I believe that medical education has to stop being guided by big pharma. The medical student of the future must fully understand the primary causes of chronic illness -- toxicity, dietary, and other lifestyle problems. The medical student of the future must understand detoxification strategies, nutrition and behavioral interventions addressing other lifestyle risk factors. Instead of focusing on pharmaceutical management of symptoms, the medical student of the future must learn about the cornucopia of healing interventions that can not only arrest chronic illness, but reverse it or heal it.
The medical student must be properly taught the risks of the diagnostic and therapeutic interventions that they are taught and how to assess whether the risks are worth the benefits. Big pharma must be shut out of medical education. Science, including empirical clinical data, as Dr. Prasad says, must rule medical education, not special interest groups. Preventive medicine should be taught to every student, including prevention of cancer, cardiovascular disease, and diabetes. We have a lot of work to do. It will take decades. But it begins with cleaning out the pollution that has contaminated not only medical education, but the entire biomedical system.
The fundamental problem is that we don't have the right incentives in the healthcare system. Under the current economic system, all good strategies for healing and prevention lead to less income for the doctors and therapists (and, of course, for the medical industry as well). As a doctor friend told me, "there is no money in prevention."
If you can fix the incentive structure, the rest will follow. Otherwise, nothing of significance will change.
At the individual level (for example, a doctor or nurse), people do care about the interests of the patient. But most of the healthcare policies and practices today are driven by large coroporations - pharma, insurance companies, mega-hospital chains, and so on. They are only driven by the bottom line, regardless of what they say in public to look good. Moreover, in the process, the individual doctors are losing their autonomy.
. . . To restructure medicine and, thus, rendering pharmacotherapy to a more judicious place in such a scientific revolution -- why, even using real and fairly worked, empirical conclusions, derived from patient care-driven, economically sensible hypotheses.
The structure of this scientific revolution in medicine better controls the unjust, egregious dynamics and influence of BigPharma on the therapeutic approach to respectable and beneficent medical care with nutraceuticals primarily, and pharmaceuticals additionally, when appropriate.
Health will be a more natural, less artificial construction for human beings. At least we're still free to dream it
You can lead a horse to water... Most of the population are aware of basic health measures but it often suits them not to follow. In my country of Australia, family physicians devote a lot of time on preventative medicine and are paid fee-for-service and incentives for special groups such as diabetics. The big dollar waste here is on the burgeoning bureaucracy and standards industry creating ever higher and more complex hoops to jump through
Health insurance companies have a huge stake in non-prevention. By law, they are only allowed to make a certain percenatge of premiums/revenues as profit. So more sickness means more tests, treatments, and drugs. More healthcare costs means higher insurance premiums which finally leads to higher profit.
If they really wanted to promote prevention and a healthier lifestyle, they would give premium discount to healthy people (like the auto insurance companies give discount to safe drivers).
Not my experience with my health insurance at all.
Giving a premium discount to healthy people would be awful for people with preexisting conditions and totally discriminate against them, often for condition they have zero responsibility for. It is like you want to punish people for their genetics.
Why do they have preexisting conditions? Because they had no incentive to lead a healthy lifestyle. The claim that most of their chronic health issues are due to bad genes is one of the biggest lies perpetrated by the medical industry. It serves their interest very well because people feel helpless about theri genes and thus become dependent on doctors and drugs.
This cannot be expalined in a short comment. If you are really curious, go deep into studying the true causes of disease. Most common chronic diseases, including obesity (which is a cuase of many other diseases), are entirely preventable with diet and lifestyle regardless of genes.
You should be embarrassed how much you are into clueless victim blaming. Never heard about thrifty genes and genetic predisposition to diabetes being a real thing? Add in social and economic factors which can make it difficult to obtain a good diet and it is very obviously not as easy as you claim. And an overly judgemental attitude has not helped anybody say out of depression.
Surely one just needs a little bit of willpower to get out of any mental disease/s
And are insurance carriers prohibited by law from assigning a substantial portion of their investment portfolios to health care product/device innovators and producers that proliferate and profit well upon the entrenched dynamics of the present pay for treatment model?
Your “cornucopia of healing interventions” needs to be subject to prospective controlled trials every bit as much as pharmaceuticals. Check out Vinay’s recent Youtube “Nutrition Science is Entirely Unreliable.”
Indeed, RCT's are very important. However, there are already tens of thousands of randomized clinical trials on herbs, foods, supplements, homeopathy, and other alternative treatments. Look at greenmedinfo.com and you will find a dizzying number of clinical trials that have already been conducted on many types of healing modalities. You also did not mention "quality" as a modifier to prospective controlled trials, as much of the RCT's that have been published are garbage, or show something different from what they purport to show. Indeed, research, as Mark Twain famously noted, is statistically bound, and to that extent consists in some measure of "lies and damn lies." Researchers are famous for "teasing the data' to produce the results they want. I'd rather rely on clinically proven treatments in the hands of master clinicians than stuff published in mainstream journals. Nevertheless, high quality RCT's are still an important component of demonstrating empirical efficacy and safety and we can never have too many of them.
I went to greenmedinfo.com and found 74 studies claiming positive clinical results for homeopathy. Do you believe that homeopathy is evidence-based James? Do you believe that Vinay Prasad finds homeopathy to be evidence-based?
I don't believe homeopathy is evidence-based. I know it is. I've been practicing homeopathy as well as medical herbalism, functional medicine, nutrition, environmental medicine and energy medicine for 23 years and have had amazing results from all of them. I believe everyone is entitled to believe or disbelieve whatever they want, but compared to when I practiced just allopathic medicine, I get much better results now. Please don't take my word for it. I encourage skepticism. I was very skeptical myself before I witnessed the clinical results time and again in my practice. James Tyler Kent and Constantine Hering, to of the greatest homeopaths in history started out as skeptics who tried to "disprove" homeopathy, ultimately becoming converts when the null hypothesis was rejected. I think it's important we all be clear in our own minds when we are open to scientific paradigms that don't match our preconceived perspectives and when we are just refusing to be open to them.
Homeopathy works only if you believe in magic over chemistry. There is zero doubt about it. This is why an education in basic science is an important basis for medicine. If you see results using homeopathy you see placebo effects and regression to the mean. To understand why basic science says without needing studies that homeopathy cannot work. The evidence base is important too as you illustrate, but basic science is the basis for it. We don't teach kids math before they understand numbers.
Troll or bot, you should still try to respect others' opinions, even while you're compensated or commanded to do your nasty rhetorical labor.
RCT "studies" don't all fit the evidence expected for "drug" action, safety, and efficacy patterns.
HCQ was known, by responsible care providers very early in the COVID era, to be useless in late, severely symptomatic COVID; yet the RCTs performed (by OWS-friendly facilitator-promoters of FDA's vitally needed EAU imprimatur to so "approve" the "vaccine" for distribution?) to evaluate the above parameters in CDC protocol-directed late treatment ignored this critical treatment factor. Maybe on purpose? In the end, of course, "clinical efficacy and safety could not be established via a carefully designed, well-controlled, RCT," the nightly news ran. Very conveniently for the plandemic.
Likewise, homeopathy too shows its resistance points upon contact with measuring tools used in too standardized, routine RCTs. The misfit does not establish any basis to prejudge the clinically known, unquestioned safety and usual effectiveness. Rather, it surely suggests, to those who best understand the internal dynamics and mechanics of homeopathy and its many properly combined and diluted substances, the right test, if one even exists or could be developed, hasn't been designed or applied to date.
No matter. Trained and credentialed academic scientists, looking to apply their corruptly bought, all too unethically human confirmation biases, would thus contribute their intellectual skills and analytic talents, no less the also corruptly bought prestige and professional influence of its hired hands, to find the non-petrochemically based homeopathic "substance" therapeutically worthless and a waste of time and money -- certainly an oddly styled and developed substance far too risky to use in the treatment of considerable illness.
Naturopaths are indeed leading the way. I am a conventionally trained M.D. who has gone the way of "Integrative Medicine". I got all of my I.M. training after completing my residency in 1991, by going back to school for Homeopathy, Bowenwork, Herbal Medicine, and Functional Medicine. I.M. includes many alternative treatments, but the mix differs from one practitioner to the next. What all I.M. practitioners share is an understanding that getting to the root cause of disease is absolutely fundamental. They also believe in using safe, effective alternative to pharmaceuticals and surgery wherever possible. I.M. recognizes that there are some situations where conventional medicine is superior, but for chronic illness, lifestyle interventions and health PROMOTING interventions are for the most part superior to "disease management" by way of pharmaceuticals. I have discovered this to be true in my practice. Naturopaths get this training from the get go, but there aren't many of them (nor are there many I.M. practitioners either).
