One more thing, I actually did have stage 3 melanoma 30 years ago, and my dermatologist said flat out, stay away from birth control pills as there may be a link.
Just to set the record straight, Pierre Kory is not the anonymous writer of A Midwestern Doctors' substack. Pierre Kory has interviewed this doctor, who has chosen to remain such beginning with being outspoken on COVID failed policies, which as you know, Dr. Kory never has done the same.
Did I miss something here? Did AMD have a guest-post on Sensible Medicine or was the Sensible Med platform simply extended to Dr Ortel to rebut an AMD post? I only recently have become aware of and reading AMD posts, so I don't have any framework to offer opinions as to his/her identity nor to have a full sense for how much I agree with their observations.
What I see here: the main point I got from the AMD post was that the most deadly form of skin cancer, ie melanoma, does not have direct correlation to sun exposure. This has been an extremely difficult concept for me to wrap my head around! Dr Ortel's rebuttal actually seems to support this point in his statement "we do not understand the exact interactions of solar exposure with ... steps in melanoma development." Really?! This is not what the messaging of the medical establishment is seeming to push. Does he think mothers are slathering their children from head to toe with sunscreen because they think they are limiting their risk for basal cell and squamous cell cancers down the road?? No, they feel they are saving their lives from deadly melanoma! Unfortunately, his "clarification" here did not clarify anything - it actually seems to support one of the main claims AMD makes. And I still find this quite shocking - the focus and strength of constant advice to cover yourself from any sun exposure seems to be telling us with great certainty that we are decreasing our risk of dying from "skin cancer" - the strength of these recommendations does not suggest there is anything we "still don't understand the exact interactions of"!
And was a rebuttal even necessary for the "bulging veins" comment? This was not a "Doctor's" veins bulge comment. This was a childhood/"youthful" observation that AMD had, which later caused them to question things. All of us use observations to some extent. My brain thinks in pattern-recognition. During the lifetime I've had, my brain has observed and filed away all kinds of things. When I see or hear something that contradicts the patterns I've observed, it makes me question what that thing purports. On further investigation, I might find I do agree. But I often find it only opens the door to more questions and critical review. People who just accept "facts" from others and don't question more often get led astray. AMD is obviously someone who uses their own observations to question medical dogma.
Dr Ortel's comments about sunlight and mental health are quite misleading! I don't imagine any doctor who recommends sunlight to a patient to help with depression/SAD is suggesting they "spend a long afternoon asleep in the sun". Thirty minutes of natural light in the morning is very different than that and does play a potential role in mood improvement and likely has less side effects than SSRIs.
The main sense I seem to get out of this post is an attempt to limit or call out MISINFORMATION. We have a recent focus on "those of us who know better" feeling the need to stamp out things they deem untrue. I do not think adults need protection from "misinformation". An adult possesses the intelligence and ability to review information and decide where it does or doesn't fit into their already held views. I do understand that physicians have a particular role of authority and need to consider that role. But - medicine is not as cut and dried as some (even doctors) think. There are many examples where mainstream medicine recommended something strongly that turns out to be completely wrong (peanut allergy comes to mind). Physicians need to remain humble in that regard. We are using our expertise to give advice and that advice can have its limitations. People are free to take our advice - or not.
I think it is reasonable for another doctor to counter claims made that he/she might not agree with. Unfortunately, this rebuttal by Dr Ortel did not clarify much for me and seems odd that it appeared here on Sensible Med.
Dr Ortel's final line generally negates any rebuttal he was making anyway - "the dose makes the poison". Current admonitions from medicine/dermatology to sunscreen constantly, even if inside on a cloudy day, may not have as much science as they suggest. Maybe a more nuanced recommendation would actually make more sense. (the rebuttal did not clarify this for me).
This message could have been delivered without the ad hominem tilt, the snark, and the attempt (missed) to dox AMD. If so, its persuasiveness would have increased exponentially. Still, a second opinion regardless of how it was delivered was warranted.
