Nutrition and DO's

[J1515]

After spending some time looking and researching some clinical evidence showing benefits of nutritional supplementation. I'd like to make one thing clear that when I talk about using nutritional supplementation, I am talking mainly about prevention as opposed to curing

I'll address each point as a third year student who still has nowhere near the knowledge of a resident or physician:

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Elevated intakes of calcium and vitamin D, especially from supplements, are significantly associated with lower incidence of type-2 diabetes.

There are a ton of risk factors that can be avoided to prevent type 2 diabetes from developing. The key word is "developing." I would like to know the mechanism behind the elevated calcium findings out of pure interest, but regardless, what you've mentioned above is one of many steps a patient can take to prevent Type 2 diabetes. Maybe a resident or physician can correct me if I'm wrong, but medications aren't given to PREVENT DM2 (so that shouldn't even be an argument for you at this point), they are only used to TREAT it. A well rounded healthy diet (including adequate amounts of calcium and vitamin D) and healthy lifestyle are used as preventative measures.


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A study published in the American Journal of Public Health, has found that vitamin D deficiency may account for several thousand premature deaths annually.

Again, you are talking about people who have a deficiency and seeing effects of that. Obviously if a developing fetus doesn't have adequate nutrition there will be consequences. A simple multivitamin each morning (which is what most doctors I've met recommend now) would fix that.

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[/SIZE]Although diets high in fat have been associated with an increase in cancer risk, a recent study published in the American Journal of Epidemiology concluded that a greater intake of omega-3 polyunsaturated fatty acids may be protective against colorectal cancer.

Medical schools do teach the importance of omega 3's, at least mine did. We hear about something new every day that MAY be protective against some condition - I believe I heard at some point eating cholcolate is protective against something?

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A new study published in the June 2007 issue of the American Journal of Clinical Nutrition has shown a reduction in cancer rates among postmenopausal women taking vitamin D combined with calcium.

Once again, saying there is some kind of relationship does not = cause and effect. Postmenopausal women commonly take Vitamin D and Calcium supplements anyway to prevent osteoporosis - another thing you will learn in medical school.

I don't have time to address all the other points, but you are basically saying that :

antioxidants and vitamins = good
vitamin deficiencies = bad

Eating leafy vegetables are healthy for various reasons. Eating foods high in omega 3's are healthy. You are basically stating that living a healthy lifestyle with a well rounded diet prevents disease, which no one is disagreeing with. You will still have people who will have high cholesterol high blood pressure and atherosclerosis for unknown reasons, genetic reasons or because they choose not to eat healthy and exercise. Treating them with leafy vegetables and omega 3 pills will not fix this. When offered in the form of so-called "supplements" - they are meant for just that purpose - to SUPPLEMENT, not to treat.

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[J1515]

First of all, I never brought up free radicals. You are putting words in my mouth. What I am talking about is completely different and really can't be lumped into the same category. I am once again going to suggest that you actually read the information that I have presented to you before you start judging it and give the book a try. I never said that microwaving in a plastic container is going to necessarily cause genital malformations. You are, once again, putting words in my mouth. However, we are exposed to so many plastics and plasticizers, that they can be found in most people's fat, pee, and breast milk. This could be of concern if the plastics do in fact affect the endocrine system and they have found that changes can occur in a person with differences in as little as a few tens of ppbs. I also never said that I know anything about recommending drugs to people whatsoever so I definitely didn't say that I would recommend to stop microwaving. You are, for the third time in one post, putting words in my mouth. This is what I am talking about when I talk about propagandizing (my own term) an argument.


I'm actually intruiged that you have seemed to take an interest in this argument especially since in one of your posts you seemed to indicate that you hate research. So what I'm asking you to do is actually read and do some research on the topic of what I have presented and you have decided to try to negate about environmental toxins looking at both sides of the story and I will be ecstatc to discuss it with you.

That is correct, I hate research and have little interest in it. My apoligies for lumping you into the "free radical" argument that the other pre-med was making. So you are speaking of exposure to androgens during pregnancy if I'm not mistaken.

" The new study indicates that exposure to normal levels of phthalates may have a similar effect on humans. "

"The findings suggest that some phthalates have antiandrogenic effects, meaning they may suppress the hormones involved in male sexual development," the scientists state".

"A national study in the US found that the majority of the general population had measurable exposure to multiple phthalates, the scientists stated."

See the use of the words "may" and "some"? That does not indicate a cause and effect. This is one of thousands of studies where there MAY be something important there, but further research needs to be done. Furthermore, if the majority of the general population is exposed to this, why isn't every child born with genital defects? This is where your thinking is flawed. There is no cause and effect established. Perhaps there is something else going on, maybe the child is predisposed for some reason?

