One then says that your test values are abnormal if they deviate too much from the reference population.

This creates two statistical caveats.

  1. For simplicity most tests assume that the disease is randomly distributed among the population. This isn't in general true. (Although it makes calculating the variance of something so easy!) For example, any disease is conditionally dependent on its causative risk factors. So, if the risk factors aren't normally distributed, the disease must not be. So sometimes a test is valid only for a certain population. Often the doctors don't bother to learn that and wrongly apply it too widely.
  2. Signal Detection Theory quantifies how poor an aid many tests are in medical decision making (evidenced-based medicine is notoriously light on evidence). Even if the test really indicates that you have a lab value very different from everyone else's, science has often only shown that the thing you are testing for is correlated with some disease process. This makes for good tenure-getting and dinner conversation but without a causative role (thing X is necessary and sufficient for thing Y), it can be myopic to focus on lab values.

I hope that helps, Mike

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436 · February 19, 2011 at 2:08 PM

Interesting question, Eva. I'm not so sure that it can be done justice on this forum, but I'd like to throw out a few nuggets for consideration:

The practice of medicine aims at treating disease (including injury and illness). It is focused on understanding anatomy (the structure of body parts and systems), physiology (the functioning of body parts, systems and networks), identifying pathology of those and treating them to minimize symptoms (palliation), repair injuries (surgery, invasive procedures such as ablation, dilatation of narrowed parts, and excision and removal of foreign bodies and intrusive growths (cancer, overgrowths, etc).

Physicians receive a breadth of education in the basic sciences. Social science and humanities education is more variable, and in some cases, may be missing.

Education about health and well-being is very much a secondary focus, if covered at all.

Success is measured by the absence of disease and recovery from injury/illness. Primary care is aimed at the prevention of illness.

So you can see where this is heading.

Health and well-being and their promotion are not a focus of the practice of medicine.

However, professional nursing does address these, but only in university curricula for nurses educated at a minimum of the baccalaureate degree. Unfortunately, that's only about 1/3 of all nurses practicing in the US. Nurse practitioners and advanced practice nurses are educated at the master's level or above.

An interesting item to note is that multiple studies have shown equal or better patient outcomes and satisfaction with their care when received from nurse practitioners. My guess is that this is due in part to the focus on health and patient self-management - in other words partnering with patients instead of prescribing to them.

Where would I get reliable health-focused care?

I would use a primary care physician for illness prevention/screening and as a gatekeeper referral to these services:

A certified nurse practitioner.

A certified exercise kinesiologist.

A crowd sourcing health site, such as Patients Like Me and Cure Together.

PubMed, to read and evaluate the science.

A careful selection of research-based science and health-focused bloggers who provide primary source links and references and who make their own biases clear to readers.

Systematic reading of the health focused literature.

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7967 · February 24, 2011 at 11:43 AM

Yes, I think lipid ratios, blood pressure, and bodyfat percentage are fairly good indicators of general health.

Don't forget that a low-calorie weight loss diet is a high fat diet. ;) I think those guys were much healthier for the month they were on those ridiculous diets, because they were getting half their calories from many pounds of their own fat! I feel like hell eating like that immediately (I have done it before unfortunately), because I only have around 20 lbs of body fat and can't spare much to fuel my body in the absence of healthy food and fats.

And plenty of people have good general health even eating like crap, especially young people. Life isn't fair. I still had perfect cholesterol ratios, low blood pressure, etc when I was eating high-grain - and felt terrible! Good lipid panels, low blood pressure, and low weight run in my whole family - and we don't get heart disease and diabetes. We do have tons of autoimmune issues (most of my problems) and mental illness.

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1023 · February 19, 2011 at 3:31 PM

Sometimes you can trust labs as an indicator of health problems (A1C, PSA) and sometimes you can't (total cholesterol).

