61–70 of 142 posts
Fred Kummerow seems like a credible authority on the subject of heart disease: "My findings indicate fried foods, powdered egg yolk, excess vegetable oils, partially hydrogenated vegetable oils and cigarette smoke as the greatest culprits in heart disease." http://www.futuremedicine.com/doi/full/10.2217/clp.13.34
I tend to think of doctors as mechanics. Often when something breaks on my car, the explanation is "it's an old car, that happens eventually." And when they talk about it after fixing it, it's usually "Toyota's a good brand. Take care of it and you'll get another 100k miles from that engine." If I took my car to my mechanic with nothing wrong and asked what I should be doing to make sure the transmission lasts as lon…
I love your analogy, but I think you drew the wrong conclusion. Doctors don't have an incentive to prevent you from getting sicker any more than your mechanic has an incentive for keeping your car out of the shop. Why would your doctor read the latest research on preventing disease when he can make a tidy profit from treating your disease? Now this isn't to say that doctors are bad people who want to make you sick...…
The folks who go into primary care - i.e. GP's, pediatricians, etc, tend to be more altruistic, and think along the lines of preventative medicine. (They certainly aren't in it for the money...). It's really the subspecialties you hear about some random doc who is pushing tests or surgeries somewhere.
There is a push behind the new "Accountable Care Model" that tries to incentivize better performance on overall health metrics that tries to address this, but too soon to tell how well it works.
(0) Be female. Don't be born with heart defects. Don't be old. Don't have Marfan or Loeys-Dietz syndromes. (All of the unfair/can't modify factors will get lumped into recommendation #0.)
(1) Don't use tobacco or cocaine, and don't drink too much alcohol.
(2) Don't get exposed to radiation or chemotherapy.
(3) Don't have diabetes.
(4) Don't have high blood pressure.
(5) Have low levels of LDL and triglycerides.
(6) Don't eat too much. This is tightly related to #3 and #4, and reasonably related to #5.
(7) Have extremely low levels of LDL and triglycerides throughout your entire life. Having low LDL throughout your entire life reduces your risk of heart disease, even moreso than you would expect based on the LDL value alone. It seems that lifelong exposure to low LDL is more valuable than just late-life exposure to low LDL. [a]
Most of the genetic variants that we can currently interpret when accounting for risk (as opposed to the innumerable ones which we cannot yet interpret) fall into lipoprotein-related pathways. It will be interesting to learn about ones that do not, yet still confer meaningful cardiovascular risk. I don't think that we have a mechanistic explanation yet for the risk conferred by variants in the 9p21 locus, for example. [b]
I'm reasonably certain that your HDL is not particularly important (except as a poor proxy for your socioeconomic status, perhaps).[c] And omega-3 fatty acids have no visible effect when examined in the rigorous way in which we examine any other new drug. [d]
a = http://www.ncbi.nlm.nih.gov/pubmed/20579540
b = http://circgenetics.ahajournals.org/content/6/2/224.long
Earlier quoted context omitted.
> Why would your doctor read the latest research on preventing disease when he can make a tidy profit from treating your disease? Woah woah woah there. Are you really saying doctors don't read the latest research so that they can make a greater profit? Really? You could have at least picked a more realistic example of misaligned incentives in medicine... e.g. using a more expensive drill bit during a surgery because…
The OP phrased it badly, but the point is sound. Suppose a doctor has a choice of two activities: 1. Read research, unpaid 2. Treat patient, paid The doctor clearly has an incentive to focus on treating disease. They do read research, but they would surely read even more if they were paid directly to do so. There's nothing nefarious in this, it happens in any industry. We do more of the things we're paid to do, and l…
Suppose a pilot has a choice of two activities:
1. Read FAA safety report, unpaid 2. Fly plane, paid
Doctors, especially at academic institutions, are required not only to be up to date in the latest research, but contribute to it. If a doctor treats a patient in a way not up to par with current practices in research, he will be sued and lose his licensure.