Having a solid cause and effect relationship is important when you give patients advice (speaking from my relatively limited experience as a 3rd year). There are thousands of studies where they conclude "X may be associated with Y." Just because it makes sense to you doesn't make it true. Congenital Adrenal Hyperplasia CAUSES genital malformations. Androgen secreting tumors CAUSE genital malformations. These are known causes and effects and therefore this is what medical schools teach you.

Despite what you may be thinking, I'm not picking apart the study or looking for ways to disprove it. But once you've gone through medical school and learned the big picture you will see that there are tons of studies released every day. Physicians can't advise their patients based on the results of every study released. When something has a proven direct effect, then it must be worked into the medical school curriculum. Until then, it may or may not be mentioned in passing.

 

[t-funk]

Having a solid cause and effect relationship is important when you give patients advice (speaking from my relatively limited experience as a 3rd year). There are thousands of studies where they conclude "X may be associated with Y." Just because it makes sense to you doesn't make it true. Congenital Adrenal Hyperplasia CAUSES genital malformations. Androgen secreting tumors CAUSE genital malformations. These are known causes and effects and therefore this is what medical schools teach you.

Despite what you may be thinking, I'm not picking apart the study or looking for ways to disprove it. But once you've gone through medical school and learned the big picture you will see that there are tons of studies released every day. Physicians can't advise their patients based on the results of every study released. When something has a proven direct effect, then it must be worked into the medical school curriculum. Until then, it may or may not be mentioned in passing.

I see what you are saying and thank you for the response. I will be the first one to admit that I know nothing about clinical medicine, what happens in medical school or how it's taught by first-hand experience. All that I know is there is a ton of material thrown at you in a very short time frame and somehow you have remember some of it to pass your tests and then take the boards. I am 100% ignorant. But what I do know about is personal experiences and my 4 yrs of research at my current job, reading the literature (of which I have mountains of on my desk), running experiments, going to conferences, and talking with some of the foremost people in my area. This stuff is very interesting to me. From the OPs profile, it appears that he has extensive experience in nutrition and just wanted to have a friendly discussion about what interests him and then the thread turned kind of crazy.

Pre-meds know that they have a lot to learn in medical school, but that doesn't mean that they aren't able to hold intelligent, friendly conversations about the things they do know about. I am pretty much open minded and will be relatively malleable with respect to what I am taught in medical school but that doesn't mean I will forget what I have learned before medical school. I just don't think the "Your just a pre-med" argument is very well thought out.

I do believe that once in practice, many physicians read the literature and will make recommendations to their patients based upon it. I say this from the sheer fact that my endocrinologist said to me that research is starting to show that some people's bodies just can't tolerate birth control, and due to my personal susceptability, it might have triggered PCOS. Also my SO had an experimantal surgery done to his back to try and avoid fusion (it was called a dyna-sys and he had to have a fusion a year later) since he was in his mid-twenties that the neurosurgeon had read about a guy doing in some other country. If I happen to enter endocrinology, I would probably read up on the research in environmental contaminants and the possible effects to the endocrine system. However, I am going to probably enter a field that I have no prior personal experience with so that I can start fresh and try to avoid having any biases.

I do think that there are many really good doctors out there that will look at current studies but, please don't attack me for this, that the current populace is losing respect for doctors bc many are not willing to look at all the information available to them. (That was kind of what I was trying to say with doctors that would rather say a fat person is just a constantly eating pig even when that person tells them otherwise.) Maybe I will turn into that type of a doctor too after medical school but I sure hope not.

 

[J1515]

I do think that there are many really good doctors out there that will look at current studies but, please don't attack me for this, that the current populace is losing respect for doctors bc many are not willing to look at all the information available to them. (That was kind of what I was trying to say with doctors that would rather say a fat person is just a constantly eating pig even when that person tells them otherwise.) Maybe I will turn into that type of a doctor too after medical school but I sure hope not.

This is where I beg to differ. This entire argument (in the thread, not between me and you) started because there were pre-meds criticizing the teachings of medical school and how doctors practice, based on their personal experiences and feelings. We had pre-meds saying that medical schools don't emphasize nutrition enough - how would they know? Nobody here ever said nutrition wasn't important.

I disagree that doctors as a whole would tell an obese person he/she is a fat pig and not examine other possible causes for their health problems. Perhaps that is your personal experience and I'm sorry for that, but when you are exposed to hundreds or thousands of doctors throughout your career you will see that is not the majority. What if there is a pituitary tumor or thyroid condition causing these problems and the patient dies from it. Do you know the kind of lawsuits the doctor would be faced with for just telling the patient "stop eating you fat pig" and ending the examination with that?

