Michael Harrop
Active member
Patients with zero medical training/knowledge are forced to resort to basically being their own doctors via internet research.
I have raised this issue in many places, talked to some doctors about it, brought it up with a doctor who is also a lawmaker. I've also contacted my state's medical board about it. Few people seem to care enough to do anything about it. The legislator didn't even respond and the state board seemed extremely apathetic.
The "systems" - education, medical, research - in this country are all incredibly unsystematic. There seems to be no one who sets policy. Any random establishment anywhere in the country is free to do as they please. Doctor knowledge & recommendations vary drastically from one to another. That is not evidence based!
I just found this extremely excellent presentation about this exact issue given by a doctor at the European Parliament.
A few highlights:
1:13:08 Switches speaker to Sir Richard Thompson, personal physician to the queen and former president of royal college of physicians.
1:26:50 Switch to Professor Hanno Pijl, internist, endocrinologist, and professor of Diabetology at Leiden University. Promotes lifestyle changes instead of drugs for chronic, lifestyle-related diseases such as colon cancer, stroke, coronary heart disease, type 2 diabetes.
1:32:00 Switch to Sarah Macklin, journalist & nutritionist. Mentions outdated guidelines taught in university.
1:42:10 Begins Q&A.
More info:
A staggering 36,000 randomized controlled trials (RCTs) are published each year, on average, and it typically takes about 17 years for findings to reach clinical practice (2017): https://web.archive.org/web/20170710152725/http://catalyst.nejm.org/implementing-evidence-based-practices-quickly/ - A Model for Implementing Evidence-Based Practices More Quickly.
These flaws in the medical system and extensive delay in updating according to the latest research results in major problems like the collateral damage from antibiotics being ignored when the latest microbiome literature shows it to be a major degrader of human health and development: https://archive.fo/ebPKO#selection-803.0-803.1 - https://archive.fo/yL2gF#selection-887.0-887.1
The Mythology Of Science-Based Medicine (2010): https://www.huffingtonpost.com/entry/the-mythology-of-science_b_412475 "when you take your sick child to the hospital or clinic, there is only a 36 percent chance that he will receive a treatment that has been scientifically demonstrated to be either beneficial or likely to be beneficial"
Only one in ten medical treatments are backed by high-quality evidence (Sep 2020, GRADE) https://theconversation.com/only-one-in-ten-medical-treatments-are-backed-by-high-quality-evidence-145224 - a metaepidemiological study of Cochrane reviews.
Most healthcare interventions tested in Cochrane Reviews are not effective according to high quality evidence: a systematic review and meta-analysis (Apr 2022) https://www.sciencedirect.com/science/article/abs/pii/S0895435622001007
Too Many Medicines Simply Don’t Work. A pair of new studies sheds light on an old problem: Some things doctors do are useless. Some are even harmful. (May 2019) https://www.bloomberg.com/news/articles/2019-05-30/too-many-medicines-simply-don-t-work.
The illusion of evidence based medicine (Mar 2022) https://archive.ph/glcDr/
Medical Error Is Third Leading Cause of Death in US http://www.medscape.com/viewarticle/862832
A New, Evidence-based Estimate of Patient Harms Associated with Hospital Care (2013): https://journals.lww.com/journalpatientsafety/Fulltext/2013/09000/A_New,_Evidence_based_Estimate_of_Patient_Harms.2.aspx 250,000 - 400,000 mostly needless iatrogenic deaths in hospitals each year (the 3rd leading cause of death in the USA) costing between $37.6 billion and $50 billion per year
An estimated 795,000 Americans become permanently disabled or die annually across care settings because dangerous diseases are misdiagnosed. The results suggest that diagnostic error is probably the single largest source of deaths across all care settings (~371 000) linked to medical error. https://qualitysafety.bmj.com/content/early/2023/07/16/bmjqs-2021-014130 Burden of serious harms from diagnostic error in the USA (Jul 2023)
Dr Michael Greger and Gene Stone's book "How Not to Die" has an excellent chapter (15) on iatrogenic deaths, which includes coverage of the fact that there is a severe lack of informed consent for standard treatments that come with significant harm. Also covered is the fact that medical professionals are regularly doing 36 hour shifts, which is just insane. A person cannot function properly on that kind of lack of sleep. And they need to be at 100% when they have people's lives in their hands. He also covers his history of traveling the country educating doctors on nutrition, and the lack of nutrition education that doctors get.