Agreed. The problem with doctors and other experts using snark and ad hominem attacks is it allows fair turn-around back to them when they aren't correct on every detail. It is also a big part of why trust in medicine, "science", and doctors seemed to decrease during the pandemic. Humility in the true limits of what you are saying goes a long way to counter that. As does the acknowledgment that adult humans can form rational and reasonable conclusions taking many different inputs into account. Paternalism doesn't play well in current society (at least to many people). A simple point of view statement would have been better.
Continuous exposure and intermittent is old. Previous century. My melanoma prepared when young then one beach exposure at fifty detected v. soon after. Has the ozone hole produced much melanoma? I’ve had at least five cancers since the melanoma. Moved from Palo Alto to Santa Barbara with many sunburns in 5th grade.
Fairly certain AMD is NOT Pierre Kory. If memory serves I think AMD has mentioned somewhere that he’s in Michigan? So not even the same practice state. Starting off with a faulty assumption and zero things to confirm this isn’t a great opening
According to this dermatologist, among AMD claims that are so ridiculous they "could have been headlines from the National Enquirer" is this: "Health benefits of sun and ultraviolet radiation exposure."
How do the mainstream docs manage to consistently be this dumb???
Dermatologists and neurologists and cosmetic surgeons and endocrinologists are the least trustworthy of the Medical Industrial Complex. If we let the MIC rule our lives, we'd all live in "safe and secure" bubbles, never go outside, and live a couple of years longer, like caged animals in zoos.
blood vessels under the skin dilating in sunlight - wouldn't that be because the body increases blood flow to cool down the slowly(or quickly) warming skin surface?
I’m about to have my third MOHS surgery since August. Not fun. (Skin cancers x9 now) This is what happens when your heritage is Scots-Irish and you grow up living at the pool all summer. I have worn sunscreen every day since my first BCC, but the damage has been done. Put on the sunscreen or wear SPF clothes, friends!
I see this 'damage has been done' sentiment often and find it interesting. What makes you so confident that the cause of all these skin cancers is in the past and your sunscreen use is only protective and not potentially contributing to the issue since majority of these cancers have occurred with daily sunscreen use? I think it's important to consider your heritage and where you currently live in relation to sun exposure. You may be "designed" to live at latitudes further from the equator with less UV availability. But its not obvious to me that sunscreen is a solution to this alteration. Sunscreen is an artificial alteration to our environmental exposure. What would your ancestors have done if they travelled towards the equator and started getting a sunburn? Probably moved under the shade of a tree? Is blocking UV (or only certain frequencies of UV depending on the sunscreen) while continuing to get direct sunlight and high exposure to the higher energy visible spectrums the answer? Is there not likely unintended consequences that result form artificially altering our interaction with the environment in ways that are inconsistent with our evolution? (rhetorical questions here just to promote consideration of different perspectives, I'm not trying to be confrontational or anything)
People should spend more time discussing geographical-based human evolution and less time spreading hysteria. Sunscreen does not prevent skin cancer in those predisposed to it, and is pointless for those of us not predisposed.
Just like with SCV2, different strokes for different folks.
Veins bulge to reach the sun!? Sunglasses bad for your eyes!? This is what happens when medical professionals lose the public trust, people start believing quack doctors and utter nonsense.
BAD sunglasses are worse than nothing. If you wear no sunglasses, your brows and lids significantly shield your eyes from the light. If you're wearing shades that don't block rays, then your eyes are wide open, and absorbing the whole damned lot of it. Probably 90% of all shades sold are crappy and accomplish nothing.
I don't know if it's UVA, UVB, visible or infrared light from the sun that does the trick. But I absolutely detest cloudy days and dark dreary interiors. I wish the Sun could be at zenith 24/7, 365 days of the year. I bought a little light screen and it's a very poor remedy for mid Atlantic winters. But it does help. And when we get 10 successive days of overcast as we sometimes do here on the Atlantic Coast, I get so pissed off I want to slap the Sun in his big fat face. But then I forgive him.