This whole problem was amplified with the "invention of the internets" as Bush might say. Now the average patient has all this information available to them right at their fingertips but they don't know how to integrate it into their overall healthcare. That's what medical school and residency teaches you. Anyone can buy medical textbooks or google their symptoms and come up with their own diagnosis. This has led to patients not trusting doctors and searching for alternative methods of healthcare which are sometimes helpful, but potentially harmful. Go to www.askapatient.com, a website where patients write their personal reviews and experiences with medications. Based on that website alone you would think levaquin is the most fatal, evil medicine known to mankind. So how do you think this influences the average person who isn't in the healthcare profession? Wouldn't you agree this makes patient compliance a much more difficult task for the physician? But I digress...

I'm not saying doctors know everything. I'm sure there are some doctors like you mentioned above who are closed-minded and don't listen to their patients, but I don't think that's the majority. I don't think the public's lack of respect for physicians is because modern day doctors are screwing up diagnosis and treatments, but rather patients feel like they can do the job of a doctor simply with the use of the internet.

 

[endocardium]

I basically agree with J1515. I was going to type something similar to what he wrote. However, since he pretty much nailed it, I'll just leave it be and not say too much more on that subject. Nevertheless, please allow me to wax philosophical for a few paragraphs and suggest to you the following (You see? Medical school doesn't act to beat out the idealism completely, at least it hasn't yet ):

Doctors are indeed teachers of medicine. However, I want to add, that doctors face a huge challenge in battling all the misinformation, half-truths, propaganda, opinions, and assumptions that are rampant these days in the media, much of which is propagated by folks who don't have a single iota of knowledge about how to tell the difference between what is medically sound and what is not. These days, many patients actually come demanding that they get a script for so-and-so drug because they heard about it on TV, or on the Internet, and not so much because it is indicated (and most optimal) for their condition. Perhaps they will bring in a printout from some questionable and mythical article obtained from the Internet claiming anecdotal, or non-scientifically derived evidence, that a commonly prescribed drug or treatment for their condition is somehow linked to something horrible (sometimes these articles are so bad that they are the medical equivalent of "the Martians are invading and have been living among us for years," if you will). Or worse, they'll bring in some "proof" from a marginal source about how an unproven and possibly dangerous treatment is going to be the best thing for their ailment. It's not wrong for our patients to be interested in these things and to take charge of their health. However, it is our job to debunk the stuff that is not scientifically sound and to help our patients make sense of and sort through all the information and junk around them. It's our job to cut through the crap, to dispel the myths. We need to be our patient's healthcare advocate. It's not easy sometimes, but it's our job. We've got our work cut out for us.

Don't let a few bad apples ruin your impression of physicians. A lot of what has been described doesn't have much to with how physicians are trained, or what they were taught in school (although, there's no question improvement is possible); it has more to do what kind of people these physician are. School can't teach you how to be a decent human being, let alone a good doctor; much of that rests squarely on the shoulders of those who bear the degree and assume the role. It is a lifetime commitment. By the time we graduate medical school, everything we've learned has already been out-of-date by several years, based on new evidence and new studies. So then we must be committed to continually revising our knowledge base and to keeping our minds open to learning. There are some who fall behind and some who not only fall behind, but are lousy people to begin with. Unfortunately, it's people's wellbeing they are playing with, so the impact of a few bad apples can be large. I think many are simply doing the best they can.

The basic premise is that we are our patient's healthcare advocate; this is the prime directive of doctoring. Unfortunately, we receive a lot of pressure from a variety of sources, such as the media, the insurance companies, the legal system, the government (political), pharmaceutical companies, businessmen, our places of employment, etc., and sometimes the patients themselves, who try to stand in the way of that key directive, because this directive often conflicts with their goals. So, while this isn't any excuse, it goes to show you that we have to fight hard sometimes to do what's best for our patients.

It's not as simple as changing the curriculum, etc., or the addition of more classes on nutrition. It's a multidimensional issue... Let's treat it as such. Anyway, I think we are long overdo for a major paradigm shift.

 

[t-funk]

I agree with both of you that the internet and drug companies advertizing on TV to consumers is having a huge effect on the doctor-patient relationship and what the everyday person thinks they know about thier own health related problems. When you add in the fact that many physicians are over-worked and stressed by many of the variables that Endocardium just mentioned, I understand that they just don't have the time to sit with each patient and do everything, such as going into lengths about nutrition, that they wish they could. I guess it is also hard for them to know who to believe when they have experienced so many people who are willing to lie to them to avoid embarrassment or being 'lectured'. These are most likely bigger issues in the doctor-patient relationship than the patient feeling that their physician isn't willing to listen to them.

