Why Doctors Hate Science 1064
theodp writes "A 2004 study found some 10 million women lacking a cervix were still getting Pap tests. Only problem is, a Pap test screens for cervical cancer — no cervix, no cancer. With this tale, Newsweek's Sharon Begley makes her case for comparative-effectiveness research (CER), which is receiving $1 billion under the stimulus bill for studies to determine which treatments, including drugs, are more medically sound and cost-effective than others for a given ailment. Physicians, Begley says, must stop treatments that are rooted more in local medical culture than in medical science, embrace practices that have been shown scientifically to be superior to others, and ignore critics who paint CER as government control of doctors' decision-making."
Evidence-based medicine (Score:5, Interesting)
In 1999 Merenstein examined a healthy 53-year-old man who showed no signs of prostate cancer. As he had been taught, Merenstein explained
US Doctors are fucked (Score:0, Interesting)
The next decade of 'change' in the US will reduce doctors to government functionaries. Too bad you sunk $150k into that education... you will soon be making the equivalent of 4 year engineer wages, and you'll have less discretion while earning it.
You deserve it. All of my life I've listened as the grabbers made their claims; US infant mortality is higher than the socialists, US lifespan is short because of free market medicine. Claims that the majority of US doctors would prefer a collectivized system. It all went unanswered by you. It was fear of offending your international colleagues. Fear of revealing the truth about canukistan's medicine, for instance. It's hard to defend a free market system while arguing for more government *-cade dollars, isn't it?
You kept your mouth shut because controversy is unpleasant, and now the barbarians are at the door. Enjoy your ass raping. That's what CER is all about; determining the precise technique and quatity of lubrication necessary to fuck the doctors and hospitals right up the tailpipe.
And if you educrats out there think Uncle Sam is going to pay full retail to make higher education 'free' in this country... LOL.
Re:Evidence based medicine is extremely frustratin (Score:4, Interesting)
When people bring their kids in to get some gravol for their viral gastroenteritis, I tell them that it has been shown to be no better than placebo, so I don't offer it.
Have you considered that, although it's no better than placebo, it might be better than nothing? Saying it's no better than placebo doesn't actually mean that they won't see a difference if you don't prescribe anything. It's why they use placebos in trials.
Re:Evidence-based medicine (Score:2, Interesting)
By the time a cancerous growth is detectable, 4 billion cancerous cells have been produced. Based on the average rate of cancer cell mitosis, the patient has lived with cancer for 10 years by the time an early-detection test proves positive. Therefore, in cases where precancerous growths are not detectable without invasive surgery (yours is an exception), such a result makes little difference in the remaining lifespan of the patient. Thus "early" detection should really be called "late" detection, and such tests aren't always warranted if no symptoms occur.
Re:Evidence-based medicine (Score:2, Interesting)
This is precisely the point - no doctor hates science, and the medical profession as a whole are champions of scientific thinking when most other professions have yet to be introduced to the concept.
Unfortunately this is severely mitigated by two groups - lawyers and patients.
The original article could equally be titled 'why lawyers hate science' - as the parent says, many judgements against doctors are based on whether something could have been done, not whether there was evidence to support doing it, or even whether it would have been effective.
Patients come to doctors with the expectation that something will be done, and a significant part of medicine is allaying the fears and anxieties of the patient.
The cover-your-ass imperative imposed by lawyers and the demands of anxious patients significantly skew treatment away from the scientific ideal - the desire to make money (while also significant) is a distant third, and largely reflects that monetary incentives in private medicine do not match well with the interests of the patient (i.e. a systemic funding problem).
But the title of the original article - implying that doctors hate science - is utter crap.
Re:Evidence-based medicine (Score:3, Interesting)
Re:Random quote (Score:5, Interesting)
The quote I like best is: "What do you call 'Alternative Medicine' that works?" "Medicine"
they already are pretty constrained (Score:3, Interesting)
The vast majority of procedures are highly constrained by insurance rules: either the government in the case of Medicare, or private industry in the case of various HMOs and insurance plans, have complex rules about what must be done in what order to get reimbursement. Doctors already have to follow that, so it'd at least be an improvement if those rules had some basis in scientific evidence indicating what treatments really are better.
