6 ms·

I am a high risk cancer patient who is blind, i.e. doesn't necessarily get a lot of sun exposure due to disability + occupation. Given the discussion in this t

by lynx23 3y ago

I am a high risk cancer patient who is blind, i.e. doesn't necessarily get a lot of sun exposure due to disability + occupation. Given the discussion in this thread regarding correlation with lattitude and cancer risk, me being around 47 deg, and my personal history, I would have expected a caring medical system to suggest vitamin D to me roughly 30 years ago already. But alas, it turns out you have to do your own studies to improve life expectency with our western medical system. I could tell you a lot more, regarding being abused as a subject for a medical experiment at the age of 7! But people like you will always step up and defend the system. Observe and learn, I say.

nicenewtemp84 3y ago
People are so indoctrinated they for some reason actually think most doctors want to help them. I assume they also trust their dealerships service advisor.
- jewayne 3y ago
  It's so much worse than you think. Almost ALL doctors want to help. It's system (in this case, the reimbursement system) that makes it impossible to help, even though they want to. The doctors themselves have far less agency than you think.
  - robertlagrant 3y ago
    This is far too US-centric. Western medicine is a lot broader than that.
  - JoshTko 3y ago
    Having experienced several dozen healthcare providers I'd say it's more like 50/50. Half clearly have a profit as a primary motive.
  - ipaddr 3y ago
    I would say they are the least caring group of society followed by nurses. Not their fault. When everyone around you is sick all of the time you have to turn off that part that cares or you will burn yourself out. Yourself, family, friends, favourite waitress cares about you more than your doctor.
  - nicenewtemp84 3y ago
    I actually dated a med student all through medical school and thus made a huge social circle of doctors I've kept in touch with for over a decade as they all became doctors and now have almost a decade of experience too. I'd say about half want to help, but can not due to the system. The other half enjoy maximizing their income through the system and don't care either. So that leaves very very few that are actually able and willing to actually help an average person. Now, do they help their family and close friends? Yes, as much as they still care to and remember how to. Which isn't at a very high level either IMO. Recent example, my friend dislocated his shoulder. Immediately was recommended to have surgery and attempts were made to schedule. With his insurance, he'd have to come out of pocket $7500, which he doesn't really have. I told him I know many motorcyclists at the pro level that dislocate shoulders in crashes, and without surgery are back competing on the bike. Only a handful have surgery to repair it, usually to stop it from reoccurring (since they crash often). He pressed his doctor on if he really needs the surgery and for an explanation why many athletes don't have it done and what the reasoning for auto recommending him to get it done. Their tone instantly shifted and he chose to wait it out. Shoulder back to normal now. Thousands saved, and potential medical mistakes saved during the surgery.
    - pvaldes 3y ago
      Shoulder surgery should not be delayed. The probable retraction of some damaged parts is not a joke. Your friend could have been the lucky one in the pool, but there is also a possibility that in a few years the problem will grow and the surgery required will be much heavier and expensive. > and without surgery are back competing on the bike. My bet is that they are on painkillers for life
      - InitialLastName 3y ago
        > My bet is that they are on painkillers for life Also, they are professional athletes at the peak of their bodies' physical fitness capacity with teams of doctors, physical therapists, and trainers looking after their health with a focus that few of us can imagine, and an overriding ethos of sacrificing their future health on the altar of present performance. In general, professional athletes' healthcare decisions should probably not be used as a gauge for healthcare decisions by people with priorities other than "maximal physical performance right this moment".
robertlagrant 3y ago
> But alas, it turns out you have to do your own studies to improve life expectency with our western medical system It's a shame this possibility wasn't suggested before to you, but I have never seen any evidence that western medicine isn't one of the primary drivers of global life expectancy increases.
- nradov 3y ago
  Western medicine is one of the primary drivers of global life expectancy increases only though vaccines, antibiotics, and trauma care. Other than that it has had very little effect: we could eliminate all other forms of medical care and average life expectancy would decrease only marginally. Public sanitation and food safety enforcement have had much larger effects. Where western medicine has had larger effects is increasing quality of life. Now you can get a hip replacement to restore your mobility or take a pill to fix your erectile dysfunction.
  - MVissers 3y ago
