Bad Medicine

News
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The first time I had a gall stone attack, I waited 10 hours in ER and never got seen, because the nurses triaged me as “not that bad”. As with kidney stones, if there’s a rupture it’s an emergency surgery situation.

I walked out at 6am, never having been attended to, since the pain had subsided by then and I had to go to work (hourly contract). I wore my hospital bracelet into work and told everyone I was running on 2 hours’ sleep.

The second time I went to a hospital with a better reputation, got seen relatively quickly and treated, but when I met with my surgeon later he figured out I’d still been under-diagnosed (I’d been marked down as having a more minor kind of attack, but that it had taken me a week to recover indicated it was the more major kind).

When they took the gall bladder out, they had to make the extraction incision bigger than normal because the bladder was so inflamed. That means I was at a higher risk of needing emergency surgery.

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My wife’s great aunt died of ovarian cancer back in the 1980’s because her pain was dismissed for a couple of years.

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Modern medicine is still very medieval; often worse. The field is full of doctors who make diagnoses based on nothing but a guess and the assumption that the patient must be exaggerating or lying. The #1 prescription is “Come back in a couple weeks if it’s still bothering you (and you’re not hospitalized or dead, of course), then maybe I’ll actually make an attempt to do my job. Just hope it doesn’t progress and make things worse in the meantime. But don’t worry, if it’s a legitimate disease, the body has ways to try to shut the whole thing down.”

It doesn’t help that so much of it is based on subjective descriptions by patients (who may have multiple things occurring simultaneously) interpreted subjectively by doctors who might experience or describe things differently. Even when there are tests available which might be a little more objective, they’re often not done.

Then there are things like described in the article, still poorly understood and with no obvious cause or solution. There are still a lot of things like that, even ones that probably are actually already known but not accepted (like Lyme disease is/was).

What we really need are Trek-style medscanners.

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Science has helped a little, but mostly with all the easy problems. Alas now all that are left are the hard ones. Chronic pain of unknown cause is in that bucket, I guess.

I wonder if it’s due to rogue neurotransmitters we haven’t noticed yet? Or old ones working in anomalous ways? It always kind of offends me the way one chemical does seventeen different things, depending on other chemicals present, cell types, phase of the moon, or whatever.

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Yeah, lycanzymes are temperamental.

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A post was merged into an existing topic: Well this is interesting

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And that’s how we get graded exercise therapy for fm and cfs, the fraudulent PACE study to back it up, work requirements for Medicaid, etc. Even though too much exercise is known to trigger post-exertional malaise in fm and cfs, and pacing to regain strength and stamina without triggering post-exertional malaise is notoriously difficult.

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whether it’s in your gut, or your blood, or or brain

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The way those are being used by the medical field, does that really qualify as:

This isn’t a general medical thread – this is for the truly harmful quackery (like “just ignore pain and don’t talk about it”).

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2 posts were split to a new topic: All the healthy stuff

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So does that mean I’m already dead? Because I can’t eat a lot of the foods that naturally contain a lot of important vitamins. Like vitamin c which comes from fruits and certain organ meats. And I can’t rely on a lot of the foods that are fortified with them, because they’re fortified with the wrong forms. Like thiamin mononitrate, which triggers my migraines.

P.S. And correlation is not causation. People may be taking these supplements because of health issues, whether it’s because they can’t eat certain foods, or because they’re very sick and not getting treatment and trying to find accessible and/or affordable options.

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Well, yes, that’s true. In fact, supplement use is correlated with better health. The study was trying to take care to tease out the effects of supplements, both as a whole and individually, by controlling for other health-related factors:

At first glance, those taking supplements seemed to fare well—showing a reduced risk of all-cause mortality during the survey. But that association vanished when the researchers considered demographic and health data. “Our results and those of others suggest that supplement users have higher levels of education and income and a healthier lifestyle overall (for example, better diet, higher levels of physical activity, no smoking or alcohol intake, and healthy weight) than nonusers,” they wrote. Thus, “the apparent association between supplement use and lower mortality may reflect confounding by higher socioeconomic status and healthy lifestyle factors that are known to reduce mortality.”

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That article made it sound like an incredibly vague, too-large study.

I used to eat a couple of packages of baby spinach a week and two cups of almonds a day – not exactly healthy from a calorie intake point of view. Turns out I was deficient in magnesium. Figured it out with some help when my muscles started spasming.

It took two weeks for the supplements to kick in.