This type of extreme overwork and lack of sleep for medical students, residents, and doctors seems extremely common: https://www.bostonglobe.com/ideas/2019/03/15/america-becoming-doctor-can-prove-fatal/u3x4xfPC9VR2zSCnKArgYM/story.html
Dentists practicing in the U.S. write 37 times more opioid prescriptions than dentists practicing in England. And, the type of opioids they prescribe has a higher potential for abuse (May 2019) https://today.uic.edu/us-dentists-out-prescribe-uk-dentists-when-it-comes-to-opioids
Man dies in parking lot of hospital after being discharged from 3rd visit to the ED for chest pain https://people.com/human-interest/man-dies-in-parking-lot-after-hospital-refuses-to-treat-him-says-family/
Girl dies days after being sent home from ER: https://www.youtube.com/watch?v=4uT4XZPTaic
32-year-old woman dies from bowel cancer after doctor told her she was 'too young' to have it. http://www.independent.co.uk/life-style/health-and-families/young-woman-32-dies-bowel-cancer-doctor-says-too-young-ibs-nicole-yarran-australia-a8101946.html
The doctor told him he had a virus. It turned out to be Stage 4 cancer http://www.miamiherald.com/news/state/article202777844.html
Doctors repeatedly told a woman stress was causing her symptoms. Then they pulled out a volleyball-size tumor. https://www.washingtonpost.com/nation/2022/02/09/hannah-catton-ovarian-cancer-australia/
"Mount Sinai Hospital emergency department is a ‘war zone,’ workers say" [New York Post; Dec 9, 2019; NYC] https://archive.ph/wEWjz
Doctor's son has trouble with opioid addiction, son in hospital due to car crash, father/doctor asks them not to give him opioids, they give them anyway and the son dies: https://youtu.be/j4Wr4vvd-qQ?t=1220
A “fit and healthy” teenager who was told by doctors that his severe stomach pains was constipation was found dead in his bed 24 hours later. A post-mortem found that Jack died from a condition called ketoacidosis https://uk.news.yahoo.com/welsh-teenager-17-sent-home-ae-complaining-constipation-found-dead-24-hours-later-085333189.html
Indianapolis Woman Dies From Misdiagnosed Necrotizing Fasciitis (2018): http://www.techtimes.com/articles/227639/20180513/indianapolis-woman-dies-from-misdiagnosed-necrotizing-fasciitis-what-are-the-symptoms-of-flesh-eating-disease.htm
Antibiotics for dental work: https://www.washingtonpost.com/national/health-science/did-his-artificial-hips-put-him-at-risk-of-infection-when-he-saw-the-dentist/2016/10/07/1a0d4b54-60a5-11e6-9d2f-b1a3564181a1_story.html - no evidence they help yet dentists are randomly giving them out. Another in 2019.
