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Wednesday, July 20. 2016
I resist the underlying idea of one-size-fits-all, or even the idea of a tyranny of "best practices." Each patient is unique. Furthermore, most areas of medicine are in constant controversy and dispute, with new ideas always emerging. For one example, the nutritional bureaucracies are about 20 years behind the times.
I have seen plenty of people poorly-served because of fear of rules or of law suits.
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It's only a matter of time before ideologues, cranks, and gasbags overwhelm any science.
You only have to look at the self-appointed and anointed ones who created this debacle and how they created it to deduce that the corruption and racketeering will come from the inside out.
1. Look for tens of thousands of bogus make work jobs to benefit the pols and ACORN types. Lots of non-productive, paper shuffling, box checking, pencil pushing employment, aka featherbedding, for the self- important and mediocre children of the incestuous elites.
2. Look for greater fraud: graft, kickbacks, counterfeit pacemakers etc. and payoffs by medical purveyors to get their products or services on the "preferred list".
3. Look for special interest groups to que up for preferential treatment based on thesqueaky wheel and cliched sob story.
4. Look for the healthcare industry to benefit, (as auto insurance did with compulsory insurance) even as the pols stick their hands deeper into the industry's pockets.
5. Look for the Neo-Puritans to dictate life style: preventive medicine will be the pretext, because frankly early screening is usually a wash in terms of cost/benefit.
6. Expect to pay more for less and anticipate medical protocols influenced by deep pockets and pressure groups(legitimate or crank).
In short, look for the same General Custer fluck that the pols usually create.
Best practices pretend to be "evidence-based medicine," but are really just finance-based medicine.
My wife once relayed to me an exchange between the chair of the Obstetrics Dept and a resident regarding the resident's (inappropriate) treatment of a patient.
Resident: "Well the committee's best practices list it as an appropriate treatment"
Chair: "Committee? That's a bunch of academics who haven't practiced in years sitting around writing opinions. We're all fortunate little harm was done. Do it again & you are out"
One of the challenges of medicine is that the science is based on populations, but the practices (applications) are made on individuals. There is a lot of variation between properties of populations and individuals. Best practices are a good rule of thumb, but every situation needs to be weighed critically. In many individual situations "best" practices might be worst.
When "best practices" become the norm, or worse, mandatory, how, if ever, do they improve?
mark: When "best practices" become the norm, or worse, mandatory, how, if ever, do they improve?
Through scientific investigation.
Medicine uses science and scientific techniques but it is not a straight forward science. It is more like a chaotic system that sometimes can be scientifically analyzed and accurate predictions can be made. At other times it defies scientific methods and predicting is more akin to guessing. So who gets to dissent? The experienced practitioner or the quack? The Nobel prize winner whose area of expertise has nothing to do with medicine or health or an author of books on diet? Who decides who can dissent and who decides what dissent even makes sense. We know that today there is every possible opinion of what is good for your health and what is bad. What can cure you and what can harm you. To steal an old joke; if you laid all the medical practitioners end to end in a long line they would all be pointing in different directions. Who do you trust and who do you censor?
A few years back while being hospitalized for pulmonary embolisms a night nurse came in and chatted and ended by saying she wouldn't take Coumadin/rat poison and would prefer to find some "natural" way to control blood clotting. In my opinion this was inappropriate and I considered making a complaint to the hospital. Was her opinion/dissent valid and acceptable?
I would say that in the end the health community should bring together the best minds and information. Make a recommendation and stick with it until the best minds and data require a different recommendation.
My wife, a nurse of 30+ years, refuses to participate in what we both call the 'medical cartel.' I have no health insurance as I pay my own way for the very few services I occasionally require, usually some kind of non-fatal emergency service I cannot handle on my own. Commenters 'Exasperated' and 'KCFleming' have the situation pretty well nailed; 'GoneWithTheWind' is delusional - the 'best minds' are merely well connected members of the club that will allow no dissent period.
The state medical boards only enforce non-dissent of the practitioners and the true focus of their mission, patient protection, is a joke. Look up doctors in Florida having discovered viable alternative therapies being murdered. There's a documentary I watched a few years back about a doctor here in Texas being hounded and litigated against for utilizing a cancer therapy that actually worked as opposed to chemo and radiation that typically accelerated a painful death.
The most telling essay I've encountered a few years back, 'How Doctors Die', in which the author, a physician, made the point that many doctors, when given a terminal diagnosis, wrap up their affairs, complete their bucket lists, and spend their remaining time with loved ones. They are the ones most familiar with the suffering and cost of radical end-of-life procedures and decline to accept for themselves what they prescribe for their patients. Exactly why I won't participate as well.
I'm 68yo and haven't seen a doctor in years. I take no meds. I lift weights, do a little cardio, I intermittent fast, and eat fairly clean, a combination of Paleo and Ketogenic. I do all the cooking for the household, including for the animals, in order to avoid the poisons promoted by the processed food industry. We take care of dogs for our mental health and take care of our physical health by staying as far away from the medical cartel as possible. The combination of Government and Insurance industry interference in the health care system is simply a death sentence for American health care. Obamacare is simply the final nail in the coffin.
Well said (Windy tends to take a wide rhetorical stance athwart some popularized, establishmentarian, and undefined catch-all I call Science!, a euphemism for what had been an underlying real science. It's not really scientific but it appeals to ego and posing.)
Incidentally, Bliss's question is an outright fallacy; a non-starter: Asking if dissent against a fraudulent and worst, a constitutionally and ethically unsound monopoly is "allowed" is at best a wholly codependent and thus dysfunctional plea, and at worse, a sheer capitulation to that system. It's like asking for permission to protest criminality.