    Really curious about your sources, because it doesn’t vibe with me at all (trained MD). Statins have a phenomenal improvement in outcome on cardiovascular disease. So do many cancer drugs nowadays. Diabetes also has great improvement with good treatment. Removing these would reduce life expectancy drastically.
    - nradov 3y ago
      Fair enough. It's true that modern drugs are fairly effective at extending the lives of patients with certain serious chronic conditions by a few years. But at the same time, ASCVD and T2D were much less serious problems prior to the establishment of modern medicine. So to a large extent we are just patching over problems that we have created for ourselves rather than fixing the root causes. https://www.thelancet.com/gbd https://www.thelancet.com/gbd
  - lynx23 3y ago
    Thanks for saying that, I couldn't agree more. If you break your leg, western mdeicine is great. For almost everything else, it fails pretty miserably because doctors have effectively no time to actually care for an individual. If it isn't done in 5 minutes, things are getting complicated.
psychlops 3y ago
I don't usually defend the western system, but there are plenty of other systems out there that will caringly prescribe you snake oil. Simply understand that the western system is science based within a limited range. It is usually excellent if the cause of an illness is defined on a black and white test. If not, time for the patient to do the research.
- agumonkey 3y ago
  This is the issue raised by comments like the one above. We understand that evidence based medicine handles statistical averages very well. But if you fall out of that, all you're left with is snake oil salesmen. There's a need for an intermediate layer of evidence yet "taylored" (and not kidney-costing if possible).
  - 9935c101ab17a66 3y ago
    Ya, but I think most good doctors operate with a balance of probabilities framework. Yah, there may not be conclusive evidence showing it’s widely effective, but based on this case, it’s obvious the person isn’t getting enough sunlight, and they communicated that to the doctor, and so why not do a trial of something like vitamin d? It’s widely studied, has very few serious downsides, and is cheap.
    - BeetleB 3y ago
      > but based on this case, it’s obvious the person isn’t getting enough sunlight, and they communicated that to the doctor, and so why not do a trial of something like vitamin d? Can we get to the specifics? How would you propose the doctor do it? Let's say the doctor prescribes a certain dosage per day. How will the doctor know it is helping this particular patient? How long should the trial continue before he sees results? Most studies showing Vitamin D benefits are very long term (unless it is bone related).
      - chii 3y ago
        This is why most doctors don't start recommending such medication until it is proven to work. They cannot and don't want to be held liable for damages. For example, if it did turn out that prolonged vitamin D supplementation causes an unexpected issue, what then? Would the patient have been OK with that? Or would their response have been the exact opposite of what the OP was suggesting? Self-medication is acceptable, and the patient should be made aware; the doctor should give advice, but not prescribe, in this case. Most doctors prefer not to get into this level of liability.
BeetleB 3y ago
Consider that while you are one person, a doctor sees many patients. They see that prescribing Vitamin D helps almost none of their patients in the short term, and they can only rely on research for the long term (i.e. they are not seeing the same patient over decades). Doctors run the whole gamut. There certainly are doctors who will recommend Vitamin D for any issue under the sun. I've been subjected to that, and it totally didn't impact the issues I was going to the doctor to see. At the other end you'll get doctors who will stick to the official guideline (as long as your Vitamin D levels are "normal"). And you have those in between, who will discuss it with you, give you the pros and cons, and will support you in your decision. I've had enough doctors recommend treatments that have little backing that I'll happily take the risk and stick to the studies. ("No thanks, I won't go for that surgery which studies have not shown tackle the problem" (an assessment the doctor admitted to only when I asked him directly)). I know I'll be wrong on occasion, but I suspect I'll be wrong more often if I follow the other path. Still, you'll get all sorts of doctors, and it shouldn't be hard to find one who will happily reflect back to you whatever you want to hear. As for 30 years, the major study associating Vitamin D with mortality came out about 15 years ago.
stringfood 3y ago
[dead]
rendaw 3y ago
GP wasn't defending the system, just this specific decision. I'm no fan of the medical system myself, but this is an unfair take. There are plenty of examples of the medical system doing the wrong thing... no need to twist other examples to fit. TBF though this could have been avoided if the doctor explained that studies were mixed (and even gave you a few studies as examples), and I'm not sure I believe the doctor actually knew studies were mixed.