So, I would like to ask a question out of pure curiosity as to your opinions on the subject. My grandma is the type of person who would never, never seek out an alternative therapy. She had really painful arthritis for years which is now just starting to cripple her hands and tried every medication in the book. A friend of hers bought her some shark cartilage and she reluctantly tried some and started feeling a little less pain. It has been the only thing that has ever really make the pain fade a little. She knows this from experience but she won't tell her doctor. Why? Because she doesn't want to get laughed at or told that it is all in her head which she knows it is not so she keeps it to herself. If she did tell her doctor, maybe he/she could mention it to others in passing if nothing else is helping them. "I have no experience with shark cartilage (enter any other thing people have been telling their doctor on multiple occasions), but I've heard other people in your situation say that it has helped them. This is not in my area of specialty, so take it for it's worth." Would this type of advice even be allowed? I do think situations like this are happening all over (such as my experience with taking my son off of gluten and dairy for a year or two) and it is hurting the doctor-patient relationship bc patients do not feel like they can confide in them w/o being laughed at or told that it is all in their head.

I'm quite sure the complexities are such that what I am saying is possibly not realistic when you factor in insurance, time, and liabilites and although I am not really sure about what you were referring to specifically, Endocardium, I agree that I would also like to see a paradigm shift.

 

[Dr JPH]

Would this type of advice even be allowed?

Of course its allowed.

The problem lies with the patients who omit certain aspects of their medical history (which includes OTC and non-pharmaceutical medications). I have run into situations where certain herbal supplements affect levels of certain medications, namely Coumadin. This can lead to very dangerous consequences.

Patients are so worried about being "laughed at" that they will allow their physicians to prescribe medications that can seriously injure them when mixed with the over-the-counter things they are taking.

Now, you can argue that the physician should be more receptive to these things (which many of us are) and that the physician should ask about these things (which many of us do) but in the end it is the patients responsibility to inform their doctor about any and all things they take.

I dont see anything wrong with the patient taking responsibility for themselves.

If you want to eat poorly, smoke, use drugs or drink in excess then I as your physician cannot and SHOULD NOT be held responsible for the outcomes. Therefore, when you end up in the hospital and youre having a CVA, dont blame me when you cant move your left arm.

Similar situation happed just this past month to the service I was on.

Patient on multiple meds for variety of issues (dyslipidemia, HTN, CAD, h/o TIA) who had a massive stroke. Wife fully admitted that her husband simply refused to take the medications that were sitting on the kitchen window sill.

What do you think the family was concerned about the following day after he presented to the ER?

1. Why didnt he get the medication that "cures strokes" when he came into the ER?

and

2. How come they were never warned that this could happen if he didnt take his medications?

So thats the reality folks. You honestly think that taking the time to talk to this guy BEFOREHAND would have made a difference? Hell no.

Guy already had one TIA and was working on another...continued as a 2ppd smoker and drank a case of beer per week...me telling him "now, you really need to stop all that, eat your vegetables and take these pills" would have been a waste of my time more than anything.

I think he realizes now that it was the wrong decision on his part...of course his family is still blaming the FP for not keeping a closer eye on things.

 

[Playmakur42]

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[J1515]

So, I would like to ask a question out of pure curiosity as to your opinions on the subject. My grandma is the type of person who would never, never seek out an alternative therapy. She had really painful arthritis for years which is now just starting to cripple her hands and tried every medication in the book. A friend of hers bought her some shark cartilage and she reluctantly tried some and started feeling a little less pain. It has been the only thing that has ever really make the pain fade a little. She knows this from experience but she won't tell her doctor. Why? Because she doesn't want to get laughed at or told that it is all in her head which she knows it is not so she keeps it to herself. If she did tell her doctor, maybe he/she could mention it to others in passing if nothing else is helping them. "I have no experience with shark cartilage (enter any other thing people have been telling their doctor on multiple occasions), but I've heard other people in your situation say that it has helped them. This is not in my area of specialty, so take it for it's worth." Would this type of advice even be allowed? I do think situations like this are happening all over (such as my experience with taking my son off of gluten and dairy for a year or two) and it is hurting the doctor-patient relationship bc patients do not feel like they can confide in them w/o being laughed at or told that it is all in their head.