I would posit that your life would be a lot more miserable if science were corrupted to a significant degree. You would not have electricity, would walk everywhere and medicine would work a lot less. Imagine living in the 16th century or so. What was the life expectancy then versus now? What was the childhood mortality, how many women died in childbirth?
Science is not perfect does not mean science is corrupted. All this means we need better funding for the FDA. I do agree that there needs to be supervision. But you know where supervision is sorely lacking? The field of alternative medicine. Supplements are largely unregulated despite making medical claims. Useless modalities are allowed to practice despite lack of evidence. I am sure there is corruption in standard medicine, because there is some in any human endeavor. But there is not more than in other fields.
Also you have shown zero evidence that pre scientific medicine outcomes were better. Any old graveyard has plenty evidence hoe much worse they were.
Let’s just get back to informed consent & eliminate the DEI & social justice nonsense from current med education. We might want to address the ongoing capture of nearly everyone conducting research also.
The popular acronym DEI, as the Creator of All would seem to have it, is also in fact the same letters in the same order that spell, in the ordinary, lower case, the plural form of the Latin deus, or god; and so, "gods". (St Jerome, in his Vulgate (common) Latin translation of the first Christian Bible, written in Greek, wrote down "Deus" when he translated from "Theos" -- what the earlier Hellenistic Jewish translators, fluent in Koine Greek, wrote down when they translated Elohim from the still Hebrew-speaking, post-Mosaic era Israelites, in whose trusted custody, led by Joshua, Moses placed the great lawgiver's First Five Books, or Pentateuch, the primary Torah. Jerome was working from the Septuagint, the "70-authored" translation into the Common Greek of the complete Hebrew Bible, the Tanakh, the full, written expansion and expression of Torah.
(Jonathan Cahn would argue that the same, middle-era Israelites were implicitly on to something -- grounds for the later inspired Trinity -- in connoting a singular, oral meaning, God, from a plural, written number for this, Gods.)
Following the same, Biblical narrative regarding Israel's perennial and paradigmatic struggles with its (as would be any human society's) apostatic drives, we're dealing today, quite arguably and for many learned observers and writers, with what Messianic Rabbi, renowned minister and successful author Jonathan Cahn recognizes, in his book by the related title, The Return of the Gods -- namely, the evil and destructive demons, known well to the Biblical pre-ancients (Mosaic & later Israelites) and later ancients (Christians) as Baal, Ishtar, and Moloch -- with the systematic program of the Hebrew/Jewish Hasatan, and the Christian Satan.
The present linguistic phenomenon involving DEI and its meaning in another, entirely different context is telling, in my merely lay sense of well-known old and current affairs. Call it coincidence, if you must. I call it clarion and theologically informative. It's an Admonition from Above, if you asked me.
Check out Cahn on YouTube. Hear him for yourself. Naomi Wolf pays him a lot of inspired and informed attention in her writings, you might be interested to learn, in case you're unaware.
Well, you can find a lot of homographs in the English language and even more if you expand to different languages. The English word "gift" means "poison" in German. And that has a deeper meaning of nothing.
If a deity created humans, that deity clearly loves diversity, since it created so much of it. And if we want to follow that deity, we should also love diversity.
I have nothing against diversity per se. On the contrary, I'm a huge fan of its merit and invaluableness in American society. Read me, please, rather than your script projected onto me, inter alia.
I'm sure you're ascribing an outsized importance to the institution of diversity when unbalanced and relatively exaggerated in the absence of an overarching, cohesive sociopolitical gestalt, that is unity.
Creation itself is the greatest possible, demonstrated expression of The Deity, our Lord's, inimitable Unity.
Of course, believing in diversity, I have no personal problem with your insistence on using the term deity in lieu of my more reverent selection; however if you'd rather insist, even demand, still further, outright mandate by undemocratic edict that I not capitalize my D when saying "deity," those of us who so worship and speak our free minds will oppose you, and vigorously.
With respect and in peace, we say, Don't tread on us.
Do the people who are often underrepresented in medicine say they are racist too? Or is that just your view point? What do studies say about medical outcomes if practitioners are more diverse?
How do you feel about programs based on sex? Should women earn the same wage than men for the same work?
Can you explain what DEI in other languages meaning God has anything to contribute to the discussion?
In addition: the singular genitive form of deus is also dei.
Ecologically a system is a lot more stable with more diversity. Diversity is very important. A nation of rocket scientists only would be very unstable.
It's gods, not God, just as deus ex machina doesn't actually translate into either Gods or God from the machine. There is a god, and are the gods; then, there is God in Greco-Roman pantheism. But we're not talking about Zeus or Jupiter, which are singular, but obviously super deities, or Deities, respectively.
In any case, Cahn's "gods," dei -- Baal, Ishtar, and Moloch -- I'm actually citing another's find, were certainly and are not meant to be worshipped by Israelites/Jews and early/later Christians, though they actually were by these faiths' apostates through the ages -- and today certainly are by many, too, too many in our American society and others in the world.
Specifically, I took an extended tangent-trip in reply to one of Dr Molly Rutherford's posts. It mentioned the waste of valuable time and other resources in which more and more med schools today are engaging by instituting DEI programs. I took it from there to reach implicitly atheistic, antisemitic/anti-Christian/anti-Caucasian, pro-BLM CRT, Anti-Racism, anarcho-tyranny and one-party, Cloward Piven-driven totalitarianism generally -- ie, anti-American family/anti-Western Civilization neo-Marxism replacing the ancient, historic, multicultural but homogenizing roots of our society at work in New Medicine.
I wholeheartedly demurred. And you got how I feel about my beliefs, and my ethical and moral commitments as they relate to the multiple codes-abiding standards for at least the basic restoration, if not the advancement of just and beneficent health care.
Anyway, your prompting post here, I feel, isn't intellectually honest, only disdainfully dismissive. I get the sense, your dialogs are neither collegially approached nor sincerely engaged, but rather are unfriendly, even hostile.
So, never mind, please, "Tina"; just move on from here and I wish you well.
You're certainly right about deus, dei, etc. Cannot one of two be right, per se? Too tight, I'd call your grasp.
More to your main point, though, permit me to ask first, in turn, why you find the neo-Marxist focus on diversity uber alles, unhinged from a humanly social need (we're not merely bees) for structural, meaning- and purpose-dominated unity, so enchanting and all-important.
Intersect this, Tina: How would you like to believe in the safety of the interstates and intersect with a family from Togo, whose head in the driver's seat, like the other family members, neither speaks nor reads the language of our road signs, but only his native Ngangam?
The more (ununified) diversity, the more stable the society -- and this irrelevant gibberish you pass along as hard, not even a qualified social science?
Please, Tina, get real by getting more honest. Stop lying about the faux- virtues of an unhomogenized, societal diversity. Some less skeptical folk, well-meaning folk could mistake your confident stridency for authoritative, tested and proven knowledge.
Be more transparent please about your underlying, driving, essential ideology, your view of humanity and its place on Earth, in relation to other life forms, if you'd be so kind to share here. Let it rip.
So you think it is a good idea to not have social justice? If you don't like diversity, would you say there should be no women in medicine? Just white men who come from families which can afford to pay for a medical education? If you get rid of diversity, that is what you want?
No. That’s ridiculous. When I went to med school, women were in the majority. That was 20 years ago. These Marxist ideas are evil, and we’d better get rid of them asap, or you won’t have a critical thinking doctor to take care of you. You will have a rule follower who, for example, recommends a shot to you that you do not need and that is more likely to harm you than to help you.
Maybe, rather, diversity amid a larger, more homogenized society, one the motto E Pluribus Unum best portrays.
The watchword here, friend, is our much needed and forgotten sense, to be sure, our practice of UNITY; for, lacking this, diversity is nothing but destructive fragmentation -- unless that is your real desire and goal for America. Is it?
I agree with unity. And unity is based on fairness. People are not going to feel united with others if they feel treated unfairly or feel ignored. Therefore political organizations which preach against inclusion and diversity promote fragmentation.
Reality's text however, has recorded far more to the contrary than you relate, however heartfelt, pure and noble you believe your aspirations are for us all.
There is, frankly, a circular form of logic in your general argument, which, being overly deductive, intrinsically lacks an empirical truthfulness or soundness.