Only A Third of Pediatricians Fully Follow Guidelines on Peanut Allergy Prevention in Infants (Jul 2020) https://www.luriechildrens.org/en/news-stories/approximately-a-third-of-pediatricians-fully-follow-guidelines-on-peanut-allergy-prevention-in-infants/
IBM's Watson was tested on 1,000 cancer diagnoses made by human experts. In 30 percent of the cases, Watson found a treatment option the human doctors missed. Some treatments were based on research papers that the doctors had not read. More than 160,000 cancer research papers are published a year. https://old.reddit.com/r/Futurology/comments/59ihvg/ibms_watson_was_tested_on_1000_cancer_diagnoses/
There is no major force pushing gastroenterologists to catch up with the evidence; the pharmaceutical industry and government regulatory authorities, the common spurs of change in medical practice, are not interested in this matter. https://www.statnews.com/2024/03/19/colonoscopy-preparation-liquid-only-diet-data-gastroenterologists/
It’s Hard for Doctors to Unlearn Things. That’s Costly for All of Us. (2018): https://theincidentaleconomist.com/wordpress/its-hard-for-doctors-to-unlearn-things-thats-costly-for-all-of-us/
Significant problems with America's fractured system of medical records: https://archive.fo/wcyMR
Doctors are surprisingly bad at reading lab results. It’s putting us all at risk (2018): https://www.washingtonpost.com/news/posteverything/wp/2018/10/05/feature/doctors-are-surprisingly-bad-at-reading-lab-results-its-putting-us-all-at-risk
Former Aetna Medical Director Admits To Never Reviewing Medical Records Before Denying Care (2019): https://www.forbes.com/sites/robertglatter/2018/02/11/former-aetna-medical-director-admits-to-never-reviewing-medical-records-before-denying-care/
'Widespread and dangerous': Facing medical uncertainty, some doctors tell patients it's all in their heads (2018): https://edition.cnn.com/2018/12/21/health/medical-uncertainty-diagnosis-afm/index.html
Doctors completely clueless on CFS: https://archive.is/7Ktu1 - https://archive.is/2ernc
A prime example of 0% of doctors in this thread being aware of the causes and potential fixes for the obesity crisis: https://archive.fo/6JeJD. [Hint].
The Doctor Who Gave Up Drugs: Episode 1 (2018): https://www.youtube.com/watch?v=g_ggnhpGvvA - documentary covering a doctor's attempt at reducing prescriptions.
Tennessee doctor had 5 patients die of overdoses in 11 months, so he jumped state lines and started over (2019): https://archive.fo/xx6Ls
State Medical Boards: Last Week Tonight with John Oliver (HBO) https://www.youtube.com/watch?v=jVIYbgVks7E - discusses state medical boards, and how they often fail to protect patients from bad doctors.
Original 02 May 2018.
I have raised this issue in many places, talked to some doctors about it, brought it up with a doctor who is also a lawmaker. I've also contacted my state's medical board about it. Few people seem to care enough to do anything about it. The legislator didn't even respond and the state board seemed extremely apathetic.
The "systems" - education, medical, research - in this country are all incredibly unsystematic. There seems to be no one who sets policy. Any random establishment anywhere in the country is free to do as they please. Doctor knowledge & recommendations vary drastically from one to another. That is not evidence based!
I just found this extremely excellent presentation about this exact issue given by a doctor at the European Parliament.
A few highlights:
1:13:08 Switches speaker to Sir Richard Thompson, personal physician to the queen and former president of royal college of physicians.
1:26:50 Switch to Professor Hanno Pijl, internist, endocrinologist, and professor of Diabetology at Leiden University. Promotes lifestyle changes instead of drugs for chronic, lifestyle-related diseases such as colon cancer, stroke, coronary heart disease, type 2 diabetes.
1:32:00 Switch to Sarah Macklin, journalist & nutritionist. Mentions outdated guidelines taught in university.
1:42:10 Begins Q&A.
More info:
A staggering 36,000 randomized controlled trials (RCTs) are published each year, on average, and it typically takes about 17 years for findings to reach clinical practice (2017): https://web.archive.org/web/20170710152725/http://catalyst.nejm.org/implementing-evidence-based-practices-quickly/ - A Model for Implementing Evidence-Based Practices More Quickly.
These flaws in the medical system and extensive delay in updating according to the latest research results in major problems like the collateral damage from antibiotics being ignored when the latest microbiome literature shows it to be a major degrader of human health and development: https://archive.fo/ebPKO#selection-803.0-803.1 - https://archive.fo/yL2gF#selection-887.0-887.1
The Mythology Of Science-Based Medicine (2010): https://www.huffingtonpost.com/entry/the-mythology-of-science_b_412475 "when you take your sick child to the hospital or clinic, there is only a 36 percent chance that he will receive a treatment that has been scientifically demonstrated to be either beneficial or likely to be beneficial"
Only one in ten medical treatments are backed by high-quality evidence (Sep 2020, GRADE) https://theconversation.com/only-one-in-ten-medical-treatments-are-backed-by-high-quality-evidence-145224 - a metaepidemiological study of Cochrane reviews.
