Are We Entering in a Mini-Dark Age in Medicine?

[jmj11]

Most of us are very aware of the bullshit information passed around about COVID in the past three years. As part of the county vaccination project, I found myself often in discussions with COVID deniers, vaccine opponents, etc. But I think there is a deep digression away from evidence-based medicine by a significant group of our society. Not a majority, but a significant group.

I live in very progressive area of the country, where a patient is as likely to have a naturopath or chiropractor as their PCP as a MD, DO or PA. I had a small group of patients, at the point of my retirement three years ago, who came to see me only for tests (brain MRI) that their insurance would pay for, but never believed anything I said and never followed any treatment I offered. They suffered horribly trying bogus treatment after bogus treatment.

I have been quite healthy all my life, never having been in a hospital as a patient until 2019 and I was diagnosed with cancer. Now, I exist in the world of patients. I have not participated with any type of patient support group, until this week. A question came to me from the group that I as in position to answer. So, I went to the group to answer the question and then presto, next thing I know, I’m behind the looking glass having tea with Alice. I found a community that lives and thrives on bullshit information, rather than trusting their providers. Just as I faced people screaming not to get a COVID vaccine or you would die, or melt, or turn gay … whatever; on this patient forum, were the naysayers screaming for everyone to get off their chemo and other treatments. I couldn’t bear it and will not go back.

At the Seattle Cancer Care Alliance, were I go for treatment, a few years ago they decided to form a partnership with the nearby naturopathic school. It was a business decision because patients were demanding alternative treatments for their cancer. However, soon the evidence-based providers within the system were faced with a real quandary. The alternative people were not acting in complimentary roles, giving a wider spectrum to care as they had hoped. They were contradicting the care the experts were giving, telling patients to stop their chemo and start a special diet and supplements. So they had to end the partnership. 

Don’t get me wrong. I take a bucketful of supplements every day and exercise like crazy, etc. I chose each supplement based on some scientific evidence, despite how thin that evidence is. However, I’m a realist, based on the studies done, that these supplements have a snow-balls chance in hell of influencing the outcome of my disease. Yet, they most likely will not hurt.

Maybe there are places where CAM is being realized, where people who know diet and supplements and hands-on physical medicine (chiropractic, massage, acupuncture, etc.) are working in respectful ways with evidence-based medicine. However, I sense that 25% or more of our country will have worse health outcomes and shorter lives with more suffering, because they have been told lies about the nature of disease and treatment. Don’t get me started on the franchisization of evidence-based medicine where insurance companies decide the care and the tests … yet have a financial interest in the early demise of a sick patient (they don’t pay death benefits, only medical care benefits). That story is or another day.

There’s a question in this ranting. I’ve been out of hands-on medicine for three years, but do you see it? From my experience with COVID vaccinations, I decided to stop arguing with people and let them make their own choices but I saw a friend die from COVID mis-information and several others suffer tremendously, some with long-haul COVID now.

Edited April 29, 2022 by jmj11

[ohiovolffemtp]

1 hour ago, jmj11 said:

Don’t get me started on the franchisization of evidence-based medicine where insurance companies decide the care and the tests … yet have a financial interest in the early demise of a sick patient (they don’t pay death benefits, only medical care benefits). That story is or another day.

Wow, I hadn't thought of it this way, but it certainly makes sense.  I belong to an email forum of retirees from the Fortune 50 company I worked for before medicine.  There are many threads there about hassles getting insurance to pay for diagnostics, medications, and treatments prescribed by their physicians.  I always assumed that the payers prioritized returns to shareholders above patient care, but never thought through the implications like you have.

[CAAdmission]

The government and the media have done nothing but lie to people for decades now. This has eroded the public's trust in all authority figures. 

Welcome to the death of objective reality. 

[iconic]

Mini dark age? 
 

I think it’s a dark age for a long time 

[Cideous]

8 hours ago, CAAdmission said:

The government and the media have done nothing but lie to people for decades now. This has eroded the public's trust in all authority figures. 

Welcome to the death of objective reality. 

Science is science.  The scientific method if utilized properly is truth without pride or prejudice.  The scientific method works....humans don't.

 

[sas5814]

I gave up on convincing people a few years back. Between the massive amounts of misinformation that is available and health care being twisted for political purposes... I just don't. 

