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Dave W.
Info Junkie
USA
26022 Posts |
 Posted - 08/05/2010 : 13:29:20 [Permalink]
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Originally posted by Farseeker
I feel frustrated in that I seem to lack the talent to make my point. |
No, I get where you're coming from. I just disagree to an extent.I fault only those doctors who pretend expertise they do not have. We both agree that doctors are laypeople when it comes to many aspects of medical science, such as biochemistry, orthomolecular medicine, statistical analysis, perhaps even knowing how to properly read a research paper.
An example may illustrate my frustration with our medical practitioners.
My mother-in-law was dying in the hospital because she could not eat. I asked the doctors to provide IV feeding. They refused. I offered to pay the cost. They said it was not allowed. I then took research papers to the department head (a medical doctor too), who read them and then authorized the procedure.
So, see my point? The oncologist who stood in the way of saving her life, did not seem to understand that the chemo he had given caused her inability to eat. I was not asking for alternative anything, just simple, standard TPN (nutrition via iv). Yet when I presented studies I got off the internet in one night's research, his boss saw my point. Since the hospital was paying (under our medical system), it was not a reversal of policy they undertook lightly.
Does the example better illustrate what I am trying to say? I do not expect doctors to know everything. But I also do not want them to block me based on nothing but their lack of current knowledge. |
Well, there's the thing: in your anecdote, it doesn't seem to be "nothing but their lack of current knowledge," but a policy which, in your case, is probably mandated from much higher bodies than hospital administrators. The hospital was not only paying, but liable. If something went wrong and it was discovered that they hadn't followed the standard of care, whose head would roll?
In other words, from what you've told me here, I'd bet the oncologist wasn't resistant primarily due to ignorance, he was probably just covering his ass.| I suppose I want more freedom over my own body. |
So does everyone. But the system with the most freedom (no medical regulations at all) is also the most ripe for abuse. There's gotta be a happy medium between regulation-free and regulation-heavy systems in which most people get satisfactory care, and we try to minimize the number of people who get crappy care, but understand that "zero" is unrealistic. And I say that as someone who could very well be one of the unlucky people tomorrow, for all I know.
What do you call the guy who graduates last in his class from medical school? "Doctor." |
- Dave W. (Private Msg, EMail)
Evidently, I rock!
Why not question something for a change?
Visit Dave's Psoriasis Info, too. |
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Farseeker
Skeptic Friend
Canada
76 Posts |
Posted - 08/05/2010 : 13:48:12 [Permalink]
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| Well, there's the thing: in your anecdote, it doesn't seem to be "nothing but their lack of current knowledge," but a policy which, in your case, is probably mandated from much higher bodies than hospital administrators. The hospital was not only paying, but liable. If something went wrong and it was discovered that they hadn't followed the standard of care, whose head would roll? |
I suppose that is the difference between a socialist medical system and yours.
In your system, if a sick person dies, not from their sickness, but clearly just from starvation, can the hospital be sued? Does your "standard of care" provide for saving money by the hospital by starving patients to death?
Yes, I agree, it is probably their policy to save money by not spending $15,000 on a cancer patient who was 59 years old and would probably die within months anyway. The law states a private citizen like me could not pay for the iv feeding. Don't ask my why, probably a socialist thing about equal treatment for rich and poor, but that is a guess.
When I showed up with research papers showing the benefit (extending life), did these doctors cave in to my charm and logic, or was their policy to starve patients unless someone bitched about it? I can not know, but we all can speculate.
Who was it who said "follow the money"? |
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Hawks
SFN Regular
Canada
1383 Posts |
Posted - 08/05/2010 : 15:15:17 [Permalink]
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Originally posted by Farseeker
I fault only those doctors who pretend expertise they do not have. We both agree that doctors are laypeople when it comes to many aspects of medical science, such as biochemistry, orthomolecular medicine, statistical analysis, perhaps even knowing how to properly read a research paper. |
Medical students do have to learn a fair amount of biochemistry and statistical analysis (for example), but doctors in general don't read the primary scientific literature. Neither should they have to. What they do have to follow is the guidelines regarding new treatments sent out to them periodically. Iow, doctors need to be able to use previously generated knowledge, not create it. Some are obviously better at this than others.
