Why are docs so uninformed about nutrition and health enhancers?

[Crimpjiggler]

There are 5 docs in my town, the main one I go to is an older guy, hes very knowledgeable and knows what hes doing. Its rare that I'll suggest a drug to him and he won't know what it is (although he often doesn't know the pharmacology behind it). But when I talk to him about things like nutrition and nootropics hes completely clueless. I told him about acetylcarnitine being a mitochondrial antioxidant and he'd never even heard of it. I don't him about nootropics like piracetam, vinpocetine and DMAE and he hadn't heard of any of them. There are probably doctors around that are into this stuff but I haven't met any yet. I'm guessing its not part of the med school curriculum which is ridiculous. For years I had a problem with lethargy and I felt like I needed meds to balance some kind of neurotransmitter imbalance. The meds worked to a degree but later down the line I found out I'm gluten intolerant and if I avoid eating gluten, the lethargy goes away. It was a herbalist that told me about food intolerances. The only help the docs could give me was prescribing me meds I specifically asked for (sometimes it would be a battle to get them to prescribe me something for an off label use).

And as for nootropics, theres fairly well established scientific theory behind how and why they work. DMAE for example gets binded to phospholipids (in place of choline) and gets incorporated into neuron membranes where it acts as an antioxidant. All docs should know that because of its implications for treating dementia. Coenzyme-Q10 and acetylcarnitine act as antioxidants in the place where they are most needed, the mitochondria, I'm amazed docs don't recommend old people take these supplements. Ampakines are positive allosteric modulators of the AMPA receptor which enhance learning and memory abilities. They have neuroprotective properties, I can't remember the mechanism behind that though. Vinpocetine increases cerebral blood flow and counteracts ischemia in the brain.

I think the medical system needs to be revamped. Way too much responsibility is put on doctors, they have to have an extremely wide range of knowledge, and since they're only human theres only so much they have the time to learn. I think the position of GP should be split into about 3 different fields, so they can specialise better. Psychiatry should also be split into two or more fields and nutrition, nootropics, alternative medical practices (which have been proven effective) should be incorporated into mainstream medicine. For example there should be psychiatrists who specialise in repairing and enhancing brain activity (as opposed to all round psychiatrists who often just prescribe meds to cover the symptoms without treating their cause). For example, a psychiatrist that is well versed in nutrition, nootropics as well as various drugs that target the CNS, but in this case his expertise is not in using drugs to relieve symptoms, but more to allow the brain to mend itself more effectively. I can't think of a specific example of that right now, but kinda like the way taking H2 antagonists allows stomach ulcers to heal.

I'm not a med student, so some of what I said there about how the system works is probably wrong, no need to flame me for that, just point out the mistakes. Chemistry and pharmacology are my fields, so I'm interested in medicine, but I'm not a big fan of the medical establishment itself (or the establishments I have to deal with in my field for that matter). We need to put the regulatory bodies back in their place. Their place is QA. Not legislation. In my country they made melotonin and gingko biloba prescription only. I'm fairly sure nobody would approve of that decision if they knew about these substances, but this regulatory body just goes ahead and makes these decisions for us whether we agree or not. Melotonin is a hormone released by the pineal gland when there is a lack of light hitting the retina. It readily crosses the blood brain barrier making it a good, safe sleep aid. It also happens to be a powerful antioxidant so has the added benefit of protecting neurons. It also counteracts adrenergic related tachycardia and hypertension. Thanks to the IMB (the Irish version of the FDA), the only way to obtain melotonin here is to get a prescription from a doctor, and pay a hefty fee (€40 for 30 2mg tablets) and its not covered by health insurance. In America I can get 100 10mg tablets for about $20. Sure, they're not bound by the same strict quality control guidelines but since they're not in the business of injuring people, its in their interest of supplement manufacturers to have a competent QC team on board.

I want to see the system change radically, but for that to happen we all need to work together to get it changed, because the government only makes the changes we demand when they can no longer ignore the demands like they do when its just a small group of people making them.

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[DermViser]

"I think the medical system needs to be revamped."

"Thanks to the IMB (the Irish version of the FDA), the only way to obtain melotonin here is to get a prescription from a doctor, and pay a hefty fee (€40 for 30 2mg tablets) and its not covered by health insurance. In America I can get 100 10mg tablets for about $20. Sure, they're not bound by the same strict quality control guidelines but since they're not in the business of injuring people"

"For example, a psychiatrist that is well versed in nutrition, nootropics as well as various drugs that target the CNS, but in this case his expertise is not in using drugs to relieve symptoms, but more to allow the brain to mend itself more effectively. I can't think of a specific example of that right now, but kinda like the way taking H2 antagonists allows stomach ulcers to heal."