I agree with what JPH said. Patients can try whatever they want. It is their health afterall. I would have no problem with a patient telling me they tried alternative treatment, but if I knew for a fact that said treatment was harmful, I would say so (in a civil and polite manner of course). As he said, the dangerous thing is when they don't tell doctors what alternative treatments they're currently trying. I keep hearing over and over from patients and other doctors that patients are afraid of being laughed at for admitting to their PCP that they are trying alternative treatment. While I'm sure that has happened in the past and could still happen, I believe medicine has changed to where doctors are more open to alternative treatments, even if they don't recommend it. The fact that patients are afraid to tell their doctors something just shows that they are not willing to be completely open with their doctor and don't trust them, which can greatly effect the treatment they receive.

As for your question about me telling a patient with uncontrollable pain about shark cartilage, I would not. For one thing, even if I say it in passing, it is the same thing as recommending it in the patient's eyes and I know nothing about it. Additionally, Im not an expert in medical law but God forbid the shark cartilage had a negative effect on the patient's health I do believe I would be liable for even mentioning it.

 

[J1515]

In my limited experience, I've seen patients who forgot that they've had their gallbladder removed. Chances are they might forget to mention they had some tylenol and green tea with their morning coumadin too.

Are drug interactions with most OTC medicines/herbs effectivelystudied? part of the med school curriculum?

Depends what your definition of "effectively studied" means. At our school we had a couple of lectures on herbal supplements and alternative medicine. In addition, in pharmacology, anytime there is a possible interaction with a popular herb or OTC medication it is taught. In my eyes, this constitutes "effectively taught."

 

[scpod]

... anytime there is a possible interaction with a popular herb or OTC medication it is taught. In my eyes, this constitutes "effectively taught."

Yes, but these are only "known" interactions. There really aren't too many studies on herbs. Most studies are performed by drug companies. They have no reason to study interactions with herbs or supplements.

 

[endocardium]

As for your question about me telling a patient with uncontrollable pain about shark cartilage, I would not. For one thing, even if I say it in passing, it is the same thing as recommending it in the patient's eyes and I know nothing about it. Additionally, Im not an expert in medical law but God forbid the shark cartilage had a negative effect on the patient's health I do believe I would be liable for even mentioning it.

I basically concur with the above. I'd be pretty reluctant to mention shark cartilage, or any similar sort of anecdotally propagated treatment that I did not have any good knowledge about. It's easy for a patient to mistake it for agreement, or a suggestion of treatment, when in fact, I am not agreeing or suggesting this treatment. I would, however, suggest a standard course of treatment for the condition and other possible alternative treatments and/or supportive care that have been shown to be reliably efficacious by current literature, or alternatives that were frequently used and accepted by the medical community (such as with OMM), taking care to discuss their potential benefits and negatives/side-effects.

It's important to develop trust with your patient, so that they will tell you the things that matter, things that perhaps they wouldn't even tell anybody else. Also, as was mentioned before, we are not our patient's keeper. We should encourage personal responsibility and ownership in the process as well.

If a patient comes to my office wanting to try shark cartilage for her condition, I won't be judgmental about it. I'm open to their point of view and I want my patients to tell me what they are wanting to do, or already doing, and what their experience is. I would probably tell them that I have no experience with it and that I couldn't really recommend such a course of treatment. I'd do some research about it and get back to them with what I've found out about it. In the meantime and as a matter of course, I'd proceed as I already mentioned above, presenting treatments that have known efficacy, or that are accepted alternatives, along with appropriate supportive care. I can't stop my patients from doing what they will, or from harming themselves, but I can educate and treat them the best that I can. The rest is up to them.

 

[t-funk]

Now, you can argue that the physician should be more receptive to these things (which many of us are) and that the physician should ask about these things (which many of us do) but in the end it is the patients responsibility to inform their doctor about any and all things they take.

This is very good to know. I think that doctors are much more concerned with making sure you tell them everything that you are taking, including multivitamins, than they used to be. I always seem to forget to say my multivitamin and immediately say nothing since I'm usually never on any meds. They always seem to ask 2 or 3 times anymore to get the multivitamin or OTC med out of you. It's pretty easy to forget.

I don't think any normal person would hold it against their doctor if they forgot or 'accidentally' forgot to mention a medication or supplement they were on and something happened. Unfortunately, we live in a world of irrational people who would rather blame the doctor than take responsibility for not taking their meds and then having a CVA. I most definitely am not blaming the doctors in any way, shape, or form for instances like the one you described. That is all on the patient.

