4 ms·

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, bu

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.
  - lynx23 3y ago
    Liability, tell me about it. At the age of 7, I underwent an operation without knowledge or consent of my parents. A few weeks later, my remaining 20% eyesight was down to almost 0%. IOW, so that everyone understand: I was used as a subject for a medical experiment. And here you are, telling me that doctors will never do anything because they are so afraid? Sorry, you are living in a different world as I do... I hope you never enter mine.
- kadoban 3y ago
  > Let's say the doctor prescribes a certain dosage per day. How will the doctor know it is helping this particular patient? Check on them in X weeks and see if they're improved, and maybe measure blood levels just to get some objective measurement going. Doesn't seem too terribly hard. I think I'm missing the issue.
  - BeetleB 3y ago
    The issue is that for most issues where people claim Vitamin D helps, X is very large (several years). If your goal is cancer prevention, this approach is virtually useless unless done in large groups. Other than bone issues, I don't think Vitamin D works for anyone in the short term. For a few people, they see improvements in mood within a few weeks or months. Most of these few people regress afterwords even with Vitamin D intake (i.e. the improvement was just the usual noise variation). I have my own set of chronic issues, and there is no shortage of ideas on how to help: Diet, exercise, vitamins, etc. The way I've maintained my sanity is to ask the following question: "OK, if I go with this treatment regimen, how will I know it is not working?" Most advocates simply don't have an answer. If it's vitamins, they'll simply shift to a different dosage, a different vitamin, or pull out the new paper of the week saying how vitamin X is only useful in combination with mineral Y (you can see plenty of that in this submission). By the time you give that a try, another idea will come up. There will be no way they will believe the solution is not vitamins. If it's exercise, it will always be "You're probably doing it wrong" coupled with "You need to ensure you have the proper diet". When you get to specifics, they'll pull out 20 variables that could impact your exercise regimen. You can't reasonably try 2^20 combinations, let alone 20. There will be no way they will believe the solution is not exercise. Same goes with diet. Must be the sugar. Or too many carbs. Not enough protein. Too much protein. Or the lack of Omega-3. There will be no way they will believe the solution is not diet. I'm all for trying, and I do try different things. The reason I go to the doctor is to get an expert and informed opinion. If his opinion is "the data on Vitamin D is poor", I want him to state that.
    - kadoban 3y ago
      Thanks for explaining, I appreciate it. Yeah I was not considering chronic issues. > I'm all for trying, and I do try different things. The reason I go to the doctor is to get an expert and informed opinion. If his opinion is "the data on Vitamin D is poor", I want him to state that. That would certainly be wonderful. I've never had a doctor who would be that honest, though I'm sure they exist.
agumonkey 3y ago
Doctors themselves exist in distributions, from very interested to not that much, from "motivated at that time" to "i have more pressing problems". Very often you get bounced for tiny reasons.

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.
- lynx23 3y ago
  Liability, tell me about it. At the age of 7, I underwent an operation without knowledge or consent of my parents. A few weeks later, my remaining 20% eyesight was down to almost 0%. IOW, so that everyone understand: I was used as a subject for a medical experiment. And here you are, telling me that doctors will never do anything because they are so afraid? Sorry, you are living in a different world as I do... I hope you never enter mine.
kadoban 3y ago
> Let's say the doctor prescribes a certain dosage per day. How will the doctor know it is helping this particular patient? Check on them in X weeks and see if they're improved, and maybe measure blood levels just to get some objective measurement going. Doesn't seem too terribly hard. I think I'm missing the issue.
- BeetleB 3y ago
  The issue is that for most issues where people claim Vitamin D helps, X is very large (several years). If your goal is cancer prevention, this approach is virtually useless unless done in large groups. Other than bone issues, I don't think Vitamin D works for anyone in the short term. For a few people, they see improvements in mood within a few weeks or months. Most of these few people regress afterwords even with Vitamin D intake (i.e. the improvement was just the usual noise variation). I have my own set of chronic issues, and there is no shortage of ideas on how to help: Diet, exercise, vitamins, etc. The way I've maintained my sanity is to ask the following question: "OK, if I go with this treatment regimen, how will I know it is not working?" Most advocates simply don't have an answer. If it's vitamins, they'll simply shift to a different dosage, a different vitamin, or pull out the new paper of the week saying how vitamin X is only useful in combination with mineral Y (you can see plenty of that in this submission). By the time you give that a try, another idea will come up. There will be no way they will believe the solution is not vitamins. If it's exercise, it will always be "You're probably doing it wrong" coupled with "You need to ensure you have the proper diet". When you get to specifics, they'll pull out 20 variables that could impact your exercise regimen. You can't reasonably try 2^20 combinations, let alone 20. There will be no way they will believe the solution is not exercise. Same goes with diet. Must be the sugar. Or too many carbs. Not enough protein. Too much protein. Or the lack of Omega-3. There will be no way they will believe the solution is not diet. I'm all for trying, and I do try different things. The reason I go to the doctor is to get an expert and informed opinion. If his opinion is "the data on Vitamin D is poor", I want him to state that.
  - kadoban 3y ago
    Thanks for explaining, I appreciate it. Yeah I was not considering chronic issues. > I'm all for trying, and I do try different things. The reason I go to the doctor is to get an expert and informed opinion. If his opinion is "the data on Vitamin D is poor", I want him to state that. That would certainly be wonderful. I've never had a doctor who would be that honest, though I'm sure they exist.

agumonkey 3y ago

Doctors themselves exist in distributions, from very interested to not that much, from "motivated at that time" to "i have more pressing problems". Very often you get bounced for tiny reasons.