The Twinkie diet guy didn't really get 2/3 of his calories from Twinkies. He ate some pretty healthy food, along with some junk food, but kept his calories low to lose weight. http://www.fathead-movie.com/index.php/2010/11/16/the-twinkie-diet/

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3618 · February 19, 2011 at 7:18 AM

The guy who did the Twinkie diet is on Facebook and he posted his body comp test results. As I recall it (and you can go look him up), he lost something like 8 pounds of lean mass and he only got his bodyfat level to just under obese for his age, gender, and activity level. It does not take much loss of muscle in terms of space taken up in your body to register significant weight loss on the scale. He did it all wrong and he is emphatically not "healthier" as a result. One of the parameters of his weight loss that he claimed was a sign of improved health was lower cholesterol. I'm sure you've heard by now that lower total cholesterol is associated with increased all-source mortality, including deaths from accidents. Apparently, low cholesterol makes you dumber and more amenable to risk-taking. Or just more clumsy. Or some combination of all three. Hope he's got a good life insurance policy.

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20787 · February 19, 2011 at 8:45 AM

I was not saying I think this guy was healthier. I was saying that by the commonly used doctors' metrics, they might be tempted to say he is healthier. Hence can these metrics really be trusted? People post here all the time worrying about their metrics or proud of them. But maybe these numbers don't mean quite so much after all. By the way, the twinkie guy agrees that such a diet is surely not healthy. It was done as an experiment only.

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24523 · February 19, 2011 at 8:03 AM

Why did you only put his lean mass loss? That's a little misleading. Especially because his DEXA results put him at a lean loss of 6 pounds (meaning water, glycogen, and muscle loss) and his fat loss at 25.3 pounds. That is about the same ratio as a bodybuilder cutting for a contest, which is unexpected and sort of incredible. And he got his bodyfat to just under "overweight" not "obese", which is a big difference (e.g. I am lean and technically overweight). Regardless of our collective skepticism of lab tests, we shouldn't pick and choose facts.

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24523 · February 19, 2011 at 8:23 AM

Also, obese does not depend on age, gender, or activity level. Just height and weight.

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2099 · February 19, 2011 at 7:05 AM

If the medical school curiculums weren't bought and paid for by the drug companies, it might be different, but unless that changes, I will be staying out of the doctor's office unless I need an antibiotic or stitches or something of that nature. It's really too bad that chronic illness is so bloody lucrative.

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2099 · February 19, 2011 at 10:43 PM

@mac389: you should distinguish between medical school and pharma-run "education" seminars. If you read my original answer, you will see that is *exactly* what I did!

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3184 · February 19, 2011 at 4:56 PM

I need to look into the "hidden" history of my profession? If it is hidden, I can't, by definition, find it. So please, why don't you enlighten me? And with all your medical knowledge, do tell, what nerve did you hit?

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2099 · February 19, 2011 at 11:48 PM

Its good to see your humanity, mac 389, really. But the problem is the *system*. Until we can conceive of another system...one much less brutal and power-and-profit-driven...things will remain as they are and *everyone*, patients and doctors alike, will suffer from it. That is why it is so important to know the "hidden" history of medicine...why it is like it is and how it got to be that way.

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2099 · February 19, 2011 at 3:43 PM

Btw, I seem to have hit a nerve :P

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2099 · February 19, 2011 at 9:16 PM

...a doctor is clearly about more than money. Its an *identity*. When a person's identity is at stake, they will fight tooth-and-nail to defend it. Prior investment is about making sure that you become identified with the system, and mistake it's interests for your own. It is also about putting the welfare of the system above the welfare of the patients. It is also about peer pressure and the fear of bucking the system, since the system controls the livelyhood of the doctor. So in a very real way, it is about you.

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762 · February 19, 2011 at 10:54 PM

@Helen: Let's keep this civil. Your original answer states that drug companies fund and direct medical school curricula. It doesn't mention seminars for licensed doctors. There are egomaniacs and power junkies everywhere, cf. the "masters of the universe". So why out of hand reject all doctors? The GPs who go to Appalachia, Doctors without Borders?

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2099 · February 19, 2011 at 3:11 PM

You guys need to look into the hidden history and workings of your chosen profession. But then, you might lose your illusions...never a pleasant thing to experience.

