Many Common Treatments Aren't Helpful
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- เผยแพร่เมื่อ 31 พ.ค. 2024
- There are a surprising number of treatments that get accepted into mainstream care, and covered by insurance, despite the fact that there is little evidence that they work. There's even evidence that some of these treatments may be harmful! So, how do treatments like these become the norm?
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Would love a follow up video with more examples of common practices that don't work!
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Lyrica and Gabapentin are two examples that come to mind.
Tamiflu
Yup. I think this would make a nice mini-series, like his Medicare for All and Healthcare by Country series.
I agree, where can we find a list? I keep looking for trustworthy info but it's difficult to trust sources, everyone only seems to want to make money off people. I am sometimes amazed at the things I see sold in pharmacies... though I shouldn't be surprised, for years they made money by selling tobacco products, junk food, cosmetics. Here in Canada they wanted to be the ones selling pot. I bet they would love to sell alcohol if they were allowed. I often wonder what percentage of things in pharmacies is either actually harmful or placebos? (maybe the same proportion as things in grocery stores which shouldn't count as "food" -- most of the stuff not near one of the walls of the place). Double blind and randomized trials often are not done for treatments which are free or not profitable. Drugs are often approved when they don't provide improvements over existing treatments. And somehow, physicians can prescribe drugs for uses other than what granted them FDA approval in the first place, by-passing the evaluation system. Sometimes I also suspect that correlation-based studies discourage looking for cause-effect chains and we end up with treatments for symptoms rather than actual cures. Essentially, weren't Roman entrail-readers more like correlation-based "scientists"? Finally, why aren't more physicians knowledgeable about the effects of fasting? I also am wondering whether any nutritionists can be trusted, are they more just like meteorologists and the aforementioned Roman entrail and bird flight diviners. Pay a large enough fee but do come back if you don't feel better in a few days.
My doctors kept trying to prescribe fish oil supplements after several studies debunked their effectiveness at lowering triglycerides. I finally told my doctors I'm not going to take medication that's proven to be ineffective at treating my condition just because they haven't yet reviewed the meta-studies.
Savage.
as someone who has worked in maternity...you would be shocked how many practices are done as a matter of medical culture than what is actually solidly evidence based
Such as?
@@ratamacue0320 giving birth the way women are giving birth: dorsal recumbent. Literally the most difficult position to give birth. This is why midwifery should be brought back. Midwives learn the skills that have work - through experience and training - they accompany the birthing parent over time, with emotional and physical support. I'm not a midwife or anything, but encountered midwives who have a whole different view of birth. They welcome pregnancy - unlike OB/GYN who view it as a medical condition/disease that needs to be dealt with. As a result - they rush the birthing process - inducing so much anxiety (on the birthing mother who is told all the stuff that could possibly go wrong before she pushes) and removes autonomy of the mother.
Nurses in the hospital (OR) - maintain sterile techniques, minimize any risk of infection. We are scared of lawsuit. Giving birth is a medical achievement in a hospital, rather than a natural and normal process.
@@JOJOJOJOJOJOJOJOanne I agree with you and I tried so hard to not deliver on my back. Tried a water birth but the water was so hot for me. Tried every position and I only felt comfortable on my back. I had a doula and midwives for both births and did both on my back. My doula reassured me to not feel guilty about it...she said it worked for you so well.
Woman came in wanting to do water birth. She was told that it increases the chance of infection because you'll basically be swimming in your own poo. She insisted. Gave birth, took baby out of the water. She wanted to dunk the baby back into the water for cultural/religious/etc practice. Due to legality, we had to hand over the baby.
Dunked the baby. Baby got infected from the poo water. Died soon after.
Oh yeah, the entire family jumped into the water too dueing the entire process.
Bed rest is a big thing especially since it can cause harm. I suspect doctors do it because they can't bring themselves to tell women that there really isn't anything they can do to prevent a miscarriage. Unfortunately be rest puts a woman at risk for DVT especially since pregnant women are already at high DVT risk. Also the whole giving birth on your back.
I love this. As a doctoral student in clinical psychology, I am a strong believer in evidenced based treatments and am disturbed when practitioners don’t use research to guide their decisions.
Yep, I had psychologists and psychiatrists push drugs on me that made me much worse, and when I didn't want to be worse, they said I was treatment resistant. It turned out that I had Celiac Disease, and some of the medications had gluten in them. So they actually DID make me worse. I also have the tTG6 variant so it effects the white matter, thalamus and cerebellum, so all their telling me my symptoms were Fictitious Disorder were wrong too. (and yes, I know it's factitious, but they were in fact calling me a faker since they were saying my very real symptoms from a disease weren't real).
We need a video series like this for dental health. I'd like to understand how reliable the studies are that they base their guidance on versus how much is just drinking the Kool aid.
As a pharmacist I have to say that from what I’ve seen this is part of the reason many patients don’t trust the medical community and even turn to “alternative” medicine (good video too btw!)
I saw you on CBS News this morning! Thanks for speaking up against the corruption of insurance companies!
I've been prescribed kinesiology sessions for a herniated disc by a large and renowned local clinic, covered by my health plan. They consisted of 30 minutes of magneto-therapy. I thought it was going to be a series of physical exercises to strengthen the musculature and alleviate pressure on the disc. I was thoroughly disappointed.