What you say, then, is necessarily valid, but, in the immediate space-time continuum that is our society's shared existence, simply unverifiable, given an honest accounting of the facts, past and present, and thus pretty questionable.
Diversity is onanistic in the absence of unity. Equity is a fraud, and you know it, or should. And inclusion is an old, worn-out and tiring Marxist complaint delineated from alienation, a core premise and pretense for revolutionaries everywhere and at all times.
No gratitude, no happiness. Get grateful and you'll renew your sacred life. That's the beginning and end of inclusion.
This is all about putting the horse before the cart -- as in learning the principles of EBM prior to the laws of biology, the logical premises of human physiology and pharmacology, or what's part and parcel in allopathic medicine. This horse-pulled cart is on the way to becoming more integrated, real, less metaphysical in promoting for future doctors of medicine and osteopathy a richer, sounder, more meaningful curricular content and application.
It sounds right for patients, if not for the dogmatic theoreticians of the medieval schools, as it were. Let's get out of our heads and do it.
This is just oseudoprofound ramblings. Are you using a Chopra quote generator?
If you call me a revolutionary you demonstrate that you have zero grasp on my opinions. Just a lot of your own preconceived notions. I get it that their are dear to you. But you have not remotely convinced me why they should be dear to me.
Medical education...is that a joke? Most doctors are indoctrinated to be disease and drug pushers, not real healers of the body. Unbeknownst to most of them, the body is an excellent healing mechanism on its own. No drugs required, in most cases.
That is why I always seek alternative practices first and "medically educated" doctors last. And don't tell me it isn't their fault that they do not know how to heal a patient. I am sick and tired off hearing that doctors know not what they do and should be given a free pass for administering deadly drugs and vaccines.
I disagree as a physician myself. Medicine at its very foundation is built on clinical observations. Most of the discoveries in medicine didn’t require RCT but required excellent clinicians. We have sacrificed clinical acumen for ordering diagnostic testing and pill prescribing! Doctors now skip the history and physical and jump to ordering tests that substitute for thinking as a clinician. They think that telemedicine can substitute for an personal interaction with the patient. Evidenced based medicine got us where we are now. I’m not against fact based advice but evidence based medicine is what drives protocol based decision making and not clinical acumen. I would say medical ethics should be top priority and recruiting individuals that already have demonstrated in their personal lives an ethical life style where others needs are more important then you own will take care of a lot of the issues.
Especially when the “ evidence “ can be funded by the manufacturer. The concept of evidence based medicine seems like a green signal for high cost patent drugs to make it into the treatment guidelines. A lot of so called prestigious medical journals become mouthpieces for these high cost interventions. All this vested “ evidence “ has drowned or dialed down clinical acumen as you correctly alluded to . Younger doctors tend to be more rigid protocol followers and have less critical thinking skills than clinicians with years of experience.. The issue if a person has strong clinical knowledge of the workings of the human body and strong clinical acumen they will have the confidence to deviate from a protocol because they know what that particular patient needs . On the flip side , if thr clinican”s foundation knowledge of the workings of the human body is weak and he or she does not have the critical thinking skills , it’s must easier to just follow the treatment protocol/guidelines. This way they feel safer and legally protected even though that may not be the best outcome for the patient at hand . In recent years there seems to be a desire to have less competent people hired as they tend to be more submissive.
Well said - problem now is that if an experienced clinician deviates from a treatment protocol, at the best he/she raises eyebrows and at worst they are deregistered and end up in jail.
Well, that is why you first need to base medicine on basic science like biology and chemistry. If a treatment has no plausible way in which it can work like homeopathy, we don't need RCTs.
That said, we don't know all about biology, an intervention can work, even if we don't entirely hit. But that does not mean we should throw science out of the window. We need to build on it.
Are you aware of the putative physical chemistry laws, postulated, but not yet known or understood clearly, by current scientists, that undergird as logical predicate the physiological effects Hanneman ushered into medicine with his discovery of homeopathy?
Feel the unity of science, sister. It's there to both apprehend and own.
There are no putative laws which explain homeopathy. Homeopathy was once beneficial because it was safer than quack cures. If you read up the basis of homeopathy it was never based on science. Hahnemann was no scientist and there is agreement that homeopathy is unscientific. If you were to read a proving they are obviously utter garbage based on personal dreams and emotions..
Even if it were to work via some mysterious processes which contradict our current understanding, there are no good RCTs which show that homeopathy works. Evidence based science requires no understanding of the underlying mechanism.
And are you seriously proposing that at a time we can find neutrinos that there are mysterious mythical forces? We should rather believe some people with vested interests in homeopathy with what hand waving they come up with? Science is not speculation. Until they present hard data it is not science.
Thinking like yours would believe that if the best science was used to invent and ultimate bring to market a wonder drug, all of the drug's safety and efficacy would be attributable to it and it alone and not possibly in any part or measure the constant potential for the placebo effect.
Did you, and until when if you no longer, or do you continue to find the COVID "vaccine" safe and effective -- but if not, certainly unrelated in any way to the millions killed or maimed since the availability of the "vaccine" (read accurately: the wickedly criminal deployment of a bioweapon)'s multiple means of the sure and eventual biodestruction of its host-target). After all, it's a product of science, and there is little to no evidence of corruption in science. Its methods and programs are completely reliable and trustworthy.
(Real world -- what's that, and who cares, anyway? your manner appears to scream. I believe, deep-down, it's actually a sad and lonely cry you wish you could feel but can't. Yet. So, get help. Do it for yourself, if now for nobody else.)
In the real world there are no wonder drugs. If it has a beneficial effect it is bound to also have unwanted effects. The aim is to find a substance where the benefit clearly exceeds the cost.
Using real world common sense, covid vaccines are a lot more beneficial than not. And they always and for everybody beneficial. No, of course not, but they have been proven to be a lot safer than the virus. A virus which boast zero safety and efficacy testing.
The only objections to covid vaccines are ideological. Apparently this here is a nice ideological bubble and you resent people who do not share your ideology. This does not jibe with your call for unity. Or do you mean there is only unity when everybody else finally shares your opinion?
Evidence based medicine - when RCT’s aren’t funded by profiteers. We don’t get to see the evidence that “fails” because many pharma funded studies that don’t get desired results never see the light of day. So we really need to define what qualifies as evidence before going further.
As a woman whose mainstream treated hypothyroidism - all based on guidelines and supposed ‘Knowns’ - eventually led to my falling asleep while driving on the interstate (!), which led to FINALLY finding the answer with an addition of T3 to my T4 monotherapy (T4 being standard of care) by way of yet another misinformed endocrinologist, I am now in the no-one-really-knows-a-damn-thing camp.
My symptoms resolution came on the second day, when I experienced a situation much like The Wizard of Oz: I literally saw my black and white world go Technicolor. With just this hormone addition. But then it began to go away after about 3 days bc my T4 was reduced with the T3 addition. However, once I knew that this was possible, I dug in. First, I had to get a better doctor and get better treatment - which means that ALL of mainstream endocrinology has their understanding of thyroid functioning wrong - and then I began to research. Now for 24+ years I search the literature for data. Hours daily. My God, we’re totally stuck and misinformed!! On most everything!
Morons. Seriously. Why? Because T3 creation on site differs among tissues and is not reflected in serum levels. TSH has been used to define thyroid functioning/abnormalities/treatment results. Wrong. Why? Because that issue of T4 to T3 conversion is not reliable nor consistent among tissues and organs (done by deiodinases), and it is not reflected in TSH.
Here’s a funny thing: CAC is the most reliable biomarker of death. A zero CAC translates to a 15 year warranty from death by all causes and risk increases linearly w CAC. T3 made by converting from T4 directly affects how much matrix gla protein (MGP) is created. If MGP created in arteries is activated, then no calcium can deposit. Hence, the #1 cause of death (CVD), and its accurate biomarker (CAC), are directly affected by an essential hormone conversion that no flipping docs even know about. They THINK they know, but they don’t. They’re told conversion rate is consistent and known and, so far, no humans have volunteered to be killed to test this belief.
How about cancer? Maybe close to cause of death w CVD.
Did you know that cancer is addicted to calcium? And that vitamin K2 - an incredibly important nutrient and endogenously made hormone - is a big player in calcium behavior?
Complete response by vitamin K2 analog monotherapy in sorafenib-failure advanced hepatocellular carcinoma: A case report
Sorry to vent…yes, we need reliable data, real evidence…but I have definitively found that we ask the wrong things, misunderstand etiology of most diseases, and chase BS.