I tend to think of doctors as mechanics. Often when something breaks on my car, the explanation is "it's an old car, that happens eventually." And when they talk about it after fixing it, it's usually "Toyota's a good brand. Take care of it and you'll get another 100k miles from that engine." If I took my car to my mechanic with nothing wrong and asked what I should be doing to make sure the transmission lasts as lon…
Earlier quoted context omitted.
The problem is that most people don't know what "eating well" and "exercising" really means. I will take myself as an example. When I graduated from grad. school in December of 2011, I was 270 lbs which at 5'10" is fucking fat. I had some idea that I needed to eat less. I remember going to a nutritionist and a doctor back in school. She gave me some vague ideas that were taken from the pyramid scale about how I shoul…
yep. there are tons of factors to take into account (genetic, economical, etc.), but doing this right often means changing lifestyle altogether. congrats on the change :)
Also, thanks!
[1] http://online.wsj.com/news/articles/SB1000142405274870340930...
(I have read the base scientific article but can't find the link right now.)
I tend to think of doctors as mechanics. Often when something breaks on my car, the explanation is "it's an old car, that happens eventually." And when they talk about it after fixing it, it's usually "Toyota's a good brand. Take care of it and you'll get another 100k miles from that engine." If I took my car to my mechanic with nothing wrong and asked what I should be doing to make sure the transmission lasts as lon…
Ideally, your doctor would be able to tailor your care to your genetics, your lifestyle as well as to your medical history. That is the goal of "personalized medicine". This will likely become more and more common-place over the next decade or two, in particular with respect to the genetic aspect. But for now it remains too expensive and uncertain to be rolled-out by HMOs and national healthcare systems. So you end up with "generic" advice, which is in fact in most cases the best they can do.
How to avoid heart disease: (0) Be female. Don't be born with heart defects. Don't be old. Don't have Marfan or Loeys-Dietz syndromes. (All of the unfair/can't modify factors will get lumped into recommendation #0.) (1) Don't use tobacco or cocaine, and don't drink too much alcohol. (2) Don't get exposed to radiation or chemotherapy. (3) Don't have diabetes. (4) Don't have high blood pressure. (5) Have low levels of…
How to avoid heart disease: (0) Be female. Don't be born with heart defects. Don't be old. Don't have Marfan or Loeys-Dietz syndromes. (All of the unfair/can't modify factors will get lumped into recommendation #0.) (1) Don't use tobacco or cocaine, and don't drink too much alcohol. (2) Don't get exposed to radiation or chemotherapy. (3) Don't have diabetes. (4) Don't have high blood pressure. (5) Have low levels of…
Most of those amount to "be lucky", which isn't very helpful advice.
Earlier quoted context omitted.
1. Doctors are people like any other. But they've spent years specializing in evidence based medicine. They aren't perfect. No. But they are the best we have. 2. The far bigger problem is doctors order tests that wouldn't change treatment but rather help avoid malpractice. 3. The quote -- every time I read it -- makes me laugh because it's so disingenuous. My wife had a week of dietary training in med school. You kno…
> Doctors are people like any other. But they've spent years specializing in evidence based medicine. Evidence-based medicine [1] as a norm is actually a surprisingly new thing. Assuming that because someone is a doctor they've "spent years specializing" in it is probably optimistic. [1] http://en.wikipedia.org/wiki/Evidence-based_medicine
Most here are engineers with a BS/BA. Maybe a MA. And fewer still with a PhD. Not that education is everything, but it's certainly "years specializing."
Compare that to the track of a typical specialist md:
After your undergrad degree you've got.... 4 years in med school. 4-6 years in residency. Plus a 1-3 year fellowship.
Long story short, what's the credible alternative to relying on multiple expert opinions? Are educated (engineers/lawyers/etc) ordering tests based on research they really don't understand on themselves a better? By what evidence?