You have to be careful. Im assuming your from the US where you have applied kinesiology (Bullshit) and Kinesiology (exercise). In Australia and I believe Canada, its called exercise physiology and we do exactly what you were expecting
@@musicsavedtheworld could you explain more of what the difference between the 2 discipines (spelt identical in the comment you made)? I'd reallly appreciate that as I am genuinely curious. I did notice that in Australia, they say 'physiotherapy' and in the US its more Physical therapy. Are you refering to kinesiology vs physical therapy? thanks
@@JOJOJOJOJOJOJOJOanne Yeah so Physiotherapy and Physical therapy are the same thing. Exercise physiology or Kinesiology are the same as each other. Applied kinesiology is an "alternative health" practice that has no scientific backing or evidence. Ex Phys/Kinesiology is basically the prescription of exercise to treat and manage symptoms of disease (mainly metabolic or neurological disease). In the way that exercise can be used to improve blood sugar control in a diabetic, or increase mobility in an elderly person with a lack of muscle tissue. Physiotherapy is used mainly to treat musculoskeletal pain in an acute or chronic setting but can utilise manual therapies (needling, massage, cupping) as well as basic exercises. You'll find that over the next decade physiotherapy and exercise physiology will start to amalgamate into the same role as the majority of the evidence points to exercise prescription for management of pain and function and less toward manual therapy.
@musicsavedtheworld Thank you so much,that helps a lot :)
@@JOJOJOJOJOJOJOJOanne I know it can be super confusing. My biggest piece of advice is don't major in the minors. Make sure you've got all you other lifestyle factors 80% of the way there. Sleep nutrition exercise etc and then if you're still struggling by all means try some alternative treatments if you believe they will be of value to you. The vast majority of people can't even hit basic sleep, nutrition and exercise targets and then wonder why they aren't getting any better and opt for weird therapies
To add to the list: Vitamin C supplementation and/or echinacea for the common cold, Antibiotic therapy for Acute Bronchitis, and daily Aspirin for primary prevention of cardiovascular disease.
For as far as i know vit C is good for flu or common cold which are viral infection
He's addressed some of these already: th-cam.com/video/IXJivxYPB7E/w-d-xo.html
@@Mustafa_Wrya Long term regular Vit C supplementation (prior to the onset of common cold) showed small (8%) reduction in the duration of cold symptoms with uncertain clinical relevance. Vit C given therapeutically after symptoms onset DID NOT reduce symptom duration or severity.
-From UpToDate
@@Mustafa_Wrya Only if you are vitamin C deficient. Has no effect on cold or flu.
@@fnfjan i see but usually vit c is good for immune system and works as anti oxident so still i would advice plenty of water and citrus fruit intake when it comes to flu it wont hurt you
Being a student physician, this video highlights a topic I've always had concern love it. Would love to see more
I have CFS and am v sick of being told by doctors CBT and GET are the most effective treatments based on the infamous PACE trials which have been discredited time and time again and many patients report worsening symptoms as a result of GET in particular.
Same. I have done both, neither worked for me. Fortunatelly, my docter does actually support me.
When speaking of scientific research, the term 'theory' actually means it is backed by evidence. If there is no experimental evidence you can instead use 'hypothetical'.
While technically true, I think it’s difficult to not use phrases like “in theory” because they imply high level of confidence in something that doesn’t match reality. “Hypothetical” implies low level of confidence and it would sound weird that in such situation a treatment was introduced into practice (unless you assume some ill will, which is a more serious accusation).
Beautiful video.
I'd love to see doctors beholden to their patients instead of insurance companies acting as bullies. Used to work in in home care and trying to get my clients proper medical care was like pulling teeth from a wide awake raccoon.
Its especially difficult when an unknown percentage of the product is the doctors own confidence in the treatment.
"Take half an aspirin with a glass of water and see me in the morning; you'll be right as rain."
I don't fool around with my health. If I feel bad I go straight to my astrologer.
Sarcasm?
@@heavythinker16 Yes lol
I had to watch an ad for a magic sleep headband to watch this video.
Please don’t ever stop making these videos.
You and ZDoggMD are my go to for nuanced and well researched health info. It’s much needed on TH-cam.
Thanks for the hard work.
Agreed.
Hey doc, I'd like to hear more about this lack of evidence for the efficacy or need for a pre-colonoscopy clear liquid diet. I know I'm in good company. That merits a separate video, in my opinion. I'm also curious to learn the status of the pill-cam which once seemed destined to replace colonoscopy entirely.
It would be great if you could post the link in the dooblidoo. thank you
How ironic that I got and ad for a psychic reading app before this video haha
I kept waiting for him to begin discussion those common treatments and why they don't work. I was sadly disappointed.
I read somewhere that bed rest is not helpful for many conditions. If true, it seems many hospitals use it widely, just to keep patients under control.
Would love the reference!
Especially for the England investigation suggesting 800 ineffective treatments
People have asked them to link the referenced papers in their show notes for years. Healthcare triage seems as resistant to that request as Doctors are to deadopting harmful treatments. Oh the irony.
