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Andrew B.
July 14th, 2007, 10:05 AM
Sort of depressing news about health care quality: http://v.mercola.com/blogs/public_blog/When-Doctors-Strike--Fewer-People-Die-18998.aspx

Judy G. Russell
July 14th, 2007, 06:07 PM
Sort of depressing news about health care quality: http://v.mercola.com/blogs/public_blog/When-Doctors-Strike--Fewer-People-Die-18998.aspxNo, it sure doesn't give you a secure feeling. And it doesn't surprise me in the least. Nor does it surprise me that people who can't benefit at all from modern medical treatments insist on having them anyway, and that most doctors these days are specialists, leaving fewer and fewer family physicians to handle more and more patients.

Not encouraging at all.

Lindsey
July 15th, 2007, 11:35 PM
I must be seeing a different article from the rest of you, because what I got directed to really said nothing at all about health care quality, it was just a diatribe against traditional medicine.

--Lindsey

Andrew B.
July 16th, 2007, 11:15 PM
The article draws a correlation between the death rate and activity by the medical community. It is not meant to be an overview of health care, and clearly fits into Marcola's POV. But still, it is food for thought, and it does concern me

Lindsey
July 17th, 2007, 01:10 AM
The article draws a correlation between the death rate and activity by the medical community. It is not meant to be an overview of health care, and clearly fits into Marcola's POV. But still, it is food for thought, and it does concern me
It's just that I didn't see all the things that Judy was talking about.

But at any rate, one of the first things you learn in science class is, "Correlation does not imply causation." Just because sleeping with one's shoes on is strongly correlated with waking up with a headache does not mean that sleeping with one's shoes on causes headaches.

I'm sorry, when Mercola makes the blanket claim that cancer treatments are ""ineffective and unacceptably poisonous," the guy doesn't exactly gain credibility with me. Also notice that he cites no sources for his information. That for me is another indication that his assertions are less than reliable.

--Lindsey

Judy G. Russell
July 17th, 2007, 07:47 AM
It's just that I didn't see all the things that Judy was talking about.I was adding my own thoughts. I do that occasionally. :)

Andrew B.
July 17th, 2007, 10:28 AM
Yes, I know what correlation means. And I would like to see the citations too. But really, how different is this from so many other articles on the Internet, which offer no citation. I am not posting this because I'm a researcher on a crusade, it's just one more provocative article on the Internet.

I do, however, think there had to have been justification for what happened before my last surgery. The nurse, doctor, and me all had to agree which side the hernia surgery was supposed to be on. I had to sign my skin with a pen near the spot, and so did the doctor. They said this was a practice that sprung from mistakes with surgery being done on the wrong side.

And, no, I'm not kidding. This really happened. And I was actually glad that they thought enough to start taking these precautions.

Judy G. Russell
July 17th, 2007, 01:34 PM
Yes, I know what correlation means. And I would like to see the citations too.Start with this one: "The Institute of Medicine (IOM) estimates that fully half of adverse reactions to medicines are the result of medical errors. Other adverse reactions--those that are unexpected and not preventable--are not considered errors. ... The statistics in the IOM report, which were based on two large studies, suggest that medical errors are the eighth leading cause of death among Americans, with error-caused deaths each year in hospitals alone exceeding those from motor vehicle accidents (43,458), breast cancer (42,297), or AIDS (16,516)." FDA Consumer Magazine (http://www.fda.gov/fdac/features/2000/500_err.html), Sep-Oct 2000 (this is by the way an official FDA publication -- the url is fda.gov).

The outfit the report cites, the Institute of Medicine (http://www.iom.edu/) of the National Academies, is hardly a fly-by-night operation. And its 1999 report, To Err is Human (http://www.iom.edu/Object.File/Master/4/117/ToErr-8pager.pdf) is frightening.

jdh
July 17th, 2007, 05:27 PM
Sort of depressing news about health care quality: http://v.mercola.com/blogs/public_blog/When-Doctors-Strike--Fewer-People-Die-18998.aspx

This article about the PR industry and the profession of Spin Doctoring is also rather interesting:
http://www.mercola.com/2001/aug/15/perception.htm

Something that most of us are guilty of AND which most of us have also fallen for.

DH

If you need a second opinion, how about a psychic?

Lindsey
July 17th, 2007, 11:32 PM
I was adding my own thoughts. I do that occasionally. :)
I was just thinking maybe the link had gotten pointed to a different article.

