When Evidence Says No, but Doctors Say Yes

[Elbata]

+1

Good point. One thing that I didn't realize is how little education doctors get on nutrition and diet. Pitiful.

I wonder, are there cardiologists who don't know that heart disease is reversible through diet? It's known that atherosclerosis can get worse, but can it be reversed?

My sister has had one stent and is getting another soon. I gave her a book called "How To Prevent and Reverse Heart Disease" by Dr. Esselstyn. She took it to her doctor and the good doctor said Esselstyn was a quack.

Stents and bypass are big business.

https://nutrition.org/a-time-for-change-nutrition-education-in-medicine/

How many patients gettting on the surgery table even had the wherewithal to ask what their EFR (ejection fraction rate) was or why that might be important?

Can nutrition literally reverse heart disease? Important questions to ask the doctor before surgery. And if he doesn't answer those questions, should be liable for malpractice.

 

[misshathaway]

<<-Even the process by which medical science/evidence is published is subject to a host of confounding issues>>

Like what was the assumption going in, even though you're not supposed to have any. Researchers are human.

What does "evidence based" really mean when 2 study results conflict? Or when medical / health pundits spin them to support their POV?

Nutritionist - there's another term that tells you nothing. At my club the nutritionists get paid by insurance. They put "healthy" recipes in the club newsletter that are all 10% some vegetable and 90% bread, honey, or high-fructose fruit. How can a nutritionist not have gotten the memo?

 

[whitet]

Another sobering article along similar lines:

https://www.theatlantic.com/magazine/archive/2019/05/the-trouble-with-dentistry/586039/

 

[Wishing]

I was a marathoner for over a decade, and I developed cardiac hypertrophy (normal in endurance athletes). Internal medicine doc diagnosed abnormality (ectopic heartbeat) and immediately ordered nuclear stress test and echocardiogram - even though she didn’t think the abnormality was significant. Naively, I agreed to the tests. Results were consistent with exercise-induced heart enlargement. Then came the bill - over $10K to tell me my heart was fine. And I had a $6K deductible. Ouch. Fast forward to this year. I moved to Florida and was trying out new doctors. I’ve been following a thyroid nodule for over a decade. Endocrinologist had been following it for 5 years with no change in size and no bloodwork abnormalities. I’m hypothyroid and take daily levothyroxine. New Florida doctor ordered bloodwork and thyroid ultrasound. Radiologist started jumping up and down screaming biopsy. I asked how much the nodule had enlarged (Iprovided several years of previous ultrasound exams). She refused to answer my question, so I self-referred myself to a local endocrinologist. She agreed with me that there was 95% chance the nodule was benign, but I let her talk me into a needle biopsy which of course was read out as benign. It scares me that the average person doesn’t have sufficient medical knowledge to be able to advocate for their own well-being.

 

[aja8888]

It scares me that the average person doesn’t have sufficient medical knowledge to be able to advocate for their own well-being.

It scares a lot of us, but many of us are figuring things out and trying to get smart on what may be the problem one has ahead of seeing a doc.

Last year, I developed an uncontrollable heartbeat and suspected (myself, through research) that it probably was SVT. I took action accordingly, found the right cardio person, did the right testing, and I was right. Got it fixed last December. Maybe I was lucky? Don't know, but the info and data is out there at your fingertips these days.

 

[Chuckanut]

Another sobering article along similar lines:

https://www.theatlantic.com/magazine/archive/2019/05/the-trouble-with-dentistry/586039/

Guesswork in dentistry! What could possibly go wrong?

 

[6miths]

Maybe piling on but an article from one of my favorite medical authors, Atul Gawande - 'Overkill'

 

[daylatedollarshort]

Guesswork in dentistry! What could possibly go wrong?

I had a chipped tooth once and the first dentist I saw said I'd need braces and then he would have to rebuild my jaw. The second one just put in some kind of resin filling and it looks fine.

 

[blueskyk]

Very well written and interesting article which is noting among several things that

-Physicians often do not follow current evidence based guidelines
-Even the process by which medical science/evidence is published is subject to a host of confounding issues

I have no solutions to these problems but I wanted to offer my thoughts on what may improve the odds you will get good care, based on my experience as a health care provider and also as a patient and family member of patients:

-Try to get health coverage that preserves choices in providers-both doctors and hospitals. Favor regular Medicare over Medicare Advantage plans. Favor PPO's over HMO's.