I'm guessing that would refer to the National Institute of Health and Care Excellence (NICE) in England, although I don't know why Healthcare Triage couldn't just mention its name. Instead they phrased it as 'the organisation that assessed the value of treatments in England' ... I know the channel's target audience is American but surely including the actual name (and then its descrption) wouldn't be that difficult?
I’m a clinician in the NHS, so this info (if referenced) would really change my practice. I’ve looked all around, but can’t find it.
My understand is that it's potassium (helped me, anyway) that actually has something to do with leg cr-
CLEAR LIQUIDS BEFORE COLONOSCOPIES!? After the number I've had (and I'm only 35) thanks to ulcerative colitis, with so many more expected in the future, and it's so annoying to do that and then have the prep too.
At least they stopped with the gallon of gag-juice.
If I'm not mistaken, it's Magnesium citrate. At least the stuff I power washed my guts with was.
As a nurse, i really wish science would catch up with practice. Id hate to do anything for my patients that is wasteful or ineffective. Bothers the crap out of me
I am choking down SuPREP as I watch this, been on a clear liquid diet all day for a colonoscopy! I almost spat it out when I saw that! What the heck have I been starving myself all day for then?!? Argh!
Blech! I hate the taste of SuPREP. I had a colonoscopy after I turned 50 and one after I turned 60. No polyps or anything. That's it. Not doing it again.
@@steveh46 it didn't even work! I have to go back and try again with something stronger next month 🤦🏻♀️😭
Ugh, I feel your frustration at the timing of this video. I just had my second colonoscopy 3 months ago, and my first experience with SUPREP. My experience wasn't bad, though. Having read a mix of comments that ranged from "awful" to "easy," I took every precaution I had read about or heard. I chilled the fluid in the refrigerator, drink it through a straw, and even pinched my nose while doing so (not that it smelled bad, but because I know that reduces the sensation of taste). Having done all that, and drinking it fairly fast, I _barely tasted it at all._ Hopefully that's helpful for someone.
April - why were you prescribed a colonoscopy? What symptoms do you have that indicate that procedure?
@@poppys3728 Chronic constipation since birth & severe abdominal pain that recently got worse. Most doctors just shrugged it off or blamed meds or diet or inactivity (aka it's my fault I'm sick.) Plus the pain has been blamed on periods and then I had a hysterectomy for endometriosis and the pain get worse. Some days I seriously hate my body. I'm dx with fibromyalgia but my symptoms have never quite fit that, they just can't find anything else to explain it. (You asked, lol)
Fantastic video. Very important topic!
Lancet: Chu: Oral Immunotherapy is an emerging experimental treatment for peanut allergy, but its benefits and harms are unclear. 1 JUNE 2019
Could you discuss the findings of the 2016 Danish national study linking hormonal contraceptives with depression risk? I think it’s difficult for many people to choose a contraceptive method that is right for them, especially with all the confusion and/or lack of study regarding most things hormonal. The study seems to be reputable, but I think you could break down the methodology and implications of its findings better than anyone. Thank you!
You’d speak very dimly about your field of work (in this episode) with very good intent. I wholly appreciate your diligence. I wish you could be my doctor. How do I find someone like you in MN?
Thank you for the regular dose of sanity. 🙂
Sounds like how at one point in EMS, we were expected to give oxygen to everyone.
A couple of years ago my Nan was given acupuncture on the NHS here in the uk. She had many sessions and it did nothing.
We need to cut them out to reduce overall healthcare expenditures.
I can't find the article from the bmj, do you normally provide links in video descriptions?
They stubbornly don't and it's infuriating.
What is up with clear liquid diet for colonoscopy?
I believe it's to avoid the possibility that food colorings or pigments could make their way to the colon. But because we break most of that down before it makes it that far, I'm not surprised it was found to be unnessecary.
@@scotty15002 Oh, so the important part of that sentence is the "clear"? Meaning there is no evidence for the liquid diet to be clear, but there is evidence for a liquid diet?
Meta-analysis of 9 studies (~1700 total patients) comparing liquid diet vs. low residual diet before colonoscopy. Conclusion: "An LRD [low residual diet] before colonoscopy resulted in improved tolerability by patients and willingness to repeat preparation with no differences in preparation quality and adverse effects."
www.ncbi.nlm.nih.gov/pubmed/26460222
Just don't expect your gastroenterologist to believe it though.
Was on a LR diet for two days and a clear liquid diet today and colonoscopy tomorrow. I can't believe I'm learning this as I'm in the middle of it! But I'm too worried about the dr getting mad and refusing to see me to go against what he said.
@@StrongMed Thanks! I've always called LRD a white food diet. Besides, you wouldn't want to surprise your doc, now would you? Maybe with a warning so they know what to expect...😀 I'm curious to know the composition of the experimental diets. Did you read the article? I'll have to get it. Anything to improve the experience of the preparation is welcome.
How about getting non clinician administrators making doctors ask non evidence based screening questions that wastes so much time?
That is one of the main reasons I resist seeing a doctor. The receptionist OVER THE PHONE will ask me why I want to see the doctor. I really only want to talk to the actual doctor about my reasons.