--Lindsey

Lindsey
July 17th, 2007, 11:52 PM
But really, how different is this from so many other articles on the Internet, which offer no citation.
Which is the reason to be skeptical of what you find floating out on the Web. ;) All I'm saying is that I don't think that claim all by itself is a reason to feel insecure about health care in general. I think you'll find that the long term statistics will tell you that those who have it do better than those who do not.

I had to sign my skin with a pen near the spot, and so did the doctor. They said this was a practice that sprung from mistakes with surgery being done on the wrong side.

And, no, I'm not kidding. This really happened.
Oh, I don't doubt that at all. I would never say that doctors don't make mistakes, sometimes very bad ones. They're human, after all. What you describe is quite common when you go in for surgery. You are often asked several times in the course of the preparation who you are and what you are there for. It's not that they forget, it's just a double- and triple-checking that is part of their QA procedure. I think marking and signing your skin with a pen is a pretty nifty idea.

--Lindsey

Lindsey
July 17th, 2007, 11:54 PM
medical errors are the eighth leading cause of death among Americans, with error-caused deaths each year in hospitals alone exceeding those from motor vehicle accidents (43,458), breast cancer (42,297), or AIDS (16,516)."
Of course, you could look at that from the other direction and ask what the death rates from motor vehicle accidents, breast cancer, and AIDS would be if there were no doctors...

--Lindsey

Andrew B.
July 18th, 2007, 01:12 AM
Which is the reason to be skeptical of what you find floating out on the Web. ;)I think you'll find that the long term statistics will tell you that those who have it do better than those who do not.Perhaps. But we have no link to that citation either. It is just accepted as common knowledge.

Oh, I don't doubt that at all. I would never say that doctors don't make mistakes, sometimes very bad ones. They're human, after all.This is true. But the same thing can be said for people making driving errors. And we don't simply dismiss this. So if it is true that medical errors cause more deaths than traffic accidents or guns, I think it deserves at least as much public concern as these other causes of death.

Judy G. Russell
July 18th, 2007, 08:35 AM
Of course, you could look at that from the other direction and ask what the death rates from motor vehicle accidents, breast cancer, and AIDS would be if there were no doctors...No doubt. But we constantly work to lower deaths by motor vehicle accidents, breast cancer and AIDS, and we do it in part through awareness. Deaths by medical errors should be no different.

Lindsey
July 19th, 2007, 12:34 AM
Deaths by medical errors should be no different.
I never said they should be. But that doesn't mean that you're better off not seeing doctors at all, as the article seemed to be suggesting.

--Lindsey

Judy G. Russell
July 19th, 2007, 08:24 AM
I never said they should be. But that doesn't mean that you're better off not seeing doctors at all, as the article seemed to be suggesting.The article is a bit over the top, true, but there are times when you ARE better off not seeing the doctor at all -- such as when you have a cold and the doctor gives you antibiotics. The antibiotics, of course, will do nothing for the cold, but may leave you defenseless ultimately against a later bug which has become resistant to the overused antibiotics.

Andrew B.
July 19th, 2007, 11:01 AM
I never said they should be. But that doesn't mean that you're better off not seeing doctors at all, as the article seemed to be suggesting.The message I got is that seeing a doctor is much more risky than I imagined. But I see your point about the article. And I would also like to know why fewer people die when doctors go on strike.

Andrew B.
July 19th, 2007, 11:12 AM
If you need a second opinion, how about a psychic?I've been wondering the same thing. Who do I ask for a second opinion.

Andrew B.
July 19th, 2007, 11:20 AM
Start with this one:Thanks. I'm working my way through them.

Here's one at the Mercola site that has more hard information. http://www.mercola.com/display/router.aspx?docid=30236.

Judy G. Russell
July 19th, 2007, 02:29 PM
I would also like to know why fewer people die when doctors go on strike.Me too...

ndebord
July 19th, 2007, 06:20 PM
Me too...

My Great Uncle, the country doctor said that modern doctors were hung up on tests. He would feel your throat, look in your eyes and ears, examine your fingernails, do all the normal thumping and ask you lots of questions. More times than not, he would diagnose you properly.

Judy G. Russell
July 19th, 2007, 07:28 PM
My Great Uncle, the country doctor said that modern doctors were hung up on tests. He would feel your throat, look in your eyes and ears, examine your fingernails, do all the normal thumping and ask you lots of questions. More times than not, he would diagnose you properly.The one big difference between your great uncle, the country doctor, and many doctors today is time. He could take the time to "feel your throat, look in your eyes and ears, examine your fingernails, do all the normal thumping and ask you lots of questions." Today's doctors are expected to get you in, out, diagnosed and treated in less than 10 minutes.