-If you require surgery or have a complex medical condition, seek care or get a second opinion from a physician with a university based medical center. In my opinion, the clinicians at these centers are often more up to date and have less of a tendency to be influenced by factors not related to the patient's best interest.

-Be an informed patient. use websites like "uptodate" (my favorite) or as mentioned above by 6miths to learn about your disease and treatment options.

-If you or a loved one have a serious illness, be ready to do some hard work and recruit other family/friends to assist. It should not be the case, but there is a strong correlation between effort invested and quality of care received. I have been the primary person arranging medical care for several family members who were very ill and I don't think anything I have ever done was more high stakes, challenging and exhausting. Among other things, be ready to do battle with health insurance companies, research treatment options, health care facilities, health care providers, and spend hours arranging appointments, getting prescriptions, obtaining and delivering records.

-If you have a family member in the hospital, be there as much as possible, ideally around the clock. Keep a notebook in the room and keep it updated with information on what has happened and what is planned. As much as possible, double check everything being done-there is still no perfect system for preventing medical errors. Try to make sure everyone and everything that touches the patient has gloves or has been sanitized.

The above is of course all my opinion, very generalized and by no means applicable to every situation.

^Word.

A medical advocate as you’ve described is a tremendous gift to another - May there be someone special like you in your corner if it’s ever your turn to navigate a serious condition through the rapids of healthcare.

 

[kcowan]

Just curious, but 90 HB does not appear to be that high. When my SVT showed up last Fall, I was recording 200+ HB.

Monitoring now with just walking, my HB is 90 - 100 with moderate effort.

Could be that we are all just a bit different.

The 90 referred to % arterial blockage not pulse. In fact, my pulse was around 50 until I got tachycardia. But I did have chronic HBP and my pulse is now 65 and BP of 120/73 under medication.

I asked the technician about it and he said that they use stents if there is a single blockage. Otherwise they do a bypass. But he says they seldom put stents into the coronary artery because the risk of heart attack is too high.

 

[Scratchy]

^Word.

A medical advocate as you’ve described is a tremendous gift to another - May there be someone special like you in your corner if it’s ever your turn to navigate a serious condition through the rapids of healthcare.

Thanks so much blueskyk, that's a wonderful wish!

 

[RAE]

Being an informed patient is probably appreciated by the best doctors. I know my PCP is never put-off by my relating information I've gathered through my own research. In fact, he seems energized by it.

Man, I would LOVE to find a doctor like that. Every doctor I have been to around here has been the exact opposite - I have tried to bring up information I've gathered through my own research, and it's either completely ignored, or immediately brushed off (laughed off?) as quackery. Totally impossible to even have a short discussion about it. And I am talking about information published in peer-reviewed medical journals, not just fluff articles from popular media. The last time I had a (fairly) serious medical issue, three different docs had no idea what was wrong with me, so I eventually did my own research, figured it out, and fixed it myself (through diet and lifestyle, mainly). As Audrey said, it's not easy or quick to do your own research, but I learned that it is something that I simply have to do if i want to stay healthy. Scratchy - your posts are most appreciated, and I'd love to find a doctor like you around here also!

 

[Clover5]

I had a FL cardiac specialist who did nuclear tests annually. He joined a new practice and on my annual test he said I need to see his partners for catheritization due to abnormalities, I chose to go back to my original cardiac Dr for the cath, which indicated absolutely no change in my status. They also commented that annual nuclear was ridiculous. Never been back to that Dr. imho it’s all about money, period!

 

[RetMD21]

I think it's worth getting a second opinion on major things.

I have posted this before but you can easily look up your projected risk of having a cardiac "event" in the next 10 years.

ASCVD Risk Estimator +

I think statins can work fine in women but the cardiac risks are much lower over a 10 year period that treatment of women may not be justified. If I keep my bp and lipid entries the same but tick the female box the result drops from 11.5% to 5.7% (intermediate to borderline)