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METHINKS IT IS LIKE A WEASEL
It's a small, off-duty czechoslovakian traffic warden! |
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Farseeker
Skeptic Friend
Canada
76 Posts |
Posted - 08/05/2010 : 16:25:31 [Permalink]
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| Medical students do have to learn a fair amount of biochemistry and statistical analysis (for example), but doctors in general don't read the primary scientific literature. Neither should they have to. What they do have to follow is the guidelines regarding new treatments sent out to them periodically. Iow, doctors need to be able to use previously generated knowledge, not create it. Some are obviously better at this than others. |
Well I agree, except in the case of those doctors specifically paid to do research.
What I found objectionable, is that those doctors that do not do research, that do not keep up with whatever affects me or my loved ones, present an attitude that they should not be questioned.
Naturally I know, the the doctor with the lowest mark in his graduating class puts his diploma on the wall... just like the doctor who was at the top of his bottom half of his class. You might want to read the above sentence again, I may not have been clear.
So... the point is, at least in my opinion, Do Not Pretend You Know The Answer If You Do Not.
Do not piss on others opinions if you have no foundation in fact or experience to disagree.
Let those you obviously can not help try something else. It is not your money. Feel free to give your opinion, do not feel free to condemn them to failure.
Bottom line, if you think the only reason I am healing is the placebo effect, please do not stop it from working!
Do you believe someone could make a ground vehicle, using only wind, that will go twice as fast as the wind?
If you say that is impossible, hand in your medical diploma. People who are certain right away, scare me.
T. |
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Dave W.
Info Junkie
USA
26022 Posts |
Posted - 08/06/2010 : 19:26:39 [Permalink]
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Originally posted by Farseeker
In your system, if a sick person dies, not from their sickness, but clearly just from starvation, can the hospital be sued? |
In our system, perhaps shamefully, hospitals can be sued for just about any reason.| Does your "standard of care" provide for saving money by the hospital by starving patients to death? |
So far as I know, the people who set the standard of care - state medical boards - generally ignore cost. Ideally, the board members shouldn't be beholden to any medical institution or insurance company, but I don't know how well that works out in practice.| Yes, I agree, it is probably their policy to save money by not spending $15,000 on a cancer patient who was 59 years old and would probably die within months anyway. |
I wouldn't know whether the reason was "saving money" or not.| The law states a private citizen like me could not pay for the iv feeding. Don't ask my why, probably a socialist thing about equal treatment for rich and poor, but that is a guess. |
Yeah, that's just weird.When I showed up with research papers showing the benefit (extending life), did these doctors cave in to my charm and logic, or was their policy to starve patients unless someone bitched about it? I can not know, but we all can speculate.
Who was it who said "follow the money"? |
That last aphorism also cuts in all sorts of directions. After all, the manufacturers of TPN supplies and equipment have a vested interest in seeing as many patients get TPN whether they need it or not. I'm not saying that that had any influence in your particular situation, I'm just saying that a "follow the money" argument is about as useful as an "unintended consequences" argument. |
- Dave W. (Private Msg, EMail)
Evidently, I rock!
Why not question something for a change?
Visit Dave's Psoriasis Info, too. |
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Farseeker
Skeptic Friend
Canada
76 Posts |
Posted - 08/07/2010 : 14:46:36 [Permalink]
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| I'm not saying that that had any influence in your particular situation, I'm just saying that a "follow the money" argument is about as useful as an "unintended consequences" argument. |
I did not mean it as an argument, but as a suggestion for further thinking / research.
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Farseeker
Skeptic Friend
Canada
76 Posts |
Posted - 08/07/2010 : 15:10:21 [Permalink]
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| Yes, I agree, it is probably their policy to save money by not spending $15,000 on a cancer patient who was 59 years old and would probably die within months anyway. |
I wouldn't know whether the reason was "saving money" or not. |
in one sense, you are right. I was not the $15,000 for TPN. After all, every day she was alive cost the medical system many additional thousands of dollars for the room, nursing, morphine and other drugs, doctor fees, etc. I can not know his thinking, but he brought it up, not me. So, it was on his mind.
She even had supplementary private insurance, but it only allowed for the extras allowable by law, such paying for the surcharge for a private room.
