Facts vs judgement and empathy in doctors

Med students are made to study facts.
.........to regurgitate facts on demand.
.........are tested on facts.
So that becomes their goal in school.
On rounds the one who can regurgitate the most facts is commended.
In case discussion conferences fellows and faculty often are expected to do the same.

What thay need is to learn, judgement, discrimination, empathy and ethics.

That is difficult to teach .......to learn.......to model................to test.

So facts is where the focus remains.

Unfortunately facts in medicine change regularly, frequently.

Current system of medical education and training produces doctors who regurgitate facts on demand, score high on tests of old facts , believe those old facts and act decisively on that knowledge.

A focus on judgement is finally possible and very desirable in this era of vast amount of facts avaialable on finger tips.
Facts easy with iPads iPhone in hand and all the resources of the largest medical libraries just a tap away.
So ability to learn, research information, do a great history, physical eexam, develop decision making skills and judgement, learn ethics and spend time with patients and family so empathy for the sick becomes ingrained. is what
That is where medical school teaching should focus on, test on and 

Turmeric is good. Canadian Doctors studied curcumin presuming it was THE ONLY active ingredient

I am writing here about the recent New York Times article about the lack of efficacy for Turmeric in medical studies done in Canada in some surgical patients. What they had actually studied was Curcurmin in their patients with the presumption that curcurmin is THE active ingredient in turmeric responsible for all it’s beneficial effects.



The same mistake has been made in medical studies before wherein a natural product in this case turmeric is pooh-poohed when an ingredient that makes up less than 5% of the whole natural product -curcurmin is studied and the results are presumed to be applicable to the natural ingredient well accepted and known to be widely beneficial in Ayurveda in the first place. It is likely the reason curcumin was studied was that it has an enormous cost premium as compared to the natural turmeric powder widely available.



Two prior similar mistakes come to mind - walnuts and carrots



Walnuts consumption had been found to be helpful in some way for vascular disease. Medical doctors presumed that the active beneficial ingredient responsible for improved outcomes in walnuts was vitamin E. For many years doctors encouraged all to take over-the-counter vitamin E to help prevent vascular disease. That ended when subsequent studies showed no benefit of vitamin E. No one questions that walnuts are beneficial possibly Due to the omega-3 fatty acids in them.



The same story applies to carrots found to be beneficial in reducing certain cancers. In that case the active ingredient was presumed to be beta carotene which was subsequently studied and no benefit was found. The fallacy of presuming the nature of active ingredient in the natural product was brought forth again. I would like to remind the researchers in Canada of these two studies so that any further planned studies are done with turmeric powder rather than Curcurmin.



My goal here is also to help stop this confusion in the lay public. I believe the Canadian researchers are jumping to conclusions from lack of efficacy in their curcurmin study to questioning Turmeric’s many Long accepted beneficial effects.

My prediction in 2005 of decreasing lifespan in USA coming true

In August 2005 in a letter to the editor of the Washington Post I had brought up that life expectancy in America would be expected to drop. I was concerned about heavy consumption of trans fats in fast foods as well as most baked goods. To add to the toxic mix of transfat laden foods was consumption of liquid sugars in high calorie soda pop, energy drinks and juices. In my medical practice I had noticed more younger patients were being admitted to the hospital with serious infections then in prior years.


Increasing data over the last few years has corroborated my concern from 2005.


A recent study of 50 years of mortality data confirms that US life expectancy has not kept pace with other wealthy countries and is now decreasing. A significant increase in death rates in the prime years of life ages 25 and 44 is noted in ALL races. This study is by Stephen Woolf MD MPH and Heidi Schoomaker MAEd. JAMA2019(20):1996-2016. Eli:10.1001/jama.2019.16932

Search engine for $$ paid by Pharmaceutical Companies to your Doctor

Dollars for Docs

How Industry Dollars Reach Your Doctors

This is Pro Publica's search engine with data from over 2 million transactions in the public domain of $$ paid to your health care provider/ institution.

Use it to understand the consulting fees, meals, travel paid out. The data is part of the settlement from years ago that the drug companies agreed to furnish this data.

Pro Publica has put it in a much better searchable format.

Ask Doctor Vinod: McDonald’s Transfat Settlement Aug 24 2005- 2013 SUCCESS IN USA FDA MOVES TOTAL BAN

Ask Doctor Vinod: McDonald’s Transfat Settlement Aug 24 2005---- SUCCESS IN USA -- FINALLY 2013 FDA MOVES FOR TOTAL BANhttp://askdoctorvinod.blogspot.com/2006/07/mcdonalds-transfat-settlement-aug-24.html

Worship the sun for good health/Tan and live longer

All Asians want to be gora. White skin! Indians I knew about, but Chinese cherish white skin too.  Since forever.

So sun is shunned.  From childhood. Krishna, Shiva and Kali of dark skin have been forgotten. All want to be Sita and Ram.

And Asians, newly wealthy are the target for corporates. Money is to be made. Print, Radio and TV media tout western lightening creams and sun block creams. Articles expounding skin modern doctors, sun hating convictions, fill magazines and Cricket TV broadcasts. I ran across one just yesterday on my flight from Goa to Mumbai. "Just take Vit D supplements" it said and "cover yourself with sun screen". SPF - sun protection factors, of - different branded creams was conveniently listed.