Most healthcare interventions tested in Cochrane Reviews are not effective according to high quality evidence: a systematic review and meta-analysis (Apr 2022) https://www.sciencedirect.com/science/article/abs/pii/S0895435622001007
Too Many Medicines Simply Don’t Work. A pair of new studies sheds light on an old problem: Some things doctors do are useless. Some are even harmful. (May 2019) https://www.bloomberg.com/news/articles/2019-05-30/too-many-medicines-simply-don-t-work.
The illusion of evidence based medicine (Mar 2022) https://archive.ph/glcDr/
Medical Error Is Third Leading Cause of Death in US http://www.medscape.com/viewarticle/862832
A New, Evidence-based Estimate of Patient Harms Associated with Hospital Care (2013): https://journals.lww.com/journalpatientsafety/Fulltext/2013/09000/A_New,_Evidence_based_Estimate_of_Patient_Harms.2.aspx 250,000 - 400,000 mostly needless iatrogenic deaths in hospitals each year (the 3rd leading cause of death in the USA) costing between $37.6 billion and $50 billion per year
An estimated 795,000 Americans become permanently disabled or die annually across care settings because dangerous diseases are misdiagnosed. The results suggest that diagnostic error is probably the single largest source of deaths across all care settings (~371 000) linked to medical error. https://qualitysafety.bmj.com/content/early/2023/07/16/bmjqs-2021-014130 Burden of serious harms from diagnostic error in the USA (Jul 2023)
Dr Michael Greger and Gene Stone's book "How Not to Die" has an excellent chapter (15) on iatrogenic deaths, which includes coverage of the fact that there is a severe lack of informed consent for standard treatments that come with significant harm. Also covered is the fact that medical professionals are regularly doing 36 hour shifts, which is just insane. A person cannot function properly on that kind of lack of sleep. And they need to be at 100% when they have people's lives in their hands. He also covers his history of traveling the country educating doctors on nutrition, and the lack of nutrition education that doctors get.
This type of extreme overwork and lack of sleep for medical students, residents, and doctors seems extremely common: https://www.bostonglobe.com/ideas/2019/03/15/america-becoming-doctor-can-prove-fatal/u3x4xfPC9VR2zSCnKArgYM/story.html
Dentists practicing in the U.S. write 37 times more opioid prescriptions than dentists practicing in England. And, the type of opioids they prescribe has a higher potential for abuse (May 2019) https://today.uic.edu/us-dentists-out-prescribe-uk-dentists-when-it-comes-to-opioids
Man dies in parking lot of hospital after being discharged from 3rd visit to the ED for chest pain https://people.com/human-interest/man-dies-in-parking-lot-after-hospital-refuses-to-treat-him-says-family/
Girl dies days after being sent home from ER: https://www.youtube.com/watch?v=4uT4XZPTaic
32-year-old woman dies from bowel cancer after doctor told her she was 'too young' to have it. http://www.independent.co.uk/life-style/health-and-families/young-woman-32-dies-bowel-cancer-doctor-says-too-young-ibs-nicole-yarran-australia-a8101946.html
The doctor told him he had a virus. It turned out to be Stage 4 cancer http://www.miamiherald.com/news/state/article202777844.html
Doctors repeatedly told a woman stress was causing her symptoms. Then they pulled out a volleyball-size tumor. https://www.washingtonpost.com/nation/2022/02/09/hannah-catton-ovarian-cancer-australia/
"Mount Sinai Hospital emergency department is a ‘war zone,’ workers say" [New York Post; Dec 9, 2019; NYC] https://archive.ph/wEWjz
Doctor's son has trouble with opioid addiction, son in hospital due to car crash, father/doctor asks them not to give him opioids, they give them anyway and the son dies: https://youtu.be/j4Wr4vvd-qQ?t=1220
A “fit and healthy” teenager who was told by doctors that his severe stomach pains was constipation was found dead in his bed 24 hours later. A post-mortem found that Jack died from a condition called ketoacidosis https://uk.news.yahoo.com/welsh-teenager-17-sent-home-ae-complaining-constipation-found-dead-24-hours-later-085333189.html
Indianapolis Woman Dies From Misdiagnosed Necrotizing Fasciitis (2018): http://www.techtimes.com/articles/227639/20180513/indianapolis-woman-dies-from-misdiagnosed-necrotizing-fasciitis-what-are-the-symptoms-of-flesh-eating-disease.htm
Antibiotics for dental work: https://www.washingtonpost.com/national/health-science/did-his-artificial-hips-put-him-at-risk-of-infection-when-he-saw-the-dentist/2016/10/07/1a0d4b54-60a5-11e6-9d2f-b1a3564181a1_story.html - no evidence they help yet dentists are randomly giving them out. Another in 2019.
