5 ms·

One other point to highlight: Many of the doctors quoted in the article couldn't dispute the data (reminiscent of nutrition conventional wisdom) but inexplicabl

by PKop 8y ago

One other point to highlight: Many of the doctors quoted in the article couldn't dispute the data (reminiscent of nutrition conventional wisdom) but inexplicably advocated not to get benefits mentioned from sun, but instead take statins/blood pressure drugs. This is ridiculous, and if one looks into the criticisms of these drugs, mirrors the terrible advice peddled by same doctors as nutrition advice, to the detriment of millions. Why does this mentality persist, always and everywhere take blood pressure drugs? Madness.

burlesona 8y ago
Well, I’ve come to see it that western primary care doctors main job is to try and match your symptoms to a pill that can help. I’m not trying to disparage all the doctors or say they do nothing else. But if you look at it like that, then a lot of the behavior makes sense. “I don’t know about sun exposure, but I’m confident this pill will help you, so avoid the sun and take the pill.”
- classichasclass 8y ago
  A more charitable view would be, "Currently I have better evidence in the literature that this medication would be more helpful than sun exposure, which in large quantities has more evidence of harm than benefit." That's not an indictment of physicians, that's a recognition that our evidence base is skewed (for a variety of reasons). But there is good evidence that at least for some people, sun exposure above some level does more harm than benefit. You're saying the average primary care doctor should just toss that out. Who says this isn't the latest whim to be disproven in 20 years? The evidence base for lifestyle interventions sucks because it's much harder to measure and pharma has certainly been able to tip the scales, no question. That should change and I hope it does. But when I have a patient come in and ask, we go with what we've got.
  - pakitan 8y ago
    > A more charitable view would be, "Currently I have better evidence in the literature that this medication would be more helpful than sun exposure, which in large quantities has more evidence of harm than benefit." That's indeed a very charitable view. The more realistic view, in my experience is "I just go with the mainstream as nobody got fired or sued for going with the mainstream and I don't really have the time, nor the inclination to keep up with the latest studies". > Who says this isn't the latest whim to be disproven in 20 years? A million years of evolution, spent in extreme sun exposure, without sunblock? I've long suspected that the "Always put on sunblock" advice is bollocks and have never used the substance. Partly because of common sense (evolution of human species) and partly because of simple observation. All my grandparents and their relatives were raised in villages (and quite a few still live or lived there till they passed away), with serious sun exposure, working on the field, long before the age of sunblock. Yet, none of them had skin cancer. Other cancers, diabetes, heart attacks, strokes, yes. Skin cancer - not a single one of them. Why is that, if the sun is so dangerous? And while you may dismiss my anecdata, note that the article says "outdoor workers have half the melanoma rate of indoor workers"!! So, for me this isn't the "latest whim", we're just going back to common sense.
- arkades 8y ago
  Well, for starters, the Centers for Medicare & Medicaid Services uses “what percentage of people with qualifying conditions get the right pill” as a quality measure, which reduces your income as it goes down. Docs can’t fight CMS. That’s not “western medicine,” that’s the US government.
- darkerside 8y ago
  It's much more akin to "nobody ever got fired for going with IBM". Nobody gets sued for recommending the conventional wisdom. You need to show your doctor that you're a reasonable person--and not a walking lawsuit--before they'll trust you enough to recommend their own judgement. It's sad, but understandable. A malpractice lawsuit is a life-changing and career-derailing risk that most of us don't have a clear corollary for.
alexandercrohde 8y ago
I think it's some sort cognitive dissonance. I think it's emotionally hard for doctors to recognize the cases when the product they peddle (medicine) is actually worse than the solution they have no control over (a more natural lifestyle). I think this leads to systematic bias towards intervention.

by PKop 8y ago

burlesona 8y ago

Well, I’ve come to see it that western primary care doctors main job is to try and match your symptoms to a pill that can help. I’m not trying to disparage all the doctors or say they do nothing else. But if you look at it like that, then a lot of the behavior makes sense. “I don’t know about sun exposure, but I’m confident this pill will help you, so avoid the sun and take the pill.”

classichasclass 8y ago
A more charitable view would be, "Currently I have better evidence in the literature that this medication would be more helpful than sun exposure, which in large quantities has more evidence of harm than benefit." That's not an indictment of physicians, that's a recognition that our evidence base is skewed (for a variety of reasons). But there is good evidence that at least for some people, sun exposure above some level does more harm than benefit. You're saying the average primary care doctor should just toss that out. Who says this isn't the latest whim to be disproven in 20 years? The evidence base for lifestyle interventions sucks because it's much harder to measure and pharma has certainly been able to tip the scales, no question. That should change and I hope it does. But when I have a patient come in and ask, we go with what we've got.
- pakitan 8y ago
  > A more charitable view would be, "Currently I have better evidence in the literature that this medication would be more helpful than sun exposure, which in large quantities has more evidence of harm than benefit." That's indeed a very charitable view. The more realistic view, in my experience is "I just go with the mainstream as nobody got fired or sued for going with the mainstream and I don't really have the time, nor the inclination to keep up with the latest studies". > Who says this isn't the latest whim to be disproven in 20 years? A million years of evolution, spent in extreme sun exposure, without sunblock? I've long suspected that the "Always put on sunblock" advice is bollocks and have never used the substance. Partly because of common sense (evolution of human species) and partly because of simple observation. All my grandparents and their relatives were raised in villages (and quite a few still live or lived there till they passed away), with serious sun exposure, working on the field, long before the age of sunblock. Yet, none of them had skin cancer. Other cancers, diabetes, heart attacks, strokes, yes. Skin cancer - not a single one of them. Why is that, if the sun is so dangerous? And while you may dismiss my anecdata, note that the article says "outdoor workers have half the melanoma rate of indoor workers"!! So, for me this isn't the "latest whim", we're just going back to common sense.
arkades 8y ago
Well, for starters, the Centers for Medicare & Medicaid Services uses “what percentage of people with qualifying conditions get the right pill” as a quality measure, which reduces your income as it goes down. Docs can’t fight CMS. That’s not “western medicine,” that’s the US government.
darkerside 8y ago
It's much more akin to "nobody ever got fired for going with IBM". Nobody gets sued for recommending the conventional wisdom. You need to show your doctor that you're a reasonable person--and not a walking lawsuit--before they'll trust you enough to recommend their own judgement. It's sad, but understandable. A malpractice lawsuit is a life-changing and career-derailing risk that most of us don't have a clear corollary for.

alexandercrohde 8y ago

I think it's some sort cognitive dissonance. I think it's emotionally hard for doctors to recognize the cases when the product they peddle (medicine) is actually worse than the solution they have no control over (a more natural lifestyle). I think this leads to systematic bias towards intervention.