by lynx23 3y ago

nicenewtemp84 3y ago

People are so indoctrinated they for some reason actually think most doctors want to help them. I assume they also trust their dealerships service advisor.

jewayne 3y ago
It's so much worse than you think. Almost ALL doctors want to help. It's system (in this case, the reimbursement system) that makes it impossible to help, even though they want to. The doctors themselves have far less agency than you think.
- robertlagrant 3y ago
  This is far too US-centric. Western medicine is a lot broader than that.
- JoshTko 3y ago
  Having experienced several dozen healthcare providers I'd say it's more like 50/50. Half clearly have a profit as a primary motive.
- ipaddr 3y ago
  I would say they are the least caring group of society followed by nurses. Not their fault. When everyone around you is sick all of the time you have to turn off that part that cares or you will burn yourself out. Yourself, family, friends, favourite waitress cares about you more than your doctor.
- nicenewtemp84 3y ago
  I actually dated a med student all through medical school and thus made a huge social circle of doctors I've kept in touch with for over a decade as they all became doctors and now have almost a decade of experience too. I'd say about half want to help, but can not due to the system. The other half enjoy maximizing their income through the system and don't care either. So that leaves very very few that are actually able and willing to actually help an average person. Now, do they help their family and close friends? Yes, as much as they still care to and remember how to. Which isn't at a very high level either IMO. Recent example, my friend dislocated his shoulder. Immediately was recommended to have surgery and attempts were made to schedule. With his insurance, he'd have to come out of pocket $7500, which he doesn't really have. I told him I know many motorcyclists at the pro level that dislocate shoulders in crashes, and without surgery are back competing on the bike. Only a handful have surgery to repair it, usually to stop it from reoccurring (since they crash often). He pressed his doctor on if he really needs the surgery and for an explanation why many athletes don't have it done and what the reasoning for auto recommending him to get it done. Their tone instantly shifted and he chose to wait it out. Shoulder back to normal now. Thousands saved, and potential medical mistakes saved during the surgery.
  - pvaldes 3y ago
    Shoulder surgery should not be delayed. The probable retraction of some damaged parts is not a joke. Your friend could have been the lucky one in the pool, but there is also a possibility that in a few years the problem will grow and the surgery required will be much heavier and expensive. > and without surgery are back competing on the bike. My bet is that they are on painkillers for life
    - InitialLastName 3y ago
      > My bet is that they are on painkillers for life Also, they are professional athletes at the peak of their bodies' physical fitness capacity with teams of doctors, physical therapists, and trainers looking after their health with a focus that few of us can imagine, and an overriding ethos of sacrificing their future health on the altar of present performance. In general, professional athletes' healthcare decisions should probably not be used as a gauge for healthcare decisions by people with priorities other than "maximal physical performance right this moment".

robertlagrant 3y ago

> But alas, it turns out you have to do your own studies to improve life expectency with our western medical system It's a shame this possibility wasn't suggested before to you, but I have never seen any evidence that western medicine isn't one of the primary drivers of global life expectancy increases.