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762 · February 19, 2011 at 10:40 PM

@Helen: Many aspects of medical education are designed to make doctors-to-be act the part. All medical schools have a class where they grade you on how'doctor-like' you act with fake patients. Still, the uniformity in medicine doesn't appear to go to the core. There are many historical antecedents to the modern doctor. Physicians and surgeons are different, for example. As RG73 noted, you should distinguish between medical school and pharma-run "education" seminars.

1acc4ee9381d9a8d998b59915b3f997e
2099 · February 19, 2011 at 10:45 PM

sorry about the goof-up in my last comment when I quoted mac389. My own comment is "If you read my original answer, you will see that is *exactly* what I did."

1acc4ee9381d9a8d998b59915b3f997e
2099 · February 19, 2011 at 7:44 PM

http://www.nytimes.com/2009/03/03/business/03medschool.html http://jama.ama-assn.org/content/285/15/2009.extract http://www.sntp.net/fda/piper_griffin.htm http://www.themurielsmillerfoundation.org/conspiracy.htm http://www4.dr-rath-foundation.org/open_letters/pharma_laws_history.html The nerve I hit is the one that causes the person to reflexively reject all facts that contradict his world-view, in order to save himself from examining his beliefs. At any rate, the links I have found should get you started...you can find plenty more from there. The history of your chosen profession...

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762 · February 19, 2011 at 11:14 PM

@Helen: There is no excuse for what this physician did to you. But, physician aren't infallible. They are all too human. It's something they and the public must come to terms with. I have stayed up many nights wondering how many people I will inadvertently kill in residency. It is a sobering thought. But, how else to residents learn? Writ larger how else does medicine learn by mistake on humanity?

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2099 · February 20, 2011 at 2:58 AM

No, I haven't read *Arrowsmith*, but it sounds very interesting, and I'm going to see if I can get a copy if its in print, because that narrow educational focus is intensely interesting to me for several of reasons. Btw, PMing would be fine, but I don't see how to do it.

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2099 · February 19, 2011 at 11:15 PM

p.s. I was young at the time, and trusted the doctor. Foolishly, as it turns out.

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2099 · February 19, 2011 at 10:36 PM

Well, if I am, Kamal, then I am harming only myself. But when medical professionals are influenced by pharmaceutical money *plus their own logical fallacies*...like "cholesterol causes heart disease", just to use one example, then they end up killing people by the hundreds of thousands of every year. I have been brutalized by the medical profession enough times in my life to have come to heartily loath it. I distrust doctors on principle.

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2099 · February 19, 2011 at 11:18 PM

*I* know that they aren't infallible...I wish to god that more of *them* knew that, too, instead of being arrogant, callous butt-heads who put too much stock in tests and numbers instead of learning the subtle *art* of medicine.

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24523 · February 19, 2011 at 10:16 PM

Even if RG73 is being influenced by pharmaceutical money, I do believe Helen is being influenced by a multitude of logical fallacies.

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762 · February 19, 2011 at 12:17 PM

Medical school curriculums are nationally set, inasmuch as they must prepare people for the boards. Drug companies have little to do with that. Drug companies do heavily influence the medications private practice physicians prescribe when those doctors are choosing among drugs they were taught are equally effective.

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2099 · February 19, 2011 at 7:46 PM

...is hidden by your own beliefs about it. It is hidden from you by your ignorance and arrogance and by your need to believe in the system that you are investing yourself in.

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762 · February 19, 2011 at 10:56 PM

@Helen: I do agree with your point that surgeons & physicians have a different European history, especially in England. I sympathize with the problem's physicians face in that the presentation and mechanisms of injury are more subtle.

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3184 · February 19, 2011 at 7:43 AM

Umm, medical school curriculums are bought and paid for by the drug companies? I wish, then I wouldn't be taking out ridiculous amounts of money in loans. I haven't seen a drug company rep yet at our school. All the pharmacology lectures have done is convinced me that I want to save drugs for rare cases where they are actually needed because the side effects usually suck. I wouldn't doubt that there are some schools more tainted by drug company money, but don't tar all of us with that brush. There are a few Paleo adherents in my class even. Have hope, the good docs are on the way.