It’s cute to cite evidence-based medicine…but we’ve asked the wrong things!
Evaluating the Association Between Low-Density Lipoprotein Cholesterol Reduction and Relative and Absolute Effects of Statin Treatment: A Systematic Review and Meta-analysis
Who among us are really appreciating relative risk v absolute risk and how very manipulative these are?
I mean, cardiogists seem fooled.
Modern medicine faces real issues, but continues with data from incorrect questions. So our evidence is faulty. Almost all the time….
That's great that you're doing your own research. Any cures or improvements we found for chronic issues in our family was because we did our own research. The people who don't do their own research will be put on forever meds without addressing root causes.
Vintage piece, Dr. Prasad. Like the rest of our education system, medical school needs to be overhauled. Doctors in my family entered med school knowing what a woman is, but now they don’t and display no interest in thinking for themselves or having curiosity about the world. Here is a sad email exchange with them in which they compared their job to car mechanics and deferred to “experts” on any topic outside of their specialty: https://yuribezmenov.substack.com/p/how-to-do-no-harm-part-3
It's truly scary. Been going on for a long time, in the 80's EUSOL got demonised and withdrawn from usage due to misleading research funded by a Big Tech company promoting its new wound care product. Currently we are seeing Med Tech companies hijack Standards Organisations and governments to get rid of time proven protocols to promote single-use items and consequent cash flow. The current generations of doctors and nurses are so brow-beaten by clinical governance that they're afraid to speak up, even if they understand the issues.
I have to say I disagree with Vinay on this one. In order to understand the underlying basis of medicine, you have to know some basics physiology (including neuroscience), anatomy and biochemistry. That provides one with the tools to think critically which is so crucial when it comes to evidence-based medicine and RCTs. That's especially so when not all RCTs are created equal or done correctly (as indeed Vinay continually points out when it comes to cancer drugs).
I agree. I do find it rather concerning that what should be a blog advocating for science appears to be a happy place for people who don't seem to believe in modern medicine, but rather in what is now called CAM, which embraces a lot of unscientific approaches and the voice of reason appears to be rare.
If and only if the laws of biology are the exclusive path to understanding the multitude of biochemical wonder that is the human being, made in "God's image"
I think not, but also include the power and purpose of frequencies and light, not yet considered and appreciated, let alone grasped in full by Rockefeller-funded biologists.
Vinay gets something like, if not exactly this.
Nonetheless, I am heartened and led by your high pedagogy. It is certainly good and right.
Yep. That is commonly called science. Teach how to think critically like a scientist before relying entirely on RCTs. At least not before understanding the limits of RCTs.
A simple question to start your next Dr visit; can men get pregnant? An answer in the affirmatuve or evasion should be a warning to you. This person is clueless or captured by big med dogma. Get up and leave.
Any monkey can follow a protocol and call themselves a doctor or even a mid-level for that matter, but is that the type of provider you want caring for you or your family? Medical providers are automatons; cogs in the systematic wheel....”follow the protocols....quote the current literature...hope the authors got it right and weren’t shilling for a pharmaceutical company, or worried about losing grant money! God forbid they should question and think outside the box. Biology and Anatomy are critical foundations that should absolutely come first lest we all start believing men really can have babies....”’cause it says so in the literature”...biology smology! Keep dumbing it down and that’s who’ll be caring for you in the future!
Yes. Totally. Don't follow current dogma how to treat a fracture. Throw that out of the window. A class in meditation and vigorous ancient wisdom based yoga is superior /s
This piece made me think of a video where the dr was trying to differentiate mds vs mid level providers. This dr said that doctors are different bc they’ve been educated to understand all the mechanisms of how and why things are happening and mid-levels are just “recognizing patterns”, they see things enough to know how to respond in most cases but when something is unusual they lack the deeper understanding of the science behind it and are unable to deal with complex cases. It was a really crappy argument I thought bc it’s assuming anyone knows the scientific mechanisms. I love the idea of starting with the history of medicine - it means presenting what the practice of medicine actually is and where it came from.
CDC has scheduled 3 mRNA covid vaccines for new born babies by the time, they are ten months old. doubt it trump and the rest of the team with gottlieb, fauci, collins, biden and obama have not done their home work ... but we shall see ...
. @Vinay Prasad is completely wrong. Biology and thus UNDERSTANDING MECHANISMs is far more important than RCT based EBM. Medicine today is an abject failure due to lack of such understanding.
In fact, understanding mechanisms would mean clinical equipoise does not exist thus making RCTs unethical.
Aircraft safety is not based on RCTs. Doctors need to learn safety from us engineers.
Even before teaching about evidence-based medicine, medical students need to be taught serious courses in probability and statistics. According to one survey, 97% of the general public and 85% of doctors cannot correctly answer this important question:
Assume that the PSA test used for prostate cancer screening has a sensitivity of 80% and a specificity of 60%, meaning that 80% of people with cancer will test positive and 60% of people without cancer will test negative. Based on his age and race, a man has a 1% probability of prostate cancer before the PSA test. What is his probability of cancer after the test if he tests positive?
An approximate answer to the nearest whole number (in %) is fine.
Ok, as an old school surgeon, I'll bite the bullet. Sensitivity and age-related incidence are irrelevant in your example. The specificity of (only) 60% means that your chap/chapess has a 60% probability of having prostate cancer. I did get up to PhD level stats a long time ago!
As a colonoscopist, I am faced with the occasional dilemma of treating a trans-sexual (sometimes undeclared) and deciding on whether to report prostate findings on the routine DRE. I think DEI philosophy would rather I ignore findings as part of an inclusive process.
Apparently this article was written by ChatGPT. Lol. That explains its quality, but it does not explain why somebody would be willing to post it under their name.
Here is a simple way to explain this: Let us say that 1000 men take the PSA test. Only 1% of them, or 10, have cancer, 80% or 8 of which will be detected as true positive. Of the remaining 990 men, 40% or 396 will be detected as false positive. So the probability of having cancer (if tested positive) is 8/(8+396) = 2%.
I think numbers are not that dissimilar for mammograms? It was always emphasized to me that a recall after a mammogram does not mean one has cancer. And that is why I just had two needle biopsies which made my provider tell me that I don't have cancer. Since prognosis is better with early detection I personally did prefer getting some needles stuck into me than just wait and see.
Since one biopsy used ultrasound it was fascinating to watch on a screen taking samples. Hurra for basic science.
A lot of studies have shown that, on average, mammograms do not have more benefits than harm. They are likley to cause overdiagnosis and overtreatment. Also, they tend to classify DCIS as cancer when in fact it should be viewed merely as a risk factor. Here is an article I wrote on this topic a while ago:
I believe that medical education has to stop being guided by big pharma. The medical student of the future must fully understand the primary causes of chronic illness -- toxicity, dietary, and other lifestyle problems. The medical student of the future must understand detoxification strategies, nutrition and behavioral interventions addressing other lifestyle risk factors. Instead of focusing on pharmaceutical management of symptoms, the medical student of the future must learn about the cornucopia of healing interventions that can not only arrest chronic illness, but reverse it or heal it.
The medical student must be properly taught the risks of the diagnostic and therapeutic interventions that they are taught and how to assess whether the risks are worth the benefits. Big pharma must be shut out of medical education. Science, including empirical clinical data, as Dr. Prasad says, must rule medical education, not special interest groups. Preventive medicine should be taught to every student, including prevention of cancer, cardiovascular disease, and diabetes. We have a lot of work to do. It will take decades. But it begins with cleaning out the pollution that has contaminated not only medical education, but the entire biomedical system.
The fundamental problem is that we don't have the right incentives in the healthcare system. Under the current economic system, all good strategies for healing and prevention lead to less income for the doctors and therapists (and, of course, for the medical industry as well). As a doctor friend told me, "there is no money in prevention."
If you can fix the incentive structure, the rest will follow. Otherwise, nothing of significance will change.
And I remember a time when people did things because it was the right thing to do ... money was made, but it was not the be all and end all!
Why not consider that the “ incentive “ is being in alignment with what best serves the patient ?
At the individual level (for example, a doctor or nurse), people do care about the interests of the patient. But most of the healthcare policies and practices today are driven by large coroporations - pharma, insurance companies, mega-hospital chains, and so on. They are only driven by the bottom line, regardless of what they say in public to look good. Moreover, in the process, the individual doctors are losing their autonomy.
Yes, agreed!