Just such nonsense is likely what brought a young man to see me the other day. I was surprised he had severe Vit D deficiency despite hours in the sun, golfing. He diligently applied expensive sun block cream every time he golfed. Lately he had been tired, moody and had no energy. Extensive heart tests had been normal. D levels were low despite a year of supplementation. Was he still missing something? Read on!

Sun has been worshipped http://www.britannica.com/EBchecked/topic/573676/sun-worship by native peoples since the beginning of time. Sun temples abound in at least in Asia, Egypt, Sumeria and Central and South America and the sun dance of the Plains Indians,

 My friend Kaushik told me 40 years ago that after his bath he, fully bare chested, hands folded recited the Gayatri mantra slowly 21 times, facing the sun. Daily. I did it for a while over the years in the US.

Somehow, the new source of all knowledge and wisdom, the Western medical establishment has declared the sun to be the devil. All humans are to avoid the sun, or if perchance they cannot they are to put chemical potions to block the sun devil. These sun blocking chemicals(retinoyl palmitate? carcinogen; oxybenzone-hormone disruptor, pthalates), are absorbed into us from the skin. Dr Oz says "No published studies have shown a link with cancer". That would be reassuring except it took decades to prove asbestos a carcinogen.

For the white skinned the sun maybe the devil, but Asians, even the whiter among us, are better off being in the sun longer, so our darker skin can make Vitamin D along with sundry chemicals such as the mood elevating Serotonin, the blood pressure lowering and heart healthy NO, or nitric oxide among others.

Just taking Vit D thus is not enough. If a car is how you get around, assume that you are sun deprived. A Vit D level blood test can confirm that. Or just take my word for it.

Please fix that. Exposé your skin to the sun, protect your eyes and face and not between 10 and 2pm in the west. No SPF anything.

My father lived to 92. He loved gardening 2 hours every morning. My brother golfs without sunscreen. For me it is gardening, manual work or lately like my mother,  I just sit in the sun, 30 minutes a day.

Often I think of Sonali, how one day I stopped her from tanning herself like her white friends by our pool in Bismarck years ago. Just like most in 1990, I had been brain washed by the medical/industrial complex of the west. I had forgotten sun worship. Marketing does that.  I was wrong then.

So worship the sun. Save your life.

If you so believe, say the Gayatri 21 times slowly, hands folded, facing the sun.

Daily.

Grand Rounds at Dartmouth 7/26/2013

Rare diseases are often given importance at Grand Rounds everywhere. Dartmouth is no exception. Esoteric is exciting, in medicine too!

Today's topic Hepato-Renal Syndrome by Dr Block, is remarkably rare. It is a manifestation of end stage liver disease. We hear about MELD scores and renal/ kidney cortical venoconstriction. International Ascites Club... gets a good laugh. They have criteria to diagnose it. Type 1 die quickly without liver transplantation. Other types..2,3,4 live somewhat longer.

New to me, fancy markers of Acute Kidney injury, Cystatin C and NGAL are talked about. More esoterica. Mayo does these tests. Apparently the results of these do not help patients. But keep your eyes out for these anyway. Great on rounds to impress your colleagues! And for high scores on tests!

At DHMC they have not done too many trans venous kidney biopsies, Dr Block says. Can help clarify the causes of the kidney problems. In expert hands it is listed as safe.

Sympathetic nervous system activation in HRS makes the kidney avidly reab sorb sodium.
There is more blood flow to the liver and gut, less to kidney and brain.

Prevention of HRS was discussed. Could give daily Norflox. Also use Pentoxyfylline in Alcoholic Hepatitis. Not used much apparently at DHMC.

Over a hundred people paid for with patient $$, either their medical insurance or their taxes, heard
this discussion in the beautiful weather controlled auditorium. Some watched the live telecast. Others not present either provided care in clinic or hospital or were recovering from night call.

Much more common ailments affecting us were saved fro another day.

If you have read this far skip and go to my blog about Tylenol, an under recognized liver toxin at less than large doses. Usual doses of Tylenol can be toxic. Depending on how much glutathione you have to detoxify NAPQI, a metabolic product of Tylenol.

Or check Wikipedia about NSAIDs, widely prescribed group of drugs and bought directly under names such as Advil, Motrin, Naproxen etc that have under recognized gut inflammation and kidney toxicity in population studies.

It just is not as exciting as esoteric diseases such as HRS.

The patient discussed did well. Mortality postponed by 8 weeks per the speaker. A liver transplant would help longer.MARS could keep these patients a alive as a bridge till transplant is available. A machine that does this was borrowed from Yale on another patient but was unsuccessful in preventing death. But everything possible is often done.

The patient died despite a TIPS done later. Interesting.

Prevention is slow steady work.  Who will tell people what will keep them well in our fee for service system?

Everyone clapped at the end of the talk. 

Questions followed and comments.

I did not speak up about the futility of such end stage care.

I did not speak up about the huge expenses incurred by such care or the costs of conferences that teach doctors about esoteric diseases.

Someone did. 

That was good. 

We Doctors do care. 








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