Insurance company propaganda (Score:5, Interesting)
The cost effectiveness arguments she makes are bunk. E.g., if the old line drugs for schizophrenia are so great, why haven't they worked? And why is dehydrating someone the best way of treating high blood pressure? Give me a break.
Politicians may hate science, and certainly the health insurance companies hate science, and both like to think in terms of cost effectiveness, unless of course it's their own health that's at stake, in which case they want the best "science" available. And maybe some journalists hate science if they've absorbed enough behind the scenes insurance lobby propaganda.
But of all the groups mentioned in the article, it is the doctors who hate science least, and who are most about trying to find the right answer, the right answer meaning the one that is best for the patient's health, as opposed to the insurance company's bank account.
(And in case you're wondering, I'm not a doctor, and have never even had any relative or personal friend who is a doctor; but I do remember my first doctor, who had, under a large glass dome, a giant gold microscope, which occupied the central place of honor in his office... a clear homage to his love and reverence for Science. And in practice he cared for the lives of his patients as though they were his own. And I guess they were.).
Re:The assumption here (Score:1, Interesting)
The assumption here is that pap smears are of no value in women who do not have a cervix. While this sounds true on its face, where are the data? Vaginal cancer has many of the same risk factors as cervical cancer and is increasing in frequency. Can a pap test detect vaginal cancers and pre-cancerous conditions?
Re:Evidence-based medicine (Score:5, Interesting)
This simply demonstrates that the system is being rigged by a culture of "Get Rich" thinking. A significant number of people practicing medicine today shouldn't be allowed to practice playing a Kazoo, and they're in it, because they thought they could make a lot of money (plastic surgeons who shouldn't be allowed to butcher meat seem to spring to mind first.) Insurance companies who keep jacking malpractice insurance into further and further into space, happy to support hospitals in charging 10,000% markups on supplies, because it allows them to justify taking larger and larger cuts without looking like they're the source of the problem. Lawyers looking to sue at the first instance of a patient passing a particularly unpleasant flatus. Drug companies whoring out doctors to peddle their products, making silly analogs that are less effective than 20 year OCR alternatives, but pushing these pseudo-new-drugs at top dollar because the can bring in massive profits with little or no research. Finally patients, suing anyone and everyone for the most ridiculous and insane excuses. Did I say finally? Forgive me. A government made up of lawyers who've meticulously built a system that empowers every one of these participants in pursuing endless litigation, all in desperate hope of winning their personal legal lottery ticket.
Returning medicine to a social service designed to promote health and treating illness would solve the whole problem. Unfortunately, as long as you have this financial circle-jerk, with each participant's hand in his neighbor's pocket greedily digging for what only God knows, the chances of any sanity coming to this venue are slim and none. In short, anybody with more that two neurons to rub together would have to agree, it's a total botch, and we need to overhaul it if there's any hope of it getting fixed. Sadly, the folks most engaged are the ones who have the most to lose, and the ones who will fight hardest to keep taking as big a slice as the limits of avarice and capital punishment will allow.
Re:Evidence-based medicine (Score:4, Interesting)
no doctor hates science, and the medical profession as a whole are champions of scientific thinking when most other professions have yet to be introduced to the concept.
I agree.
Unfortunately this is severely mitigated by two groups - lawyers and patients. The original article could equally be titled 'why lawyers hate science' - as the parent says, many judgements against doctors are based on whether something could have been done, not whether there was evidence to support doing it, or even whether it would have been effective.
That is sheer and utter nonsense.
Patients come to doctors with the expectation that something will be done
What's wrong with that?
and a significant part of medicine is allaying the fears and anxieties of the patient.
1. That's not the "medicine" part, that's hand holding. And any way
2. What's wrong with that?
The cover-your-ass imperative imposed by lawyers
The only "imperative" imposed by the courts is that "reasonable care" be applied? Why is that so terrible? Why is that so onerous? Most medical care is far, far above that relatively low standard.
and the demands of anxious patients significantly skew treatment away from the scientific ideal
Nonsense.
