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132 thoughts on “Perpetual Motion: More on the Bravewell Report

  1. sarah007 says:

    Chris said “And there are several others. In short, nothing is immune from criticism on this blog. The difference is that it is based on science, not anecdotes.”

    Oh you missed out, pandemic flu is exempt from critique because it is a science anecdote and that makes it unquestionably ok, right.

  2. luarky says:

    Mark Crislip:

    It often seems to me the problems voiced with science based medicine is more the individual doctor, who does not, for a variety of possible reasons, live up to the expectations of an individual patients needs.

    Not true – I was pointing out systemic and general problems and tendencies, widely true in my experience.
    For example, when you have certain lab tests available that you’ve been trained to see as the best diagnostic tool, you tend to think in terms of those lab tests. And not the diagnostic tools that are available when there aren’t good lab tests.
    And, the fact that it didn’t turn out to be a nutrient deficiency is irrelevant. It *could* have been one of those nutrients for which there isn’t a good lab test. For those nutrients, what you can do is try supplementing them.
    It’s an “I have a hammer, I see nails” phenomenon.
    Sure – it is exactly what I was saying, that very good science-based doctors would also deal well with the areas of uncertainty, the areas where little is known in medicine. They would do things that are perhaps trial and error, perhaps rely on patient participation more than is usual, when they don’t have a good lab test or are confronted with a vague problem.
    It’s exactly what I was saying, that those areas of uncertainty are areas that many doctors deal with by ignoring them, brushing them aside as hypochondria or some triviality.
    That is a major reason why people seek out that unfiltered “vox pop” and end up using alternative medicine.
    And, the MAJOR problem of not keeping up with research. I was shocked that the two allergists I had seen, seemed to have no familiarity with 10-15 years of research on local allergies.
    However, from my experience, these problems seem to be common.
    Mark Crislip’s comment implies, “failings of individual doctors, most doctors aren’t like that” – but instead, these problems seem to be common and systemic.

  3. luarky says:

    Chris:

    nothing is immune from criticism on this blog. The difference is that it is based on science, not anecdotes.

    But, what is the person to do, who has problems that are NOT well understood by science?
    Most science-based doctors don’t address those problems well. They stick to what little science and lab tests can tell them.
    It has actually been my experience that vox pop and alternative medicine had true observations to make that were not to be found in the science literature and were NOT told to me by science-based doctors.
    They could be doing a better job in those gray, unknown areas, in ways that I’ve been trying to point out. But doing a better job is less simple than learning a lot of lab tests. It might involve things like teaching the patient to take an active role in the diagnosis. Something that I’ve learned about, largely on my own.
    It would involve keeping your ear to the ground, to get a sense of what vox pop is saying, that might have something to it. I was startled to find out later that many non-doctors had been telling me true things.
    These problems that are not well understood by science, are a major reason for the existence of alternative medicine. Not that alt-med practitioners deal with them well – people turning to alt-med are jumping from the frying pan into the fire, often – but in some instances, they may help people in ways that they weren’t helped by the science-based doctors.

  4. ^ lol. The old “alternative medicine practitioners have a magical understanding of the world and are privvy to information that legitimate medical practitioners are unable to understand” gambit.

    -

    The best warning sign that someone is about to tell you a load of crap is if the sentence starts with “your doctor doesn’t know, but….”

  5. Scott says:

    But, what is the person to do, who has problems that are NOT well understood by science?

    Cope. There’s really nothing more that CAN be done. “Integrative” approaches, in such a case, simply amount to “make up random BS until some coincidence makes it seem like one of the bits of BS worked.”

    If there’s no good science, there’s no good way to do anything about the condition. Sad but true.

  6. nybgrus says:

    I was pointing out systemic and general problems and tendencies, widely true in my experience.

    Hmm… you must be one very sick man. Seeing enough physicians in enough locations in enough specialties to have an adequate sample size to make such an astute observation.

    when you have certain lab tests available that you’ve been trained to see as the best diagnostic tool, you tend to think in terms of those lab tests.

    Trained in science based medicine using the tools of science based medicine… and it is somehow a bad thing to use the tools you are trained to use….

    And not the diagnostic tools that are available when there aren’t good lab tests.

    So when we don’t have good tests to use for [X] condition we use… what exactly? Right. Made up CAM hokum.

    And, the fact that it didn’t turn out to be a nutrient deficiency is irrelevant. It *could* have been one of those nutrients for which there isn’t a good lab test.