Status says Pre-Medical

 

[Trod]

Well, I see where you're coming from. Its up to the doctor to stay informed as its part of their profession to keep up with the literature. My doctor is great TBH, he actually recommended I try the gluten free diet and also gave me pointers about meditation and its usefulness for people like me. I no longer eat as much gluten since I do feel it saps my motivation if I eat it frequently, but I don't avoid it entirely. He always explains the mechanism behind any drugs that he recommends also, which is awesome for me.
So I don't think its necessary to revamp medical education. Doctors should be responsible for their own knowledge, and if your doc isn't then find a new one.

 

[Trod]

But what do I know, I haven't even been through medical school...

 

[KnuxNole]

It's not a part of medical education, on our exams, something we are never taught. I haven't had any nutrition lectures or fitness lecture. But, docs can refer to the appropriate venue.

 

[PL198]

Yes listen to a herbalist for how to cure your symptoms. Growing plants in your backyard is certainly what gives someone the training to cure illness, not oh idk attending medical school and completing a residency along with fellowship possibly.
If you expect your doctor to know some random mitochondrial antioxidant is, then I guess you better have a computer for a doctor. All the **** you just listed is 99 % stuff PhDs would be concerned about, and MDs wouldn't. Do you have any idea how the system of medicine works? Physicians don't memorize basic science textbooks about what binds to phospholipids to be incorporated into the cell membrane of neurons.

Also newsflash, alternative medicine that has been proven doesn't exist. Why? Because then it's just called medicine. It's just called alternative when you have some nut on a TV show talking about how taking pills is stupid(which are filled with various chemicals from nature) and that instead you should buy capsules filled with some compound they discovered backpacking in the swiss alps that will cure all your life's problems.

 

[plumazul]

There are 5 docs in my town, the main one I go to is an older guy, hes very knowledgeable and knows what hes doing. Its rare that I'll suggest a drug to him and he won't know what it is (although he often doesn't know the pharmacology behind it). But when I talk to him about things like nutrition and nootropics hes completely clueless. ...snip...

Did I just read an infomercial?

 

[neusu]

Take your broscience and get out of here!

 

[dadaddadaBATMAN]

.

Sorry, I'm ignoring the wall of text. I need to at least preserve the illusion of having a life.

Anyways, the main reason is that nutritional studies tend to be difficult to manage scientifically. It's nearly impossible to ethically control patients well enough for a longer term, randomized look at an individual variable.

Imagine trying to force 100+ people to eat nothing but walnuts, and comparing it to some standard diet. Even if you could properly control by including the bare minimum of necessary nutrients, you would still have age, genetics, various disease states, and other factors. Once you do that, you would need to pay attention to a whole host of risk factors: if you increase HDL, are you also lowering triglycerides/LDL/VLDL?

Even a simple study, like when you're looking at carb vs protein vs fat, you have to adjust at least two factors in any given moment....% carb goes up, then % fat and protein must go down. And what happens to calories in this situation? If you control them, are you altering the way the subjects are eating?

I can go on and on. It's a very problematic field of study. So you often get limited to these prospective/retroactive studies without randomization.

Long story short, we don't learn it because much of the science is poorly controlled (not because of lack of effort, but because it's nearly impossible).

 

[Danbo1957]

Doctors are not in the profession of nutritions or health, we deal with medicine. We don't "heal" either. We cure illness and fix injuries, that's it.

 

[LivingEdge]

I don't know about any other medical students or physicians, but I for one don't know about nootropics because I'm NOT STUPID ENOUGH TO THINK YOU CAN TAKE A PILL TO GET SMARTER, and I don't know about GNC products to cure lethargy because if you're lethargic without an underlying medical cause it's because YOUR LIFESTYLE SUCKS.

I know a hell of a lot about nutrition, however.

 

[AnonymousD.O.]

It's not a part of medical education, on our exams, something we are never taught. I haven't had any nutrition lectures or fitness lecture. But, docs can refer to the appropriate venue.

We get a fair amount of nutrition at VCOM currently. It's pretty useful, but a lot of it isn't supported scientifically yet, and as you said, you can just look it up. We are taught it by a certified dietitian, I would say about 2 or 3 hours worth a "systems block" It is something that students tend to wean out of their studies because it isn't as important obviously as some other classes.

But I guess it is cool they are teaching it to us.

 

[SouthernSurgeon]

Anyways, the main reason is that nutritional studies tend to be difficult to manage scientifically. It's nearly impossible to ethically control patients well enough for a longer term, randomized look at an individual variable.

OP's post references a lot of hooey, but at the same time, they are right in that medical students learn a woefully small amount of nutrition during their four years.

As danbo hints at, the current philosophy of medical education focuses mostly on correction of illness, not maintenance of health. That, to me, has some significant drawbacks.