 

[endocardium]

I don't think any normal person would hold it against their doctor if they forgot or 'accidentally' forgot to mention a medication or supplement they were on and something happened. Unfortunately, we live in a world of irrational people who would rather blame the doctor than take responsibility for not taking their meds and then having a CVA. I most definitely am not blaming the doctors in any way, shape, or form for instances like the one you described. That is all on the patient.

We live in a litigious society. Many would rather sue and blame than take personal responsibility. *sigh*

 

[J1515]

Yes, but these are only "known" interactions. There really aren't too many studies on herbs. Most studies are performed by drug companies. They have no reason to study interactions with herbs or supplements.

I agree. But given the fact that herbs are so widely used and what you just mentioned above, I believe medical schools are doing all they can to inform doctors of potential effects and interactions. I'm not saying I would ever recommend herbs to a patient given how little we know about them at this point in time, but patients will take it upon themselves to try it.

 

[toothless rufus]

There's a little thing known as "standard of care" that you need to examine closely before you open up that practice. The first time that you don't give drugs, and they "might" have helped your patient....you'll lose the lawsuit, your license. and a large chunk of your butt as well. Maybe you should be looking at Naturopathy instead of Osteopathy?

Its interesting to note that this "standard of care" thingie is expected to be applied even in situations where it might not be warranted; but ya better do it anyways to cover your arse! And that by following this Care-That-Is-Standard (Indian name) it probably happens to line the coffers of those who produce these standard care packages. Yet another reason "The Man" don't want us stepping outside the box....Time for Pizza!

 

[Dr JPH]

I don't think any normal person would hold it against their doctor if they forgot or 'accidentally' forgot to mention a medication or supplement they were on and something happened. Unfortunately, we live in a world of irrational people who would rather blame the doctor than take responsibility for not taking their meds and then having a CVA. I most definitely am not blaming the doctors in any way, shape, or form for instances like the one you described. That is all on the patient.

First, patients arent normal.

Second, patients lawyers feel it is the responsibility of the physician to find and correct each ailment the patient has.

We are viewed like mechanics...I bring my car in because there is a grinding noise when I turn the wheel to the right. If the mechanic doesnt fix that (regardless of whether or not its a problem that CAN be fixed), he gets sued. Even if the mechanic DOES fix that but now there is a slight squeak when I turn the wheel to the right, he still gets sued. Oh...and he gets sued if the trunk smells like ass because when I brought the car in I forgot about the groceries in the trunk...but its the mechanics fault because he should have looked.

Patients do not want to take responsibility for themselves. I cant tell you how many people have threatened to sue for the most ridiculous things.

One patient put it very simply. "I dont eat right and I dont take my glucophage, but every few months I end up in the hospital and you people fix me all up."

Thats the attitude of most of your patients. Its not MY problem, the doctor will fix it.

 

[JWE27]

First, I'd like to thank t-funk and endocardium for being the brave, mature souls they are in settling down both sides and getting this back to a great, thought-provoking discussion . Obviously the rest of us couldn't seem to do it!

Sadly, this "internet scientist" scourge that has been afflicting patients these days hits very close to home in my work life. Simply because you can find it on the internet doesn't make it correct or allow you to be able to incorporate it into effective, safe healthcare! I think I deal with this situation almost daily in my practice as a dietitian. I may be in a slightly different position to deal with it than most, however. Many (if not all) supplements, herbs, and products that are brought to my attention by patients I have at least some knowledge of (some much more than others). Unfortunately, most products are either ineffective or don't contain what they say they contain (which is a whole different mess that is still very-poorly regulated right now). Believe me, I wish many of these products were more useful, but there just isn't the research behind most of it (and I mean enough research to be comfortable with recommending it, not just a handful of studies funded by the company selling the product!). I use the knowledge I have of these products to logically debunk the patient's urge to take these things (e.g., creatine may exacerbate existing kidney disease, etc., etc.). It almost always works if I can use real data and/or scientific logic to explain why it is a bad idea to take certain OTC supplements. Sometimes my recommendations are as simple as "we don't know enough about that to safely consider taking it; and, it will likely only offer minor effect (if any) so the risks outweigh the potential benefits...". I do, however, encounter the militant patient who seems they're only telling me what they're taking to brag, rather than hear feedback on whether it's a good idea to take. All I can do in these situations is say that I'm only telling them the facts, and they can do what they want with that info.

I'd like to believe I will continue this practice of justifying my recommendations to patients with specific knowledge and/or data to help solidify why I'm saying what I'm saying into my career as a physician. Many patients have expressed to me that they didn't have faith in other healthcare providers' suggestions because they felt they were just regurgitating something they were told to recommend rather than fully buying into the logic behind it. Well, it's worked relatively well for me so far most of the time, so I just thought I'd share my experience with these "internet scientists" we all love sooo much...