@@cindygiesbrecht3146 Oh man, I hate when they ask that. Cause they're basically asking me to either self-diagnose or start describing all my symptoms. I know they do it so they can gauge how long the appointment might take and book accordingly, but it's just awkward.
One of your better episodes.
So important!!!!!
I've seen a change in the past several years, especially with the younger doctors I've had.
Some of it's good: I was told to go home and just do life when I went to the ER on Christmas Day, 2016, for what I thought was about to be full-blown labor. I went to work the following day. My water broke that night.There would have been no reason for me to be bedbound for almost 48 hours. It probably would have delayed things.
Some of it, not so good: I have fibromyalgia. I question if that's even what it is, but at this point, every doctor looks at my history, shrugs, and refuses to look into it further. I'm in -constant- pain, somewhere in the 7-8 range. The only time I wasn't? When I was pregnant. (And this is apparently not uncommon, from what I've read.) The treatment I get is for pain management... which is fine. If I can get something to actually help with the pain. And guess what? I can't. I don't want to be pain-free, I just want to be functional. I'm given NSAIDs, which at this point have absolutely ruined my gut. I was in the ER for diverticulitis, and I got NOTHING but an antibiotic, not even an NSAID, or a "go take tome Tylenol." I know pain medications aren't good on your gut health (holy shit do I know), but seriously? Nothing? I missed work because of the pain. I had to go back (because of course my awful PCP couldn't see me for a month), and when they found out I wasn't given ANYTHING for pain, the new doctor I saw that time was, honestly, pissed. (And, ftr: Of the 15 pills I got for pain, I took 3 in the following few days. The rest were used for pain in the months following, when my colon flared back up.)
NSAIDs don't work for fibro because there is no inflammation with fibro. Current guesses are that it's a neurological disorder. NSAIDs do not treat nerve pain. Look up "Low Dose Naltrexone" for fibromyalgia. It's still in clinical studies but it shows a lot of promise. When I started taking it, the difference was between in bed all day vs going around the house to do things. Then we added 100mg tramadol immediate release (not ER) once a day. With the two meds (tramadol at noon, LDN before bed; you do not want to take these at the same time), I'm able to exercise again. I still can't work but I have a better quality of life than without. Unfortunately most medical studies on fibro are stupid stuff like meditation, mindfulness, and, I kid you not, flower arranging as treatment options. It's an insult to our pain. I hope some of this info helps you.
I feel like, at least in outpatient settings when a disease is non-lethal and when alternative treatments have significant side effects, a treatment doesn't really need to be effective to be used. As long as it's very safe, why shouldn't we take advantage of the placebo effect. In fact, for mild disease, why not try it first line before we try something more risky, sort of like psychiatrists do with SSRIs for OCD.
To me, knowingly prescribing a placebo without disclosing that it's a placebo is unethical, unless perhaps if the patient is actively dying and beyond any other help. If patients want to try things themselves that I don't know will help but have no reason to think will hurt, I'm fine with that. But I don't feel right personally recommending that someone spend their money on something that I know won't be anything more than an expensive sugar pill.
I'm inclined to agree that it's unethical to prescribe a placebo without disclosing that it is one.
But at the same time, I also feel that it is therefore also unethical to publish research that demonstrates a lack of efficacy for a non-harmful treatment, especially when there is no safe first line* choice for the treatment of a non-lethal disease. Because publishing that information does more harm than good.
*First line being different from gold standard. Gold standard means most efficacious. First line meets a balance of safety and efficacy.
How much of this comes out of our legal system? There's pretty solid evidence that stents don't have much effect. But, decline to give a patient a stent and then have them die of a heart attack... I wonder how that case is going to go down? This across the board. If you don't use all the accepted treatments, you open yourself up to lawsuits because you could have done more.
I'm curious what data you've seen that stents don't have much affect. I've seen many patient with significant chest pain and reduced exercise tolerance found to have CAD. They get stented, go to cardiac rehab and are much more able bodied and pain free afterward. Is the suggestion that if we just ignored the 70-90% occluded vessel and ischemic cardiac tissue that its causing when exerting and somehow it will just get better on it's own?
It sounds like George Washington should have had a COVID-19 test judging by those symptoms...
Lol I came to the comment section just for this
A link to the mentioned study would be nice, Doc.
BMJ has a pay wall. e.g. this one mentions surgeries and treatments which won't be covered as easily: www.bmj.com/content/362/bmj.k2903
We've been asking for links in the video description for years and they keep ignoring our requests.
This reminds me of how Lyrica and Gabapentin fail in clinical trials for neuropathy, fibromyalgia, and other nerve pain. Yet they're handed out like candy, and yes, in lieu of pain medication. Also, recent rodent studies suggest that the above medications may prevent the brain from performing new synapses. ETA: Also the class action lawsuits for Cymbalta causing massive chemical dependence that makes opioid withdrawal look like a joke. There are patients who literally cannot wean off of this medication because the withdrawal is that intense.