 

[DermViser]

OP's post references a lot of hooey, but at the same time, they are right in that medical students learn a woefully small amount of nutrition during their four years.

As danbo hints at, the current philosophy of medical education focuses mostly on correction of illness, not maintenance of health. That, to me, has some significant drawbacks.

Yes, but that's not a doctor's job. Maintaining your health outside of the doctor's office is the patient's responsibility. There are so many resources out there it's not that hard.

 

[SouthernSurgeon]

Yes, but that's not a doctor's job. Maintaining your health outside of the doctor's office is the patient's responsibility. There are so many resources out there it's not that hard.

Well, it should be easy but a lot of our patients are doing a piss poor job of it. I wonder how much chronic illness could be prevented with better health maintenance.

 

[TooMuchResearch]

Yes, but that's not a doctor's job. Maintaining your health outside of the doctor's office is the patient's responsibility. There are so many resources out there it's not that hard.

Lol?

 

[DermViser]

Well, it should be easy but a lot of our patients are doing a piss poor job of it. I wonder how much chronic illness could be prevented with better health maintenance.

A lot of illness can be prevented with health maintenance on the part of patients. It doesn't matter if I check off every box for health maintenance (screening colonoscopy, etc.) in the office, if you go home and chow down on cheeseburgers and fries.

With patients, you can give them all the information you want. You can handhold them for every single step (which is cost prohibitive at the moment) like they are 5 year olds. But if the patient doesn't care or reverts back to poor health maintenance a doctor can't prevent that. All the more reason why P4P is a bad idea esp. on the primary care side.

 

[DermViser]

Lol?

What's funny about that? There are reams of websites which teach you how to make quick, easy, healthy meals, how to exercise, etc. For the patients who complain about how much their smartphone can give them all the medical information they need (vs. their doctor) they sure suddenly become Internet novices when it comes to looking up things on how to eat right and exercise.

 

[TheShaker]

What's funny about that? There are reams of websites which teach you how to make quick, easy, healthy meals, how to exercise, etc. For the patients who complain about how much their smartphone can give them all the medical information they need (vs. their doctor) they sure suddenly become Internet novices when it comes to looking up things on how to eat right and exercise.

To be fair, the fitness and diet industries are full of snake oil. There's a disorienting amount of information out there, most of which is bullcrap. I do agree that they can at least try though.

 

[DermViser]

To be fair, the fitness and diet industries are full of snake oil. There's a disorienting amount of information out there, most of which is bullcrap. I do agree that they can at least try though.

Sorry but there are great websites that teach you how to cook healthy great tasting meals, how to exercise, etc. If you're smart enough to know how to use a smartphone, you can do that.

 

[KnuxNole]

What's funny about that? There are reams of websites which teach you how to make quick, easy, healthy meals, how to exercise, etc. For the patients who complain about how much their smartphone can give them all the medical information they need (vs. their doctor) they sure suddenly become Internet novices when it comes to looking up things on how to eat right and exercise.

For the average American, those exercise things are "too complicated". Same with meals.

 

[dadaddadaBATMAN]

OP's post references a lot of hooey, but at the same time, they are right in that medical students learn a woefully small amount of nutrition during their four years.

As danbo hints at, the current philosophy of medical education focuses mostly on correction of illness, not maintenance of health. That, to me, has some significant drawbacks.

We do get relatively little nutritional information, but as dermviser points out below, it isn't necessarily all our job. Some of it does fall under the province of public health/education. I completely agree that our knowledge of preventative processes is low (at least lower than I'd like). However, I'd maintain that some of the science behind nutrition is weaker than I feel comfortable with.

Maybe I'm biased by my current research (in nutrition), or maybe I just hold other medical science on a pedestal it doesn't deserve. I imagine experience will help me figure that out.

A lot of illness can be prevented with health maintenance on the part of patients. It doesn't matter if I check off every box for health maintenance (screening colonoscopy, etc.) in the office, if you go home and chow down on cheeseburgers and fries.

With patients, you can give them all the information you want. You can handhold them for every single step (which is cost prohibitive at the moment) like they are 5 year olds. But if the patient doesn't care or reverts back to poor health maintenance a doctor can't prevent that. All the more reason why P4P is a bad idea esp. on the primary care side.

It might not be our job, but it is the way the political winds seem to blow.

To me it doesn't seem all bad...
1. It really can help, if implemented
2.there's money to be made in these things, even if the evidence isn't perfect. See Dr. Oz.
3. It feels like every time we say "that's not our job" we lose a little bit of ground to other professions.

 

[PL198]

OP's post references a lot of hooey, but at the same time, they are right in that medical students learn a woefully small amount of nutrition during their four years.

As danbo hints at, the current philosophy of medical education focuses mostly on correction of illness, not maintenance of health. That, to me, has some significant drawbacks.