I say "this is the truth as I understand it" and then they are free to make their own decisions good, bad, or otherwise. I don't lose a minute of sleep over it.

We have to thin the herd out somehow.....

[Cideous]

18 minutes ago, sas5814 said:

I gave up on convincing people a few years back. Between the massive amounts of misinformation that is available and health care being twisted for political purposes... I just don't. 

I say "this is the truth as I understand it" and then they are free to make their own decisions good, bad, or otherwise. I don't lose a minute of sleep over it.

We have to thin the herd out somehow.....

Comedian Bill Burr has a hilarious bit on thinning the herd.  He talks about loading up cruise ships, sending them out to sea on vacation then sinking them with a torpedo from a sub.  The bit is really funny and I think stemmed from him getting pissed while sitting in traffic, LOL!

[ventana]

No need for the torpedos.  Just put Covid mary on the ship full of unvaccinated.  
 

I am resigned to help those that want my help.  Rest of them I simply don’t have the energy for.  
 

yup gonna get worse.  

[CAAdmission]

15 hours ago, Cideous said:

Science is science.  The scientific method if utilized properly is truth without pride or prejudice.  

That sounds great, but the practical reality is much more complex. The great unwashed masses think you run a study, get the results, and have your answer wrapped neatly up like an episode of House. In real life, you run 12 studies, three of which say "yes," three of which say "no," and the remaining three are inconclusive. 

It's the utter hubris of government that destroys confidence. 

 

[ANESMCR]

4 hours ago, CAAdmission said:

That sounds great, but the practical reality is much more complex. The great unwashed masses think you run a study, get the results, and have your answer wrapped neatly up like an episode of House. In real life, you run 12 studies, three of which say "yes," three of which say "no," and the remaining three are inconclusive. 

It's the utter hubris of government that destroys confidence. 

 

More like 12 studies say yes. One person not involved with the study with no expertise on the subject matter ideologically disagrees. Is louder. Has an audience willing to listen. Voila.

[rev ronin]

7 minutes ago, ANESMCR said:

More like 12 studies say yes. One person not involved with the study with no expertise on the subject matter ideologically disagrees. Is louder. Has an audience willing to listen. Voila.

That's possible, but what @CAAdmission is saying clearly also happens.

Take this NotTheBee article (Yes, it's related to the Babylon Bee):

https://notthebee.com/article/experts-are-rolling-back-decades-old-advice-about-taking-aspirin-to-prevent-heart-attacks-but-dont-worry-the-science-is-settled

Now, for those of us who have actually been reading the literature, this comes as no shock whatsoever. Science is not a mystical process delivering the right answer, but a series of experiments, surveys, trials, etc. yielding a set of best advice that can, will, and should change as we add to the knowledge storehouse on which it's based.

The public doesn't understand that. More people than ever are getting college degrees, but I fear that they are increasingly devoid of actual learning about the scientific method and process.  And thus, when guidance tips, people lambast the scientists for changing their minds and following the evidence, not understanding that science is only ever the best we understand at the moment.  It's not omniscient; it's limited by the intellectual curiosity, funding, openness to change, appropriate dissemination, and many other factors I'm sure the rest of you can help flesh out.

[rev ronin]

20 hours ago, Cideous said:

Science is science.  The scientific method if utilized properly is truth without pride or prejudice.  The scientific method works....humans don't.

There's also a misunderstanding of what science can or cannot do.

Science can tell you that there's a ridiculous amount of DNA similarity between chimpanzees and humans.  It cannot tell you whether random survival-of-the-fittest evolution, alien manipulation, or a benevolent creator God is responsible for the similarities.

On a more practical level, people do not understand the difference between models and experiments. They don't even understand the difference between correlation and causation.

Specifically with respect to Covid, we've seen policy makers abdicate their role to decide what outcomes are important to society. I'm sure all of us could go on for pages about masking guidance, school closures, the backfiring of mandates, and the like.

Bottom line? Suffering and dying people suffered and died alone. We, medicine, violated the most basic tenets of humanity, and no one is standing up to apologize for getting it wrong.  We, in many ways, collectively deserve their skepticism and scorn.

Doesn't mean a DC or ND is actually any better, but at least they'll listen and not spend the entire visit looking at an EMR.

[turnedintoamartian]

On 4/29/2022 at 7:02 AM, CAAdmission said:

The government and the media have done nothing but lie to people for decades now. This has eroded the public's trust in all authority figures. 