Andrew B.
July 19th, 2007, 10:14 PM
My Great Uncle, the country doctor said that modern doctors were hung up on tests.And the test cutoff points are not based on good health, they are based on estimates of threshold for system failure. So even if someone has symptoms of a problem, but his/her test is at the very bottom of "normal," the doctor ignores the symptoms.

Judy G. Russell
July 19th, 2007, 10:34 PM
So even if someone has symptoms of a problem, but his/her test is at the very bottom of "normal," the doctor ignores the symptoms.Worse: the test result is in what the test designers think is normal, but the norms aren't right. This used to happen a lot in thyroid tests -- it took a long time for the medical establishment to recognize that what they thought for a long time was a normal range left a lot of people feeling very very sick.

Lindsey
July 19th, 2007, 11:53 PM
The article is a bit over the top, true, but there are times when you ARE better off not seeing the doctor at all -- such as when you have a cold and the doctor gives you antibiotics.
Well, yes, that's also true. It's wise to be an informed consumer of medical services, as with anything else. And it would be nice if doctors would stand their ground better with patients and not prescribe antibiotics as a placebo. I think they are more careful about that now than they once were, but antibiotics are probably still overprescribed.

--Lindsey

Judy G. Russell
July 20th, 2007, 12:00 AM
it would be nice if doctors would stand their ground better with patients and not prescribe antibiotics as a placeboAbsolutely. Sometimes you have to be courageous enough to say "there is no treatment for this except time."

Lindsey
July 20th, 2007, 12:11 AM
And I would also like to know why fewer people die when doctors go on strike.
That is a good question, and that would be one reason it would be nice to have access to the study itself, or at least enough specifics about it to find some analysis of it.

There's always the chance there is a problem with the methodology -- that the data they are using aren't giving them the measure they think they are getting. But assuming that is not the case, and that the correlation is real and not simply apparent, the next question that occurs to me is, "Over what period of time?" I'm not sure I'd want to assume that you could make a straight-line extrapolation from a decline that occurred over the course of only a few weeks to what would happen under the same conditions over the course of, say, the next 5 years.

In a doctor's strike, one immediate effect is that only emergency surgeries are performed. And so for that period of time, you zero-out any risk that would be associated with elective surgeries. But what would happen to people if those surgeries were never performed at all? Did that study take that into account? I would doubt it.

--Lindsey

Lindsey
July 20th, 2007, 01:00 AM
So even if someone has symptoms of a problem, but his/her test is at the very bottom of "normal," the doctor ignores the symptoms.
Ignore? Not necessarily. I think that would depend on the doctor, and maybe on the condition.

Consider hypertension. Ideally, your blood pressure should be under 120/80. But if your blood pressure is, say, 130/85, the doctor is not going to prescribe medication (or additional medication) to take it down to the ideal. And the reason for that is that the added benefit of reducing it from 130/85 to, say, 115/75 is not offset by the additional risk of complications from the medication. So the aim is to keep your blood pressure under 140/90, which is, as you put it, "the threshold for system failure," or at least the point at which the effects from the increased pressure become pronounced.

Sometimes further study will show that they need to alter the treatment thresholds. They've done that cholesterol levels, with blood sugar levels, and with blood pressure levels in diabetics. Medicine is an evolving science. But it is a science.

Of course, part of what complicates the decisions these days is the interest of a third party: the insurance company. They force considerations other than science into the mix. I'm lucky in that my coverage is pretty good, and I've never had any problem with coverage, but a week or so ago when I went to pick up my prescription, I overheard the pharmacist telling one of the other patients that her insurance would not cover her medication because they would only pay for generics, and there was no generic form of the particular medication her doctor had prescribed. He suggested contacting the doctor to see if he would prescribe something else. And so, in effect, the insurance company's actuaries have the power to veto the doctor's treatment plan.

--Lindsey

Lindsey
July 20th, 2007, 01:01 AM
Absolutely. Sometimes you have to be courageous enough to say "there is no treatment for this except time."
Yeah. And in a world of fast food and instant breakfast, that's not what people want to hear.

--Lindsey

Andrew B.
July 20th, 2007, 09:56 AM
This used to happen a lot in thyroid tests -- it took a long time for the medical establishment to recognize that what they thought for a long time was a normal range left a lot of people feeling very very sick.From what I read this is still happening with thyroid tests. They have adjusted the cutoffs at least twice, but have yet to learn from the past mistake of going only by the numbers.