- the desire to make money (while also significant) is a distant third, and largely reflects that monetary incentives in private medicine do not match well with the interests of the patient (i.e. a systemic funding problem).
Oh yeah and the insurance companies' financial interests do match up?
But the title of the original article - implying that doctors hate science - is utter crap.
On that we can agree.
CER and medical culture (Score:3, Interesting)
I guess we do, now.
The quote is from a very interesting article [newyorker.com] on the use of checklists in emergency rooms, how effective they are, and how much the medical culture resists them.
Re:Evidence-based medicine (Score:1, Interesting)
at some point it must again become desirable to just do the test for X on everyone. Does that make sense?
Only if the problem with the test was that it had false positives. The problem with prostate screening is that the vast majority of people die of old age before their prostate tumor kills them, meaning that if you go and cut him open as a matter of routine, you're more likely to kill him (eg MRSA) than you are to save his life.
Re:Evidence based medicine is extremely frustratin (Score:3, Interesting)
I guess I do sometimes prescribe and perform treatments that have little evidence behind them. The problem is that the placebo effect is not necessarily statistically significant. Is it worth taking the gravol to have one less barf over the course of the illness? Maybe...
It's hard for me to recommend anything that has potential to harm, unless I firmly believe that the benefits outweigh the harms. That's the crux of the issue for me.
Many people I see take a number of medications, prescription and non that I may not even know about. There are potential dangerous interactions there that I don't/can't/won't know about. Even non dangerous side effects can be problematic. There is also the fact that medications cost money. I don't want people to waste their money on a treatment that is no better than placebo.
I do prescribe things that are of nebulous benefit, when people are desperate to try something, or to cling to their experience that it works.
It's just not my style to prescribe unnecessarily (in my opinion). If you see me for your cold. I will tell you to rest, take some advil or tylenol, suggest a decongestant and give you a note for work if you need it. If you see my partner, you will get a prescription for cough syrup (most do nothing), painkillers and decongestants. He also has a very low threshold for prescribing antibiotics. The net result is that his patients are extremely satisfied and his visits are quicker. My patients leave somewhat disappointed, often come back (I'm STILL sick!!!) and I have to spend a lot more time educating my patients. The patient populations self select over time and the pill poppers go to him, and the pill averse come to me.
Re:Smart move (Score:5, Interesting)
I had an unfortunate incident of that. I came in with depression/anxiety, and my doctor put me on Paxil. Not because it was the best choice, but because it was the NEWEST one, and the lovely dinner the pharamceutical company paid for had these nice salesmen who told all the doctors how safe and effective with it.
After one night on it, I stopped it and made another appointment with the doctor. To say I had a bad reaction would be an understatement. I'd describe it as extreme anxiety with hot sweats and other wonderful symptoms. Cut to a few years later, I start reading in the news about "unreported" side-effects of Paxil and the drug maker being forced to issue updated clinical notes. Now the warnings [medicinenet.com] list all these things.
The appallingly bad knowledge, especially about new drugs, family doctors have is downright frightening.
If you want to know how my story turned out, I got a referral to a psychiatrist who had many, many years of experience and helped me figure out my problem was a combination of biology, a sleeping disorder I'd recently been diagnosed with and really bad work environment. He helped me figure out which drug worked better for me (one that was new, but was relatively less marketed), talked me through how to make the appropriate changes in my thinking and lifestyle to survive bad times and then after the appropriate monitoring time, sent me on my way, and I've been overall pretty good.
The lesson here is our doctors need real medical knowledge to draw on--not just what the marketers and sales people tell them. Family doctors are usually over worked trying to pay the office rent, the receptionist, the malpractice insurance, etc. And they don't have the time or energy to keep learning anymore, and what they do have time for is usually not of high quality to begin with.
I for one am looking forward to this. It doesn't just benefit America--it could benefit everybody.
Re:Smart move (Score:5, Interesting)
Comment removed (Score:1, Interesting)
Re:Evidence-based medicine (Score:4, Interesting)
US emergency medicine guidelines, for example, are extremely aggressive and notorious for over investigating.