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Farseeker
Skeptic Friend
Canada
76 Posts |
Posted - 08/12/2010 : 07:47:53 [Permalink]
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| Another example is the recent discovery that DNA can be changed by the environment. |
Recent? Seems to me that we've known that for decades. |
I finally found the reference I needed to illustrate my point about DNA. I was not sufficiently clear in my earlier statement, so I hope this study helps clarify what I was trying to say. Namely, that old theories are constantly being either modified or replaced.
Journal Reference:
1. O. Paun, R. M. Bateman, M. F. Fay, M. Hedren, L. Civeyrel, M. W. Chase. Stable epigenetic effects impact adaptation in allopolyploid orchids (Dactylorhiza: Orchidaceae). Molecular Biology and Evolution, 2010; DOI: 10.1093/molbev/msq150
This is a new understanding (or at least, provisional understanding) of DNA and inheritance of environmental factors.
from wikipedia:
"Epigenetic theory is an emergent theory of development that includes both the genetic origins of behavior and the direct systematic influence that environmental forces have, over time, on the expression of those genes. The theory focuses on the dynamic interaction between these two influences during development. These vastly contradicting ideas are the foreground of biological studies."
T. |
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Dave W.
Info Junkie
USA
26022 Posts |
Posted - 08/12/2010 : 08:26:20 [Permalink]
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Originally posted by Farseeker
This is a new understanding (or at least, provisional understanding) of DNA and inheritance of environmental factors. |
"New" still meaning "decades ago." A search of PubMed for "epigenetic" returns over 15,000 articles written in the last 40+ years.
But yes, scientific theories change as the evidence warrants. Unfortunately, that change isn't predictable, so we can't do anything with that knowledge other than wait. |
- Dave W. (Private Msg, EMail)
Evidently, I rock!
Why not question something for a change?
Visit Dave's Psoriasis Info, too. |
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Farseeker
Skeptic Friend
Canada
76 Posts |
Posted - 08/12/2010 : 16:03:52 [Permalink]
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By new, I meant there is new insight. Wikipedia actually differentiates between epigenetics and epigenetic theory.
In any case, there is new information backing up the idea of much faster evolutionary change than previously thought possible.
So, what does that mean for us?
Well, while any change to one specific theory, or even one specific aspect of a theory may be unpredictable, evidence suggests that changes to the theory will happen (based on past performance of "science").
I would suggest that the main point to be learned is that "theories" are unreliable when taken as a "given" and that we need to always take them with a grain of salt. Even physical "laws" have been known to change, or at least, have areas where they are questioned.
General relativity is a well tested theory, but it breaks down in certain instances and then quantum physics takes over (at least, on the level of very small). And quantum physics and general relativity have not been completely reconciled.
When it comes to medical "science", I think the ground is even less firm. One area I am watching with interest is the whole cholesterol theory, at least as far as it being a cause of CVD. My guess is that it is simply a correlation, not a cause and effect.
Perhaps you have heard about Bill Clinton and how his arteries are again clogged? Call me simple, but if the plumbing in my house gets clogged, I do not put in bypass pipes. I find out what is causing it to become clogged and "fix the cause". If I can not find the cause, then I analyse (CDN spelling) the clog and determine where it comes from. Or who did it. In any case, apparently Bill Clinton has good cholesterol numbers, eats right but still has more arteries getting clogged and has had stents implanted.
So, how much longer will the cholesterol theory reign?
T.
T.
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Dave W.
Info Junkie
USA
26022 Posts |
Posted - 08/12/2010 : 22:32:23 [Permalink]
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Originally posted by Farseeker
By new, I meant there is new insight. Wikipedia actually differentiates between epigenetics and epigenetic theory.
In any case, there is new information backing up the idea of much faster evolutionary change than previously thought possible.
So, what does that mean for us?
Well, while any change to one specific theory, or even one specific aspect of a theory may be unpredictable, evidence suggests that changes to the theory will happen (based on past performance of "science").