Thank you for leaving this comment. I never reply to TH-cam comments but wanted to say I have had experience with both these drugs. I was put on Cymbalta for Fibromyalgia pain (because doctors believe that you're just crazy and want to shut you up with SSRIs) even though I didn't have depression. It took me 2 whole years to fight to wean off that drug which gave me no benefit and a slew of career-ending, debilitating side effects. I was also put on Lyrica, which I am still weaning off after 2 years. Each time I drop my dose, the withdrawals are so bad my partner has to take time off work to prevent me from killing myself. Yet doctor after doctor told me it couldn't have these effects, until very recently. Doctors often don't listen to feedback from patients, and that is another huge problem with the medical "industry".
@@sapphfire24 I am so, so sorry you went through this. I also have fibro and I have avoided those. My treatment plan is 100mg tramadol at noon, and LDN 4.5mg before bedtime. Low Dose Naltrexone is still in studies, but it's promising. And when I've accidentally missed a dose, no withdrawal. Just a flare. The Frida Center for Fibromyalgia recommends trying LDN. My only side effect was nausea and some lack of appetite, but that went away after a few months. Given those side effects, I'm okay if it turns out that LDN isn't that effective. Tramadol is generally considered the only opiate that has shown to help fibro, but ofc, good luck getting any further large studies on any opiates these days. OTOH, I tried Topamax for migraines and it made me paranoid to the point where I didn't leave the house, and every little health symptom for myself or my dog was interpreted as certain death. And weaning off of it made me suicidal. I could have done so much more with the past 4 years of my life without that med. I barely have memories from that time, even. I hope that you come out of this okay. Hang in there; there is light after coming off of the med. Fibro folks are immensely tough. And by God, we deserve better than all these asinine studies about mindfulness, yoga, and flower arranging as "great treatment options" for fibro.
Thank you for your kind response and understanding. I also appreciate suggestions. I'd rather listen to recommendations from other patients than doctors these days. I agree we deserve better research, and I am so sorry that you too have suffered so much on a prescription medication. It really just feels like we're all guinea pigs with these drugs. Good luck on your journey. May you find things that work for you with minimal side effects.
@@sapphfire24 I've heard a lot of people rave about medical marijuana for breakthrough pain, but the legality and the fact that you absolutely cannot drive and end up useless on it are drawbacks. According to Migraine Buddy users, it also works really well for migraines. It's immensely frustrating to not have options!
@@xfortunesquex Yes I am actually taking legal medicinal cannabis which helps me sleep, and CBD oil helps take the edge off the pain. Problem is that it's hideously expensive (not to mention difficult) to obtain legally here in Australia so I have to be very sparing which is frustrating given how easy and cheap it is to produce in one's own backyard! I am disallowed from driving on it even though I'm not taking enough to get high. :/ Wherever there are options, there are obstacles!
A friend of mine was recently diagnosed with asthma. They were prescribed inhaler with no spacer. I have no idea how much medicine she wasted trying to figure out how to breathe in at the right time. Geez.
Rocio Silverroot aside from anything else, breathing from the spacer is very soothing during a mild asthma attack, much like breathing in a paper bag during anxiety
@@CaraBea Yeah if she was having an attack, we probably would have found her on the floor with the inhaler for in her hand. She has a spacer now.
Sources in description would be nice.
We've been asking for that for years and fallen on deaf ears so far.
is there a video on Testosterone injections for men? I've seenq video feom Hank Green where he suggests creatine is helpful for training. I can't gauge if my sleep and moods are age related and I should be fatalistic about it or in 2022 there are things I should be doing to improve my mind and body
Vioxx is an interesting example because it might have been no more harmful than the other class of NSAID pain medications, it's reduced side effects compared to its predecessors might have just made the risk more visible since people were taking it over longer periods of time.
If clear liquid diets aren't proven helpful for colonoscopy, why did I have to do it every time?
Hi, i'm having trouble looking for the bmj article. Could someone please hare a link or DOI to reach it?
Hi! This should help: theincidentaleconomist.com/wordpress/half-of-medical-treatments-of-unknown-effectiveness/ -Tiffany
I literally just came here from your recent pregnancy and alcohol video, and the fifteen seconds unskipable ad was for a certain tequila recipe... Edit: Oh my... I left to go research a topic from this video, and when I came back I got an ad for hard seltzer... Wtf!?!?
Great video! Curious how many of the "ineffective" results in research were really just a lack of statistical significance due to small sample size. Just my math nerd two cents :)
Have you ever discussed eczema? A baby of 5 months is on his second cream (nystatin & mupiricin) and no improvement, rather he's worsening. What does the evidence on eczema show?
Speaking of addictive opioids, I’ve been struggling with my stupid addiction for about 15 years. I’ve tried stopping to no avail. Put myself in a rehab once, but that didn’t work. I’ve been taking Suboxone for much longer than I ever thought... albeit, low doses. Recently, I tried taking kratom. It was very surprising how it suppressed much of my withdrawal. Even though I had evidence it was working, I still went back to buprenorphine. Any advice? 🙏🏼
So I’ve been addicted to kratom for seven years now and I implore you, sir, to put that bag of evil dirt away and just try cold turkey. The reason why it’s staved off your withdrawal effects was because it’s giving you more of the same drug. Trust me you’ll have even worst withdrawal effects if you continue to use it. I’m not kidding I’d rather be a dick to the street drugs.