Not sure I agree. Anyone that understands biochem and doesn't just binge and purge in their class should have a more than adequate handle on proper nutrition for the basic macros at least.

 

[PL198]

For the average American, those exercise things are "too complicated". Same with meals.

Says who? If calories in, calories out is too complicated, then someone deserves adverse health effects. Survival of the fittest. You can't really make it any easier than that besides putting them in a cage and feeding them every meal, controlling it's contents.

To be fair, the fitness and diet industries are full of snake oil. There's a disorienting amount of information out there, most of which is bullcrap. I do agree that they can at least try though.

It's not really snake oil. I always laugh when people talk about snake oil. Things like that are simply created by dumb people that don't take action when a product is unsuccessful. If people(in which improvement is possible or likely) don't improve following a method, then either a) they didn't follow the method properly b) it's incorrect. It's like when you see the typical person at the gym running a bro-split at the gym. You see the same dudes that are 5'9 150 for their whole life who never change in appearance, even though you know they are trying to. I don't feel sorry for the person who isn't intelligent enough to change their actions after doing multiple years of them fails to elicit a change.

 

[SouthernSurgeon]

It's not really snake oil. I always laugh when people talk about snake oil. Things like that are simply created by dumb people that don't take action when a product is unsuccessful. If people(in which improvement is possible or likely) don't improve following a method, then either a) they didn't follow the method properly b) it's incorrect. It's like when you see the typical person at the gym running a bro-split at the gym. You see the same dudes that are 5'9 150 for their whole life who never change in appearance, even though you know they are trying to. I don't feel sorry for the person who isn't intelligent enough to change their actions after doing multiple years of them fails to elicit a change.

There is definitely a lot of stuff out there in the nutrition/holistic/alternative medicine world (see Dr. Oz's show for some references) that would correctly fall under the classification of "snake oil". By definition snake oil products are for someone trying to shortcut their way into a solution without putting in any work - which is your pet peeve as I do recall...

 

[KnuxNole]

Says who? If calories in, calories out is too complicated, then someone deserves adverse health effects. Survival of the fittest. You can't really make it any easier than that besides putting them in a cage and feeding them every meal, controlling it's contents.


It's not really snake oil. I always laugh when people talk about snake oil. Things like that are simply created by dumb people that don't take action when a product is unsuccessful. If people(in which improvement is possible or likely) don't improve following a method, then either a) they didn't follow the method properly b) it's incorrect. It's like when you see the typical person at the gym running a bro-split at the gym. You see the same dudes that are 5'9 150 for their whole life who never change in appearance, even though you know they are trying to. I don't feel sorry for the person who isn't intelligent enough to change their actions after doing multiple years of them fails to elicit a change.

You are overrating the American citizen. Do some counseling, and they will have no idea what that means. Or roll their eyes, or call you vain, since curvy is in! That, and the willpower, which is huge. Tell the average obese person "calories in < calories out, easy peasy", and they WILL. EAT. YOU. ALIVE.

I'll admit, I have NO idea what the **** basic macros are.

 

[PL198]

There is definitely a lot of stuff out there in the nutrition/holistic/alternative medicine world (see Dr. Oz's show for some references) that would correctly fall under the classification of "snake oil". By definition snake oil products are for someone trying to shortcut their way into a solution without putting in any work - which is your pet peeve as I do recall...

Yes absolutely, I just think people deserve it, if they're willing to buy into some "get rich quick" or equivalent for whatever modality of life they're trying to change. It seems to me that in life, nearly anything that's a positive significant change isn't going to be easy, so when people fall for these, I feel like it's just a natural selection. If something appears too good to be true, it probably is. So when people fall for Dr. Oz pulling his " eat this juniper-boysenberry hybrid and lose 15 lbs in 2 weeks " crap, they deserve it.

 

[KnuxNole]

Hell, hospitalizing people and keeping them to a strict diet CAN help, to a small extent. Does this mean we hospitalize every obese person? I doubt that.....

 

[SouthernSurgeon]

Yes absolutely, I just think people deserve it, if they're willing to buy into some "get rich quick" or equivalent for whatever modality of life they're trying to change. It seems to me that in life, nearly anything that's a positive significant change isn't going to be easy, so when people fall for these, I feel like it's just a natural selection. If something appears too good to be true, it probably is. So when people fall for Dr. Oz pulling his " eat this juniper-boysenberry hybrid and lose 15 lbs in 2 weeks " crap, they deserve it.

Again we seem to come down to a fundamental difference in philosophy.