Time for parallel institutions and a paradigm shift…
. . . To restructure medicine and, thus, rendering pharmacotherapy to a more judicious place in such a scientific revolution -- why, even using real and fairly worked, empirical conclusions, derived from patient care-driven, economically sensible hypotheses.
The structure of this scientific revolution in medicine better controls the unjust, egregious dynamics and influence of BigPharma on the therapeutic approach to respectable and beneficent medical care with nutraceuticals primarily, and pharmaceuticals additionally, when appropriate.
Health will be a more natural, less artificial construction for human beings. At least we're still free to dream it
You can lead a horse to water... Most of the population are aware of basic health measures but it often suits them not to follow. In my country of Australia, family physicians devote a lot of time on preventative medicine and are paid fee-for-service and incentives for special groups such as diabetics. The big dollar waste here is on the burgeoning bureaucracy and standards industry creating ever higher and more complex hoops to jump through
Health insurances have a huge stake in prevention. It saves them money. That is why they pay for yearly physicals and vaccines.
Health insurance companies have a huge stake in non-prevention. By law, they are only allowed to make a certain percenatge of premiums/revenues as profit. So more sickness means more tests, treatments, and drugs. More healthcare costs means higher insurance premiums which finally leads to higher profit.
If they really wanted to promote prevention and a healthier lifestyle, they would give premium discount to healthy people (like the auto insurance companies give discount to safe drivers).
Not my experience with my health insurance at all.
Giving a premium discount to healthy people would be awful for people with preexisting conditions and totally discriminate against them, often for condition they have zero responsibility for. It is like you want to punish people for their genetics.
Why do they have preexisting conditions? Because they had no incentive to lead a healthy lifestyle. The claim that most of their chronic health issues are due to bad genes is one of the biggest lies perpetrated by the medical industry. It serves their interest very well because people feel helpless about theri genes and thus become dependent on doctors and drugs.
This cannot be expalined in a short comment. If you are really curious, go deep into studying the true causes of disease. Most common chronic diseases, including obesity (which is a cuase of many other diseases), are entirely preventable with diet and lifestyle regardless of genes.
You should be embarrassed how much you are into clueless victim blaming. Never heard about thrifty genes and genetic predisposition to diabetes being a real thing? Add in social and economic factors which can make it difficult to obtain a good diet and it is very obviously not as easy as you claim. And an overly judgemental attitude has not helped anybody say out of depression.
Surely one just needs a little bit of willpower to get out of any mental disease/s
Exactly, and right on, VG.
And are insurance carriers prohibited by law from assigning a substantial portion of their investment portfolios to health care product/device innovators and producers that proliferate and profit well upon the entrenched dynamics of the present pay for treatment model?
Your “cornucopia of healing interventions” needs to be subject to prospective controlled trials every bit as much as pharmaceuticals. Check out Vinay’s recent Youtube “Nutrition Science is Entirely Unreliable.”
Indeed, RCT's are very important. However, there are already tens of thousands of randomized clinical trials on herbs, foods, supplements, homeopathy, and other alternative treatments. Look at greenmedinfo.com and you will find a dizzying number of clinical trials that have already been conducted on many types of healing modalities. You also did not mention "quality" as a modifier to prospective controlled trials, as much of the RCT's that have been published are garbage, or show something different from what they purport to show. Indeed, research, as Mark Twain famously noted, is statistically bound, and to that extent consists in some measure of "lies and damn lies." Researchers are famous for "teasing the data' to produce the results they want. I'd rather rely on clinically proven treatments in the hands of master clinicians than stuff published in mainstream journals. Nevertheless, high quality RCT's are still an important component of demonstrating empirical efficacy and safety and we can never have too many of them.
I went to greenmedinfo.com and found 74 studies claiming positive clinical results for homeopathy. Do you believe that homeopathy is evidence-based James? Do you believe that Vinay Prasad finds homeopathy to be evidence-based?
I don't believe homeopathy is evidence-based. I know it is. I've been practicing homeopathy as well as medical herbalism, functional medicine, nutrition, environmental medicine and energy medicine for 23 years and have had amazing results from all of them. I believe everyone is entitled to believe or disbelieve whatever they want, but compared to when I practiced just allopathic medicine, I get much better results now. Please don't take my word for it. I encourage skepticism. I was very skeptical myself before I witnessed the clinical results time and again in my practice. James Tyler Kent and Constantine Hering, to of the greatest homeopaths in history started out as skeptics who tried to "disprove" homeopathy, ultimately becoming converts when the null hypothesis was rejected. I think it's important we all be clear in our own minds when we are open to scientific paradigms that don't match our preconceived perspectives and when we are just refusing to be open to them.
Interesting. What’s your education and training, and where did you practice?
Homeopathy works only if you believe in magic over chemistry. There is zero doubt about it. This is why an education in basic science is an important basis for medicine. If you see results using homeopathy you see placebo effects and regression to the mean. To understand why basic science says without needing studies that homeopathy cannot work. The evidence base is important too as you illustrate, but basic science is the basis for it. We don't teach kids math before they understand numbers.
Troll or bot, you should still try to respect others' opinions, even while you're compensated or commanded to do your nasty rhetorical labor.
RCT "studies" don't all fit the evidence expected for "drug" action, safety, and efficacy patterns.
HCQ was known, by responsible care providers very early in the COVID era, to be useless in late, severely symptomatic COVID; yet the RCTs performed (by OWS-friendly facilitator-promoters of FDA's vitally needed EAU imprimatur to so "approve" the "vaccine" for distribution?) to evaluate the above parameters in CDC protocol-directed late treatment ignored this critical treatment factor. Maybe on purpose? In the end, of course, "clinical efficacy and safety could not be established via a carefully designed, well-controlled, RCT," the nightly news ran. Very conveniently for the plandemic.
Likewise, homeopathy too shows its resistance points upon contact with measuring tools used in too standardized, routine RCTs. The misfit does not establish any basis to prejudge the clinically known, unquestioned safety and usual effectiveness. Rather, it surely suggests, to those who best understand the internal dynamics and mechanics of homeopathy and its many properly combined and diluted substances, the right test, if one even exists or could be developed, hasn't been designed or applied to date.
No matter. Trained and credentialed academic scientists, looking to apply their corruptly bought, all too unethically human confirmation biases, would thus contribute their intellectual skills and analytic talents, no less the also corruptly bought prestige and professional influence of its hired hands, to find the non-petrochemically based homeopathic "substance" therapeutically worthless and a waste of time and money -- certainly an oddly styled and developed substance far too risky to use in the treatment of considerable illness.
Not true
You make a powerful argument. I'll think your point through.
So well said!
These are the Naturopaths of our present day medical system.
Naturopaths are indeed leading the way. I am a conventionally trained M.D. who has gone the way of "Integrative Medicine". I got all of my I.M. training after completing my residency in 1991, by going back to school for Homeopathy, Bowenwork, Herbal Medicine, and Functional Medicine. I.M. includes many alternative treatments, but the mix differs from one practitioner to the next. What all I.M. practitioners share is an understanding that getting to the root cause of disease is absolutely fundamental. They also believe in using safe, effective alternative to pharmaceuticals and surgery wherever possible. I.M. recognizes that there are some situations where conventional medicine is superior, but for chronic illness, lifestyle interventions and health PROMOTING interventions are for the most part superior to "disease management" by way of pharmaceuticals. I have discovered this to be true in my practice. Naturopaths get this training from the get go, but there aren't many of them (nor are there many I.M. practitioners either).
Your patients are fortunate to be under your guidance with respect to their health issues.
Yes, and naturopathy are infamous for using unscientific notions. Not the way medicine should go. Medicine needs to stay science based.
When “the science” is corrupted, the “evidence based medicine” is corrupted.
Yeah, we have literally seen 'gold standard' studies created to attack Ivermectin.
Worse, such studies are incredibly expensive, meaning they are only done by Big Pharma.
What we need is more acceptance of real-world evidence, which requires something similar to the VAERS system but open-source and transparent.
So you don't believe Dr. Prasad when he advocates for evidence based medicine and the importance of well designed RCTs?
You seem to be of the opinion that real world evidence has to agree with your preconceived notions? Real world evidence are viruses which don't care.
Evidence needed that science is corrupted.