Only A Third of Pediatricians Fully Follow Guidelines on Peanut Allergy Prevention in Infants (Jul 2020) https://www.luriechildrens.org/en/news-stories/approximately-a-third-of-pediatricians-fully-follow-guidelines-on-peanut-allergy-prevention-in-infants/
IBM's Watson was tested on 1,000 cancer diagnoses made by human experts. In 30 percent of the cases, Watson found a treatment option the human doctors missed. Some treatments were based on research papers that the doctors had not read. More than 160,000 cancer research papers are published a year. https://old.reddit.com/r/Futurology/comments/59ihvg/ibms_watson_was_tested_on_1000_cancer_diagnoses/
There is no major force pushing gastroenterologists to catch up with the evidence; the pharmaceutical industry and government regulatory authorities, the common spurs of change in medical practice, are not interested in this matter. https://www.statnews.com/2024/03/19/colonoscopy-preparation-liquid-only-diet-data-gastroenterologists/
It’s Hard for Doctors to Unlearn Things. That’s Costly for All of Us. (2018): https://theincidentaleconomist.com/wordpress/its-hard-for-doctors-to-unlearn-things-thats-costly-for-all-of-us/
Significant problems with America's fractured system of medical records: https://archive.fo/wcyMR
Doctors are surprisingly bad at reading lab results. It’s putting us all at risk (2018): https://www.washingtonpost.com/news/posteverything/wp/2018/10/05/feature/doctors-are-surprisingly-bad-at-reading-lab-results-its-putting-us-all-at-risk
Former Aetna Medical Director Admits To Never Reviewing Medical Records Before Denying Care (2019): https://www.forbes.com/sites/robertglatter/2018/02/11/former-aetna-medical-director-admits-to-never-reviewing-medical-records-before-denying-care/
'Widespread and dangerous': Facing medical uncertainty, some doctors tell patients it's all in their heads (2018): https://edition.cnn.com/2018/12/21/health/medical-uncertainty-diagnosis-afm/index.html
Doctors completely clueless on CFS: https://archive.is/7Ktu1 - https://archive.is/2ernc
A prime example of 0% of doctors in this thread being aware of the causes and potential fixes for the obesity crisis: https://archive.fo/6JeJD. [Hint].
The Doctor Who Gave Up Drugs: Episode 1 (2018): https://www.youtube.com/watch?v=g_ggnhpGvvA - documentary covering a doctor's attempt at reducing prescriptions.
Tennessee doctor had 5 patients die of overdoses in 11 months, so he jumped state lines and started over (2019): https://archive.fo/xx6Ls
State Medical Boards: Last Week Tonight with John Oliver (HBO) https://www.youtube.com/watch?v=jVIYbgVks7E - discusses state medical boards, and how they often fail to protect patients from bad doctors.
Original 02 May 2018.
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