Having practiced oncology for 30 years, the main difference I have observed with younger generations is their transactional approach to care. Every day practice is nothing but the implementation of guidelines generated by doctors with conflicts of interest. Worse yet, so called academic institutions carry out research intended to approve new drugs with little data. Trials are designed to show the minimal statistical proof that leads to FDA approval , often with little benefit to patients. We used to have journal clubs where we dissected published data and gained knowledge from imperfect and flawed studies. This exercise in critical thinking has vanished.
Furthermore, in writing those guidelines, where no evidence exists the guideline authors frequently quote “consensus opinion of the experts”, which has always struck me as a very fancy (and intellectually dishonest) way to describe “groupthink”. In the long history of medicine, there are countless examples where the consensus opinion of the experts turned out to be something useless, or even harmful. When writing guidelines, if no evidence exists, then say so, and then recommend that someone do some research.
One of the best courses in grad school was one where we were given 4 peer reviewed articles and we had to evaluate them for design, statistical analysis and results. Of course this was in the 1970’s. As I recall 3/4 had fails in at least one are that rendered the results as useless.
They're also incorrect re: e.g., RCTs on vaccines being "unethical." If you really sit down and map it out, this ends up being a complete red herring but basically anyone who isn't actually a scientist believes it.
It is the essence of the pseudoscientific argument. Not homeopathy. Not crystals. Doctors who believe their career rests of propping up certain lines of propaganda published by authoritarian medical policymakers who almost entirely work for large profit interests.
It’s unethical to inject infants with a potentially toxic substance and NOT have an inert control. Back when Salk conducted the polio vaccine trial he followed three groups of kids: one for the vaccine, one got a placebo which was not inert but contained the monkey kidney broth sans the inactivated poliovirus, and a third batch of children who were not injected with anything at all. Guess who had the highest rate of polio? The injected placebo group--higher than the group of children not injected. Injections no matter what’s in them, carry risks.
Covid did expose a truth problem in the medical sciences. I believe that part of the problem is the way we select, educate, and train doctors. Too much regurgitation of received facts, too much deference to authority figures, too much obedience. Too little challenging of received wisdom, too little critical thinking. Hopefully more leaders will see the need for reform.
Even Physics has problems with people not wanting better data.
When I was an undergrad in Physics one of my professors had built a detector, for use by a second professor in the department, to monitor the second professor's experiment. The experiment was designed to discover a hypothesized physical process. The detector found a signal at the right energy level to indicate the presence of the hypothesized process, but the signal was weak, almost indistinguishable from noise near the sensitivity limit of the detector. The second professor was nonetheless able to publish the result and received some attention for the apparent discovery.
Meanwhile, my professor designed and built an improved detector with orders of magnitude greater sensitivity, intending to allow it to be used in a second, confirmatory experiment. But the second professor refused to re-run his experiment with the new detector, probably suspecting that his claim to fame would disappear with better data.
This was a small experiment purporting to detect a subtle, non-commercially useful process / effect, not connected to any significant government funding or economic impact. Yet some degree of fame and the opportunity to publish "new physics" apparently corrupted the pursuit of truth (i.e., of better data).
Extrapolate from this one small study to other studies, in Physics and other disciplines, relating to subjects--like climate change for instance--where government funding is vast and politics is strong.
Too bad that every person and every body is different. There is NO data on obesity that is correct and yet there are thousands of studies. We are entering the Age of Embarrassment since all the data is based on calories in/out and this approach has failed since it is flawed. Forget Calories HORMONES RULE. But keeping your hormones in balance means eating less quantity and no one-- no official in biz or gov-- wants any American to buy less.
Yes, but let's not forget the importance of what we eat. Ditch the sugar, the ultraprocessed carbs and seed oils. Become aware of contaminants in the human food supply, and the feed of livestock. Research the importance of fasting and time-restricted eating and the role of autophagy. Get enough exercise and sleep. Try to control stressors.
Totally disagree. Our food has no taste-- thus no nutrition. It is simply for energy; and it doesn't satisfy the soul since it is so simplistic. One billion are dying of starvation and we have ten kinds of milk on the refrigerated shelf. We are just me myself and I and 65% OBESE. Only Ozempic can save us. Wellness bitches will soon be attacked so be careful.