    “And the fact that I was wrong and indeed the physician was right is irrelevant. [S]he could have been wrong, thus vindicating the story I have crafted”

    It’s an “I have a hammer, I see nails” phenomenon.

    “I have science and rationale for what I do, so I am going to use it. Not magical joo-joo beams when I feel like it”

    They would do things that are perhaps trial and error, perhaps rely on patient participation more than is usual, when they don’t have a good lab test or are confronted with a vague problem.

    Agreed.

    It’s exactly what I was saying, that those areas of uncertainty are areas that many doctors deal with by ignoring them, brushing them aside as hypochondria or some triviality.

    I believe Dr. Crislip addressed this quite nicely

    And, the MAJOR problem of not keeping up with research. I was shocked that the two allergists I had seen, seemed to have no familiarity with 10-15 years of research on local allergies.

    And that.

    However, from my experience, these problems seem to be common.

    Refer back to first quote. Though I’ll add that in the experience of the population (i.e. quality and length of life improvement – from 49.7 years in 1900 to 77 years in 2003) doesn’t seem to jibe to well with your experience.

    … but instead, these problems seem to be common and systemic.

    Say it enough times and it becomes true.

    But, what is the person to do, who has problems that are NOT well understood by science?

    Apparently, magic joo-joo beams. And random guesses with post-hoc rationalizations.

    Most science-based doctors don’t address those problems well. They stick to what little science and lab tests can tell them.

    “Most airplane pilots don’t address those problems well. They stick to their little flight manual books and training. Really, they should use the power of ancient wisdom and joo-joo beams. Never forget the joo-joo beams”

    It has actually been my experience that vox pop and alternative medicine had true observations to make that were not to be found in the science literature and were NOT told to me by science-based doctors.

    And the ancient Chinese knew about cold fusion, but us close minded Westerners would rather not have energy than use something coming from so base a source.

    or

    Those darned science based doctors! They didn’t tell me something that wasn’t science based! How dare they not make up stuff on the spot!

    They could be doing a better job in those gray, unknown areas, in ways that I’ve been trying to point out

    Oh the humanity! If only they would use the magic joo-joo beams like I have been telling them! Why, oh why must they stick to their “science” instead?

    It might involve things like teaching the patient to take an active role in the diagnosis. Something that I’ve learned about, largely on my own.

    Hmmm… that’s funny. Are you in med school? Because I am. And that is what is pounded into my head daily.

    It would involve keeping your ear to the ground, to get a sense of what vox pop is saying, that might have something to it.

    Right. Because there is no research in any CAM modalities at all. All this wonderful knowledge slipping right past us! Too bad there isn’t some sort of, I dunno, National Center for um, Complimentary and Alternative Medicine research that could be funded in the hundreds of millions of dollars by the government, with the sole task of finding out which CAMs have utility. If there were such an entity, I bet they would have an absolute treasure trove of useful data in, oh I dunno, lets say less than a decade? For sure.

    I was startled to find out later that many non-doctors had been telling me true things.

    I know right? My girlfriend is an engineer and I was startled that a non-doctor could say anything true at all! Let alone about medicine! I mean, dang, she even once said that alcohol hurts your liver. How could she know that?!?!

    These problems that are not well understood by science, are a major reason for the existence of alternative medicine. Not that alt-med practitioners deal with them well – people turning to alt-med are jumping from the frying pan into the fire, often…

    2/18 – 11.1% That is how many quotes of yours are actually reasonably correct and insightful. I guess you could be a pinch runner in the majors.

    …but in some instances, they may help people in ways that they weren’t helped by the science-based doctors.

    But… but… they helped meeeeeeee!

  7. sarah007 says:

    The best warning sign that a doctor is about to tell you a load of crap is if the sentence starts with “I have the latest medical research to show you that this new……..”

    Scott ejaculated ” There’s really nothing more that CAN be done. “Integrative” approaches, in such a case, simply amount to “make up random BS until some coincidence makes it seem like one of the bits of BS worked.”

    If there’s no good science, there’s no good way to do anything about the condition. Sad but true.”

    That’s got to be the funniest whines I have had the pleasure to read yet. So these guys in white coats are the only people with real knowledge, like we are all gonna die from swine flu and being fat is a medical/surgical emergency and you are wondering why the Septik message is falling on deaf ears. Priceless.

    nyborg said”“I have science and rationale for what I do, so I am going to use it.” yeah like worldwide pandemic death lurgy threat.”