Andrew B.
July 20th, 2007, 10:33 AM
Ideally, your blood pressure should be under 120/80. But if your blood pressure is, say, 130/85, the doctor is not going to prescribe medication (or additional medication) to take it down to the ideal. And the reason for that is that the added benefit of reducing it from 130/85 to, say, 115/75 is not offset by the additional risk of complications from the medication. I was talking about symptoms being overlooked because the tests are normal. But I do agree that it is pointless to go simply by numbers and try to reach the middle range.

Of course, part of what complicates the decisions these days is the interest of a third party: the insurance company.True. What I would hope to get from a doctor is advice about what should be done, regardless of this. And if the insurance doesn't cover it, then we go from there. I pay for it myself, or we look at plan B. What I don't' like, though, is having the knowledge of the better options withheld because of what the insurance company might (or will) do.

And I do understand about the financial problems doctors have these days. I've been reading articles about this too, and seeing what some doctors are doing to solve this.

Lindsey
July 20th, 2007, 11:00 PM
What I would hope to get from a doctor is advice about what should be done, regardless of this. And if the insurance doesn't cover it, then we go from there. I pay for it myself, or we look at plan B. What I don't' like, though, is having the knowledge of the better options withheld because of what the insurance company might (or will) do.
I agree with you 100% on that. Patients should be treated as grownups who can be trusted to make their own decisions, not children who need other people to decide for them.

--Lindsey

ktinkel
July 22nd, 2007, 07:57 PM
I overheard the pharmacist telling one of the other patients that her insurance would not cover her medication because they would only pay for generics, and there was no generic form of the particular medication her doctor had prescribed. He suggested contacting the doctor to see if he would prescribe something else. And so, in effect, the insurance company's actuaries have the power to veto the doctor's treatment plan.I feel like venting.

I am on Medicare Part D prescription coverage. At first, I figured it would be comparable to what we had from CIGNA when Jack was working; now I see that the best we can hope for is an average 40% discount, and that is much worse than it appears. I have three prescriptions that are discounted about 3% (because they cost only that much more than the highest-costing tier). My average monthly co-pay for drugs is $240.

One of those is Lipitor. Last week I got a strenuous urging from my insurer to switch to a generic. It was time to renew my prescription so I called my doctor, and he said it should not be a problem, so I did it. But I was seething with resentment — the drugs are comparable but not the same. (When I first started on cholesterol-lowering treatment, my then doctor prescribed Pravachol, because he said it gave him more control over dosage, but CIGNA refused to pay for it, so he switched me to Lipitor!)

Last summer I had a violent reflux problem; my gastroenterologist prescribed something called Aciphex twice a day. The insurer said no dice; I should take an OTC drug instead. So I did, but it didn’t help. My gastro wrote an impassioned letter on my behalf, but it had no effect. So he gave me samples for the duration of my condition (which, thankfully, passed). Wonder what the drug companies think of that? I have heard of others who live on samples because the insurers will not cover the meds.

Oh, and then there are the blood tests that neither Medicare nor my supplemental insurer will pay for, even though my rheumatologist needs the result four times a year. I have to pay $93 for each of them, because they are not on the list of approved tests (regardless of the patient’s condition).

It is not only infuriating for me and the doctors when this stuff happens. It is not only that it costs doctors time to try to stand up for their patients. But it costs everyone (except the patient, presumably) real money to deal with. And the money the insurer gets is probably not cost-effective in the long run.

One thing the insurance companies have done is help patients and doctors forge an alliance. We used to bitch about doctor bills. Now we join with the MDs and bitch about the insurance companies. I guess that’s progress.

I think I have been ranting. I will stop now. :(

Lindsey
July 23rd, 2007, 01:02 AM
Kathleen,

I think you have every right to vent! This is exactly the sort of thing Michael Moore is getting at in "Sicko." (I haven't seent it yet, just read about it, but I very much want to see it.)

This past week's New Yorker had a good commentary (http://www.newyorker.com/talk/comment/2007/07/23/070723taco_talk_gawande) by a practicing surgeon on the movie and the general health care insurance situation here in this past week's issue.