You appear to see the unmotivated general public and say "f** them, they won't work, they don't deserve it"

I see the unmotivated general public and see tremendous medical expenses in a few years/decades due to their comorbidity burden, and want to find a way to impact their health. If it is through a miracle pill, better education, bariatric surgery, or some other intervention that someone smarter than me will come up with - I don't really care. I just want something that will work and turn our population back from the current obesity slow death spiral it is locked in.

 

[PL198]

You are overrating the American citizen. Do some counseling, and they will have no idea what that means. Or roll their eyes, or call you vain, since curvy is in! That, and the willpower, which is huge. Tell the average obese person "calories in < calories out, easy peasy", and they WILL. EAT. YOU. ALIVE.

I'll admit, I have NO idea what the **** basic macros are.

I mean if I'm counseling someone I'm obviously not going to literally say the phrase " calories out, vs in , kthnx bye don't forget to schedule your follow-up."
I'm saying that general concept, once explained in detail, won't be too complicated for someone to understand. It's literally reading the nutrition label, writing it down in a notebook and adding it all up. It takes me 2 minutes a day total. 2 minutes buys me never wondering how biochemically my body is doing from a fat vs muscle standpoint, something I'll gladly take.

 

[KnuxNole]

I mean if I'm counseling someone I'm obviously not going to literally say the phrase " calories out, vs in , kthnx bye don't forget to schedule your follow-up."
I'm saying that general concept, once explained in detail, won't be too complicated for someone to understand. It's literally reading the nutrition label, writing it down in a notebook and adding it all up. It takes me 2 minutes a day total. 2 minutes buys me never wondering how biochemically my body is doing from a fat vs muscle standpoint, something I'll gladly take.

That's the difference. You are motivated to read the label(something most people NEVER look at, especially the American citizen), writing down the nutrients(counting calories is very time consuming and involves discipline....which once again, is a rare trait in the country to find). You my friend, are the rare oak tree in the forest who doesn't care or want to put any effort. As you know, the easy way is what everyone wants. Lap band surgery is what people want to jump to, and for quite a few people, the FIRST option they want. Or a quick fix pill without ever having to walk a lot, lift heavy things, or eat yucky plants. Your 2 minute regimen requires too much work for a large amount of people. Which can be very disheartening, I agree. That's the challenge we all face....

 

[PL198]

Again we seem to come down to a fundamental difference in philosophy.

You appear to see the unmotivated general public and say "f** them, they won't work, they don't deserve it"

I see the unmotivated general public and see tremendous medical expenses in a few years/decades due to their comorbidity burden, and want to find a way to impact their health. If it is through a miracle pill, better education, bariatric surgery, or some other intervention that someone smarter than me will come up with - I don't really care. I just want something that will work and turn our population back from the current obesity slow death spiral it is locked in.

hah yeah of course, and I don't want to basically just repeat an old discussion but one question is this:

Do you worry about the message you are sending to people when you develop those successful interventions that are basically "get rich quick" schemes that actually work. Like bariatric surgery for instance. That's certainly effective, but do you have concerns for the philosophy this instills in patients?

 

[KnuxNole]

Again we seem to come down to a fundamental difference in philosophy.

You appear to see the unmotivated general public and say "f** them, they won't work, they don't deserve it"

I see the unmotivated general public and see tremendous medical expenses in a few years/decades due to their comorbidity burden, and want to find a way to impact their health. If it is through a miracle pill, better education, bariatric surgery, or some other intervention that someone smarter than me will come up with - I don't really care. I just want something that will work and turn our population back from the current obesity slow death spiral it is locked in.

A miracle pill would be pretty sweet 😀

That would definitely make our lives easier.

 

[SouthernSurgeon]

hah yeah of course, and I don't want to basically just repeat an old discussion but one question is this:

Do you worry about the message you are sending to people when you develop those successful interventions that are basically "get rich quick" schemes that actually work. Like bariatric surgery for instance. That's certainly effective, but do you have concerns for the philosophy this instills in patients?

I think you underestimate the effort we ask of Bariatric patients up front in advance of surgery. Similar to etoh liver patients ahead of a transplant, we do actually take steps to try and cut down on the recidivism rate postoperatively.

Anyone can eat their way through a bypass. It's not easy but it's very doable.

Now - some patients will try and circumvent the requirements and do stupid stuff like go to mexico for a bypass...which is an entirely other can of worms.

 

[DermViser]

I think you underestimate the effort we ask of Bariatric patients up front in advance of surgery. Similar to etoh liver patients ahead of a transplant, we do actually take steps to try and cut down on the recidivism rate postoperatively.

Anyone can eat their way through a bypass. It's not easy but it's very doable.

Now - some patients will try and circumvent the requirements and do stupid stuff like go to mexico for a bypass...which is an entirely other can of worms.