    ” But, what is the person to do, who has problems that are NOT well understood by science?

    Apparently, magic joo-joo beams. And random guesses with post-hoc rationalizations.”

    Why is the only other thing availible not going to work? Is medical science so randomly arogant that nothing else at all is true? Sounds like the rantings of a religious maniac, why on earth would I consult a doctor for an opinion on my health?

    Chris said “It’s an “I have a hammer, I see nails” phenomenon.” Well what is the difference with a doctor just seeing whats on the treatment protocol guidelines and seeing nothing else? You have a temperature and you don’t feel well, here’s some Tamiflu, that was what happened in England when people rang the swine flu hotline. Medical science is so up its own arse it actually thinks that everything it does is true.

    With regard to your stance on alt med being some kind of evil thang, where are the bodies, where are the patient complaints, where are the disasters, where are the Shipmans?

    On the medical side of this comment the list is massive!

  8. Connor says:

    @sarah007

    I’m curious Sarah, if I get ill… who are you suggesting I should be going to see? Who is your trusted source of medical/health information?

  9. weing says:

    @Connor,

    Why would you even ask the time of day from an ignorant troll, who has no problems confabulating an answer for you?

  10. lilady says:

    Don’t let the Troll derail a thread, just talk around the Troll…it works all the time.

  11. sarah007 says:

    Conner, I don’t get ill, I stay well. WEing wong again.

    Ah Lilady, what did you eat today, hoagies, croissants, nice choco/lati milky stuff. How about a big mac?

    But… but… they helped meeeeeeee!

  12. windriven says:

    It would be useful if WordPress would implement a user level filter. This would absolve webmasters of responsibility for blocking trolls but would allow individuals – if they so choose – to block those who disrupt threads through the sheer volume of their detritus. This might take the form of a [+] box that would preferentially collapse the comments of posters on a given individual’s troll list. The suspect comments would still be available if one needed a dose of comic relief but wouldn’t disrupt the flow of a thread. All comments other than those associated with the troll list names would display normally.

    This would have the additional benefit of allowing one to collapse comments that s/he had already read and easily identify new and unread comments.

  13. nybgrus says:

    I haven’t read the trolls comments in full (or much at all) in quite some time. There is nothing worth reading.

  14. Mark Crislip says:

    Early in my career I was told that if you do not have data to support what you do, ie, just trying stuff, the odds are that you will do more harm than good. That is the problem with being old, I do not remember where I learned this factoid in the last 30 yrs, or even it is ture. I can’t find a reference.

    I would say it is approximately right, with all the certainty of confirmation bias, and one of the many irrational aphorisms in medicine is the corollary that less certain you that an intervention is needed/effective, the more likely it is the patient will have a complication. It is why, most of the time, doing nothing is superior to trial and error if you have no idea what is going on. People tend to overestimate the beneficence of doing random crap and underestimate the potential downsides. I probably lean the other way.

  15. sarah007 says:

    Windy said “It would be useful if WordPress would implement a user level filter. This would absolve webmasters of responsibility for blocking trolls but would allow individuals – if they so choose – to block those who disrupt threads through the sheer volume of their detritus. This might take the form of a [+] box that would preferentially collapse the comments of posters on a given individual’s troll list. The suspect comments would still be available if one needed a dose of comic relief but wouldn’t disrupt the flow of a thread. All comments other than those associated with the troll list names would display normally.

    This would have the additional benefit of allowing one to collapse comments that s/he had already read and easily identify new and unread comments.”

    Well that’s a brilliant idea, that way we could all collapse the whole site and considering its density create some kind of black hole full of compressed septics!

  16. sarah007 says:

    Mark said “People tend to overestimate the beneficence of doing random crap and underestimate the potential downsides.”

    What like handing Tamiflu out to anyone with a temperature and then losing all the data just in time for the post myth audit?

    How about giving everyone with psoriasis, arthritis and kidney transplant the same immuno suppressant.

    I haven’t spelt nyfugus’ avitar properly either (or much at all) in quite some time. There is nothing worth reading.

  17. rwk says:

    @sarah007
    I doubt any of septics even get the slang.

  18. Chris says:

    Perhaps it is because neither of you know how to spell. Which along with you complete lack of logic, is yet another reason you are both ignored.

  19. DW says:

    “those areas of uncertainty are areas that many doctors deal with by ignoring them, brushing them aside as hypochondria or some triviality.”