I am curious to know what the 1 research study that reviewed hundreds of articles covering a previous medical practice used as the criteria to determine if a medication that was given was helpful or not helpful for a patient. I feel that it is a hard line sometimes to determine exact what is deemed helpful or not helpful for a patient when it comes to treatment as every patient can have a different experience with a medication or other forms of treatment that they themselves could deem beneficiary but someone else would not. As a future physician I believe and hope that all physicians do their best to be educated on the medications they prescribe their patients as well as the different treatments they utilize or encourage for their patients. I don’t believe physicians are attempting to go out of their way to harm a patient when they prescribe a medication or treatment, their goal and my future goal is to provide the patient with a treatment that has proven to be beneficial in the past but also inform my patient that this may not work for you and we will have to try other forms of treatment to improve their symptoms. I do not want to speak for all doctors, but I inherently focus on the four pillars of medical ethics and want to highlight beneficence, autonomy and non-maleficence. As a future physician I plan to provide my patients will all the information necessary for them to make a fully informed decision but hide no forms of treatment that they can evaluate to be best suited for them. Treatment discussed with patients will be focused on their best interest as well as allowing them to freely choose the best option for themselves while providing them with all the necessary pieces of information to make that decision.
Additionally, I feel that commonly when treatments and medications are deemed ineffective they tend to be removed from the market so saying that many common treatments are unhelpful seems a bit of a stretch. Presently I feel that a lot of disease requiring medications revolve around HTN, diabetes, high cholesterol, heart issues, etc. and most of the medications associated with these treatments are helpful and if they do not work for that given patient then a different medication that has been deemed beneficial is tried and the patient can have an amazing response to that medication. I could be fully misunderstanding the argument but my overall thought is that physicians do not go out of their way to prescribe treatments that are ineffective for their patients, sure it happens and there are doctors who have bad intentions, but overall most physicians am their treatments, care and medicine prescribing to benefit a patient’s health.
How does off-label (but logical) use of medications factor into these data?
Huh, magnesium supplements dont help against leg cramps? Is there a reason you specifically said leg cramps? Do they help for other cramps? Or is it only the placebo that keeps me taking magnesium after sports sometimes?
he only said there wasn't good evidence for it, not that there is evidence against it.
I'd like to know what it is in my one-a-day multivitamins that is definitely preventing my leg cramps then. Because when I take them daily I don't get leg cramps. If I stop taking them for 5+ days, I will get severe leg cramps waking me up. I've tested this multiple times by stopping taking them when I've been told about low absorption rates, and such supplements not actually helping, but time and time again I stop taking them, and the consistent leg cramps at night reappear. I've often though it was a combination of the magnesium and potassium. Whatever it is, I'm going to keep taking them, because at least for my body they are helping.
Looks to me like science is still missing something. Maybe I should offer myself up as a test subject, since efficacy of something in the multivitamins can consistently be demonstrated to be reducing my leg cramps.
@@OrthodoxAtheist again, noone said there is evidence against it, there is just a lack of evidence that proves it's effectiveness.
In simple language: nobody has yet studied if it's beneficial. That doesn't mean it definitely doesn't work, it means that we don't know. You can keep taking your supplements.
A 2012 Cochrane Review of Mg for muscle cramps concluded: "It is unlikely that magnesium supplementation provides clinically meaningful cramp prophylaxis to older adults experiencing skeletal muscle cramps. In contrast, for those experiencing pregnancy-associated rest cramps the literature is conflicting and further research in this patient population is needed. We found no randomized controlled trials evaluating magnesium for exercise-associated muscle cramps or disease state-associated muscle cramps (for example amyotrophic lateral sclerosis/motor neuron disease)."
www.ncbi.nlm.nih.gov/pubmed/22972143
Since then, there was another double-blind RCT from 2017 (166 patients) comparing oral Mg supplements vs. placebo for the treatment of nocturnal leg cramps (NCL). Conclusion: "Oral magnesium oxide was not superior to placebo for older adults experiencing NLC. The decrease in the mean number of NLC per week, from the screening to the treatment phase in both groups, is probably a placebo effect that may explain the wide use of magnesium for NLC."
www.ncbi.nlm.nih.gov/pubmed/28241153
There's still no evidence (that I could quickly find) re: Mg for exercise-induced leg cramps either way.
@@fmleverynameistakenx yep, I was just curious because he mentioned leg cramps in specific and not all cramps. Thx for the reply anyways :)
In a world where there is a growing distrust in healthcare professionals and medicine, doctors really need to focus on using evidence-backed treatments on their patients. They especially want to make sure that they are not causing any harm in the long run due to side effects or long-term consequences of the treatments they are prescribing. When taking the principles of medical ethics into consideration, the principle of non-maleficence stands out here because healthcare providers must be doing their best to not cause harm. The video stated that “Some practitioners cling to weak evidence of effectiveness even when strong evidence of lack of effectiveness exists.” This might have worked in the past, but as more and more people gain access to technology and social media, the demand for transparency and evidence in medicine is growing. Patients are learning to advocate for themselves by trying to educate themselves on hot topic medical issues. Unfortunately, there is a lot of misinformation that circulates through the internet, especially for those who base all their knowledge on information acquired through social media platforms or other unreliable sources. This has turned many patients away from actual evidence backed medicine such as vaccines. In the spirit of non-maleficence and not causing harm, practitioners need to be flexible and willing to part ways with practices that lack proper evidence. Whether it be a matter of disliking change or practitioners feeling more comfortable with certain treatments, medicine is a rapidly evolving field, and it cannot be expected that the way something is treated today will be treated the exact same way 50 years from now. All practitioners need to stay up to date on revised guidelines and research. This way patients will be able to trust their healthcare providers and patients will be more likely to stay complaint with their treatments. As a current medical student, there is a disclaimer before each of my clinical lectures informing myself and my peers that the current guidelines may not be applicable for when we are in practice and that we must stay vigilant of the rapid changes occurring in healthcare.