Good God I know this part first hand. I went to the ER because I had chest pain in my left side. I'm young, so I thought heart problems were highly unlikely but better safe than sorry. The doctor that saw me surmised that it was probably an irritated GI tract, which I know that I have problems with, and was nothing serious. Then he proceeded to order blood tests, CT scans, and others. I said screw that and refused treatment. A nap did just fine to make the problem pass. Again, some evidence suggests that CT scans may do more harm than good, and really should only be used when necessary. Diagnosing constipation is hardly a proper use for a CT scan and racking me up a couple thousand dollars in medical expenses.
Comment removed (Score:1, Interesting)
Re:Evidence-based medicine (Score:5, Interesting)
US emergency medicine guidelines, for example, are extremely aggressive and notorious for over investigating. The priority is protecting practitioners from litigation rather than appropriately treating the patient.
Actually one of the big reasons that EM diagnostic evaluation is more aggressive than usual is that (shock) patients actually do have a hint of what is important. That is, if you take a random person who goes to his family doc with chest pain versus one who goes to the ER the former is less likely to have significant coronary artery disease. So its not surprising that if you compare ER with primary care, it is good medicine to be more aggressive with diagnostic evaluations in the ER.
That said, hell yeah as an ER doctor I sometimes practice defensive medicine. If you place me in an environment where people can effectively sue me for what I might make full time in 20 years for a bad outcome that happens despite me practicing medicine that meets the standard of care in my practice environment I sure as hell am going to practice defensive medicine. The fact that I don't always do aggressive diagnostics in every patient is either me being a Pollyanna or perhaps taking my patient's best interests at heart. I'm willing to put my neck on the line somewhat to avoid a CT in a toddler who just has overprotective parents, but your fat, diabetic, smoking, sedentary, litigious ass is just not cute enough to get the my sympathy.
Re:Politics of health care (Score:5, Interesting)
The other proposal came from McCain, who wanted to eliminate the employer's tax-credit (the part Obama emphasized during debates) in favor of giving each individual a tax-credit (the part Obama never acknowledged) to be spent on their own health care. This would've created the same kind of market for health insurance as exists for, say, auto, term-life, house, and other insurances. The decoupling of health care from employment would've been much more fare, and the prices would've come down because of genuine competition.
"fare" is right! What kind of negotiating position does someone who needs life-saving care have versus an insurance company? A poor one. The only people who would be able to afford health insurance in that plan are people who don't need it. You'll note that McCain himself didn't seem to eager to buy his own insurance rather than take his employers.
The most efficiently run medical payment service in this country right now is medicare with over 95% efficiency in terms of money going to treatment vs. overhead.
Re:Smart move (Score:5, Interesting)
You are seriously misinformed. There are two important things wrong with what you're saying.
First, the cost of providing emergency care for accidents isn't something that can be reduced, period. What we can do to reduce health care cost is to increase participation in early detection and treatment of disease, which is *FAAAR* more effective (and cheaper) than treatment later on. It's like a city providing free needle exchanges, because that's are far cheaper than treating someone who contracts HIV or some other horrible disease.
Of course, US health care doesn't run on logic, but rather puritan morals and vague capitalist ideology. The most effective way to prevent teen pregnancy, as determined empirically, is early sex education and free condoms, not home schooling and regular church attendance. But we can't use the most effective method.
Secondly, health care is something that people need throughout their lives. As our population gets older, it's not "insurance" for accidents, but rather an on-going part of their care. Which means there is a continuous, fixed cost that must be paid to take care of someone. Therefore, an "insurance" scheme, where risk/profit is calculated to determine premiums doesn't really work. It's much better to spread the risk to the whole population, and have full benefits for everyone.
The reason health care system in the US is so broken is because it's dominated by interest groups that want a continuous supply of "sick" but rich people. Think of the drug and insurance companies, the plastic surgeons and viagra peddlers. Nobody is really interested in the well-being of the people, and those who should--the citizens of this country--can only imagine a world they see in commercials made by drug and insurance companies. Sad indeed.
It's reflex (Score:1, Interesting)
My father is a doctor-- a radiologist. He is definitely good at medicine, and chemistry, and a lot of the science related to his job.
We talked about the tedium of work (comparing engineering to medicine). He all but told me that 99% of the time it is reflex. And the remaining 1% of the time is actually interesting.