Recidivism - as if they're terrorists. 😆😆😆

 

[TooMuchResearch]

What's funny about that? There are reams of websites which teach you how to make quick, easy, healthy meals, how to exercise, etc. For the patients who complain about how much their smartphone can give them all the medical information they need (vs. their doctor) they sure suddenly become Internet novices when it comes to looking up things on how to eat right and exercise.

It's all very easy if one is the type of person that finds working 60-80 hrs/week normal. Even easier if one has spent decades intently searching and reading. It's not so easy for everyone. I know unemployed people that spend 12 hours/day lying on a couch watching tv. They haven't learned the skills you think everyone easily possesses. Everyone is not accomplished or high (or even moderate) achieving.

Yes, helping people learn how to take care of themselves and offering advice is part of the job.

 

[TooMuchResearch]

Says who? If calories in, calories out is too complicated, then someone deserves adverse health effects. Survival of the fittest. You can't really make it any easier than that besides putting them in a cage and feeding them every meal, controlling it's contents.


It's not really snake oil. I always laugh when people talk about snake oil. Things like that are simply created by dumb people that don't take action when a product is unsuccessful. If people(in which improvement is possible or likely) don't improve following a method, then either a) they didn't follow the method properly b) it's incorrect. It's like when you see the typical person at the gym running a bro-split at the gym. You see the same dudes that are 5'9 150 for their whole life who never change in appearance, even though you know they are trying to. I don't feel sorry for the person who isn't intelligent enough to change their actions after doing multiple years of them fails to elicit a change.

So here we sit atop our mountain of advanced education misrepresenting Darwin...

 

[PL198]

So here we sit atop our mountain of advanced education misrepresenting Darwin...

It's not misrepresenting, it's my opinion. A fool and their money deserve to be parted with. Your unemployed people you know that spend 12 hrs/day on the couch are lazy. Nothing else. Plain and simple. If they were busting their *ss looking for a job, then totally cool with it. When you're a lazy f*ck that sits on the couch for half the day, you get 0 sympathy from me. I'm already having to pay for their laziness in their unemployment, not ok with paying for them to have more visits with medicaid and have them ignore whatever a physician tells them anyway. Funny how the only thing people recommend for "disadvantaged" patients is counseling, which is the population in which that doesn't work .

 

[styphon]

Have I been just sold something?

Some people are confused and think because I work at an Indian Health Service clinic that I do herbal/alternative medicine. They are shocked to find that my main treatments are Lyrica, Elavil, joint injections, and referral to counseling. The only herbals I can think I have suggested to patients are St Johns Wart, Black Cohash, medical marijuana(in the future)...

One of the wierder moments in my residency in the poor urban part of town: In between patients w/ chronic pain on multiple opiates, complications from gunshots, uncontrolled diabetes, and florid schizophrenia I had a healthy patient ask me to "adjust his chakras".

 

[SouthernSurgeon]

It's not misrepresenting, it's my opinion. A fool and their money deserve to be parted with. Your unemployed people you know that spend 12 hrs/day on the couch are lazy. Nothing else. Plain and simple. If they were busting their *ss looking for a job, then totally cool with it. When you're a lazy f*ck that sits on the couch for half the day, you get 0 sympathy from me. I'm already having to pay for their laziness in their unemployment, not ok with paying for them to have more visits with medicaid and have them ignore whatever a physician tells them anyway. Funny how the only thing people recommend for "disadvantaged" patients is counseling, which is the population in which that doesn't work .

The point is that if you let these "lazy" people languish, you're going to be paying a LOT more on the backend for their healthcare when they are all end-stage diabetics on dialysis or getting bad heart disease...or the new spectre on the horizon which is that NAFLD is going to be more common than HCV/HCC/etoh cirrhosis and in a generation these people are going to be in liver failure...the short term cost of increased PCP/physician visits will pale in comparison to the costs as their comorbidity burden piles up.

No one is "only" recommending counseling...just saying we need to find some effective interventions.

 

[pkwraith]

So much pseudoscience blabber.

I'll just say this. We don't give a crap about "fairly well established scientific theory behind how and why they work". We don't practice on theory. We give a crap about "fairly well established evidence if something works or not"

Co-Q10 is the only thing in the long list of garbage "nootropic" that you mentioned that has actually been tested close to an acceptable level. It's the only thing I see indexed by NCCAM and that I can find in my Nutrition Guide for Clinicans pocketbook (CoQ10 only has evidence support for improved heart function). Plenty of doctors prescribe supplement that actually work (melatonin) for their indication.

You can get back to us being so uniformed, when you have studies, not an intellectual masturbation on theory.

 

[PL198]

The point is that if you let these "lazy" people languish, you're going to be paying a LOT more on the backend for their healthcare when they are all end-stage diabetics on dialysis or getting bad heart disease...or the new spectre on the horizon which is that NAFLD is going to be more common than HCV/HCC/etoh cirrhosis and in a generation these people are going to be in liver failure...the short term cost of increased PCP/physician visits will pale in comparison to the costs as their comorbidity burden piles up.

