Systemic Problems in Medicine

[cdmguy]

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Earlier we discussed systemic problems in chiropractic without mentioning that medicine has some big problems of its own. Let's discuss:

http://chirotalk.proboards.com/index.cgi?action=display&board=summaries&thread=5333&page=1

I completely agree about the superiority of med school to chiropractic school. However, it is far from perfect. As a patient I've found medicine to overly sales oriented, heavily politically influenced and often as much a mill as any chiropractic clinic. A research study showed that most MDs can't interpret research correctly and don't know basic statistics. They have huge egos and hate when patients take an active role in their own care because it forces them to make decisions rather than just do what every one else is doing. So medicine is largely a concensus field with little independent thinking. Most of the time they have no problem dictating treatment without knowing what options are available and dismiss options based on rumor and bias, often missing alternatives outside medicine that they don't take the time to investigate. But when they do take the time to investigate, their lack of research skills makes them unqualified to judge whether a treatment is effective so they are easy marks for quacks.

Given the climate is this really science based? Sometimes while often they are limited to the sales pitch of a drug rep or the latest research summary blurb in a reference source that is really just based on falsified studies from biased researchers on the take from the manufacturer or a biased FDA panel with similar vested interests. It's profitable but not good care. Given how little learning is actually going on in medical schools vs. slave labor for hospitals (especially residency-remember 80 hour work weeks?) I think the British are right to keep the training short. Unfortunately, medical and nursing education is big business for US colleges so the system has many incentives to keep it drawn out.

All of this is ammunition for the quacks to use against medicine and lure students in.

and

The problems I cited are just as systemic as the ones in chiropractic and the practitioners are so indoctrinated that they don't know they are doing the wrong thing. Try asking a psychiatrist to state the effectiveness and side effect profile of the (amino acid) supplement SAM-e compared to Lexapro, 9 out of 10 times you'll get a blank stare. If a patient asks them to prescribe it for moderate depression they will refuse.

Ask 20 GPs to name the symptoms of bartonella vinsonii infection (a stealth infection of red blood cells and bone marrow that is commonly acquired from scratches and flea bites from outside cats; it doesn't give CBC findings and there is only one sensitive lab test for it). 19 of them will have never heard of it and misdiagnose it as chronic fatigue syndrome, symptom magnification with overlying major depression and idiopathic headache (leaving patients untreated with a treatable but otherwise chronic disabling illness that is hard to substantiate for disability claims-leaving them homeless and without financial support of any kind).

I am not overgeneralizing. In many cases medicine is in a sorry state and doesn't serve patients. This is exactly how the insurance companies and drug companies, the largest lobbying group, want it.

 

[cowme]

 

[OveractiveBrain]

Earlier we discussed systemic problems in chiropractic without mentioning that medicine has some big problems of its own. Let's discuss:

http://chirotalk.proboards.com/index.cgi?action=display&board=summaries&thread=5333&page=1



and

Imagine the human torch and porky pig met.

OK. Now that I've made you hungry (I didn't intend on you thinking bacon)

Fuh...Fuh...Fuh...FLAME ON!

 

[OveractiveBrain]

Earlier we discussed systemic problems in chiropractic without mentioning that medicine has some big problems of its own. Let's discuss:

http://chirotalk.proboards.com/index.cgi?action=display&board=summaries&thread=5333&page=1



and

So... In an actual response to this post...

ONE person's erroneous perspective of how things work in medicine doesn't mean thats how they actually are. Actually discussing a topic based on misgivings of one person really isn't worth it at all. The debate we should be having is whether or not the things you've quoted or even accurate, not how they impact medicine in general or what we should do to "prevent other fields from luring students."

Almost nothing said is accurate. In fact, I'd request the mods to just take down the post. Its only intention is to incite flaming, and since it is full of inaccuracies can really bias people looking for information in the wrong direction. It would take hours to undo the damage done by the post. Too long, even for me. Even though Im in clinic. Without any patients. And have nothing else to do.


What the post boils down to, and why there will be many pictures of trolls/orcs/goblins, is because it is started by someone without insight. The statements are clearly written by someone not in medicine, taking a position of propaganda, focusing on nuances or TV drama depicitions of how medicine works. It turns out that medicine isn't practiced like the romantic comedy "Love and Other Drugs" or "Hawthorne" would have you beileve. They don't have an insight on the practice of medicine, on systems in place, on the concepts of patterns and prevelance. Its full of lies, propaganda, and microscopic out-of-context nonsense. Overall, pretty painful.

You best start believing in troll threads. You're in one.

Don't feed the troll.

uMad? (squigglies)

uMad? (dancing abs)

uMad? (troll)

 

[cdmguy]

OB,

Your response is a total crock of (pick your expletive). This stuff happens all the time. Perhaps you just don't have enough exposure to outside practice to see it. Censorship isn't the answer. If you aren't part of the solution you are part of the problem.