 

[Beau Geste]

This isn't nutrition-related, but I thought I'd share....

I had the parent of a kid I see tell me she uses peroxide to clear of sinus infections. Me: WTF? She told me she rinses her ear with a capful when she has congestion.

After laughing hard on the inside, I had to explain the what the eardrum (TM) is and does and relate to her that if she's getting peroxide in her middle ear when she does that, she has bigger problems such as a perforated TM which, depending on the size could lead to hearing loss and infection. But no, not her, she said she does it when she notices a stuffy nose.

Where did she get this information, you might ask? A "holistic healer" that lives upstairs from her. I bet that guy probably does "candling" too.

The most amusing part, IMO was the look of disbelief she gave me when I described the anatomy and physiology of the outer/middle ear to her. I really think she still believes the "healer".

 

[Playmakur42]

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[Beau Geste]

Idiots Guide to Common Sense: Rule #183,746
Do not take medical advice from the guy who lives in the same run down apartment building as you.

The apartment building is actually brand new, built earlier in 2007.

But you have the general idea

 

[J1515]

Where did she get this information, you might ask? A "holistic healer" that lives upstairs from her. I bet that guy probably does "candling" too.

Anyone ever heard of these guys being sued? What exactly happens? Do they have malpractice insurance?

 

[Beau Geste]

Anyone ever heard of these guys being sued? What exactly happens? Do they have malpractice insurance?

Haven't a clue.

But I do know that "candling" does nothing more than put you at risk for severe burns to your pinna and external ear canal.

 

[LauraDO]

Anyone ever heard of these guys being sued? What exactly happens? Do they have malpractice insurance?

No, most do not have malpractice insurance, it is really a different sort of situation. People do get sued though, especially when they kill people, which happens more often than what you might want to know. The loop hole that normally exists is that patients came on their own free will to seek out alternative treatment or something like that, but there are law suits, especially when it comes to irresponsible modalities like chelation or attempting to treat someone from a condition that they really should be on medication/hospitalized for. The whole thing sort of falls into the same sticky area that people who refuse to take medications due to 'religious' reasons do.

I think many of you might remember that I did one year at a naturopathic school before I realized that is was by no means right for me (actually one quarter but I stuck it out for the year) I think this thread brings up alot of the reasons why. Although I think there are many 'alternative' ideas and treatments that can be very helpful (I am especially talking about diet and supplementation here) overall I did not agree with the philosophy that naturopathic medicine is guided by. There is a tendency to jump to conclusions based on biased or incomplete knowledge. There is a tendency to take to only have a limited understanding of pathology and therefore effects of treatment. In general I was also turned off by the general belief of a 'healing crisis' and that pretty much every pathology just needs a good round of detoxification. I think this is dangerous and irresponsible.

There are alot of very good naturopathic doctors that have done alot of outside research and really know alot, but there are an alot that don't.

 

[RySerr21]

interesting article on CNN about nutrition!!! thoughts? concerns? from reading that article it seems like meat and animal based foods are the only sources of protien, which is completely false.

http://www.cnn.com/2008/HEALTH/diet.fitness/01/02/healthmag.bad.foods/index.html

 

[Dr JPH]

Wait...mass media incorrectly reporting on medical issues? Naahh...I dont believe it.

 

[RySerr21]

Wait...mass media incorrectly reporting on medical issues? Naahh...I dont believe it.

point taken. but why????? surely they are not thaaaaat ignorant.

 

[Beau Geste]

point taken. but why????? surely they are not thaaaaat ignorant.

More of an agenda than ignorance. The sponsor or source of the article is from Health magazine. Not my favorite fitness magazine as it's full of misleading and plain wrong information (I used to subscribe).

 

[VQuick]

This isn't nutrition-related, but I thought I'd share....

I had the parent of a kid I see tell me she uses peroxide to clear of sinus infections. Me: WTF? She told me she rinses her ear with a capful when she has congestion.

After laughing hard on the inside, I had to explain the what the eardrum (TM) is and does and relate to her that if she's getting peroxide in her middle ear when she does that, she has bigger problems such as a perforated TM which, depending on the size could lead to hearing loss and infection. But no, not her, she said she does it when she notices a stuffy nose.

Where did she get this information, you might ask? A "holistic healer" that lives upstairs from her. I bet that guy probably does "candling" too.

The most amusing part, IMO was the look of disbelief she gave me when I described the anatomy and physiology of the outer/middle ear to her. I really think she still believes the "healer".