I would posit that your life would be a lot more miserable if science were corrupted to a significant degree. You would not have electricity, would walk everywhere and medicine would work a lot less. Imagine living in the 16th century or so. What was the life expectancy then versus now? What was the childhood mortality, how many women died in childbirth?
https://blogs.bmj.com/bmj/2014/01/31/richard-smith-medical-research-still-a-scandal/
https://www.pbs.org/newshour/health/fda-increasingly-approves-drugs-without-conclusive-proof-they-work
https://www.npr.org/sections/health-shots/2017/05/09/527575055/one-third-of-new-drugs-had-safety-problems-after-fda-approval
Science is not perfect does not mean science is corrupted. All this means we need better funding for the FDA. I do agree that there needs to be supervision. But you know where supervision is sorely lacking? The field of alternative medicine. Supplements are largely unregulated despite making medical claims. Useless modalities are allowed to practice despite lack of evidence. I am sure there is corruption in standard medicine, because there is some in any human endeavor. But there is not more than in other fields.
Also you have shown zero evidence that pre scientific medicine outcomes were better. Any old graveyard has plenty evidence hoe much worse they were.
Tina, you’re not very bright, so I’m not going to waste any more time on you.
Troll. Bot. All as if you're really in the know.
Let’s just get back to informed consent & eliminate the DEI & social justice nonsense from current med education. We might want to address the ongoing capture of nearly everyone conducting research also.
Have you seen or heard?
The popular acronym DEI, as the Creator of All would seem to have it, is also in fact the same letters in the same order that spell, in the ordinary, lower case, the plural form of the Latin deus, or god; and so, "gods". (St Jerome, in his Vulgate (common) Latin translation of the first Christian Bible, written in Greek, wrote down "Deus" when he translated from "Theos" -- what the earlier Hellenistic Jewish translators, fluent in Koine Greek, wrote down when they translated Elohim from the still Hebrew-speaking, post-Mosaic era Israelites, in whose trusted custody, led by Joshua, Moses placed the great lawgiver's First Five Books, or Pentateuch, the primary Torah. Jerome was working from the Septuagint, the "70-authored" translation into the Common Greek of the complete Hebrew Bible, the Tanakh, the full, written expansion and expression of Torah.
(Jonathan Cahn would argue that the same, middle-era Israelites were implicitly on to something -- grounds for the later inspired Trinity -- in connoting a singular, oral meaning, God, from a plural, written number for this, Gods.)
Following the same, Biblical narrative regarding Israel's perennial and paradigmatic struggles with its (as would be any human society's) apostatic drives, we're dealing today, quite arguably and for many learned observers and writers, with what Messianic Rabbi, renowned minister and successful author Jonathan Cahn recognizes, in his book by the related title, The Return of the Gods -- namely, the evil and destructive demons, known well to the Biblical pre-ancients (Mosaic & later Israelites) and later ancients (Christians) as Baal, Ishtar, and Moloch -- with the systematic program of the Hebrew/Jewish Hasatan, and the Christian Satan.
The present linguistic phenomenon involving DEI and its meaning in another, entirely different context is telling, in my merely lay sense of well-known old and current affairs. Call it coincidence, if you must. I call it clarion and theologically informative. It's an Admonition from Above, if you asked me.
Check out Cahn on YouTube. Hear him for yourself. Naomi Wolf pays him a lot of inspired and informed attention in her writings, you might be interested to learn, in case you're unaware.
Well, you can find a lot of homographs in the English language and even more if you expand to different languages. The English word "gift" means "poison" in German. And that has a deeper meaning of nothing.
If a deity created humans, that deity clearly loves diversity, since it created so much of it. And if we want to follow that deity, we should also love diversity.
I have nothing against diversity per se. On the contrary, I'm a huge fan of its merit and invaluableness in American society. Read me, please, rather than your script projected onto me, inter alia.
I'm sure you're ascribing an outsized importance to the institution of diversity when unbalanced and relatively exaggerated in the absence of an overarching, cohesive sociopolitical gestalt, that is unity.
Creation itself is the greatest possible, demonstrated expression of The Deity, our Lord's, inimitable Unity.
Of course, believing in diversity, I have no personal problem with your insistence on using the term deity in lieu of my more reverent selection; however if you'd rather insist, even demand, still further, outright mandate by undemocratic edict that I not capitalize my D when saying "deity," those of us who so worship and speak our free minds will oppose you, and vigorously.
With respect and in peace, we say, Don't tread on us.
I too value diversity, but the programs infiltrating our institutions are racist. No other way to describe it.
Do the people who are often underrepresented in medicine say they are racist too? Or is that just your view point? What do studies say about medical outcomes if practitioners are more diverse?
How do you feel about programs based on sex? Should women earn the same wage than men for the same work?
Can you explain what DEI in other languages meaning God has anything to contribute to the discussion?
In addition: the singular genitive form of deus is also dei.
Ecologically a system is a lot more stable with more diversity. Diversity is very important. A nation of rocket scientists only would be very unstable.
It's gods, not God, just as deus ex machina doesn't actually translate into either Gods or God from the machine. There is a god, and are the gods; then, there is God in Greco-Roman pantheism. But we're not talking about Zeus or Jupiter, which are singular, but obviously super deities, or Deities, respectively.
In any case, Cahn's "gods," dei -- Baal, Ishtar, and Moloch -- I'm actually citing another's find, were certainly and are not meant to be worshipped by Israelites/Jews and early/later Christians, though they actually were by these faiths' apostates through the ages -- and today certainly are by many, too, too many in our American society and others in the world.
Specifically, I took an extended tangent-trip in reply to one of Dr Molly Rutherford's posts. It mentioned the waste of valuable time and other resources in which more and more med schools today are engaging by instituting DEI programs. I took it from there to reach implicitly atheistic, antisemitic/anti-Christian/anti-Caucasian, pro-BLM CRT, Anti-Racism, anarcho-tyranny and one-party, Cloward Piven-driven totalitarianism generally -- ie, anti-American family/anti-Western Civilization neo-Marxism replacing the ancient, historic, multicultural but homogenizing roots of our society at work in New Medicine.
I wholeheartedly demurred. And you got how I feel about my beliefs, and my ethical and moral commitments as they relate to the multiple codes-abiding standards for at least the basic restoration, if not the advancement of just and beneficent health care.
Anyway, your prompting post here, I feel, isn't intellectually honest, only disdainfully dismissive. I get the sense, your dialogs are neither collegially approached nor sincerely engaged, but rather are unfriendly, even hostile.
So, never mind, please, "Tina"; just move on from here and I wish you well.
You're certainly right about deus, dei, etc. Cannot one of two be right, per se? Too tight, I'd call your grasp.
More to your main point, though, permit me to ask first, in turn, why you find the neo-Marxist focus on diversity uber alles, unhinged from a humanly social need (we're not merely bees) for structural, meaning- and purpose-dominated unity, so enchanting and all-important.
Intersect this, Tina: How would you like to believe in the safety of the interstates and intersect with a family from Togo, whose head in the driver's seat, like the other family members, neither speaks nor reads the language of our road signs, but only his native Ngangam?
The more (ununified) diversity, the more stable the society -- and this irrelevant gibberish you pass along as hard, not even a qualified social science?
Please, Tina, get real by getting more honest. Stop lying about the faux- virtues of an unhomogenized, societal diversity. Some less skeptical folk, well-meaning folk could mistake your confident stridency for authoritative, tested and proven knowledge.
Be more transparent please about your underlying, driving, essential ideology, your view of humanity and its place on Earth, in relation to other life forms, if you'd be so kind to share here. Let it rip.
This is just a distraction to the answers what role your deity plays here.
So you think it is a good idea to not have social justice? If you don't like diversity, would you say there should be no women in medicine? Just white men who come from families which can afford to pay for a medical education? If you get rid of diversity, that is what you want?
No. That’s ridiculous. When I went to med school, women were in the majority. That was 20 years ago. These Marxist ideas are evil, and we’d better get rid of them asap, or you won’t have a critical thinking doctor to take care of you. You will have a rule follower who, for example, recommends a shot to you that you do not need and that is more likely to harm you than to help you.
So you say it would be ridiculous to have diversity in the medical field, but that diversity is Marxist?
What do you think Marxist means?
Can you be concrete about the shot one does not need? A postnatal vitamin K shot?
I don’t have time to debate you. I’m seeing patients.
A fitting desert, doctor, for a pseudodebater.
I would recommend to sometimes use a dictionary and look up what the word desert means.
Because you are again not making any sense.
I find it very curious that you are the second person unwilling to debate me on this forum. I can only read a lack of ability jntobthis unwillingness.
Sorry that should read "ridiculous NOT to have diversity"
Maybe, rather, diversity amid a larger, more homogenized society, one the motto E Pluribus Unum best portrays.