I would suggest that the main point to be learned is that "theories" are unreliable when taken as a "given" and that we need to always take them with a grain of salt. Even physical "laws" have been known to change, or at least, have areas where they are questioned. |
Yes, of course. All scientific conclusions are held tentatively, not as if they're written in stone.| General relativity is a well tested theory, but it breaks down in certain instances and then quantum physics takes over (at least, on the level of very small). And quantum physics and general relativity have not been completely reconciled. |
But that's a completely different issue. All scientific theories have limits. Relativity doesn't apply in the quantum realm, like electron theory doesn't apply to population dynamics. This isn't a flaw in any theory, it's a natural part of what a theory is.| When it comes to medical "science", I think the ground is even less firm. |
Just be sure to distinguish between medical scientists and practicing doctors. Like you'd distinguish between a research hydrologist and a plumber. The overlap isn't very large.| One area I am watching with interest is the whole cholesterol theory, at least as far as it being a cause of CVD. My guess is that it is simply a correlation, not a cause and effect. |
Well, you know where PubMed is, and I'm sure you know where a decent reference library is so you don't need to rely on abstracts, and I'm sure you could go get a degree in cardiology if you really wanted to know, instead of just guess. Really, you're implying here that your admitted guesswork is as good as medical science... in which case, why aren't you just poo-pooing it all and treating whatever ails you and your family with whatever random unguents you happen across?
Also, your Clinton anecdote seems designed to malign the idea that cholesterol is a problem as regards CVD in any way, when what we know says that it is one of many risk factors, and not the only possible cause. You said yourself, "it being a cause of CVD," but Clinton's cardiac problems not being cholesterol-related is irrelevant to the question of whether or not high cholesterol is a risk factor, unless you can go on to show that all people with CVD have low cholesterol, which we both know that you can't do. |
- Dave W. (Private Msg, EMail)
Evidently, I rock!
Why not question something for a change?
Visit Dave's Psoriasis Info, too. |
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Farseeker
Skeptic Friend
Canada
76 Posts |
Posted - 08/13/2010 : 00:38:32 [Permalink]
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| Really, you're implying here that your admitted guesswork is as good as medical science.. |
No, I do not wish to imply that. What I will state firmly is that one can not roll over and accept whatever an "expert" says, especially if the expert is speaking in an area possibly outside of his expertise. I apply my own life experiences, personal values and thinking process to everything, whether I have a degree in that subject or not.
I ran the IT department for a billion dollar company for many years. My job included differentiating between "experts" who were full of it (at least as regards my company's specific problem... who said that when all you have is a hammer every problem looks like a nail?).
I do not have a degree in computer science. I do not have a degree in business. I formed my own company. I developed (I hired programmers to do the work) a 5th generation language (by the IBM definition of such at that point in time, 1993-1997). When challenged by a government science auditor with many fancy degrees to his name, we were denied tax status for my project. I hired a person with appropriate degrees to rephrase the wording of the project (cost $40,000) and re-applied. We were given over a million dollars in Scientific Research and Experimental Development grants. I am not sure what lesson to take from this. That new thoughts have to be phrased a certain way? That one should always have important documents include an "expert" (lawyer, accountant, PHd) to lend credibility? At the point of the audit, our language was already working and producing results. This seemed to confuse the auditor. He kept saying, "how could it be research if it already worked?"
I used my 5th GL to develop an insurance application that was sold in the USA, Canada, New Zealand, Australia and Brazil. Then I had a heart attack and started learning about CVD. I don't think I need a degree to apply reason and logic to the problem of CVD, especially not in the specific instance of my personal biochemistry.
So, my life experience is that the academic approach is very valuable, but the underlying thinking process does not require a degree.
I am sure we have all heard of the breakthrough thinking that comes from outside the "establishment". History is full of these lessons, from the germ theory, development of penicillin, etc.
When it comes to cholesterol in the blood, I have much more faith in the experts who are NOT cardiologists but medical researchers specializing in lipid research.
By the way, the plumbing analogy might work well here. Draino will clear many (not all) clogs, no plumber needed. Iodine will dissolve wax. Cholesterol is a wax. I will not get into the raging debate surrounding cholesterol, but suffice it to say that books by respected medical professionals and researchers are written on the subject. The Cholesterol Myth is one such, with lots of referenced scientific studies.