I agree---nothing better than sunshine to raise the spirits. Southern California fills the bill. Pretty much year round sunshine. Never too hot or too cold. No humidity. No bugs. The weather may be a limiting factor only a few days of the year. In the winter you can drive to the mountains for snow in the morning and be back on the beach in the afternoon if you are so inclined.
You're so right. My family lived in Southern Cal till I was 8. It was a wonderful place to be a little kid! To this day I hate shoes, because we ran barefoot most of the year.
Ever tried infrared beds or other light therapy beds at day spas during the months when the days are relatively short and the sun's apex isn't as high at noon? I'm very curious how helpful it'd be, esp for people whose mood and wellness change seasonally
I haven't tried those. Yet. But what does help is a trip to my local Walmart where the bright overhead lights make up for lack of sunlight. Yeah, I know it's not elegant. But it works. I'm good friends now with several of the greeters.
For hundreds of thousands of years (assuming man has been around that long), humans have been exposed to the sun. Like with many things, too much sun can cause some damage to the body. Usually it is repairable. If the sun is so dangerous, humanity would have never survived. We would have perished from overexposure or an accumulation of ill effects.
I do not need to see any "studies" or hit pieces about the meanness of the sun. It is there and without it we wouldn't be here. Sun exposure is not a one-size-fits-all proposition as this is the bedrock of 90% of medicine, which is beyond stupid. For some, it may cause much harm and others hardly any.
I get out in the sun for a while as much as I can (living in Michigan), haven't used sun screen in over 35 years and this despite my younger brother dying of skin cancer in 1997. If I was at risk from "heredity" factors as they told me, I wouldn't be alive.
Modern medicine is mostly BS and designed to scare you into becoming a lifelong citizen of the medical community...as a patient.
Yeah I don't use sun screen and have had basal cell and squamous stuff surgically removed from my face and I don't care. Because when you rub that sun screen all over your face the ingredients are going to go into your blood stream. To do what? We don't know. Same reason I don't run DEET on skin.
One more thing, I actually did have stage 3 melanoma 30 years ago, and my dermatologist said flat out, stay away from birth control pills as there may be a link.
Just to set the record straight, Pierre Kory is not the anonymous writer of A Midwestern Doctors' substack. Pierre Kory has interviewed this doctor, who has chosen to remain such beginning with being outspoken on COVID failed policies, which as you know, Dr. Kory never has done the same.
Did I miss something here? Did AMD have a guest-post on Sensible Medicine or was the Sensible Med platform simply extended to Dr Ortel to rebut an AMD post? I only recently have become aware of and reading AMD posts, so I don't have any framework to offer opinions as to his/her identity nor to have a full sense for how much I agree with their observations.
What I see here: the main point I got from the AMD post was that the most deadly form of skin cancer, ie melanoma, does not have direct correlation to sun exposure. This has been an extremely difficult concept for me to wrap my head around! Dr Ortel's rebuttal actually seems to support this point in his statement "we do not understand the exact interactions of solar exposure with ... steps in melanoma development." Really?! This is not what the messaging of the medical establishment is seeming to push. Does he think mothers are slathering their children from head to toe with sunscreen because they think they are limiting their risk for basal cell and squamous cell cancers down the road?? No, they feel they are saving their lives from deadly melanoma! Unfortunately, his "clarification" here did not clarify anything - it actually seems to support one of the main claims AMD makes. And I still find this quite shocking - the focus and strength of constant advice to cover yourself from any sun exposure seems to be telling us with great certainty that we are decreasing our risk of dying from "skin cancer" - the strength of these recommendations does not suggest there is anything we "still don't understand the exact interactions of"!
And was a rebuttal even necessary for the "bulging veins" comment? This was not a "Doctor's" veins bulge comment. This was a childhood/"youthful" observation that AMD had, which later caused them to question things. All of us use observations to some extent. My brain thinks in pattern-recognition. During the lifetime I've had, my brain has observed and filed away all kinds of things. When I see or hear something that contradicts the patterns I've observed, it makes me question what that thing purports. On further investigation, I might find I do agree. But I often find it only opens the door to more questions and critical review. People who just accept "facts" from others and don't question more often get led astray. AMD is obviously someone who uses their own observations to question medical dogma.