I am not sure if you actually totally disagree after all. Yes, MOST of 'our food' is crap, practically devoid of nutritional value and relying on it is very likely the cause of 'the diseases of civilization' (See the lecture by Dr. Chris Knobbe https://www.youtube.com/watch?v=7kGnfXXIKZM and others) such as Type 2 Diabetes, metabolic syndrome, kidney disease, cardio & cerebrovascular disease, etc.
Yes, western society is largely self centered, narcissistic and ignorant with respect to health of body, spirit and society.
Wellness proponents have always been disparaged, vilified and marginalized by those who profit from junk food and 'therapeutics' for chronic diseases (which arise from junk food etc), but their message and data is out there to be found by those interested, at least for the time being (thank you Elon for your part in that).
And what you eat matters. Calories which have hitchhiker chemicals, synthetic colors and flavors, preservatives, etc produce more obesity which is the bodies way of using fat to encapsulate the toxins it can’t rid itself of.
Unfortunately the story with physics is no longer that heroic. Nobel prize 2021 for modeling climate change resembles 2023 Nobel for Medicine. And non-main stream physics theories are cancelled, too, without due diligence. It was a physicist, Max Planck, who is credited with saying sth that amounts to the statement that progress is made one funeral at a time. Though, experiments carried out in physics are much more trustworthy, that's undeniable.
Lucky are physicists that people's life and wellbeing do not depend on their truths (or at least people don't think so) and they can spend 100 years on the experiment without other people attention.
But when it concerns "real life", like in the case of climate change (or fictional Earth-threatening comet in "Don't look up" movie), they encounter the same turmoil we have in medicine.
I just finished four months of chemotherapy which degraded my palate so almost everything tasted awful. I learned that taste is personal and for most Americans their uneducated palates coupled with gluttony and food fears cannot be fixed. Finally I can taste so my sons are treating me to a good meal at Cote next week. Believe me, I won't be thinking about "healthy" while I enjoy the pleasures of cuisine.
I couldn't help think of Emil J Freireich, who was a pioneer treating childhood leukemia. He plowed ahead in the face of much resistance, and was proved correct. Yes, many of his early child-patients died [..I think that Freireich believed they would likely die anyway?] so he felt he should continue to pursue other solutions than those "acceptable" at the time.
"With the bleeding problem solved, Freireich turned his attention to curing childhood leukemia. Another difficult-to-treat disease, tuberculosis, recently had been cured. He believed the TB treatment approach might work for leukemia as well.
“We knew that three drugs controlled tuberculosis, but you had to administer them all at once. If given separately, they didn’t work,” he says. “I had an inkling the same method would work for leukemia.”
So Freireich began combining chemo drugs instead of giving them one at a time. First he administered two of the highly toxic drugs, then three. With each addition, children became seriously ill, and some were brought to the brink of death. When he upped the ante to four drugs in a 1961 trial, an outcry arose from the medical establishment.
“They said I was unethical and inhumane and would kill the children. Instead, 90 percent of them went into remission immediately. It was magical.”
What is the evidence behind “psychosomatic” symptoms besides an absence of evidence of an organic illness?
Why is this fundamental principle not applied to this “scientific” and “evidence based” medicine?
Some guy decided at some point in history that if he can’t easily find a cause, with the most basic of investigations, then the symptoms are NOT organic. Why do people go on with such magical thinking disguised as science?
Even when we do a proper randomized controlled trial in medicine, the threshold for significance is two sigma (p< 0.05) vs. five sigma (p<0.0000003) in physics.
It is no wonder that most published research findings in medicine are false (non-repeatable).
Having practiced oncology for 30 years, the main difference I have observed with younger generations is their transactional approach to care. Every day practice is nothing but the implementation of guidelines generated by doctors with conflicts of interest. Worse yet, so called academic institutions carry out research intended to approve new drugs with little data. Trials are designed to show the minimal statistical proof that leads to FDA approval , often with little benefit to patients. We used to have journal clubs where we dissected published data and gained knowledge from imperfect and flawed studies. This exercise in critical thinking has vanished.
Seems those who pay for the research profit from the research. 🧐
Furthermore, in writing those guidelines, where no evidence exists the guideline authors frequently quote “consensus opinion of the experts”, which has always struck me as a very fancy (and intellectually dishonest) way to describe “groupthink”. In the long history of medicine, there are countless examples where the consensus opinion of the experts turned out to be something useless, or even harmful. When writing guidelines, if no evidence exists, then say so, and then recommend that someone do some research.