Their travails are by turns depressing, blackly comical, and infuriating. There’s the twenty-two-year-old who was denied reimbursement for her cervical-cancer treatment because someone at her insurance company thought that she was “too young” to have the disease; the seventy-nine-year-old on Medicare who works picking up trash at his local Pathmark store to pay for the medicines that he and his wife need; the thirty-something-year-old who matter-of-factly sews up a trickling five-inch gash in his leg with kitchen thread, because he doesn’t have insurance to cover an emergency-room visit.

These have become ordinary tales in America. Just this year, in my own surgical practice, I have seen a college student who couldn’t afford the radiation treatment she needed for her thyroid cancer, because her insurance coverage maxed out after the surgery; a breast-cancer patient who didn’t have the cash for the hormone therapy she needed; and a man denied Medicare coverage for an ambulance ride, because the chest pain he thought was caused by a heart attack wasn’t—it was caused by a tumor. The universal human experience of falling ill and seeking treatment—frightening and difficult enough—has been warped by our dysfunctional insurance system.

--Lindsey

ndebord
July 23rd, 2007, 03:28 PM
The one big difference between your great uncle, the country doctor, and many doctors today is time. He could take the time to "feel your throat, look in your eyes and ears, examine your fingernails, do all the normal thumping and ask you lots of questions." Today's doctors are expected to get you in, out, diagnosed and treated in less than 10 minutes.

Judy,

I don't recall that he took much longer than 10 minutes to do all that. If he wasn't busy, he would stop to swap gossip, but that aside, he was all about business.

Judy G. Russell
July 23rd, 2007, 05:00 PM
Yeah. And in a world of fast food and instant breakfast, that's not what people want to hear.Ain't that the truth. For me, hey, instant gratification takes too long!

Judy G. Russell
July 23rd, 2007, 05:01 PM
From what I read this is still happening with thyroid tests. They have adjusted the cutoffs at least twice, but have yet to learn from the past mistake of going only by the numbers.Some doctors are getting the idea that the numbers don't tell the whole story. But too many of them are too pressed for time to do anything more than run down the checklist: "within the norms? check..."

Judy G. Russell
July 23rd, 2007, 05:04 PM
I feel like venting.When it comes to insurance companies and how they are set up to screw the consumer every time, there's no such thing as venting enough. All I have to do is think about some of my insurance snafus and steam comes out of my ears. Such as the time Prudential pre-approved a thyroidectomy and 24 hours of care. Then they refused to pay for it because I'd been in the hospital overnight. They finally gave in when I asked them what planet they were on where 24 hours of care didn't include an overnight... (and the threat to sue them may have had some impact as well).

Judy G. Russell
July 23rd, 2007, 05:08 PM
a man denied Medicare coverage for an ambulance ride, because the chest pain he thought was caused by a heart attack wasn’t—it was caused by a tumorOh. My. God. That is just simply outrageous...

Judy G. Russell
July 23rd, 2007, 05:11 PM
I don't recall that he took much longer than 10 minutes to do all that. If he wasn't busy, he would stop to swap gossip, but that aside, he was all about business.I think you may be underestimating the time your relative spent with his patients, Nick. The fact is, the one critical element in all of medical treatment is getting the right information communicated between doctor and patient. An experienced practitioner may be able to tell at a glance whether a certain rash is measles or some closely related ailment, but he can do it a lot faster if he's been the doctor for a while, knows the patient already had measles or, alternatively, knows the patient has an odd rash that recurs when the patient is exposed to (say) strawberries. You just don't get that today. Doctors don't even have time to review the charts half the time.

Lindsey
July 23rd, 2007, 09:57 PM
Oh. My. God. That is just simply outrageous...
Isn't it? What was the guy supposed to do -- run his own diagnostics before dialling 911?

--Lindsey

Judy G. Russell
July 24th, 2007, 12:35 AM
Isn't it? What was the guy supposed to do -- run his own diagnostics before dialling 911?But of course not. What he was supposed to do was die, and stop being a drag on the system!

ktinkel
July 24th, 2007, 11:14 AM
… the time Prudential pre-approved a thyroidectomy and 24 hours of care. Then they refused to pay for it because I'd been in the hospital overnight. They finally gave in when I asked them what planet they were on where 24 hours of care didn't include an overnight... (and the threat to sue them may have had some impact as well).Aaargh. That is a classic.

At least you have a good cudgel; even insurance company people prefer not to tangle with lawyers. <g>

ktinkel
July 24th, 2007, 12:05 PM
Sort of depressing news about health care qualityI have been distracted, by health care stuff, in fact, so did not read this carefully when you posted it.