HRT saves bone...it stops hot flashes...that part works. It's all I can use for osteoporosis.
My apologies if you've covered this and I missed it, but in one of your posts, you said that statins sometimes increased the probability of developing Type II diabetes. I even found a study that said that I was in the high-risk group for this when I started taking them, and now I do have diabetes. Is there any evidence that if you *stop* taking statins, insulin sensitivity improves? If so, I want to tell my doctor about it and talk to her about taking me off the statin, but I can't seem to find any studies on it. Can you point me to any solid evidence either way? Thank you.
If you have diabetes, I would go off statins. See Dr Pamela Popper's TH-cam, she talks about statins. I hear that the best way to improve insulin sensitivity is a whole foods mostly plant diet that is very low in saturated fat. Saturated fat is worse than sugar itself for ruining insulin sensitivity. Intermittent fasting might help too.
th-cam.com/users/drpamsnewschannel
As to magnesium I know from personal experience there is something to it. But I don't have the exact same condition. And it only helps me (almost immediately, I might add!) when topically applied as an oil. So far no pill form has had any effect. That's because putting something in your stomach does not automagically mean it will enter your bloodstream in the way you would like. In a similar vein glucosamine and/or chondroitin supplements which are overwhelmingly recommended for joint pain may be no more effective that placebo! I would suspect for the same reason.
I started taking magnesium to see if it helped with a different issue, and it didn't help that, but my leg cramps went away (and they were killer before), so I take it gratefully now. :) I wish he had elaborated, because it could just mean "no one has done an official study" and not "a study found it was ineffective."
If I stop taking magnesium pills, I'm pretty much guaranteed to get a massive leg cramp at night within 2-3 days. And I'd get cramps about twice a week without it. With a magnesium supplement it's only happening about once every 2 months. That's a huge blessing because the night cramps in my left leg are so bad I literally can't walk for about 2 hours afterwards, and the whole day my leg is sore if I put weight on it. Doctors didn't find anything wrong with my leg or blood/urine values. I tried a magnesium supplement as a home remedy and it immediately helped. I have no idea what conditions it helps with and what doesn't, but I've got strong anecdotal evidence it was a huge help. Either that or it's a very strong placebo that works while I'm sleeping, because I only get cramps while asleep.
I think the most difficult part about this problem of performing non-evidence-based practices is the discrepancy between the physicians' knowledge and the ethical principle of beneficence. I would argue that no doctor wakes up in the morning and thinks “Hey, I’m going to really mess up my patients’ life by prescribing something that is not evidence-based.” However, I think it is beyond human capacity to know all the risks/benefits of every treatment modality for each unique patient with their unique condition. So, when a provider can offer something that could provide potential benefit without knowing all the facts, they are just trying to do what is best for the patient. As a future physician, I intend to do the same but also encourage my patients to come to me with their research and to seek out alternative medicine and just allow me to support them and care for them as best as I can. Healthcare should be a team effort with physicians and patients working together.
Whilst clients are dehumanised and referred to as patients, there will always be a power imbalance. Don't physicians have to follow guidelines even if they disagree with them, so that they won't get sued?
ug, and then there are the things you do need that insurance doesn't cover.
I question the use of calcium supplements for arthritis.
Hi, is ozone therapy a thing? Today is a very common thing here in Brazil, even for pets.
Best use of statins: Put in porcelain bowl. Grasp silver handle and turn until water rushes through said porcelain.
Does blood letting help with any heath condition?
Hemochromatosis actually!
I mean, I suppose it would help with high blood pressure, but not in a good way.
Clear liquid diets before colonoscopies may be pointless?!?!?!??!!! So colonoscopy patients can eat as normal before the bowel prep 🤯 Ugh!!!
I would focus on the word "may" which you correctly inserted in your first sentence.
FYI While stem cells tx may not be appropriate for breast cancer now it saved my life. I had bone marrow cancer and did SCT in 2015. Grateful for those early pioneers.
I love your show and your book. But I feel like I’m watching Blue’s Clues with that background 😬
My doctor said I should quit baby aspirin.
Another controversial one is circumcision, LOL
Uncut Gems starring Adam Sandler, coming to a surgical theatre near you!
Add to that unethical violation of the right of bodily integrity and religious freedom of the child. It's one big white collar crime.