Dr Ortel's comments about sunlight and mental health are quite misleading! I don't imagine any doctor who recommends sunlight to a patient to help with depression/SAD is suggesting they "spend a long afternoon asleep in the sun". Thirty minutes of natural light in the morning is very different than that and does play a potential role in mood improvement and likely has less side effects than SSRIs.
The main sense I seem to get out of this post is an attempt to limit or call out MISINFORMATION. We have a recent focus on "those of us who know better" feeling the need to stamp out things they deem untrue. I do not think adults need protection from "misinformation". An adult possesses the intelligence and ability to review information and decide where it does or doesn't fit into their already held views. I do understand that physicians have a particular role of authority and need to consider that role. But - medicine is not as cut and dried as some (even doctors) think. There are many examples where mainstream medicine recommended something strongly that turns out to be completely wrong (peanut allergy comes to mind). Physicians need to remain humble in that regard. We are using our expertise to give advice and that advice can have its limitations. People are free to take our advice - or not.
I think it is reasonable for another doctor to counter claims made that he/she might not agree with. Unfortunately, this rebuttal by Dr Ortel did not clarify much for me and seems odd that it appeared here on Sensible Med.
Dr Ortel's final line generally negates any rebuttal he was making anyway - "the dose makes the poison". Current admonitions from medicine/dermatology to sunscreen constantly, even if inside on a cloudy day, may not have as much science as they suggest. Maybe a more nuanced recommendation would actually make more sense. (the rebuttal did not clarify this for me).
This message could have been delivered without the ad hominem tilt, the snark, and the attempt (missed) to dox AMD. If so, its persuasiveness would have increased exponentially. Still, a second opinion regardless of how it was delivered was warranted.
Agreed. The problem with doctors and other experts using snark and ad hominem attacks is it allows fair turn-around back to them when they aren't correct on every detail. It is also a big part of why trust in medicine, "science", and doctors seemed to decrease during the pandemic. Humility in the true limits of what you are saying goes a long way to counter that. As does the acknowledgment that adult humans can form rational and reasonable conclusions taking many different inputs into account. Paternalism doesn't play well in current society (at least to many people). A simple point of view statement would have been better.
Continuous exposure and intermittent is old. Previous century. My melanoma prepared when young then one beach exposure at fifty detected v. soon after. Has the ozone hole produced much melanoma? I’ve had at least five cancers since the melanoma. Moved from Palo Alto to Santa Barbara with many sunburns in 5th grade.
Fairly certain AMD is NOT Pierre Kory. If memory serves I think AMD has mentioned somewhere that he’s in Michigan? So not even the same practice state. Starting off with a faulty assumption and zero things to confirm this isn’t a great opening
Moderation in all things.
Yes; generally remains true.
I guess this is called being ratioed
Too snarky, imo.
I’m more concerned with the ingredients of things we put on and in our bodies than what the sun may or may not do…
According to this dermatologist, among AMD claims that are so ridiculous they "could have been headlines from the National Enquirer" is this: "Health benefits of sun and ultraviolet radiation exposure."
How do the mainstream docs manage to consistently be this dumb???
Dermatologists and neurologists and cosmetic surgeons and endocrinologists are the least trustworthy of the Medical Industrial Complex. If we let the MIC rule our lives, we'd all live in "safe and secure" bubbles, never go outside, and live a couple of years longer, like caged animals in zoos.
blood vessels under the skin dilating in sunlight - wouldn't that be because the body increases blood flow to cool down the slowly(or quickly) warming skin surface?
Correct. It's just heat.
I’m about to have my third MOHS surgery since August. Not fun. (Skin cancers x9 now) This is what happens when your heritage is Scots-Irish and you grow up living at the pool all summer. I have worn sunscreen every day since my first BCC, but the damage has been done. Put on the sunscreen or wear SPF clothes, friends!