The watchword here, friend, is our much needed and forgotten sense, to be sure, our practice of UNITY; for, lacking this, diversity is nothing but destructive fragmentation -- unless that is your real desire and goal for America. Is it?
I agree with unity. And unity is based on fairness. People are not going to feel united with others if they feel treated unfairly or feel ignored. Therefore political organizations which preach against inclusion and diversity promote fragmentation.
Perfect theory for a revolutionary like yourself.
Reality's text however, has recorded far more to the contrary than you relate, however heartfelt, pure and noble you believe your aspirations are for us all.
There is, frankly, a circular form of logic in your general argument, which, being overly deductive, intrinsically lacks an empirical truthfulness or soundness.
What you say, then, is necessarily valid, but, in the immediate space-time continuum that is our society's shared existence, simply unverifiable, given an honest accounting of the facts, past and present, and thus pretty questionable.
Diversity is onanistic in the absence of unity. Equity is a fraud, and you know it, or should. And inclusion is an old, worn-out and tiring Marxist complaint delineated from alienation, a core premise and pretense for revolutionaries everywhere and at all times.
No gratitude, no happiness. Get grateful and you'll renew your sacred life. That's the beginning and end of inclusion.
This is all about putting the horse before the cart -- as in learning the principles of EBM prior to the laws of biology, the logical premises of human physiology and pharmacology, or what's part and parcel in allopathic medicine. This horse-pulled cart is on the way to becoming more integrated, real, less metaphysical in promoting for future doctors of medicine and osteopathy a richer, sounder, more meaningful curricular content and application.
It sounds right for patients, if not for the dogmatic theoreticians of the medieval schools, as it were. Let's get out of our heads and do it.
This is just oseudoprofound ramblings. Are you using a Chopra quote generator?
If you call me a revolutionary you demonstrate that you have zero grasp on my opinions. Just a lot of your own preconceived notions. I get it that their are dear to you. But you have not remotely convinced me why they should be dear to me.
Medical education...is that a joke? Most doctors are indoctrinated to be disease and drug pushers, not real healers of the body. Unbeknownst to most of them, the body is an excellent healing mechanism on its own. No drugs required, in most cases.
That is why I always seek alternative practices first and "medically educated" doctors last. And don't tell me it isn't their fault that they do not know how to heal a patient. I am sick and tired off hearing that doctors know not what they do and should be given a free pass for administering deadly drugs and vaccines.
Nice, and quite right.
I disagree as a physician myself. Medicine at its very foundation is built on clinical observations. Most of the discoveries in medicine didn’t require RCT but required excellent clinicians. We have sacrificed clinical acumen for ordering diagnostic testing and pill prescribing! Doctors now skip the history and physical and jump to ordering tests that substitute for thinking as a clinician. They think that telemedicine can substitute for an personal interaction with the patient. Evidenced based medicine got us where we are now. I’m not against fact based advice but evidence based medicine is what drives protocol based decision making and not clinical acumen. I would say medical ethics should be top priority and recruiting individuals that already have demonstrated in their personal lives an ethical life style where others needs are more important then you own will take care of a lot of the issues.
Especially when the “ evidence “ can be funded by the manufacturer. The concept of evidence based medicine seems like a green signal for high cost patent drugs to make it into the treatment guidelines. A lot of so called prestigious medical journals become mouthpieces for these high cost interventions. All this vested “ evidence “ has drowned or dialed down clinical acumen as you correctly alluded to . Younger doctors tend to be more rigid protocol followers and have less critical thinking skills than clinicians with years of experience.. The issue if a person has strong clinical knowledge of the workings of the human body and strong clinical acumen they will have the confidence to deviate from a protocol because they know what that particular patient needs . On the flip side , if thr clinican”s foundation knowledge of the workings of the human body is weak and he or she does not have the critical thinking skills , it’s must easier to just follow the treatment protocol/guidelines. This way they feel safer and legally protected even though that may not be the best outcome for the patient at hand . In recent years there seems to be a desire to have less competent people hired as they tend to be more submissive.
Well said - problem now is that if an experienced clinician deviates from a treatment protocol, at the best he/she raises eyebrows and at worst they are deregistered and end up in jail.
Correct, true and tragic.
Deviation from treatment protocol has to be extremely egregious to be struck from any medical register.
Well, that is why you first need to base medicine on basic science like biology and chemistry. If a treatment has no plausible way in which it can work like homeopathy, we don't need RCTs.
That said, we don't know all about biology, an intervention can work, even if we don't entirely hit. But that does not mean we should throw science out of the window. We need to build on it.
Are you aware of the putative physical chemistry laws, postulated, but not yet known or understood clearly, by current scientists, that undergird as logical predicate the physiological effects Hanneman ushered into medicine with his discovery of homeopathy?
Feel the unity of science, sister. It's there to both apprehend and own.
There are no putative laws which explain homeopathy. Homeopathy was once beneficial because it was safer than quack cures. If you read up the basis of homeopathy it was never based on science. Hahnemann was no scientist and there is agreement that homeopathy is unscientific. If you were to read a proving they are obviously utter garbage based on personal dreams and emotions..
Even if it were to work via some mysterious processes which contradict our current understanding, there are no good RCTs which show that homeopathy works. Evidence based science requires no understanding of the underlying mechanism.
And are you seriously proposing that at a time we can find neutrinos that there are mysterious mythical forces? We should rather believe some people with vested interests in homeopathy with what hand waving they come up with? Science is not speculation. Until they present hard data it is not science.
Thinking like yours would believe that if the best science was used to invent and ultimate bring to market a wonder drug, all of the drug's safety and efficacy would be attributable to it and it alone and not possibly in any part or measure the constant potential for the placebo effect.
Did you, and until when if you no longer, or do you continue to find the COVID "vaccine" safe and effective -- but if not, certainly unrelated in any way to the millions killed or maimed since the availability of the "vaccine" (read accurately: the wickedly criminal deployment of a bioweapon)'s multiple means of the sure and eventual biodestruction of its host-target). After all, it's a product of science, and there is little to no evidence of corruption in science. Its methods and programs are completely reliable and trustworthy.
(Real world -- what's that, and who cares, anyway? your manner appears to scream. I believe, deep-down, it's actually a sad and lonely cry you wish you could feel but can't. Yet. So, get help. Do it for yourself, if now for nobody else.)
In the real world there are no wonder drugs. If it has a beneficial effect it is bound to also have unwanted effects. The aim is to find a substance where the benefit clearly exceeds the cost.
Using real world common sense, covid vaccines are a lot more beneficial than not. And they always and for everybody beneficial. No, of course not, but they have been proven to be a lot safer than the virus. A virus which boast zero safety and efficacy testing.
The only objections to covid vaccines are ideological. Apparently this here is a nice ideological bubble and you resent people who do not share your ideology. This does not jibe with your call for unity. Or do you mean there is only unity when everybody else finally shares your opinion?
Gayln Perry, I agree 100% 🎯
Evidence based medicine - when RCT’s aren’t funded by profiteers. We don’t get to see the evidence that “fails” because many pharma funded studies that don’t get desired results never see the light of day. So we really need to define what qualifies as evidence before going further.
As a woman whose mainstream treated hypothyroidism - all based on guidelines and supposed ‘Knowns’ - eventually led to my falling asleep while driving on the interstate (!), which led to FINALLY finding the answer with an addition of T3 to my T4 monotherapy (T4 being standard of care) by way of yet another misinformed endocrinologist, I am now in the no-one-really-knows-a-damn-thing camp.
My symptoms resolution came on the second day, when I experienced a situation much like The Wizard of Oz: I literally saw my black and white world go Technicolor. With just this hormone addition. But then it began to go away after about 3 days bc my T4 was reduced with the T3 addition. However, once I knew that this was possible, I dug in. First, I had to get a better doctor and get better treatment - which means that ALL of mainstream endocrinology has their understanding of thyroid functioning wrong - and then I began to research. Now for 24+ years I search the literature for data. Hours daily. My God, we’re totally stuck and misinformed!! On most everything!
See this?
https://www.liebertpub.com/doi/10.1089/thy.2022.0397?url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org&rfr_dat=cr_pub++0pubmed
Morons. Seriously. Why? Because T3 creation on site differs among tissues and is not reflected in serum levels. TSH has been used to define thyroid functioning/abnormalities/treatment results. Wrong. Why? Because that issue of T4 to T3 conversion is not reliable nor consistent among tissues and organs (done by deiodinases), and it is not reflected in TSH.