I'VE BEEN Lintoning. For along time and Stoped ? And now I. Seem. Like I need it my DOCTOR DOES BLOOD WORK 1st TO SEE IF MY BLOOD IS UP, OR LOW POLYSEMA FORTE ONE AND TWO IS WHAT I'M SUPPOSED TO HAVE OKAY WOULD LIKE SOME KIND OF UNDERSTANDING FROM A PROFESSIONAL YOUR SHOWS SEEM TO BE REALLY INTERESTING AND GOOD THANK YOU VERY MUCH,
can you please add captions
I have (Anecdotal (personal)) experience with magnesium working. Downed a Litre of chocolate milk and pain in my legs that had been there for a few days subsided within about three hours, fully disappearing within a day. It was a one-shot issue, it's not been reoccurring (as I've changed my diet as it came shortly after another nutritient deficiency), and I'm glad I made the decision, I hope that gets tests that clarify where it's appropriate to use
You do realize that 1 liter of chocolate milk has around 130 mg of magnesium.
Person develops muscle pain when deficient significantly. So drinking 130mg (that's is much less that in a basic 1 magnesium pill) will not elevate blood magnesium levels to the point where you wont experience pain.
You clearly had a different reason for muscle pain.
The Opioid Crisis is far deeper then belief it was not addict and more to do with politics and the handful of company who benefit greatly from it, some of them knowingly distributing Opioids to pharmacies in towns that the population would overdose if they were truly the ones consuming them.
Often effective therapy isn't delivered because some stake holders are ....
Does he voice other channels?
Doctor Mike!!!!!!!!
Why wouldn't you want to give somebody oxygen after a heart attack?
"The avoidance of peanuts to prevent allergies in kids"
The entire state on Israel: ROFL while eating Bamba!!!
Hope we are doing better… 2020 doesn’t give me hope tho
💙
This applies to all alternative medicine. Chiropractors and accupunturists and the like are all quacks.
Acupuncture has been around for over two thousand years.and is a documented medical practice
@@lovely-mk4rt How long something has been around has nothing to with with empirical evidence for its effectiveness.
@@lovely-mk4rt that doesnt mean it works
@@lovely-mk4rt Acupuncture is based on the movement of "Chi life force energy". There's no science behind it
One thing I would like to see in medicine in the future is the recognition that each person is different, and a treatment that helps one person may not help another. For example, I had to try a bunch of different antidepressants until I found one that worked for me. But a friend of mine took Paxil, the one I'm on, and it did nothing for him.
The DEA should have raided the Sackler compound the same way they would any other family drug cartel
Vioxx was not a pain killer, it was an NSAID.
Which are...used to treat pain. It was specifically targeted at arthritis pain. So that's a pain killer.
Wait peanuts, do you mean not allowing all kids to eat peanuts or just kids with nut allergies?
kkcat I think just all kids in general.
So, Medicine is a Russian roulette.
Just check out resuscitation science - gabber my flast.
Clear liquid diet before colonoscopy.....curious how that's not supported with evidence.
Wait, what?! "Clear liquid diets before colonoscopies"? Also, the bull**it women get handed them because "there's no feeling down there."
Insurance companies are a joke.
Haha. It was my grandfather who blood let George Washington. He was his personal physician. 😣☹️
@Ron Maple Dr. Gustavus Brown. He was his personal physician and his daughter married Washington's son.
@Ron Maple Google my last name Moncure 😉☺️
A man took antibiotic, this is what not happen to his cold....
Joke aside, do remember that the study investigated studies, like journal which is notorious on publishing positive results. Who knows how many stuffs we can't see in the rejected submission pile.
circumcision
How are clear liquid diets before colonoscopies ineffective or harmful? How can the doctor properly diagnose if they can’t see the entire wall of the large intestine because it’s filled with crap?
www.chicagotribune.com/lifestyles/health/sc-eat-before-colonoscopy-health-0608-20160526-story.html
There are other diets that work just as well that people are more likely to adhere to.
To be clear (no pun intended) he did not say that clear liquid diets are harmful or ineffective, although that may be what he thinks. What he said was that it's among the treatments or advice which are "provided without evidence." A subtle but distinct difference.
That said, I'm with you in wondering whether he thinks there's a better alternative. Have we been misled into thinking that the colon has to be _clean_ for the doctor to see and/or remove polyps? I would certainly think a clean colon makes it _easier._
Joy G, thanks. That's an interesting article, though it refers mostly to one very small study (83 patients!). I'm eager to learn more.
Whist I’m sure your intentions are good, you need to include sources and information for credibility. Otherwise this just becomes another platform of misinformation
One of the most harmful medical practices out there, and one rarely talked about but practiced often, is intersex genital mutilation. There are a lot of different ways people can be intersex, but a common practice is for doctors to lie to their patients, telling them they have cancer, removing sex organs, and then telling them afterwards they have to take medication for the rest of their life to supplement the hormones lost. In some cases, they recommend plastic surgery on prepubescent children so their genitalia will look "normal."
One intersex activist (who uses she/her pronouns) talked about how she regularly got pelvic exams when she was a kid, not because they were necessary, but because doctors were curious.
About 2% of the world is intersex, but doctors often withhold that information from patients (preferring to lie and say they have cancer).