Part of the problem with "medical science" is the cost of research. However, the cost of doing science does not change the conclusions of science. It simply delays finding out the truth (or, more correctly, proving the value of a new theory) until the monies are made available.
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Farseeker
Skeptic Friend
Canada
76 Posts |
Posted - 08/13/2010 : 18:24:40 [Permalink]
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But that's a completely different issue. All scientific theories have limits. Relativity doesn't apply in the quantum realm, like electron theory doesn't apply to population dynamics. This isn't a flaw in any theory, it's a natural part of what a theory is. |
You may be right, but then, Einstein disagrees. I believe the operative quote is "God does not play dice with the universe".
Not to imply I agree with everything he said. But I do agree with this, attributed to Einstein:
... a paraphrase... "if you know your subject well, you can explain it to your grandmother."
Yeah... I buy that !
T.
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H. Humbert
SFN Die Hard
USA
4574 Posts |
Posted - 08/13/2010 : 19:36:38 [Permalink]
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Originally posted by Farseeker
You may be right, but then, Einstein disagrees. I believe the operative quote is "God does not play dice with the universe".
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Einstein was wrong.
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"A man is his own easiest dupe, for what he wishes to be true he generally believes to be true." --Demosthenes
"The first principle is that you must not fool yourself - and you are the easiest person to fool." --Richard P. Feynman
"Face facts with dignity." --found inside a fortune cookie |
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Kil
Evil Skeptic
USA
13477 Posts |
Posted - 08/13/2010 : 19:50:10 [Permalink]
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Farseeker:
I will not get into the raging debate surrounding cholesterol, but suffice it to say that books by respected medical professionals and researchers are written on the subject. The Cholesterol Myth is one such, with lots of referenced scientific studies. |
The International Network of Cholesterol Skeptics
Harriot Hall:
This movement seems to have started with Uffe Ravnskov’s book The Cholesterol Myths, published in Swedish in 1991 and in English in 2000. That book has been severely criticized, for instance in The Skeptic’s Dictionary , where Bob Carroll points out some of the distortions and deceptive techniques found in the cholesterol skeptics’ arguments. A typical claim: “Cholesterol is highly protective against cancer, infection and atherosclerosis” and “high TC [total cholesterol] and LDL levels are beneficial at all ages.” These statements are not only false, they are potentially dangerous to the health of those who believe them.
I’ll admit there is a grain of truth in what they say. The public may falsely perceive cholesterol as some kind of “Great Satan” of heart disease, and diet has been overemphasized, and some doctors may be over-prescribing statins. But there is plenty of evidence from multiple avenues of research to show that high cholesterol is a risk factor for heart disease and that lowering it reduces risk. A Lancet article from December 2007 reviewed trials involving nearly a million people and found that “Total cholesterol was positively associated with IHD [ischemic heart disease] mortality in both middle and old age and at all blood pressure levels.”
Another Lancet meta-analysis of over 90.000 patients concluded “Statin therapy can safely reduce the 5-year incidence of major coronary events, coronary revascularisation, and stroke by about one fifth per mmol/L reduction in LDL cholesterol, largely irrespective of the initial lipid profile or other presenting characteristics. The absolute benefit relates chiefly to an individual’s absolute risk of such events and to the absolute reduction in LDL cholesterol achieved. These findings reinforce the need to consider prolonged statin treatment with substantial LDL cholesterol reductions in all patients at high risk of any type of major vascular event.” |
Read on...
Also:
Lancet. 2007 Dec 1;370(9602):1829-39. Blood cholesterol and vascular mortality by age, sex, and blood pressure: a meta-analysis of individual data from 61 prospective studies with 55,000 vascular deaths.
| INTERPRETATION: Total cholesterol was positively associated with IHD mortality in both middle and old age and at all blood pressure levels. The absence of an independent positive association of cholesterol with stroke mortality, especially at older ages or higher blood pressures, is unexplained, and invites further research. Nevertheless, there is conclusive evidence from randomised trials that statins substantially reduce not only coronary event rates but also total stroke rates in patients with a wide range of ages and blood pressures. |
Frankly, I think The Cholesterol Myths is a load of crap.
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Uncertainty may make you uncomfortable. Certainty makes you ridiculous.
Why not question something for a change?
Genetic Literacy Project |
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