Welcome to the death of objective reality. 

Easy scapegoats that are popular to everyone but I don’t think this adds value to any discussion. 

[turnedintoamartian]

2 hours ago, rev ronin said:

There's also a misunderstanding of what science can or cannot do.

Science can tell you that there's a ridiculous amount of DNA similarity between chimpanzees and humans.  It cannot tell you whether random survival-of-the-fittest evolution, alien manipulation, or a benevolent creator God is responsible for the similarities.

On a more practical level, people do not understand the difference between models and experiments. They don't even understand the difference between correlation and causation.

Specifically with respect to Covid, we've seen policy makers abdicate their role to decide what outcomes are important to society. I'm sure all of us could go on for pages about masking guidance, school closures, the backfiring of mandates, and the like.

Bottom line? Suffering and dying people suffered and died alone. We, medicine, violated the most basic tenets of humanity, and no one is standing up to apologize for getting it wrong.  We, in many ways, collectively deserve their skepticism and scorn.

Doesn't mean a DC or ND is actually any better, but at least they'll listen and not spend the entire visit looking at an EMR.

Please explain your paragraph regarding medicine’s violations. 

[rev ronin]

6 minutes ago, turnedintoamartian said:

Please explain your paragraph regarding medicine’s violations. 

Denying the dying and their family members access to each other? Thought that was pretty self-explanatory. I mean, I can go on: denying families access to anyone hospitalized, making women labor alone... we forgot that humanity requires contact, touch, and caring. Shame on us.

[MediMike]

9 hours ago, CAAdmission said:

That sounds great, but the practical reality is much more complex. The great unwashed masses think you run a study, get the results, and have your answer wrapped neatly up like an episode of House. In real life, you run 12 studies, three of which say "yes," three of which say "no," and the remaining three are inconclusive. 

It's the utter hubris of government that destroys confidence. 

 

But...what about the LAST three studies?

[jmj11]

A more extreme (and over simplified) example.

A patient who has a history of melanoma situ. Was excised and given a clean bill of health, but told to do annual checks. Five years later she has a cluster of rapidly developing black spots on her skin. She is worried and goes to her alternative care provider. The following conversation ensues:

Patient: I'm terrified my melanoma is back. It looked just like these spots, but now there's more of them.

Alternative Provider: Melanoma is not really cancer. It's a fungus in the skin that comes from missing certain micro-nutrients in the diet. I'm going to give you a cream to used on the black dots made from the milk of thistle that has profound anti-fungal properties. Then I'm going to do an analysis of your hair and figure out what micro-nutrients you are missing and we will formulate a specially supplement that will get your system back in balance.

Patient: Wait a minute. Are you saying I never had melanoma? They did a biopsy and it was positive for melanoma.

Alternative Provider: That's what western medicine providers tell patients. They lie. There's no such thing as cancer, only an imbalance of our body's natural systems. Western providers love to call things "cancer" because they are in a conspiracy with big pharm and hospitals to make money from making you think you're sick and they need to save you with surgery and chemicals. It's all a big lie.

Patient (with a puzzled look): But how do I know you are telling the truth? Do you have studies to back up the fact this is really a fungus?

Alternative Provider: Plenty! I have studied the natural health guru's book, "Cancer and Other Lies Your Doctor Tells You."

Postscript:  The patient dies at age 35, six months later. The conclusion of her family is, "The western doctors missed the fact that she was missing micronutrients and was having fungal infections on her skin five years ago. Because her underlying problem was never corrected, she died from an overwhelming fungal infection. The Alternative Provider tried her best to save her, but it was too late. Damn those western providers!" 

Commentary: So I respect people who really know nutrition, based on science and not diet fads. They can make a tremendous contribution to patient care. However, when they contradict what science says and generate conspiracy theories to cover for their lack of science, there's the problem.

 

 

[CAAdmission]

3 hours ago, turnedintoamartian said:

Easy scapegoats that are popular to everyone but I don’t think this adds value to any discussion. 

Cool.

 

1 hour ago, MediMike said:

But...what about the LAST three studies?

It depends whether they are designed better or worse than the previous studies.