The mingling of 1970s-vintage data with more recent, with no or few cites to indicate the value of the data sets off alarms for me.

Beyond that, Mercola’s name rang another sort of bell, especially when I see his link to Gary Null, who is notorious in some circles (see this QuackWatch article (http://www.quackwatch.org/04ConsumerEducation/null.html)).

There is plenty to criticize in American medicine, but the solution is probably not the abandonment of logic and science but more consistent use of these. Be depressed about the insurance companies’ role in medicine, or the tendency to treat patient care as the same sort of service as car-waxing — not because of a sloppy, unsubstantiated article on the web! :)

Judy G. Russell
July 24th, 2007, 04:01 PM
Aaargh. That is a classic.That wasn't the worst Prudential did. They were, beyond a doubt, without exception, the worst insurance company I ever had the misfortune to have to deal with. I ended up threatening to sue three times and reported them to the state Commissioner of Insurance twice.

The one that made me literally see red was when I settled a very small, very minor lawsuit involving a slip and fall. It wasn't really a money issue at all but was a matter of principal (though I threaten suit where appropriate, I am actually most unlikely ever to actually sue -- what I wanted and would have been happy with was an apology; what they got by refusing was an angry lawyer as the injured party). Within 48 hours of the settlement being executed, I got a letter from Prudential that said, in essence, "We hear you settled a personal injury lawsuit. In order to ensure that your future medical claims are promptly resolved, it is necessary that you sign and return the enclosed agreement to pay us back for any medical bills we have paid that may be related in any way to your injury."

Only one hitch. Such a demand is illegal under New Jersey law. Here, you're not allowed to collect from the tortfeasor (the bad guy) for damages paid by a third party (like an insurer), and if you can't get that money from the tortfeasor, the third party can't get it from you. But tell me: other than a lawyer, how many people getting that letter would have known that and NOT signed the enclosed agreement and handed over money to the insurer that the insurer had no right to? Especially people settling small claims without the benefit of an attorney of their own? Especially people who have other medical claims that they need Prudential to pay promptly? In other words, the people who can least afford to hand over part of a small settlement to a greedy insurance company...

I truly hate Prudential.

ktinkel
July 24th, 2007, 09:20 PM
I truly hate Prudential.Don’t blame you. And now I do too.

I thought I hated a couple of insurance companies, but obviously wasn’t properly tested!

Judy G. Russell
July 24th, 2007, 10:22 PM
Don’t blame you. And now I do too.Good! Friends don't let friends buy from Prudential!

I thought I hated a couple of insurance companies, but obviously wasn’t properly tested!Oh I'm sure you've had plenty of reason. I don't think there's one out there that's actually good. Just some are worse than others.

Lindsey
July 24th, 2007, 10:35 PM
But of course not. What he was supposed to do was die, and stop being a drag on the system!
Shades of Charles Dickens and Ebenezer Scrooge!

(Come to think of it, there really is something Dickensian about the operation of the health insurance system...)

--Lindsey

Judy G. Russell
July 25th, 2007, 09:07 AM
Shades of Charles Dickens and Ebenezer Scrooge! (Come to think of it, there really is something Dickensian about the operation of the health insurance system...)And more than a little something.

Andrew B.
July 31st, 2007, 02:03 PM
Beyond that, Mercola’s name rang another sort of bell, especially when I see his link to Gary Null, who is notorious in some circles (see this QuackWatch article (http://www.quackwatch.org/04ConsumerEducation/null.html)).

I don't think Mercola backs up his claims, and I don't think the QuackWatch link does better. For example, I can poke fun at things doctors have said to me, just as Stephen Barrett, M.D. does with his text in red. I was prescribed Provigil by a doctor who had never seen me or reviewed any of my tests, based on a chat with a primary care physician who has never asked me for my symptom pattern or reviewed my tests. The primary care physician could not tell me how the drug works, mentioned that it was not developed developed for or tested on people with the problem I have, but it might help with my problem. I don't see this as any more scientific than what Gary Null does.

Dodi Schultz
July 31st, 2007, 05:25 PM
Doesn't give me a secure feeling either, Andrew, but for different reasons.

I'm inclined to agree with Lindsey's reaction. That piece by Mercola isn't an article; it's a rant. Or, rather, it's intended to make you feel insecure just like the TV commercials for--well, almost any nostrum being promoted: Once you've bought the story, you're meant to believe that you (a) have the disorder or disease in question and (b) will experience blessed relief if you'll buy the product. And in addition to the specifics cited by Lindsey: Gary Null is apparently Mercola's favorite medical authority.