It kind of put it in perspective: Some doctors handle many cases a day, over decades of work, and the problems are fairly routine. I bet it would be difficult not to develop some sort of internal automation to handle the boredom.
Hell, I get bored working on the same system for more than a year. I can't imagine working on the same system (human) for my entire career.
Re:Evidence-based medicine (Score:5, Interesting)
Unfortunately this is severely mitigated by two groups - lawyers and patients.
The original article could equally be titled 'why lawyers hate science' - as the parent says, many judgements against doctors are based on whether something could have been done, not whether there was evidence to support doing it, or even whether it would have been effective.
That is sheer and utter nonsense.
I wish it were nonsense. There was a US case about a patient who had an acute spinal cord injury. There is a controversy about whether or not to give steroids in these cases to reduce swelling and decrease subsequent injury. So far the consensus is that it doesn't help. The ER attending physician therefore did not give steroids. The patient had a bad outcome. The ER attending was found guilty (not sure what the correct term is) because the prosecution found an expert witness who said that it might have helped.
The only "imperative" imposed by the courts is that "reasonable care" be applied? Why is that so terrible? Why is that so onerous? Most medical care is far, far above that relatively low standard.
The difficulty is in defining reasonable. It seems that some lawyers are very good at skewing this definition.
Most physicians practice 'defensive medicine'. That means they do things that are medically unnecessary, solely to protect themselves from frivolous lawsuits. Good medicine alone unfortunately won't protect you from malicious (or vulnerable and wounded) people, looking for someone to blame.
I can tell you a number of cases where the physician was found guilty and they did nothing wrong. The jury just didn't like how things turned out for the patient.
(Big fan of yours by the way!)
Re:Smart move (Score:5, Interesting)
Sorry but you are massively uninformed. There are different kinds of health insurance just like there's different kinds of auto and disability insurance. What you are talking about is a "major medical" policy that only kicks in when your costs exceed ~$2k. This is the exact kind of policy I have. Why do I have this kind of policy? Because to get a policy that starts at $0 would cost me over a $1k a month. So, these policies already exist and they are already VERY common. The fact that you and the parent poster don't know about them is utterly fucking shocking to me. Even with major medical, I still have to pay over $200 a month for health insurance just for myself (non-smoker, non-obese).
The bottom line is that the cost of health care has skyrocketed compared to average income. It becomes less and less affordable and is becoming a greater and greater burden on the economy. In fact, the idiots that perpetuate the system we have today are driving us into socialized medicine (their worst fear) just because there will be no other way to deal with the costs. Frankly, I can't wait just so I can laugh my fucking ass off. Most doctors fucking suck anyway. Like everything else, 90% of them are worthless. Too bad you don't have time to shop around while you're in the middle of a heart attack.
"After all, if the government was or is so efficient at providing health care then why not have them provide other things too like cars, vacations, computers, designer clothing, and everything else that people want."
You must be fucking kidding me. It would be impossible for even the government to be less efficient than what we have today. Socialized systems in other western countries are far more efficient. We spend TWICE what England and Canada do per capita on health care.
Seriously, you need to actually READ about this stuff before you spout your mouth off. You have no idea what you're talking about.
Re:Evidence-based medicine (Score:3, Interesting)
Re:Smart move (Score:3, Interesting)
Dude... if an appeal to humanity doesn't move you, how about cold, hard economics? Yes, actually it IS your responsibility. It's the responsibility of all of us, and it makes good business sense to make it our responsibility. I am content to delegate those responsibilities to specialists and trustworthy organizations, and not worry overmuch about it myself. But I know it costs, and I'm willing to bear my share of those costs. Naturally I want the resources used wisely.
Our tax money paid for his education. I am NOT willing to have that huge investment thrown away, not when a tiny little thing can save it. Presumably he's eminently employable, and pays more in taxes than he takes in services. It'd be different if he was old and suffering, terminally ill. But for a relatively young person, you'd have to be crazy to have him die when a one time operation can save his life, enabling him to provide many, many more years of service to the community. If the Goose that Lays the Golden Eggs catches the flu, and the choice is spend a little on medicine to save it, or let it die, you'd be stupid to let it die. Even if it's not your goose you should still want it to live, and be willing to help if possible.