Anyway, the medical establishment, like much of science itself, is by now bogus. It's as much a self-interested cabal as it is a valid, advanced system of solving real problems. Not uncommonly, it foments what it purports to cure.
Reading your comments I believe your opinion's are sincere. But in fact you prove my point. Do you really believe the medical cartel is killing doctors in Florida because they discovered viable alternative therapies? There are about a million doctors in the U.S. and all or them are well trained and stay current on their technology and specialty. Do you really believe all one million of them are part of the scam to kill us all early for money??? Is this really the meme you want to convince us of.
And then their are the faux documentaries or the one enlightened doctor being hounded and litigated. Really!
As for chemo; Cancer is many different cancers and humans themselves are a massive bundle of variables. No one treatment can cure all cancers or even one cancer consistently. Chemo works where it works and sadly fails where it fails. I honestly believe that in some cases the doctors do not believe that chemo will help some individuals. BUT what else can they do? They can make recommendations and give advice but often the patient themselves are grasping at straws and want the chemo. Does chemo work? Undoubtedly. Is it the universal cure for cancer, all cancers? Sadly no. Does that make doctors co-conspirators in some huge scam to extort money and cause early death? That is simply crazy talk.
Chemo works where it works and sadly fails where it fails.
And the cow jumped over the moon. Chemo "works" at what, exactly?
I honestly believe that in some cases the doctors do not believe that chemo will help some individuals.
What you honestly believe someone else believes applies to successful, curative medicine? Specifically, to cancer medicine, such as it is?
BUT what else can they do?
As part of a highly regulated establishment, not much. By calling everyone not roughly aligned with this vague medical presupposition a "quack" you aren't exactly helping things.
That's my beef: You consistently happily and anecdotally outlaw X but give no justification for Y, where Y leads to negative Z.
They can make recommendations and give advice but often the patient themselves are grasping at straws and want the chemo.
And? That neither applies to the complete body of common knowledge, new and/or alternate findings and as-yet unaccepted methods, or the fuller available data. Neither does the established medical art, as it frequently turns out.
Does chemo work? Undoubtedly.
"Work" at what? At being a "cure", as you use the word, or at being a crude scalpel to roughly excise tumors without addressing causes? I don't think anybody sees chemo as a cure. Chemo is just learning to run faster across a speeding freeway.
Is it the universal cure for cancer, all cancers? Sadly no.
Who, aside from you, alluded it was a cure? Who said all cancers were the same?
Does that make doctors co-conspirators in some huge scam to extort money and cause early death?
If you willingly eat copious junk food - about which you have prided yourself - and develop cancer, are you a co-conspirator in bad thinking concerning health? Mindset matters, obviously. Momentum, inertia. Institution.
Obviously, there is active fraud and then there is ignorance. In medicine, the latter may be further insulated by convention and regulation; not so much in conventional wisdom like yours where one could and should take a much different tone.
That is simply crazy talk.
Off-kilter diversions and assertions like yours sound kinda Z-Botish.
Sorry Ten, I can't help you. Your problem is simply that you do not know what you do not know. Worse, you think you do.
Chemo works! And, it's true that sadly it will not work for every cancer or every person. For that reason a doctor cannot easily deny a patient chemo without risking a malpractice suit. I have know cancer patients with no hope and knowing that they could not (or most likely could not) be cured with chemo still choose chemo. What would you do facing certain death? We are human and we don't want to go easy into that dark night. My sister-in-law's sister is alive today thanks to chemo, radiation and surgery. Your advice seems to be she should have given up or maybe eaten raw organic broccoli instead. Ultimately the decision is up to the individual. When/if your crisis comes you can choose science or superstition. It's your choice and I wish you luck.
I can only wonder what it must be like to project like you do, Windy Whole Cloth. But then I'm not a progressive.
Dissent in health care? Not if you value your career.
Doctors and nurses are taught in school to advocate for their patients and stand up when they see something wrong. If you do that in real life, you'll get your azz handed to you on a plate as you're ushered out the door.
Dr. Joy Bliss: I resist the underlying idea of one-size-fits-all, or even the idea of a tyranny of "best practices."
What alternative to the application of scientific principles do you prescribe?
The application of so called scientific principles has resulted in chronic obesity, chronic diabetes, and other diseases due to the 'scientific principles' supporting flawed studies blaming fats these last few decades for the above mentioned conditions. See Gary Taubes on 'Why We Get Fat' and Dr. Dominic D'Agostino on Metabolic Optimazation with ketones.
I support personal responsibility for my health and doing my own research and finding what works by trial and error. If it comes from the mouths of government I conclude in advance they are lying. Anywhere government has inserted itself there is nothing but corruption and fraud. Too many health care related industries have been infected with government fraud. The medical profession has lost much of it's trustworthiness by aligning itself with government and the insurance cartel.
The rightist meme that fat equals health is simply another faddist myth. The rice diet, for example, is probably the single most effective weight loss regime ever conceived. It has no peer, except maybe an otherwise 100% whole plant diet.
Fat is fattening unless you put yourself into, as you allude, a ketogenic state. That's not an "optimized" metabolism; it's an obviously impaired one nutritionally starved into compliance.
Carbs aren't the evil villain blind rightists insist they are so they can tout their burger-and-fries cultural affection. The western mixed diet is. Vegans down pounds of carbs and remain rail thin. My daughter eats a couple pounds of rice, a half dozen bananas, and a couple bean or potato burritos a day and weighs 130# on a 5'7" frame.
Your screed on govt guidelines is certainly well founded and noted. Your underlying dietary rationale is simply faulty.
Rightists never get a clue on any of this because of their cultural blinders.
Jake: trial and error
Individual trial and error hasn't been generally as effective as medical science at curing many diseases, from scurvy to streptococcus, as well as modern surgery techniques.