If you are correct then why aren't bartinella vinsonii and other bartinella sp. infections listed in the Merck Manual under bartinella? Instead I see only quintanis, henselae and bacilliformus.

http://www.merckmanuals.com/professional/sec15/ch184/ch184b.html#v1006329

You'd better not come into contact with any outside cats or you're screwed.

Pet me and die

How many hours of education did you get on non-pharmaceutical nutraceuticals from trustworthy sources? Probably zero.

 

[voidlogin]

yeah you can find some rare things that most doctors haven't heard of before. In reality majority of patients present with common problems, not some mysterious ones like in House. So it makes sense for doctors to learn in-depth about common problems, instead of being jack of all trades. As for bartonella vinsonii (cat scratch fever?), its called taking a history + physical : I see scratches in your arm, do you have cats? Did your fever come after your cat scratched you? Do you have heart and neuro problems?

And yes, everyone likes to badmouth pharm companies. You specifically mentioned psych drugs. Well, before anti-psychotics came along, schizophrenics used to be "locked-up" in mental wards. Now they can at least live a semi-normal life. Pharm companies may be sales oriented, but they do contribute to improving pt outcome.

 

[Freakfarm0]

Earlier we discussed systemic problems in chiropractic without mentioning that medicine has some big problems of its own. Let's discuss:

http://chirotalk.proboards.com/index.cgi?action=display&board=summaries&thread=5333&page=1

 

[cdmguy]

yeah you can find some rare things that most doctors haven't heard of before. In reality majority of patients present with common problems, not some mysterious ones like in House. So it makes sense for doctors to learn in-depth about common problems, instead of being jack of all trades. As for bartonella vinsonii (cat scratch fever?), its called taking a history + physical : I see scratches in your arm, do you have cats? Did your fever come after your cat scratched you? Do you have heart and neuro problems?

And yes, everyone likes to badmouth pharm companies. You specifically mentioned psych drugs. Well, before anti-psychotics came along, schizophrenics used to be "locked-up" in mental wards. Now they can at least live a semi-normal life. Pharm companies may be sales oriented, but they do contribute to improving pt outcome.

The reality is that GPs are responsible for the screening so if they don't know what they are doing the patients aren't going to be treated. All of the bartonella subtypes have different symptoms and it can be afebrile.

Pharm companies are as a rule unscrupulous. Look at how many lose lawsuits for ethical breaches. There was an article on this in Time magazine recently. Too much conflict of interest with the researchers and FDA panels.

Anyway, lots of people fall between the cracks and get poor treatment. Don't sugar coat it.

 

[facetguy]

Makin' friends wherever you go!

 

[cowme]

The reality is that GPs are responsible for the screening so if they don't know what they are doing the patients aren't going to be treated. All of the bartonella subtypes have different symptoms and it can be afebrile.

Pharm companies are as a rule unscrupulous. Look at how many lose lawsuits for ethical breaches. There was an article on this in Time magazine recently. Too much conflict of interest with the researchers and FDA panels.

Anyway, lots of people fall between the cracks and get poor treatment. Don't sugar coat it.

And these are the people that put people in hocus-pocus medicine like yours into business. You should be grateful

And bartonella is most often a completely self-limiting disease. There is no clear-cut evidence to treat it if there are NO signs of infection (which, most GP's can see).

I gotta admit tough, your logic is cracking me up. Here is how your arguments go:
"I think this. Here's one unsubstantiated example. I read an article recently, but won't give a link because it is actually completely unrelated "

 

[cdmguy]

Where is your reference for bartonella being self limited?

"We detected infection with a Bartonella species (B. henselae or B. vinsonii subsp. berkhoffii) in blood samples from six immunocompetent patients who presented with a chronic neurological or neurocognitive syndrome including seizures, ataxia, memory loss, and/or tremors. Each of these patients had substantial animal contact or recent arthropod exposure as a potential risk factor for Bartonella infection." (Breitschwerdt, E. JOURNAL OF CLINICAL MICROBIOLOGY, Sept. 2008, p. 2856–2861)

What probably happens is that bartonella stays low level, localized and asymptomatic until a time when immunity is low (i.e. EBV infection) then it becomes systemic and disabling.

If SAM-e has fewer side effects and is the best agent for a patient then psychiatrists should know how to use it responsibly.

 

[Staradmiral]

I do agree that Medical education is rediculously too long in the US and Canada. 4 years of undergrad is not needed to begin medicine. All the prereqs could easily be taught in two years, followed by 2 years of medical basic sciences. only one year of clerkships should be required for those interested in primary care, making med school 3 years for those students and 4 for those going for specialties. Residencies are also ridiculously long with a lot of working and not much learning. Residency is long so the hospital can take advantage of cheap labour as long as possible and not have you pay you the specialist salary. 50k/year vs 250k/year.