    Sometimes it IS hypochondria, or a triviality. There are lots of hypochondriacs out there, and they seek medical attention avidly – often more avidly than actual sick people.

    CAM preys on these people.

    Other times the patient is sick and the doctor doesn’t know the answer. There are areas of uncertainty in medicine and probably always will be. I don’t know why CAM proponents find this so damning. Medicine isn’t magic. This is apparently intolerable to some people. It’s understandable, but dealing with reality is still the best plan – not making shit up.

  20. windriven says:

    @rwk

    I have bad habits older than you and the troll combined and I get the slang. Arrogant yet puerile; quite a feat.

  21. weing says:

    @luarky,

    “For example, when you have certain lab tests available that you’ve been trained to see as the best diagnostic tool, you tend to think in terms of those lab tests. And not the diagnostic tools that are available when there aren’t good lab tests.”

    I was taught that a careful history and physical exam are the best diagnostic tools. I still have no idea why you would think giving you an unneeded supplement is a good idea. Unless I was trying to make money off of you by selling you supplements. But then it would be good for me and not for you. Maybe you are like the type of person that wants an antibiotic for a cold? Do you think the doctor didn’t do anything for you because he/she didn’t give you a prescription?

  22. sarah007 says:

    Dr Crispo said “Medicine isn’t magic. This is apparently intolerable to some people. It’s understandable, but dealing with reality is still the best plan – not making shit up.”

    What like swine flu? Hang on what is this ‘intolerable shit Chris, what’s the reality check Chris? Where did I put that Tamiflu?

    Weing, wong again “I still have no idea why you would think giving you an unneeded supplement is a good idea.” Nor have I, why would anyone need an unneeded supplement. This is Septik logic, you don’t like the discussion so you make up something that’s nonsense or post some research that proves something else and claim a victory.

    This is why ordinary citizens don’t believe the hype boys. It’s tobacco science.

    “Medicine isn’t magic.” It certainly isn’t boys and don’t try and fool us it is.

    DWc you are priceless “CAM preys on these people.” So where are the bodies boys, where are the death stats. Hypochondria is a dustbin diagnosis that doctors use when all their remedies have failed, if the drugs don’t work it’s the patient that’s at fault, bingo medical science yet again. What about the mass fear of pandemic glue on the tv, how’s that for creating a target audience?

  23. sarah007 says:

    Dr Chris gets all teary eyed “Early in my career I was told that if you do not have data to support what you do, ie, just trying stuff, the odds are that you will do more harm than good. That is the problem with being old, I do not remember where I learned this factoid in the last 30 yrs, or even it is ture. I can’t find a reference.”

    Isn’t that a lovely medical anecdote, just imagine Bing, snow falling. So what Chris was told at the beginning of his career effectively was to keep going with what you have and even if it is hogwash (vaccination, swine flu, etc.) just look at the data and keep peddling. It was such a profound bit of information that influenced his entire career that Chris forgot where the gem came from!

    Early on in my life if someone in a white coat said “this will hurt me more than it will you” I learnt to think Cxxx. I also learnt that just because someone is in authority it does not mean they are right, honest or acting in your best interests. I learnt to ask questions and demand answers.

    If doctors want to be accepted, like soldiers, as defenders of the populus and providers of good service they need to dump the politics and stop playing games. Stop being great pretenders because whatever the service had it is going down.

  24. mousethatroared says:

    @windriven, back in newsgroup days you could filter out comments from particular posters who were generally annoying or obnoxious…(sigh)

  25. Chris says:

    mousethatroared, I have found the scroll wheel on my mouse very handy. Now, if we could only get some folks to stop feeding the trolls!

  26. Scott says:

    rwk might want to reflect on how endorsing a lunatic’s rantings makes him look.

  27. Connor says:

    @sarah007.

    Okay let me re-phrase…

    Where do you/how did you learn how to ‘stay well’ then?

    I asked “Who is your trusted source of medical/health information?”

    “Conner, I don’t get ill, I stay well.” Doesn’t really answer my question.

  28. EricG says:

    @ Conner

    I rather like your approach. I suspect that giving her the uncontested stage will be rather informative for a casual passer-by. If the cursing, pejoratives, condescension and unintelligible drive-bys weren’t instructive enough…

    @ Sarah

    What’d you eat for breakfast today? Good vibrations?

  29. axon says:

    @Sarah
    “what happens when people keep changing their stories to fit the evidence”

    This is one of the best, to the point, concise descriptions of the scientific method I have ever read.

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