No one is "only" recommending counseling...just saying we need to find some effective interventions.

That's assuming we somehow assume the burden of their costs. I don't agree with doing that. I understand what you're saying and see it's merit, it's just a system I don't agree with.

 

[SouthernSurgeon]

That's assuming we somehow assume the burden of their costs. I don't agree with doing that. I understand what you're saying and see it's merit, it's just a system I don't agree with.

But it's the system we live in...

 

[Nephronlearner]

Doctors aren't nutritionists. Most doctors do know the basics about nutrition, but it's not the field they are in.

As for "health enhancers" - I am not sure I even understand the concept... if you are healthy - you do not need "enhancers" to be "more healthy"; if something is wrong, there are drugs for that.

I remember watching a so-called "documentary" about alternative medicine and there was a woman who talked inside some "herbal pharmacy" about the effects of different supplements. Most of the things she said were along the lines of: "regenerates your liver"; "detoxifies your blood"; "strenghtens your heart" and a bunch of similar phrases that sound great to an uneducated listener, while having no proper medical significance. (does anyone really understand the term "detoxifies your blood"?)

That is especially true now when an incredible percentage of people is so obsessed with conspiracy theories that everything "alternative" is by definition considered great. A lot of people believe in huge "pharma industry conspiracies" and being poisoned by "nasty chemicals". And any attempt to prove them wrong is invariably going to result in failure because rational arguments generally don't work. As far as many people are concerned - natural means better (not realising that for instance the deathcap mushroom is perfectly natural; and that drugs are purified useful substances without additional junk).

A friend (biology student) told me that some Amazonian tribe has cure for cancer. Evidence - documentary she saw on TV. My attempt to explain that the reason they don't have cancer is related to the fact that their life expectancy is barely 40 and not because the magic plant cures cancer (which, ironically, according to her, pharma industry is trying to hide)...
And to those people - no matter what western medicine does, it will never be good enough.

That being said, alternative medicine is "alternative" for a reason - there is no scientific evidence to support it and usually no scientific evidence to prove it won't harm the patient.


To sum up the rant, no, doctors aren't clueless, they just make decisions based on actual evidence. That's the difference between a doctor and others who call themselves healers. If you have a certain condition, you get a drug that has been effective for it. Also, doctors aren't supposed to be herbal or biochemical encyclopedias.
... if you need someone to advise you on details of what to eat - you should see a nutritionist

 

[dadaddadaBATMAN]

Says who? If calories in, calories out is too complicated, then someone deserves adverse health effects. Survival of the fittest.

It's not misrepresenting, it's my opinion. A fool and their money deserve to be parted with.

Could be wrong, but I don't think you're getting what @TooMuchResearch is driving at.

His point is that "survival of the fittest" was never meant to be used in this context. In this context, it's actually a corruption of Darwinian theory adapted by armchair-type "scientists." Your second statement, "a fool and their money deserve to be parted with" is a better representation of what you're saying.

In short, I think he is saying you are misrepresenting Darwin, not that you are misrepresenting yourself or your interpretation of Darwin.

 

[PL198]

But it's the system we live in...

So I agree with you that I'm underestimating the effort put forth by avg person getting bariatric surgery, but in general do you feel that interventions like this instill poor health maintenance in people? I feel like you might respond with something such as " no because of the effort they put forth that they would not if they weren't getting the surgery." Would you say that effort put forth is less than the effort that would be required for them to lose fat the traditional way? I guess a more definitive way to state my thoughts are the following and though I realize there are numerous other factors at stake, for the purpose of this discussion it's going to be isolated down. So if we have a -5 to 5 scale, measuring effort required for someone to maintain their fat. Let's say 0 is required to keep it stagnant with no intervention. I look at traditional methods such as calories in, calories out, as requiring +5 effort. So in my opinion, this instills in people that they have to work to lose the fat, which discourages them from acquiring it in the first place, or if they did, from acquiring it again. I look at a get out of jail free as -5. Now I'm not saying the surgery is a get out of jail free as I understand what you said about there's more effort commonly expected of patients than I assume. It still seems to me that the effort value would remain on the - side and thus reinforce poor behavior in the future.

I understand that it's our system, but I don't really think it has to be. Not to mention I don't have to tailor my health advice towards that system necessarily. I don't know enough about this to form views on how I would advise patients on the matter(though I likely never will do so as an attending in terms of obesity), but if it was my professional view that the surgery was overall less in the best interest of the patient than doing so the traditional way, wouldn't it be expected of me to recommend as such? I understand this will vary person by person, and the studies show the surgery has a positive effect, but can it measure indirect factors like I've previously discussed? I don't really see how it would.