The length of education in the US is all about universities making money rather than actually educating people. Its drawn out for years, making students take unnecessary courses just for the university to make more money. 4 years of undergrad to go to med school? are you kidding? its just a friekin cash grab. Everyone goes straight to med school after grade 12 in europe.... and europes doctor's are just as good as american.

We'd be churning out 26year old neurosurgeons if university was actually focused on education rather than making money. Reducing the length of education could reduce the doctor shortage by about 5%.

 

[cowme]

I'm not arguing with you anymore. Unless I'm unhappy with my next backrub

 

[WellWornLad]

A research study showed that most MDs can't interpret research correctly and don't know basic statistics.

Actually lol'ed when I read that. Thanks for that.

FWIW, a research study showed that your subjective blanket view of the world is not superior to my subjective blanket view of the world.

I'd stick around, but I've got to deal with that bartonella thing that everyone's dropping dead from...

 

[cdmguy]

"Annually, more than 10,000 clinical trials report their findings, thereby profiding valuable opportunities for improving patient care. The challenge for health professionals is to translate this new knowledge into practice. A recent quality of care survey concluded that 30-40% of patients in the Netherlands and in the United states were receiving optimal care. (p.131) The situation appears to be even more bleak when considering that 20-25% of the care administered was judged to be unnecessary and potentially harmful. A large U.S. study involving 30 acute or chronic conditions concluded that only 55% of the patients received recommended care. The most common deviation was undertreatment, which suggests that our national healthcare system as it exists today is failing us." (Furberg, BD. Evaluating Clinical Research: All that glitters is not gold. 2007)

The study showing MDs understanding basic statistics is somewhere there also. Someone please look it up if you have a few minutes. Good book for people who can see their limitations.

 

[Staradmiral]

MDs have a very good understanding of statistics. Some just chose to ignore them.

 

[cdmguy]

That's not what the research found. Less that half knew even the basics.

 

[MKA55]

That's not what the research found. Less that half knew even the basics.

You're right, the AAMC should make it mandatory for all MD students to rotate at a chiropractic school, so they can get a better look at what a real scientific education looks like... 🙄

 

[cdmguy]

"I always cheer up immensely if an attack is particularly wounding because I think, well, if they attack one personally, it means they have not a single (political) argument left." -Margaret Thatcher

 

[WellWornLad]

The study showing MDs understanding basic statistics is somewhere there also. Someone please look it up if you have a few minutes. Good book for people who can see their limitations.

If you don't understand why you're being unintentionally funny, I just can't explain it to you.

Thanks for the "reference," however. I'm sure your man Furberg's word is bond.

 

[loveoforganic]

MDs have a very good understanding of statistics. Some just chose to ignore them.

Not getting into anything else, I would be very surprised if most MDs have a very good understanding of statistics, unless you define "very good understanding" or "statistics" in a quirky/simplistic way.

Having taken undergrad psych stats and grad biostats, and having read at least a couple hundred articles, I'd consider myself to have a rudimentary understanding of basic statistics.

 

[cdmguy]

Yes that's what I mean love. I know the typical chiropractic angle is to bash medicine to promote black and white (cult) thinking to seal the person in as a chiropractor or patient by making them fear medicine but I'm not doing that here and It's been a long time since I was indoctrinated to be pro-chiropractic. I write from practical experience as an informed patient and person who has worked in clinical research and neuromonitoring. If you get one of the lesser known bartonella infections you will be hard pressed to get good care. The problems I cited are real, not exaggerated, and correctable if people would just acknowledge them and start speaking up. If not then you're just thought stopping the problem rather than giving it enough consideration. This is why complementary and alternative medical programs exist, the MDs get disgruntled with the problems and make the mistake of thinking that the answer is to isolate and cross pollinate with quacky professions rather than attack the problems systemically. The end result is medical offices that offer IV megavitamin treatments, Reiki, homeopathy and quacky unproven naturopathic treatments to name a few.

Regarding statistics, Furberg is the expert I cited and we have to take their analysis of the research seriously. I learned most of what I know about understanding research from his book plus a three credit required course in undergrad. Chiropractic school was a joke with them exempting the only one credit research class because I had it in undergrad. 🙁 The less science you know there the better. At least medicine could self correct if people will take the blinders off, chiropractic is doomed because of the quacky mindset and limited scope. Most of the intelligent, pro-science DCs quickly see through the mirage and tire of the profession, enrolling in PA, RN-NP and DO programs as their finances allow. I hope to see more chiropractic programs close in the coming year. So for others, don't attack me for making a past mistake and lose the egos.