To play devil's advocate, can you provide references that demonstrate that peroxide in the ear has no effect on sinus infections? Lack of evidence for x is not the same as evidence against x.

I don't know how you guys feel about Dr. Mercola (I personally have mixed feelings) but he recommended the peroxide thing years ago. Unfortunately, he did so without providing any real references. It's a shame because who knows, it could turn out that this treatment actually works through some mechanism but because there's no money in it, it's not likely to be researched. And unsubstantiated internet claims serve only to weaken the cause in the eyes of medical professionals. I am merely stating that we must be careful not to dismiss things that haven't been scientifically disproven.

 

[scpod]

I am merely stating that we must be careful not to dismiss things that haven't been scientifically disproven.

As far as I know...it has not scientifically disproven (a double-blind, placebo controlled study) that your survival odds are better if you actually deploy your parachute when jumping out of an airplane. Yet, people continue to pull that cord every single time. There is, however, anecdotal evidence which might lead one to believe this. Not everything needs a study.

 

[Instatewaiter]

To play devil's advocate, can you provide references that demonstrate that peroxide in the ear has no effect on sinus infections? Lack of evidence for x is not the same as evidence against x.

I'm not going to waste my time to find a study that relates peroxide to sinus infections but I can give you an anatomic basis why it won't work.

 

[Beau Geste]

I'm not going to waste my time to find a study that relates peroxide to sinus infections but I can give you an anatomic basis why it won't work.

Um... yeah. That little thing called the Tympanic Membrane is actually made of layers of skin - the same skin that keeps your bath water from saturating your insides.

Unless you have a perforated TM, one function of the TM is to keep foreign objects out of the middle ear. Go ahead and try it - tilt your head over and pour a cap of peroxide in your ear. Let it sit for however long you want. Tilt your head up. Do you taste peroxide? No? Because if peroxide gets into the middle ear, it's likely to get into the Eustachian tube, and the Eustachian Tube leads to the posterior oral cavity.

Peroxide in the outer ear will help clear the external ear canal of wax buildup, but that's about it. If you have otitis externa, then by all means use peroxide. But it will do no good for a sinus infection. There is some sketchy literature that suggests bacteria and viruses may enter through the external ear for middle ear infection, but nothing definitive (at least that I've come across). In addition, that discounts the useful properties of earwax, which is also antibacterial.

VQuick, I understand that you want scientific proof, however before you spout off, understand your communication partner. You are smart enough to figure out what I do for a living (before med school starts) and should understand that somewhere in my Master's Degree for speech-language pathology we took anatomy and physiology courses for the ear, as well as several audiology courses. In addition, I've had plenty of CE to back of up my education. Not only is this anatomy and physiology taught in any standard A&P textbook, I expect people going into this field to use their common sense when it comes to what can make it into the middle ear from the outer ear (hint: nothing if all is intact).

Your post validates JPH's frustration with pre-meds.

 

[FinchHead]

Lack of evidence for x is not the same as evidence against x.

That is ignorant and idiotic. It is the same flawed logic that lets people believe in any wacky belief that sounds good at the time (astrology, fortune tellers, voodoo, and I'm sure you can see where else I'm going with this...).

The burden of proof is on the person making the assertion. Even ignoring the fact that it is easy to disprove the hydroxide stuff, it is unnecessary for people to disprove things where there is no observed phenomena. No, second-hand anecdotal evidence does not count.

 

[J1515]

To play devil's advocate, can you provide references that demonstrate that peroxide in the ear has no effect on sinus infections? Lack of evidence for x is not the same as evidence against x.

Can you provide references that demonstrate that a foot massage won't cure meningitis??

It's a shame because who knows, it could turn out that this treatment actually works through some mechanism but because there's no money in it, it's not likely to be researched.

No, it's not likely to be researched because it doesn't make anatomical sense. It sounds like this "treatment" was invented by someone who had little knowledge of the human body, much like the person who said that when you put rubbing alcohol on a wound, the burning sensation is the bacteria being killed.

 

[mastamark]

Can you provide references that demonstrate that a foot massage won't cure meningitis??



No, it's not likely to be researched because it doesn't make anatomical sense. It sounds like this "treatment" was invented by someone who had little knowledge of the human body, much like the person who said that when you put rubbing alcohol on a wound, the burning sensation is the bacteria being killed.

Or catch a cold by going out with wet hair. Or every headache occurs if you don't have a regular BM. oooh or everytime I got a headache my grandmother would ask, "Did you have a BM today." I knew as a kid that theory was full of shhhhh (Pun intended).