Brutality isn't just mean, it's dumb and costly. What is your problem that you can seriously say such things? Yes, yes, rugged individualism and all that, and he ought to take care of himself, but often a person can't. Can't ever learn enough to always know when you've a problem that can be solved and is worth solving, can't be certain you will never be in a financial bind at the worst possible time. Set aside your hateful emotions and do the math! Just amazing the way some people will spitefully let something go to waste, refusing to see that doing so hurts them financially. Help your community, and in doing so help yourself!
Re:Evidence based medicine is extremely frustratin (Score:3, Interesting)
I'd much rather live in a society where ALL of the facts are on the table, even if it means some people take it the wrong way. This includes the facts of "We simply don't know. Some people think this, other people think this. The margin of error is so high that it really could go either way. So the answer is maybe, maybe not."
People HATE that.
It makes them feel like there's nothing tangible to hold onto and they're floating around in the unknown. So they cling onto the best guess. If a study has a 50% margin of error, many people take the results in the same way as a study with a 1% margin of error.
This is why politicians, doctors, computer technicians, etc, have learned to give only half of the story when recommending something. It's quick, and the person would probably come to the same decision if they had all the facts. But it leads to misinformation. And when 'exceptions' come into play, the person given the one-sided information has no tools to make an informed decision.
Re:You missed the point (Score:3, Interesting)
Ahh yes. The classic broken window fallacy [wikipedia.org].
GDP is not the end-all of economic analysis. Just because an action or a policy increases GDP does not mean that the nation is better off for it. Paying workers to dig ditches and then fill them in again will likely displace workers from projects that are actually useful. By artificially increasing the demand for labor, the supply of labor available to useful projects is diminished. By increasing the cost of an important input (labor), the number of useful projects will be diminished. The country will be worse off as a result.
No one has ever tried anything like the spending bill on such a large scale before. The coming years will provide huge amounts of interesting data for macroeconomists. I don't appreciate being a labrat in the largest macroeconomic experiment in history, but part of me is very interested in seeing the eventual results.
Re:"Over-investigating?" (Score:3, Interesting)
Yes, but maybe that is not "over-investigating". Maybe that is deliberately trying to make more money by being dishonest.
I understand that folks are cynical. People tend to be particularly cynical about professionals (lawyers, doctors, mechanics, etc.) because their deep domain knowledge is hard for outsiders to attain, but anyone can learn just enough to be dangerous or at least play armchair expert.
The fact is, there are jerks in any field, but as another poster has said, most people are honest. The media likes a good story, though, and we like to hear those good stories. No one wants to hear about the thousands of doctors who do their jobs properly. Everyone wants to hear about the evil doctor who padded his bills or the accountant who skimmed his clients' accounts.
With regard to doctors, how do you think that an ER doc is going to make more money by ordering a CT? They're paid a salary. They don't get commissions on number of CTs ordered. The reality is that most imaging services are run by organizations external to the hospital. The equipment may be on-site, but many hospitals these days work with radiology practices rather than having their own on-staff radiologists. I'm sure the hospital does make some money on it, but I'd be willing to bet the cost of a CT that the doc was just covering his ass. Malpractice insurance is expensive, and it gets more expensive if you're sued (even if you don't lose).
Bad examples (Score:3, Interesting)
If some of the examples given in the article are representative, I have to side with the doctors on this one.
The glaring one to me: "A 2006 study of schizophrenia drugs found that old-line antipsychotics were as effective as pricey new ones."
Uh, yeah. Perhaps even more effective. The main problem with those old-line antipsychotics isn't their effectiveness, it's their side effects.
Others have pointed out that testing for cervical cancer is still useful after total hysterectomy (especially if the hysterectomy was for cervical cancer), despite what the author thinks.
Re:Why kdawson hates doctors (Score:5, Interesting)
And what team would that be? For the record, I'm an Independent and always have been. I loathe the two parties nearly equally, but I have to admit, I find the Republicans particularly more onerous lately. That doesn't mean I support the Democratic agenda in any way, shape, or form.