Have you checked out the main part of the Website? In short, what Dr. Mercola's pushing is his Illinois clinic: Conventional medicine no good, Mercola's services good. And he won't accept Medicare (your first clue that those services are pretty costly).

--DS

Andrew B.
July 31st, 2007, 10:23 PM
Yes, I can see that Mercola is promoting his position, which also ties into his products.

On the flip side, I see an MD on the web criticizing someone Mercola quotes. The critic seems to have an investment in the good reputation of standard medicine. So does that make his statements just as questionable. And when doctor prescribes to me based on what a pharmaceutical company said, despite the fact that the drug has never been tested for my condition, should I trust that -- considering how much money pharmaceutical companies have invested in their products.

Truth is, I'm not sure who to trust.

Andrew B.
July 31st, 2007, 10:38 PM
In a doctor's strike, one immediate effect is that only emergency surgeries are performed. And so for that period of time, you zero-out any risk that would be associated with elective surgeries. But what would happen to people if those surgeries were never performed at all? Did that study take that into account? I would doubt it.That's a good point. And I don't know the answer. But having been involved in some real controversies where I did look up the studies, I found that it can be even worse than overlooking a variable. Sometimes people quote studies that don't exist. Or they just copy some references from a bibliography, claim these as support, but never read the studies. In several cases I found the studies didn't even study the same topic, or found the opposite results of what was claimed.

But getting back to the question at hand, I just don't know.

Lindsey
July 31st, 2007, 11:01 PM
But getting back to the question at hand, I just don't know.
I don't know either. Certainly questioning the effectiveness of standard medical practice is a perfectly valid question to ask. But I'd want more information than just one study from a doctor's strike to draw conclusions on.

Somewhere I read that a very high proportion -- I forget the numbers, but I think it's somewhere between 70 and 90 percent -- of the conditions that people go to their primary care physicians for would clear up without any intervention from the doctor at all. The real value of the physician is in recognizing when a case is one of the small proportion that will not.

--Lindsey

ktinkel
August 1st, 2007, 10:34 AM
I don't think Mercola backs up his claims, and I don't think the QuackWatch link does better. For example, I can poke fun at things doctors have said to me, just as Stephen Barrett, M.D. does with his text in red. I was prescribed Provigil by a doctor who had never seen me or reviewed any of my tests, based on a chat with a primary care physician who has never asked me for my symptom pattern or reviewed my tests. The primary care physician could not tell me how the drug works, mentioned that it was not developed developed for or tested on people with the problem I have, but it might help with my problem. I don't see this as any more scientific than what Gary Null does.Doesn’t sound too brilliant to me, either. Have you considered changing doctors?

This business of prescribing drugs for “off-list” conditions is complicated. Sometimes it works. But take a drug like neurontin, approved for seizures. Gyns prescribe it for hot flashes. GPs prescribe it for peripheral neuropathy in diabetics. Orthopedists prescribe it for sciatica. It all makes sense in a way — it does act on nerves. But it is not a panacea, and shouldn’t be treated as one.

Anyway, if you mistrust your doctor, at the very least you should consider finding a better one.

Andrew B.
August 1st, 2007, 01:26 PM
>Anyway, if you mistrust your doctor, at the very least you should consider finding a better one.

The problem is in the finding. This is not the first doctor I've seen, or the last one I've seen. And I'm still looking.

Judy G. Russell
August 1st, 2007, 03:13 PM
The problem is in the finding. This is not the first doctor I've seen, or the last one I've seen. And I'm still looking.And even if you find one, you can lose that doctor through things like (sigh) changes in insurance. I just got a letter yesterday that my oncologist at NY Presbyterian is no longer in-network. I knew he was moving to another hospital, to head up its breast cancer oncology program, but he thought he'd be keeping the various insurances. Guess not, darn it all...

Lindsey
August 1st, 2007, 10:25 PM
I just got a letter yesterday that my oncologist at NY Presbyterian is no longer in-network.
Oh, damn. This whole "in-network" business is so frustrating. It's like being told you can only telephone people who use the same carrier.

This is one big argument for a single-payor system.

--Lindsey

Judy G. Russell
August 1st, 2007, 10:34 PM
Oh, damn. This whole "in-network" business is so frustrating. It's like being told you can only telephone people who use the same carrier. This is one big argument for a single-payor system.The biggest argument of course is risk-spreading: put everyone in the same pool and you spread the risk.