I see this 'damage has been done' sentiment often and find it interesting. What makes you so confident that the cause of all these skin cancers is in the past and your sunscreen use is only protective and not potentially contributing to the issue since majority of these cancers have occurred with daily sunscreen use? I think it's important to consider your heritage and where you currently live in relation to sun exposure. You may be "designed" to live at latitudes further from the equator with less UV availability. But its not obvious to me that sunscreen is a solution to this alteration. Sunscreen is an artificial alteration to our environmental exposure. What would your ancestors have done if they travelled towards the equator and started getting a sunburn? Probably moved under the shade of a tree? Is blocking UV (or only certain frequencies of UV depending on the sunscreen) while continuing to get direct sunlight and high exposure to the higher energy visible spectrums the answer? Is there not likely unintended consequences that result form artificially altering our interaction with the environment in ways that are inconsistent with our evolution? (rhetorical questions here just to promote consideration of different perspectives, I'm not trying to be confrontational or anything)
People should spend more time discussing geographical-based human evolution and less time spreading hysteria. Sunscreen does not prevent skin cancer in those predisposed to it, and is pointless for those of us not predisposed.
Just like with SCV2, different strokes for different folks.
Veins bulge to reach the sun!? Sunglasses bad for your eyes!? This is what happens when medical professionals lose the public trust, people start believing quack doctors and utter nonsense.
BAD sunglasses are worse than nothing. If you wear no sunglasses, your brows and lids significantly shield your eyes from the light. If you're wearing shades that don't block rays, then your eyes are wide open, and absorbing the whole damned lot of it. Probably 90% of all shades sold are crappy and accomplish nothing.
I don't know if it's UVA, UVB, visible or infrared light from the sun that does the trick. But I absolutely detest cloudy days and dark dreary interiors. I wish the Sun could be at zenith 24/7, 365 days of the year. I bought a little light screen and it's a very poor remedy for mid Atlantic winters. But it does help. And when we get 10 successive days of overcast as we sometimes do here on the Atlantic Coast, I get so pissed off I want to slap the Sun in his big fat face. But then I forgive him.
I agree---nothing better than sunshine to raise the spirits. Southern California fills the bill. Pretty much year round sunshine. Never too hot or too cold. No humidity. No bugs. The weather may be a limiting factor only a few days of the year. In the winter you can drive to the mountains for snow in the morning and be back on the beach in the afternoon if you are so inclined.
You're so right. My family lived in Southern Cal till I was 8. It was a wonderful place to be a little kid! To this day I hate shoes, because we ran barefoot most of the year.
Ever tried infrared beds or other light therapy beds at day spas during the months when the days are relatively short and the sun's apex isn't as high at noon? I'm very curious how helpful it'd be, esp for people whose mood and wellness change seasonally
I haven't tried those. Yet. But what does help is a trip to my local Walmart where the bright overhead lights make up for lack of sunlight. Yeah, I know it's not elegant. But it works. I'm good friends now with several of the greeters.
For hundreds of thousands of years (assuming man has been around that long), humans have been exposed to the sun. Like with many things, too much sun can cause some damage to the body. Usually it is repairable. If the sun is so dangerous, humanity would have never survived. We would have perished from overexposure or an accumulation of ill effects.
I do not need to see any "studies" or hit pieces about the meanness of the sun. It is there and without it we wouldn't be here. Sun exposure is not a one-size-fits-all proposition as this is the bedrock of 90% of medicine, which is beyond stupid. For some, it may cause much harm and others hardly any.
I get out in the sun for a while as much as I can (living in Michigan), haven't used sun screen in over 35 years and this despite my younger brother dying of skin cancer in 1997. If I was at risk from "heredity" factors as they told me, I wouldn't be alive.
Modern medicine is mostly BS and designed to scare you into becoming a lifelong citizen of the medical community...as a patient.
Yeah I don't use sun screen and have had basal cell and squamous stuff surgically removed from my face and I don't care. Because when you rub that sun screen all over your face the ingredients are going to go into your blood stream. To do what? We don't know. Same reason I don't run DEET on skin.