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436 · February 19, 2011 at 11:01 PM

"medical school curiculums ... bought and paid for by the drug companies" Helen, I object to the fallacious attack in your answer and your insulting comments directed at others here. While there are a myriad of significant & severe problems in medical education & practice, this is not the venue in which to vent your spleen. If you want to get involved, visit the Institute for Healthcare Improvement or ePatients (empowered). There are many forms of patient advocacy at all levels. With your passion and wisdom, surely you will find one that's a good fit and that will welcome your talents.

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762 · February 19, 2011 at 12:19 PM

@Helen: Still, I understand your sentiment that like a social worker the doctor treating chronic illnesses, inasmuch as the doctor is profit-minded, an incentive to no do too much good exists. But, not all doctors treat chronic illnesses (e.g. trauma surgeon, an ER doc sometimes) and there will always be enough sick people.

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2099 · February 19, 2011 at 10:52 PM

and p.s. It was RG73 who failed to see that I distinguished between medical school and pharma-run "education" seminars and surgeons. I *did not* tar surgeons with the same brush as the physician-shills as RG73 said I did.

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762 · February 20, 2011 at 1:36 AM

@Helen: Given the length of these comments perhaps a PM is more appropriate. Nevertheless, have you ever read Arrowsmith by Sinclair Lewis? Although written at the turn of the last century, its dialog is scarily accurate (all the more so because people say those satirical lines seriously). My point is medicine's history doesn't differ much from its present. That said many student-doctors are ignorant of the history of their profession, perhaps because one chooses many college classes strategically to get into medical school not for learning on its own.

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3184 · February 19, 2011 at 8:30 PM

Helen who is the ignorant and arrogant one here? You're the one who presumes to know my worldview and my beliefs. You don't know anything about me, my worldview, my beliefs, my experiences, or my medical school for that matter. I read that NYT piece a while ago. I'm not sure what that has to do with me. So tell me Helen, what do you know about me other than I go to one of the many medical schools in the world? How much funding does my particular school get from pharmaceutical companies? And how much money control do pharma companies have over USLME and COMLEX? Don't presume to know me.

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2099 · February 19, 2011 at 10:41 PM

Being a doctor is also about being able to wield power over others. Alot of doctors are power junkies and egomaniacs...their staffs are afraid of them, and they intimidate their patients. This, too, is common knowlege.

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2099 · February 19, 2011 at 9:12 PM

Can you possibly deny that medicine, as it is currently practiced, isn't *drug based*? How do you think it got to be that way? The apple doesn't fall far from the tree, you know. It has to do with you because whether you like or not, and whether you want it to happen or not, you are being influenced by drug company money. One of the reasons, although not the only one, that tuition is so expensive is called "prior investment". By the very act of investing so much time, money and effort into the system, a person is that much more likely to support that system no matter what. Being...

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2099 · February 19, 2011 at 11:09 PM

I certainly agree with you that doctors are inculcated with arrogance. It makes many of them callous. It also predisposes them to not listen to the patient because the doctor "knows better". I nearly died of an ectopic pregnancy. Although I told the dr that I felt pregnant and that I was in pain, the pregnancy test was negative. But instead of him investigating further, I was dismissed as a hysteric and told to use a laxative. But I was right, I had been pregnant, and I was bleeding internally from a ruptured tube. So please forgive me for being unable to be objective about this.

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762 · February 19, 2011 at 10:51 PM

@Helen: One shouldn't confuse the limits of medicine with malevolence. A doctor who passionately advocates SAD may just be doing the best with what he was taught. How to educate doctors whom the system inculcates with arrogance is more the issue. The same qualities that make one confident in clinically uncertain situations make one unreceptive to knowledge at other times. Medical researchers may have more vested interests. But, let's not open that can of worms.

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