Lindsey
August 1st, 2007, 11:11 PM
The biggest argument of course is risk-spreading: put everyone in the same pool and you spread the risk.
Yes. Which, of course, means that everyone has to be required to carry insurance. The low-risk won't care for that, but it's no different from requiring everyone (or at least all mortgage holders) in designated flood plains to carry flood insurance.

--Lindsey

Andrew B.
August 1st, 2007, 11:14 PM
As it stands now, I'm willing to sink every penny I have into decent treatment, and I don't care if the insurance covers it, as long as I can cover it.

As far as my insurance company goes, I have had my differences with them. But they are also doing something most people would find hard to believe. They are trying to reverse some of the cheapskate HMO mentality that they have instilled in doctors. My foot doctor told me about this when I asked him about some signs I had seen hanging in exam rooms.

That said, I am very sorry about your insurance withdrawing the coverage with your oncologist. It is difficult to find a good doctor.

Judy G. Russell
August 2nd, 2007, 09:51 AM
Yes. Which, of course, means that everyone has to be required to carry insurance. The low-risk won't care for that, but it's no different from requiring everyone (or at least all mortgage holders) in designated flood plains to carry flood insurance.Exactly, or making everyone who drives carry insurance, even if they've never had an accident.

Judy G. Russell
August 2nd, 2007, 09:51 AM
As far as my insurance company goes, I have had my differences with them. But they are also doing something most people would find hard to believe. They are trying to reverse some of the cheapskate HMO mentality that they have instilled in doctors.Good heavens. What a notion! I'm glad to hear it, but find it hard to believe!

Andrew B.
August 2nd, 2007, 11:04 AM
Good heavens. What a notion! I'm glad to hear it, but find it hard to believe!I was surprised too. My foot doctor said the insurance company is also taking action by trying to reverse patterns where many modern doctors have become lazy, like neglecting to examine the feet of diabetic patients. And reminding them of tests they should be giving that they don't give. He said all of this came about because companies are starting to ask harder questions of insurance companies regarding what type of care they are buying for their employees.

But this doesn't mean everything is covered that could be. Just that things are better than before.

Judy G. Russell
August 2nd, 2007, 09:12 PM
all of this came about because companies are starting to ask harder questions of insurance companies regarding what type of care they are buying for their employees.That plus the fact that I think some insurers are finally wising up to the idea that preventive medicine is a whole heck of a lot cheaper than treating the results of not having preventive medicine.

Lindsey
August 3rd, 2007, 12:06 AM
Exactly, or making everyone who drives carry insurance, even if they've never had an accident.
An even better example! Except I'm not sure you're always required to carry collision insurance, just liability, to protect other people you might hit. (I think no-fault states do require collision, though. Virginia is not a no-fault state, but Pennsylvania is. I just can't remember what the requirement was when I was there.)

--Lindsey

Andrew B.
August 3rd, 2007, 01:50 AM
That plus the fact that I think some insurers are finally wising up to the idea that preventive medicine is a whole heck of a lot cheaper than treating the results of not having preventive medicine.Interesting, my insurance company has followed up on some of my medical tests, and sent me some brochures about related health issues.

Judy G. Russell
August 3rd, 2007, 03:09 PM
An even better example! Except I'm not sure you're always required to carry collision insurance, just liability, to protect other people you might hit. (I think no-fault states do require collision, though. Virginia is not a no-fault state, but Pennsylvania is. I just can't remember what the requirement was when I was there.)Okay, then just considered uninsured motorist coverage which is first person coverage like health insurance is. Most states DO require that you buy that, so you're covered if some uninsured motorist hits you.

Lindsey
August 6th, 2007, 11:40 PM
Okay, then just considered uninsured motorist coverage which is first person coverage like health insurance is. Most states DO require that you buy that, so you're covered if some uninsured motorist hits you.
I'm not sure what Virginia requires, but having been hit and rather badly injured by an uninsured motorist, I would never consider going without that kind of coverage!

--Lindsey

Judy G. Russell
August 7th, 2007, 09:10 AM
I'm not sure what Virginia requires, but having been hit and rather badly injured by an uninsured motorist, I would never consider going without that kind of coverage!NJ has long had first person insurance (no fault) but they've backed off in recent years, allowing people to buy these paltry little policies (literally paltry -- $5000 coverage) to at least try to get people to have SOME insurance rather than none. All of which makes uninsured and underinsured motorist coverage the single most important coverage I buy.