nradov 3y ago
Western medicine is one of the primary drivers of global life expectancy increases only though vaccines, antibiotics, and trauma care. Other than that it has had very little effect: we could eliminate all other forms of medical care and average life expectancy would decrease only marginally. Public sanitation and food safety enforcement have had much larger effects. Where western medicine has had larger effects is increasing quality of life. Now you can get a hip replacement to restore your mobility or take a pill to fix your erectile dysfunction.
- MVissers 3y ago
  Really curious about your sources, because it doesn’t vibe with me at all (trained MD). Statins have a phenomenal improvement in outcome on cardiovascular disease. So do many cancer drugs nowadays. Diabetes also has great improvement with good treatment. Removing these would reduce life expectancy drastically.
  - nradov 3y ago
    Fair enough. It's true that modern drugs are fairly effective at extending the lives of patients with certain serious chronic conditions by a few years. But at the same time, ASCVD and T2D were much less serious problems prior to the establishment of modern medicine. So to a large extent we are just patching over problems that we have created for ourselves rather than fixing the root causes. https://www.thelancet.com/gbd https://www.thelancet.com/gbd
- lynx23 3y ago
  Thanks for saying that, I couldn't agree more. If you break your leg, western mdeicine is great. For almost everything else, it fails pretty miserably because doctors have effectively no time to actually care for an individual. If it isn't done in 5 minutes, things are getting complicated.

psychlops 3y ago

I don't usually defend the western system, but there are plenty of other systems out there that will caringly prescribe you snake oil. Simply understand that the western system is science based within a limited range. It is usually excellent if the cause of an illness is defined on a black and white test. If not, time for the patient to do the research.

agumonkey 3y ago
This is the issue raised by comments like the one above. We understand that evidence based medicine handles statistical averages very well. But if you fall out of that, all you're left with is snake oil salesmen. There's a need for an intermediate layer of evidence yet "taylored" (and not kidney-costing if possible).
- 9935c101ab17a66 3y ago
  Ya, but I think most good doctors operate with a balance of probabilities framework. Yah, there may not be conclusive evidence showing it’s widely effective, but based on this case, it’s obvious the person isn’t getting enough sunlight, and they communicated that to the doctor, and so why not do a trial of something like vitamin d? It’s widely studied, has very few serious downsides, and is cheap.
  - BeetleB 3y ago
    > but based on this case, it’s obvious the person isn’t getting enough sunlight, and they communicated that to the doctor, and so why not do a trial of something like vitamin d? Can we get to the specifics? How would you propose the doctor do it? Let's say the doctor prescribes a certain dosage per day. How will the doctor know it is helping this particular patient? How long should the trial continue before he sees results? Most studies showing Vitamin D benefits are very long term (unless it is bone related).
    - chii 3y ago
      This is why most doctors don't start recommending such medication until it is proven to work. They cannot and don't want to be held liable for damages. For example, if it did turn out that prolonged vitamin D supplementation causes an unexpected issue, what then? Would the patient have been OK with that? Or would their response have been the exact opposite of what the OP was suggesting? Self-medication is acceptable, and the patient should be made aware; the doctor should give advice, but not prescribe, in this case. Most doctors prefer not to get into this level of liability.

BeetleB 3y ago

Consider that while you are one person, a doctor sees many patients. They see that prescribing Vitamin D helps almost none of their patients in the short term, and they can only rely on research for the long term (i.e. they are not seeing the same patient over decades). Doctors run the whole gamut. There certainly are doctors who will recommend Vitamin D for any issue under the sun. I've been subjected to that, and it totally didn't impact the issues I was going to the doctor to see. At the other end you'll get doctors who will stick to the official guideline (as long as your Vitamin D levels are "normal"). And you have those in between, who will discuss it with you, give you the pros and cons, and will support you in your decision. I've had enough doctors recommend treatments that have little backing that I'll happily take the risk and stick to the studies. ("No thanks, I won't go for that surgery which studies have not shown tackle the problem" (an assessment the doctor admitted to only when I asked him directly)). I know I'll be wrong on occasion, but I suspect I'll be wrong more often if I follow the other path. Still, you'll get all sorts of doctors, and it shouldn't be hard to find one who will happily reflect back to you whatever you want to hear. As for 30 years, the major study associating Vitamin D with mortality came out about 15 years ago.

stringfood 3y ago

[dead]

rendaw 3y ago

GP wasn't defending the system, just this specific decision. I'm no fan of the medical system myself, but this is an unfair take. There are plenty of examples of the medical system doing the wrong thing... no need to twist other examples to fit. TBF though this could have been avoided if the doctor explained that studies were mixed (and even gave you a few studies as examples), and I'm not sure I believe the doctor actually knew studies were mixed.