Anecdote not data, blah blah blah, but I couldn’t help but notice the article failed to mention of the people taking the supplements were actually deficient in anything, or if they had difficulty absorbing certain nutrients (B12 is another one for me).

Yes overall diet is important – which is why models and actresses infamously need to watch their fat intake, because if it goes too low they are at risk of not being able to absorb vitamins E and A – but it falls to address how a lot of us wind up on supplements in the first place: because we’re eating the prescribed foods and winding up deficient anyhow.

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My vitamin D was low, probably due to low rate of absorption due to crohn’s, so I started taking supplements. The level went up. Makes sense.

But if you’re getting enough through food, then supplements won’t do a darn thing, and may cause problems – too much calcium can lead to calcification of blood vessel plaque and blood clots, strokes, heart attacks and so on.

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I think that was the point they were trying to make, along with the fact that if, as an example, your calcium intake goes through the roof due to dairy products, your body can eliminate the excess a lot easier than if it goes through the roof due to a calcium supplement, and the same seems to hold true for other supplements.

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But how are you supposed to know? Unless you have access to a doctor and approval for blood tests?

Aside from watching symptoms-- my slightly bluish sclerae and recurring folliculitis may point to some kind of anemia, or maybe not. my neurological issues, and fatigue, and post-exertional migraines, who knows.

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This is assuming a decent health care system that doesn’t exclude people, which we do not have.

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I think both of these things can be true without necessarily contradicting each other. Clearly, vitamins/micronutrients affect your health, especially if you have too much or too little of a particular one. My mother (if I may add my own anecdata point) was having issues with fatigue and energy levels and went through quite a bit of dietary experimentation and analysis until they ultimately ended up giving her a vitamin B (maybe B12?) shot, or rather, a series of such shots, and she said it was like night and day. It fixed her right up.

But most people aren’t my mother.1 And I think that was kind of the point of the study. Not that they can’t help some people, but that supplements are probably useless for most people taking them, and might even make things worse for some.

FTA:

Still, more than half of all adults in the US say they use supplements. Ten percent of us report using four or more each day.

That’s a lot of people taking something they probably don’t need, and some of them will likely be worse for the wear. And I think that’s a point worth raising.

I once heard a nutritionist describe their efficacy as something like “vitamins mostly just give you expensive pee.” The way she phrased it was funnier than that, and she was careful to qualify her skepticism, but the point was that most of whatever nutrient you get from a supplement is going to just pass right through, instead of being absorbed by the body.

That’s a good point. If you can’t get some help identifying the root of a particular complaint, I can totally sympathize with the urge to experiment with whatever potential remedies are available to you. I even get hedging your bets and taking a daily multivitamin “just because”.

But I think there’s also another form of the “how do I know?” question. At the risk of adding to your uncertainty, how do you know that the supplements you’re taking actually contain the nutrients that you think they do, in the dosages that you think you’re getting?

The OP contains a link to another Ars post, that says:

The Food and Drug Administration is not authorized to review supplements for safety and efficacy before they hit the market. That means the bottles and capsules that line the aisles of grocery stores, pharmacies, and specialty shops may not contain what they say they do. They may have wildly variable amounts of supplements in each batch. They may have hidden, illicit components like amphetamines. They may even have harmful contaminants such as lead and cadmium.

The bottom line is that these supplements could contain just about anything, and you have no practical way of knowing what’s really in them. I used to feel like I needed a tin foil hat disclaimer when I talk like this, but given the reality of our neoliberal global economy, late stage capitalism, and all that, I don’t think I actually sound all that wacky. After all, just because you’re paranoid doesn’t mean they’re not out to get you. And we’ve seen plenty of evidence that they really are out to get us (e.g. Purdue Pharma and the Sacklers).

1. which I suppose is kind of tautologically obvious, I’ll admit. :wink:

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Regarding a slightly different kind of supplement

This is why when people tell me I should try this super fancy herbal supplement they found I tell them that I will stick with ibuprofen for my headaches and desloritidine (Aerius) or Benadryl for my allergies. Because drugs are regulated.

I don’t care how “natural” your exotic plant extract is. Mine comes from somewhere with proper QA and has known side-effects and interactions. The LD-50 has been recorded. Sure, it’s manufactured chemical. It’s also an unadulterated (fillers, yes. Undeclared substances, no) measured and standardised dose.

Big Pharma may not be angels, but I generally trust them more than Big Supplement (and some of those are huge).

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