Anyway, this is a good talk because although my opinions are generally strong I'm learning a lot of good stuff about the matter and assuming less of a black and white stance.

 

[PL198]

Could be wrong, but I don't think you're getting what @TooMuchResearch is driving at.

His point is that "survival of the fittest" was never meant to be used in this context. In this context, it's actually a corruption of Darwinian theory adapted by armchair-type "scientists." Your second statement, "a fool and their money deserve to be parted with" is a better representation of what you're saying.

In short, I think he is saying you are misrepresenting Darwin, not that you are misrepresenting yourself or your interpretation of Darwin.

So I understand what you're saying about the criticism of what I said, but I'm not sure what the criticizer's belief that the correct representation is, if that makes sense. I don't really see how the two statements differ in meaning. I look at the fool one as a specific case of survival of the fittest.

 

[Doudline]

Says who? If calories in, calories out is too complicated, then someone deserves adverse health effects. Survival of the fittest. You can't really make it any easier than that besides putting them in a cage and feeding them every meal, controlling it's contents.

Speaking of "snake oiling".

Calories in, calories out? Really? Find me evidence that being overweight, when controlled for diet, exercise and lifestyle, poses serious health risks, and I'll eat my socks.

(p.s. You can't. And you not knowing that as a medical student speaks to how complicated this topic can get.)

 

[SouthernSurgeon]

So I agree with you that I'm underestimating the effort put forth by avg person getting bariatric surgery, but in general do you feel that interventions like this instill poor health maintenance in people? I feel like you might respond with something such as " no because of the effort they put forth that they would not if they weren't getting the surgery." Would you say that effort put forth is less than the effort that would be required for them to lose fat the traditional way? I guess a more definitive way to state my thoughts are the following and though I realize there are numerous other factors at stake, for the purpose of this discussion it's going to be isolated down. So if we have a -5 to 5 scale, measuring effort required for someone to maintain their fat. Let's say 0 is required to keep it stagnant with no intervention. I look at traditional methods such as calories in, calories out, as requiring +5 effort. So in my opinion, this instills in people that they have to work to lose the fat, which discourages them from acquiring it in the first place, or if they did, from acquiring it again. I look at a get out of jail free as -5. Now I'm not saying the surgery is a get out of jail free as I understand what you said about there's more effort commonly expected of patients than I assume. It still seems to me that the effort value would remain on the - side and thus reinforce poor behavior in the future.

I understand that it's our system, but I don't really think it has to be. Not to mention I don't have to tailor my health advice towards that system necessarily. I don't know enough about this to form views on how I would advise patients on the matter(though I likely never will do so as an attending in terms of obesity), but if it was my professional view that the surgery was overall less in the best interest of the patient than doing so the traditional way, wouldn't it be expected of me to recommend as such? I understand this will vary person by person, and the studies show the surgery has a positive effect, but can it measure indirect factors like I've previously discussed? I don't really see how it would.

Anyway, this is a good talk because although my opinions are generally strong I'm learning a lot of good stuff about the matter and assuming less of a black and white stance.

You can make the same argument for nearly any medical intervention...

Does taking a drug to lower cholesterol and blood pressure give people a get out of jail free card and instill poor health maintenance habits?

Or what about type II diabetes which we know can often be completely prevented or reversed with improved diet/exercise/weight? Does taking blood glucose instilling medications instill poor habits?

For bariatrics, it takes what was previously an insurmountable hurdle and makes it a surmountable one. Patients have to do a bit of work, for sure, but it makes the slope of the hill a lot more manageable.

 

[PL198]

Speaking of "snake oiling".

Calories in, calories out? Really? Find me evidence that being overweight, when controlled for diet, exercise and lifestyle, poses serious health risks, and I'll eat my socks.

(p.s. You can't. And you not knowing that as a medical student speaks to how complicated this topic can get.)

? Um because being overweight doesn't have a medical definition that actually shows people with an excess of fat. I'm overweight, nearly obese by BMI standards and if you saw me in person, you'd never think anything close to that. Same thing if you measured my BF%. If you use junk data to make statements, the statements will be junk too.

You can make the same argument for nearly any medical intervention...

Does taking a drug to lower cholesterol and blood pressure give people a get out of jail free card and instill poor health maintenance habits?

Or what about type II diabetes which we know can often be completely prevented or reversed with improved diet/exercise/weight? Does taking blood glucose instilling medications instill poor habits?

For bariatrics, it takes what was previously an insurmountable hurdle and makes it a surmountable one. Patients have to do a bit of work, for sure, but it makes the slope of the hill a lot more manageable.

I see what you're saying. I guess I just see it as a slippery slope where I'm not sure the line is drawn.