One of the best courses in grad school was one where we were given 4 peer reviewed articles and we had to evaluate them for design, statistical analysis and results. Of course this was in the 1970’s. As I recall 3/4 had fails in at least one are that rendered the results as useless.
The worst sort of conflict of interest is the conflict between the doctor's financial and career interests and the well-being of the patient.
I do my own critical thinking and have voted the doctor's expertise out of office several times.
I like the journal club idea
Absolutely! I've tried to reply to you but it was posted as a comment...
“it is difficult to get a man to understand something, when his salary depends on his not understanding it.” - Upton Sinclair.
“Two things are infinite: the universe and human stupidity; and I'm not sure about the universe.” -Albert Einstein
They're also incorrect re: e.g., RCTs on vaccines being "unethical." If you really sit down and map it out, this ends up being a complete red herring but basically anyone who isn't actually a scientist believes it.
It is the essence of the pseudoscientific argument. Not homeopathy. Not crystals. Doctors who believe their career rests of propping up certain lines of propaganda published by authoritarian medical policymakers who almost entirely work for large profit interests.
It’s unethical to inject infants with a potentially toxic substance and NOT have an inert control. Back when Salk conducted the polio vaccine trial he followed three groups of kids: one for the vaccine, one got a placebo which was not inert but contained the monkey kidney broth sans the inactivated poliovirus, and a third batch of children who were not injected with anything at all. Guess who had the highest rate of polio? The injected placebo group--higher than the group of children not injected. Injections no matter what’s in them, carry risks.
“the financial apparatus of medicine does not reward knowledge generation”
Thank you for stating the truth in no uncertain terms
Covid did expose a truth problem in the medical sciences. I believe that part of the problem is the way we select, educate, and train doctors. Too much regurgitation of received facts, too much deference to authority figures, too much obedience. Too little challenging of received wisdom, too little critical thinking. Hopefully more leaders will see the need for reform.
And too many pharma company reps in the schools. Even Harvard medical students couldn't get the administration to get rid of them.
Even Physics has problems with people not wanting better data.
When I was an undergrad in Physics one of my professors had built a detector, for use by a second professor in the department, to monitor the second professor's experiment. The experiment was designed to discover a hypothesized physical process. The detector found a signal at the right energy level to indicate the presence of the hypothesized process, but the signal was weak, almost indistinguishable from noise near the sensitivity limit of the detector. The second professor was nonetheless able to publish the result and received some attention for the apparent discovery.
Meanwhile, my professor designed and built an improved detector with orders of magnitude greater sensitivity, intending to allow it to be used in a second, confirmatory experiment. But the second professor refused to re-run his experiment with the new detector, probably suspecting that his claim to fame would disappear with better data.
This was a small experiment purporting to detect a subtle, non-commercially useful process / effect, not connected to any significant government funding or economic impact. Yet some degree of fame and the opportunity to publish "new physics" apparently corrupted the pursuit of truth (i.e., of better data).
Extrapolate from this one small study to other studies, in Physics and other disciplines, relating to subjects--like climate change for instance--where government funding is vast and politics is strong.
Ah the other destroyer of truths...the ego.
Unbridled arrogance destroys all.
Too bad that every person and every body is different. There is NO data on obesity that is correct and yet there are thousands of studies. We are entering the Age of Embarrassment since all the data is based on calories in/out and this approach has failed since it is flawed. Forget Calories HORMONES RULE. But keeping your hormones in balance means eating less quantity and no one-- no official in biz or gov-- wants any American to buy less.
Yes, but let's not forget the importance of what we eat. Ditch the sugar, the ultraprocessed carbs and seed oils. Become aware of contaminants in the human food supply, and the feed of livestock. Research the importance of fasting and time-restricted eating and the role of autophagy. Get enough exercise and sleep. Try to control stressors.
These are all interconnected.
I love to hunt for more than just the exercise and outdoor experience. It’s good for the body! and soul!
Totally disagree. Our food has no taste-- thus no nutrition. It is simply for energy; and it doesn't satisfy the soul since it is so simplistic. One billion are dying of starvation and we have ten kinds of milk on the refrigerated shelf. We are just me myself and I and 65% OBESE. Only Ozempic can save us. Wellness bitches will soon be attacked so be careful.