[EMEDPA]

On 4/29/2022 at 1:11 PM, Cideous said:

Comedian Bill Burr has a hilarious bit on thinning the herd.  He talks about loading up cruise ships, sending them out to sea on vacation then sinking them with a torpedo from a sub.  The bit is really funny and I think stemmed from him getting pissed while sitting in traffic, LOL!

There is a short story like that called "the marching morons". The minority of smart folks convince all the idiots to take their free vacations on Venus and the rockets fly into the sun. 

https://en.wikipedia.org/wiki/The_Marching_Morons

[turnedintoamartian]

6 hours ago, rev ronin said:

Denying the dying and their family members access to each other? Thought that was pretty self-explanatory. I mean, I can go on: denying families access to anyone hospitalized, making women labor alone... we forgot that humanity requires contact, touch, and caring. Shame on us.

I don’t think we forgot that, I think we have been trying to limit morbidity and mortality when dealing with a lot of unknowns. We’ve made plenty of mistakes but I personally am hesitant to be too harsh. Thanks for clarifying.

[rev ronin]

20 minutes ago, turnedintoamartian said:

I don’t think we forgot that, I think we have been trying to limit morbidity and mortality when dealing with a lot of unknowns. We’ve made plenty of mistakes but I personally am hesitant to be too harsh. Thanks for clarifying.

Oh, I don't dispute that it all was well-intentioned, but it doesn't make it excusable. Some medical professionals deserve to be executed for violating their obligations to humanity; Mengele is the poster child for that, but he's far from the only one.

These? These stupid, scared hospital administrators, public health bureaucrats, and medical directors don't rise to that level of malfeasance. There were less-bad solutions that they didn't bother to explore. They, are, however, well within the realm of needing to apologize for looking at morbidity and mortality rather than the essence of humanity.

[MediMike]

3 minutes ago, rev ronin said:

These? These stupid, scared hospital administrators, public health bureaucrats, and medical directors don't rise to that level of malfeasance. There were less-bad solutions that they didn't bother to explore. They, are, however, well within the realm of needing to apologize for looking at morbidity and mortality rather than the essence of humanity.

How many families have you seen at the bedside of a dying COVID patient? Any idea how many take off the CAPR? You've now got an entire family exposed to aerosolized particles who then go out and infect the rest of the community.

Any idea how many outbreaks we had among staff after family members would come in?

We tracked family visits>infected RNs>Infected patients on other floor and wards.

You're talking trash about a subject I'm guessing you don't have that much knowledge or background in based on a visceral feeling. Did I hold the hand of patients as they died? Yeah. Did it crush me to see families on Zoom not be able to be with their mom/dad/son/daughter as we pulled that tube? Better effing believe it. Measures had to be taken to protect medical staff, nursing, environmental services and other patients, none of us liked it. No administrator was like "Hell yeah let's ruin some people's lives!".

We did the best we could with the knowledge we had. Sleep studies, OTJ injuries and eating disorders is probably a different ball game, don't try to translate your experience to that of people in the hospital.

[rev ronin]

33 minutes ago, MediMike said:

How many families have you seen at the bedside of a dying COVID patient? Any idea how many take off the CAPR? You've now got an entire family exposed to aerosolized particles who then go out and infect the rest of the community.

Any idea how many outbreaks we had among staff after family members would come in?

We tracked family visits>infected RNs>Infected patients on other floor and wards.

You're talking trash about a subject I'm guessing you don't have that much knowledge or background in based on a visceral feeling. Did I hold the hand of patients as they died? Yeah. Did it crush me to see families on Zoom not be able to be with their mom/dad/son/daughter as we pulled that tube? Better effing believe it. Measures had to be taken to protect medical staff, nursing, environmental services and other patients, none of us liked it. No administrator was like "Hell yeah let's ruin some people's lives!".

We did the best we could with the knowledge we had. Sleep studies, OTJ injuries and eating disorders is probably a different ball game, don't try to translate your experience to that of people in the hospital.

You did the best you could; no one is telling you different. You're right--I wasn't doing the job you were doing, wasn't there to see what you saw, and I'm glad you were doing it. Let me say that again--I'm glad you were there holding the hands of the dying; it takes a special kind of human to do that for strangers. You've earned the right to tell me to F off.

But I don't need to be a CCU PA to know that we did the wrong thing by limiting family access to the dying.  What's one of the foundational rules of ethics? "There's no right way to do a wrong thing."