You know, normally I love anti-partisan rants like this, but re-read my post. I never advocated for any healthcare reform proposal. All I did was dispute the history behind HMOs as stated by the GP. It was a statement of fact. I never even talked about Obama and his healthcare proposal.
I shouldn't have to qualify any critique of the Republicans with a critique of the Democrats. Buying into the false dichotomy of the two-party system is part of the problem...
-Grym
Re:Why is govt-provided health care worse? (Score:3, Interesting)
Citation? I've never heard of this happening in the USA or anywhere else I've lived.
Doctors hate doing research too! (Score:3, Interesting)
At least, I've met very few doctors who would ever do any out-side research into what was ailing me. If they didn't know right-off what it was that was bothering me, they would send me away untreated. Or they would prescribe drugs that were inappropriate or superficially purported to treat symptoms.
It wasn't until I went to see a clinical nutritionist who wasn't afraid of doing some off-hours research that I was able to make any headway into the causes of my CFIDS. Turns out that the root cause of all of my problems was an intestinal parasite. On reflection, I had all the classic symptoms, both in terms of GI symtoms and other side-effects (energy problems, alergies, etc.), but every GI doctor I went to just treated my IBS symptoms and completely ignored the fatigue and never considered doing certain basic tests. Infectious disease doctors never found anything either. One doctor did a endoscopy, looking for anything mechanically wrong, but that wouldn't identify a protozoan.
Similar things happened with my wife. They wanted to treat her with antidepressants, when it turned out that she had a helmenth that caused mood problems as a symptom. When the nutritionist's ordered tests found that, some flagyl cleared it right up, and voila.
This is a problem with MD's especially. DO's are a little better, coming from a traditionally more open-minded discipline, but even they tend to operate a revolving door.
As a counter point, I also had strabismus. (My eyes crossed, and an in unusual pattern.) I had to get more than one opinion, but I found this one eye doctor who specialized in correcting pediatric eye alignment problems. He was absolutely fantastic. Other doctors told me that correcting my problem wasn't even possible. This guy knew exactly what to do, did it, and the results have been brilliant.
This leads me to differentiate between surgeons and medical doctors, and I have come to respect the surgeons a hell of a lot more. (But this is just due to my relatively small statistical sample.) Modern medicine seems to be good at treating COMMON illnesses and physical problems that are easy to measure. Anything else, and you're out of luck.
So, after the nutritionist found our problems, we went to a DO, and he happily wrote scrips. Because we had certified medical test results from respected laboratories. Which he himself would never have thought to suggest we get.
This problem with the medical system tends to lead to a catch 22. If you have a problem and don't know anything about it, they won't treat you because they don't want to investigate. You have to learn all about the medicine yourself. But when you do that and discuss symptoms and potential causes with them and even use the right terminology and talk about "differential diagnosis", they label you a hypocondriac and send you away untreated. We were just lucky enough to get a nutritionist with the right credentials who herself was willing to do the research and arm us with hard test results that we could use to get the MDs to do what we needed.
Now, while MDs won't argue with you about hard test results, they WILL argue about treatment. I have a friend who got lyme disease, having been bit by a tick. Classic bulls-eye shape. The doctor gave her the WRONG TREATMENT (one that is specifically cited as being ineffective against this disease). When it didn't work and the disease started to enter some late stage that's dangerous, my wife had to go into the doctor's office with her WITH THE MEDICAL TEXT that lists the appropriate treatments before the doctor would prescribe the right medicine. And lo and behold, the treatment worked. Fucking moron doctor.
Re:Smart move (Score:2, Interesting)
Your story is puzzling for several reasons. Paxil (paroxetine) is off-patent and now costs $15/month. For many patients, it is the best choice - really a lifesaver. Might it be possible that your physician decided it was the best choice for you after examining you carefully and knowing something about your history, and not because of a free lunch? Maybe he took your complaints seriously, rather than just suggesting a change in work environment and sleep habits?
Typically, patients ramp up to a therapeutic dose of SSRIs over several weeks. These drugs require considerable time to achieve any effect. It's unlikely that one or two pills would have had the effects you describe.