I am not sure if you actually totally disagree after all. Yes, MOST of 'our food' is crap, practically devoid of nutritional value and relying on it is very likely the cause of 'the diseases of civilization' (See the lecture by Dr. Chris Knobbe https://www.youtube.com/watch?v=7kGnfXXIKZM and others) such as Type 2 Diabetes, metabolic syndrome, kidney disease, cardio & cerebrovascular disease, etc.
Yes, western society is largely self centered, narcissistic and ignorant with respect to health of body, spirit and society.
Wellness proponents have always been disparaged, vilified and marginalized by those who profit from junk food and 'therapeutics' for chronic diseases (which arise from junk food etc), but their message and data is out there to be found by those interested, at least for the time being (thank you Elon for your part in that).
Exellent comment! And, our society needs more Elons and Tuckers who have the courage of their convictions.
Most of medicine is a one-size-fits-all approach while we have millions of patients with differing levels of health.
And what you eat matters. Calories which have hitchhiker chemicals, synthetic colors and flavors, preservatives, etc produce more obesity which is the bodies way of using fat to encapsulate the toxins it can’t rid itself of.
Unfortunately the story with physics is no longer that heroic. Nobel prize 2021 for modeling climate change resembles 2023 Nobel for Medicine. And non-main stream physics theories are cancelled, too, without due diligence. It was a physicist, Max Planck, who is credited with saying sth that amounts to the statement that progress is made one funeral at a time. Though, experiments carried out in physics are much more trustworthy, that's undeniable.
Great observation!
Lucky are physicists that people's life and wellbeing do not depend on their truths (or at least people don't think so) and they can spend 100 years on the experiment without other people attention.
But when it concerns "real life", like in the case of climate change (or fictional Earth-threatening comet in "Don't look up" movie), they encounter the same turmoil we have in medicine.
Artemiy Okhotin, MD
Politicized medicine makes no sense to me as a provider and as a patient until I factor in the $.
And the egos.
I just finished four months of chemotherapy which degraded my palate so almost everything tasted awful. I learned that taste is personal and for most Americans their uneducated palates coupled with gluttony and food fears cannot be fixed. Finally I can taste so my sons are treating me to a good meal at Cote next week. Believe me, I won't be thinking about "healthy" while I enjoy the pleasures of cuisine.
I couldn't help think of Emil J Freireich, who was a pioneer treating childhood leukemia. He plowed ahead in the face of much resistance, and was proved correct. Yes, many of his early child-patients died [..I think that Freireich believed they would likely die anyway?] so he felt he should continue to pursue other solutions than those "acceptable" at the time.
From MD Anderson Cancer Center: https://www.mdanderson.org/publications/annual-report/annual-report-2015/the-man-who-helped-cure-childhood-leukemia.html
Combo Chemo
"With the bleeding problem solved, Freireich turned his attention to curing childhood leukemia. Another difficult-to-treat disease, tuberculosis, recently had been cured. He believed the TB treatment approach might work for leukemia as well.
“We knew that three drugs controlled tuberculosis, but you had to administer them all at once. If given separately, they didn’t work,” he says. “I had an inkling the same method would work for leukemia.”
So Freireich began combining chemo drugs instead of giving them one at a time. First he administered two of the highly toxic drugs, then three. With each addition, children became seriously ill, and some were brought to the brink of death. When he upped the ante to four drugs in a 1961 trial, an outcry arose from the medical establishment.
“They said I was unethical and inhumane and would kill the children. Instead, 90 percent of them went into remission immediately. It was magical.”
What is the evidence behind “psychosomatic” symptoms besides an absence of evidence of an organic illness?
Why is this fundamental principle not applied to this “scientific” and “evidence based” medicine?
Some guy decided at some point in history that if he can’t easily find a cause, with the most basic of investigations, then the symptoms are NOT organic. Why do people go on with such magical thinking disguised as science?
Hi, sorry but the LIGO gravitational wave project was busted as a fraudulent scam back in 2014 and 2016...
http://milesmathis.com/liego.pdf
http://milesmathis.com/guth.pdf
Cheers,
Peter
Even when we do a proper randomized controlled trial in medicine, the threshold for significance is two sigma (p< 0.05) vs. five sigma (p<0.0000003) in physics.
It is no wonder that most published research findings in medicine are false (non-repeatable).
https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.0020124