Modern medicine takes a lot of heat from critics who claim that over-testing leads to over-medicalization.
But conventional Western medicine’s strongest aspect is its ability to diagnose a condition, even in the absence of symptoms.
Its weakest aspect, the function it flatly fails at, is preventing the ills and maladies that are entirely preventable (which is, by far, most of them).
Why is this?
Could it be the economic model? Is there more money and prestige to be earned by treating sick patients , rather than keeping them healthy in the first place?
Are we really in the sickness business — and merely calling it “healthcare?”
Thank you for the time and thought put into answering my questions on data transparency. Most importantly, I would encourage everyone to read the available Pfizer trial audits. I believe it will be very eye-opening about just how useful that initial RCT data is (or isn’t):
I agree that requiring perfect data can be its own EBM dogmatism that results in doing nothing. Though tbh, I think chronically doing things without raw data is a worse EBM dogmatism. Personally, I embrace doing things on weak evidence by favoring things that are intrinsically low-risk and pleiotropic. I favor “imprecision medicine”. In fact, most things that have helped my chronic health issues have had weak or no evidence. So I do not think lack of data perfection is necessarily paralyzing, but just necessitates favoring different treatment approaches. The case of mRNA vaccines is unprecedented. For the 9 reasons I listed, if the transparency line can’t be drawn here, it is clear modern medicine has no intention of ever doing so without being coerced, and thus some degree of boycotting their products and services (i.e. ceasing to enable corruption) has to be a conscious part of the solution. The price of being wrong here was and still is just too great.
For meditation: Proffer your prior probability threshold value for “vaccine RCT benefit-harm analysis actually resembles reality in the elderly” such that you are willing to recommend original 2-dose series in spite of no raw data.
Interested in the conversation about colchicine for CAD. Since many CAD patients are older and frequently have osteoarthritis (like me) and since NSAIDs are a high risk OA therapy while on anticoagulant meds, has there been a look at using colchicine to help manage OA symptoms while helping the CV system and general inflammation.
I’m not sure what Mandrola is getting at regarding COI for employed physicians. I’m generally negative on the trend towards employed physicians (like the increasing majority, I am an employed physician at the moment), but I see it more as a quality of life issue for us than a quality of care issue for patients. A physician with a direct financial relationship to the patient has some obvious incentives to do whatever results in more payment. If you’re salaried, the relationship between your compensation and the care you provide for the patient is actually less direct. It depends on the nature of your contract and how performance metrics may be used to affect compensation, but it doesn’t seem obvious to me that the incentives are worse for employed physicians.
Now the meta-level concern of physicians having to deal with HR and potentially losing their jobs if they aren’t acting in the company’s interest, that is a huge problem. And so maybe with the company riding the doctor hard you can get to the same COI you’d get to with fee for service medicine in the first place.
I think the loss of continuity of care that often comes with corporate medicine is also a problem, but not a COI per se.
Please publicly review the Getahun 2018 substudy whose KM graphs are on page 13-14 (after the references) and whose unweighted graphs plus methods are in a separate online paper. The risk of VTE and ischemic CVA with the doses of estrogen taken by men transitioning to a female phenotype is higher than I think these young (often autistic) men and their prescribing clinicians appreciate.
Shumaker et al. (2003) found estrogen+progesterone increased the risks of dementia within 5 years in women aged 65. Estrogen is prothrombotic so may insidiously decrease the intellect in younger peri-menopausal women as well as in men who are prescribed 10 times the dose in their quest to identify as women.
Modern medicine takes a lot of heat from critics who claim that over-testing leads to over-medicalization.
But conventional Western medicine’s strongest aspect is its ability to diagnose a condition, even in the absence of symptoms.
Its weakest aspect, the function it flatly fails at, is preventing the ills and maladies that are entirely preventable (which is, by far, most of them).
Why is this?
Could it be the economic model? Is there more money and prestige to be earned by treating sick patients , rather than keeping them healthy in the first place?
Are we really in the sickness business — and merely calling it “healthcare?”
One wonders.
Thank you for the time and thought put into answering my questions on data transparency. Most importantly, I would encourage everyone to read the available Pfizer trial audits. I believe it will be very eye-opening about just how useful that initial RCT data is (or isn’t):
https://openvaet.substack.com/p/pfizerbiontech-c4591001-trial-audit
https://wherearethenumbers.substack.com/p/anomalous-patterns-of-mortality-and
I agree that requiring perfect data can be its own EBM dogmatism that results in doing nothing. Though tbh, I think chronically doing things without raw data is a worse EBM dogmatism. Personally, I embrace doing things on weak evidence by favoring things that are intrinsically low-risk and pleiotropic. I favor “imprecision medicine”. In fact, most things that have helped my chronic health issues have had weak or no evidence. So I do not think lack of data perfection is necessarily paralyzing, but just necessitates favoring different treatment approaches. The case of mRNA vaccines is unprecedented. For the 9 reasons I listed, if the transparency line can’t be drawn here, it is clear modern medicine has no intention of ever doing so without being coerced, and thus some degree of boycotting their products and services (i.e. ceasing to enable corruption) has to be a conscious part of the solution. The price of being wrong here was and still is just too great.
For meditation: Proffer your prior probability threshold value for “vaccine RCT benefit-harm analysis actually resembles reality in the elderly” such that you are willing to recommend original 2-dose series in spite of no raw data.
Regarding vomiting etc. with sea bass. Has she been tested for haemochromatosis?
Interested in the conversation about colchicine for CAD. Since many CAD patients are older and frequently have osteoarthritis (like me) and since NSAIDs are a high risk OA therapy while on anticoagulant meds, has there been a look at using colchicine to help manage OA symptoms while helping the CV system and general inflammation.
I’m not sure what Mandrola is getting at regarding COI for employed physicians. I’m generally negative on the trend towards employed physicians (like the increasing majority, I am an employed physician at the moment), but I see it more as a quality of life issue for us than a quality of care issue for patients. A physician with a direct financial relationship to the patient has some obvious incentives to do whatever results in more payment. If you’re salaried, the relationship between your compensation and the care you provide for the patient is actually less direct. It depends on the nature of your contract and how performance metrics may be used to affect compensation, but it doesn’t seem obvious to me that the incentives are worse for employed physicians.
Now the meta-level concern of physicians having to deal with HR and potentially losing their jobs if they aren’t acting in the company’s interest, that is a huge problem. And so maybe with the company riding the doctor hard you can get to the same COI you’d get to with fee for service medicine in the first place.
I think the loss of continuity of care that often comes with corporate medicine is also a problem, but not a COI per se.
Please publicly review the Getahun 2018 substudy whose KM graphs are on page 13-14 (after the references) and whose unweighted graphs plus methods are in a separate online paper. The risk of VTE and ischemic CVA with the doses of estrogen taken by men transitioning to a female phenotype is higher than I think these young (often autistic) men and their prescribing clinicians appreciate.
Shumaker et al. (2003) found estrogen+progesterone increased the risks of dementia within 5 years in women aged 65. Estrogen is prothrombotic so may insidiously decrease the intellect in younger peri-menopausal women as well as in men who are prescribed 10 times the dose in their quest to identify as women.