Here’s a funny thing: CAC is the most reliable biomarker of death. A zero CAC translates to a 15 year warranty from death by all causes and risk increases linearly w CAC. T3 made by converting from T4 directly affects how much matrix gla protein (MGP) is created. If MGP created in arteries is activated, then no calcium can deposit. Hence, the #1 cause of death (CVD), and its accurate biomarker (CAC), are directly affected by an essential hormone conversion that no flipping docs even know about. They THINK they know, but they don’t. They’re told conversion rate is consistent and known and, so far, no humans have volunteered to be killed to test this belief.
How about cancer? Maybe close to cause of death w CVD.
Did you know that cancer is addicted to calcium? And that vitamin K2 - an incredibly important nutrient and endogenously made hormone - is a big player in calcium behavior?
Get this: https://pubmed.ncbi.nlm.nih.gov/30051950/
Complete response by vitamin K2 analog monotherapy in sorafenib-failure advanced hepatocellular carcinoma: A case report
Sorry to vent…yes, we need reliable data, real evidence…but I have definitively found that we ask the wrong things, misunderstand etiology of most diseases, and chase BS.
It’s cute to cite evidence-based medicine…but we’ve asked the wrong things!
e.g. statins
https://pubmed.ncbi.nlm.nih.gov/35285850/
Evaluating the Association Between Low-Density Lipoprotein Cholesterol Reduction and Relative and Absolute Effects of Statin Treatment: A Systematic Review and Meta-analysis
Who among us are really appreciating relative risk v absolute risk and how very manipulative these are?
I mean, cardiogists seem fooled.
Modern medicine faces real issues, but continues with data from incorrect questions. So our evidence is faulty. Almost all the time….
That's great that you're doing your own research. Any cures or improvements we found for chronic issues in our family was because we did our own research. The people who don't do their own research will be put on forever meds without addressing root causes.
I would like to read your opinions on thyroid. 24 years is too much to keep to yourself.
You're awake, lead on!
Brilliant !
Vintage piece, Dr. Prasad. Like the rest of our education system, medical school needs to be overhauled. Doctors in my family entered med school knowing what a woman is, but now they don’t and display no interest in thinking for themselves or having curiosity about the world. Here is a sad email exchange with them in which they compared their job to car mechanics and deferred to “experts” on any topic outside of their specialty: https://yuribezmenov.substack.com/p/how-to-do-no-harm-part-3
It's truly scary. Been going on for a long time, in the 80's EUSOL got demonised and withdrawn from usage due to misleading research funded by a Big Tech company promoting its new wound care product. Currently we are seeing Med Tech companies hijack Standards Organisations and governments to get rid of time proven protocols to promote single-use items and consequent cash flow. The current generations of doctors and nurses are so brow-beaten by clinical governance that they're afraid to speak up, even if they understand the issues.
I have to say I disagree with Vinay on this one. In order to understand the underlying basis of medicine, you have to know some basics physiology (including neuroscience), anatomy and biochemistry. That provides one with the tools to think critically which is so crucial when it comes to evidence-based medicine and RCTs. That's especially so when not all RCTs are created equal or done correctly (as indeed Vinay continually points out when it comes to cancer drugs).
I agree. I do find it rather concerning that what should be a blog advocating for science appears to be a happy place for people who don't seem to believe in modern medicine, but rather in what is now called CAM, which embraces a lot of unscientific approaches and the voice of reason appears to be rare.
Teach the proper method for discovering the truth before teaching what is currently believed to be true.
If and only if the laws of biology are the exclusive path to understanding the multitude of biochemical wonder that is the human being, made in "God's image"
I think not, but also include the power and purpose of frequencies and light, not yet considered and appreciated, let alone grasped in full by Rockefeller-funded biologists.
Vinay gets something like, if not exactly this.
Nonetheless, I am heartened and led by your high pedagogy. It is certainly good and right.
Yep. That is commonly called science. Teach how to think critically like a scientist before relying entirely on RCTs. At least not before understanding the limits of RCTs.
Viva philosophia! Death to the all too subtle propagation of ever-dangerous dogma.
A simple question to start your next Dr visit; can men get pregnant? An answer in the affirmatuve or evasion should be a warning to you. This person is clueless or captured by big med dogma. Get up and leave.
Any monkey can follow a protocol and call themselves a doctor or even a mid-level for that matter, but is that the type of provider you want caring for you or your family? Medical providers are automatons; cogs in the systematic wheel....”follow the protocols....quote the current literature...hope the authors got it right and weren’t shilling for a pharmaceutical company, or worried about losing grant money! God forbid they should question and think outside the box. Biology and Anatomy are critical foundations that should absolutely come first lest we all start believing men really can have babies....”’cause it says so in the literature”...biology smology! Keep dumbing it down and that’s who’ll be caring for you in the future!
Yes. Totally. Don't follow current dogma how to treat a fracture. Throw that out of the window. A class in meditation and vigorous ancient wisdom based yoga is superior /s
This piece made me think of a video where the dr was trying to differentiate mds vs mid level providers. This dr said that doctors are different bc they’ve been educated to understand all the mechanisms of how and why things are happening and mid-levels are just “recognizing patterns”, they see things enough to know how to respond in most cases but when something is unusual they lack the deeper understanding of the science behind it and are unable to deal with complex cases. It was a really crappy argument I thought bc it’s assuming anyone knows the scientific mechanisms. I love the idea of starting with the history of medicine - it means presenting what the practice of medicine actually is and where it came from.
CDC has scheduled 3 mRNA covid vaccines for new born babies by the time, they are ten months old. doubt it trump and the rest of the team with gottlieb, fauci, collins, biden and obama have not done their home work ... but we shall see ...
. @Vinay Prasad is completely wrong. Biology and thus UNDERSTANDING MECHANISMs is far more important than RCT based EBM. Medicine today is an abject failure due to lack of such understanding.
In fact, understanding mechanisms would mean clinical equipoise does not exist thus making RCTs unethical.
Aircraft safety is not based on RCTs. Doctors need to learn safety from us engineers.
https://twitter.com/SynthIge/status/1645560307291688960
Even before teaching about evidence-based medicine, medical students need to be taught serious courses in probability and statistics. According to one survey, 97% of the general public and 85% of doctors cannot correctly answer this important question:
Assume that the PSA test used for prostate cancer screening has a sensitivity of 80% and a specificity of 60%, meaning that 80% of people with cancer will test positive and 60% of people without cancer will test negative. Based on his age and race, a man has a 1% probability of prostate cancer before the PSA test. What is his probability of cancer after the test if he tests positive?
An approximate answer to the nearest whole number (in %) is fine.
Positive likelihood ratio is sensitivity / (1 - specificity) = 0.8/(1-0.6) = 2. Post-test probability is pre-test x likelihood-ratio = 1% x 2 = 2%
Ok, as an old school surgeon, I'll bite the bullet. Sensitivity and age-related incidence are irrelevant in your example. The specificity of (only) 60% means that your chap/chapess has a 60% probability of having prostate cancer. I did get up to PhD level stats a long time ago!
As a colonoscopist, I am faced with the occasional dilemma of treating a trans-sexual (sometimes undeclared) and deciding on whether to report prostate findings on the routine DRE. I think DEI philosophy would rather I ignore findings as part of an inclusive process.
Sorry, but you are not even close to the correct answer. Ask chatGPT.
Apparently this article was written by ChatGPT. Lol. That explains its quality, but it does not explain why somebody would be willing to post it under their name.
Thank you. I'm gonna steer clear of AI, except for detecting polyps, bit I will brush up on my stats!
Here is a simple way to explain this: Let us say that 1000 men take the PSA test. Only 1% of them, or 10, have cancer, 80% or 8 of which will be detected as true positive. Of the remaining 990 men, 40% or 396 will be detected as false positive. So the probability of having cancer (if tested positive) is 8/(8+396) = 2%.
I think numbers are not that dissimilar for mammograms? It was always emphasized to me that a recall after a mammogram does not mean one has cancer. And that is why I just had two needle biopsies which made my provider tell me that I don't have cancer. Since prognosis is better with early detection I personally did prefer getting some needles stuck into me than just wait and see.
Since one biopsy used ultrasound it was fascinating to watch on a screen taking samples. Hurra for basic science.
A lot of studies have shown that, on average, mammograms do not have more benefits than harm. They are likley to cause overdiagnosis and overtreatment. Also, they tend to classify DCIS as cancer when in fact it should be viewed merely as a risk factor. Here is an article I wrote on this topic a while ago:
https://indiacurrents.com/the-case-against-cancer-screening/