I critique our performance as an American medical community--as a whole, not yours in specific--as a medical ethicist, mathematician, and a chaplain. Your response to my critique entirely misses the point: keeping families separated caused real, tangible harm, and provided no measurable benefit, because everyone was always going to be exposed to Covid-19 eventually anyways.

Yes, there were outbreaks. Yes people got Covid-19 in the hospital.  It's because the R0 for Covid-19 is somewhere between 3.8 and 5.7, or maybe even higher with the latest few variants, not because families were or were not allowed in to hold the hands of the dying. You simply cannot control or even keep up with an airborne R0 of 4+ with presymptomatic spread. We didn't even make a sham showing of contact tracing. It was always going to touch each of us, and we knew it--the only hope was slowing the burn-through time to wait for vaccines, which upon arrival did a really good job, and PPE for those who directly cared for the sick or vulnerable.

In the final analysis, we have 993k dead Americans which is a reasonable approximation of the cumulative average of Covid-19 IFRs (as vaccines and improved therapeutics kicked in) * U.S. population. The sharp age bias to the morbidity and mortality curve was known very quickly, and yet we insisted on countermeasures that inappropriately targeted the least at risk: children and young adults. Sure, there was absolutely significant morbidity and mortality benefit from not getting everyone infected all at once, but even at the localized maxima, the hospital ships and field hospitals went unused. Personally, I'm on my county's medical reserve corps list, but not once did anyone call and ask me to go work inpatient: the cupboard was never sufficiently bare.

Medicine is not just biology. Even in the CCU, there should be a strong appreciation that humans are best understood with a bio-psycho-social-spiritual model. We did the bio part right... except we focused on it too much to the exclusion of the other three aspects of humanity.

Wikipedia's list of people who have died of Covid-19 is theoretically limited to those already 'notable' (newsworthy) for other things: (https://en.wikipedia.org/wiki/List_of_deaths_due_to_COVID-19) There's clearly a selection bias at work, in that the aged are more likely to have achieved fame or notoriety than the young, but sort the list by age and you still have a stark visual representation of how Covid-19 took out the aged, not the young.

Again, you were in the trenches doing your job.  Somewhere, someone over you owed you an intelligent, evidence-based policy that didn't separate families more than was necessary, and they failed you.

[JoeM]

On 4/30/2022 at 9:31 PM, MediMike said:

How many families have you seen at the bedside of a dying COVID patient? Any idea how many take off the CAPR? You've now got an entire family exposed to aerosolized particles who then go out and infect the rest of the community.

Any idea how many outbreaks we had among staff after family members would come in?

We tracked family visits>infected RNs>Infected patients on other floor and wards.

You're talking trash about a subject I'm guessing you don't have that much knowledge or background in based on a visceral feeling. Did I hold the hand of patients as they died? Yeah. Did it crush me to see families on Zoom not be able to be with their mom/dad/son/daughter as we pulled that tube? Better effing believe it. Measures had to be taken to protect medical staff, nursing, environmental services and other patients, none of us liked it. No administrator was like "Hell yeah let's ruin some people's lives!".

We did the best we could with the knowledge we had. Sleep studies, OTJ injuries and eating disorders is probably a different ball game, don't try to translate your experience to that of people in the hospital.

Seconded from the trenches of an urban tertiary care ICU that got crushed with COVID…..not at all saying keeping families from their loved ones is what anyone wanted but you obviously don’t have experience with the logistics of caring for these patients requiring ECMO, CRRT, vents, neuromuscular blockade, etc with skeleton/inexperienced RN/RT staff. Add having anxious families standing around the unit bothering staff, getting hostile with staff (I’ve been threatened and followed to my car multiple times after refusing to prescribe hydroxychloroquine, ivermectin, etc), interfering with patient care, etc would undoubtedly make patient care more difficult and increase mistakes. 
 

Rev, I rarely post but often read the threads and respect your opinions….but on this one I’m going to take your advice and tell you to “F off”

Edited May 2, 2022 by JoeM

[CAAdmission]

I have a morbid belief that nothing we did significantly altered the trajectory of the pandemic. Folks who were predisposed by genetics or comorbid conditions to get profoundly ill or die did so. Those of us who are left generally will not, except for a freak case now and then. Like other coronaviruses, Covid-19 will join the pantheon of bland URI viruses and we'll pretend like we saved the world.