Medical education in the days of Big Pharma

I received this detailed email from an unexpected source: a 3rd-year medical student.

In her email, Theresa describes her frustrations in what she is witnessing for the first time, proceeding through her training and getting exposed to the realities of medical life.

Medical training, particularly clinical training from the 3rd and 4th years of medical school, onwards through internship, residency, and fellowship training, consists largely of bullying, "pimping" (meaning rapid-fire grilling of questions at trainees), and sleep deprivation. It is an extended hazing period meant to demoralize and inculcate the trainee into following the lead of superiors. Buck the system and you're . . . out. Imagine you've just sunk $190,000 and 8 years of college into getting to your internship. You are not going to chance being thrown out on principle. So you just swallow your pride, go along with the game, and echo all the answers they want you to repeat.

While Theresa laments the sad state of modern American pharmaceutical- and procedure-obsessed medicine, she provides me with hope that some young people training to practice medicine today will carve out their own paths, not the one laid for them by the pharmaceutical industry, nor fall for the temptation of higher-paying procedural specialties like orthopedics and cardiology. I am impressed with her ability to see this so early in her career.


Dr. Davis,

I am a 3rd year medical student at ________ University. I came across
your blog today, and I'm very glad I did. I appreciate the value of your time,
so I want to be as succinct as possible while still getting across what I'm
really thinking and feeling:

From what I gathered exploring your blog for a while this afternoon, the
wellness strategies you incorporate into your practice are some of the exact
things I want to do with my future patients. Personally, I strongly believe in
staying healthy by eating right, staying active, etc. For instance, I don't eat
grains or much in the way of starches and sugars. So I love the fact that you
are helping your patients make these powerful and foundational changes in their
lives.

As I'm sure was your experience, a full appreciation of nutrition and lifestyle
as a first-line health strategy is not something that was taught to me in
medical school. I came to school with this deep conviction already in my heart
and mind, and now, on my 3rd year rotations, I am still conflicted and at a loss
as to how I'm going to be able to practice medicine the way I want to, which is
to incorporate these all-important principles into the care of my patients.

What I've come to understand about the medical field today is that the
information that exists is primarily subsidized by the pharmaceutical industry,
and dictated to medical professionals as "evidence-based" treatment guidelines
and recommendations by organizations with sincere and official sounding names
like American Heart Association and American Cancer Society. Add to that the
pressure of potential malpractice litigation and the complexities of the
insurance reimbursement game, and it seems to me like what you get is a bunch of
diagnostic and medication management algorithms that any half-trained monkey
could follow. In his sleep. Which I guess would be alright if at least they
weren't algorithms based on misguided, self-serving, profit-seeking Big Pharma,
Food Inc, insurance conglomerates, and agri-politics (I think I just made that
word up.)

A lot of well-intentioned physicians are just parroting the party
line, as their patients dutifully and gratefully chomp down their statins and
diabetes drugs and blood pressure pills. And I'm sorry, but "diabetes
education" programs with curriculum put together by drug companies? How is that
even legal? Massive corporations raking in massive profits that are dependent
on uncontrolled blood sugars telling people how to best control their blood
sugars?!

Anyway, forgive my rant. What I'm getting at is this: How can I practice
medicine, with the freedom to educate/coach/treat my patients with diet and
lifestyle changes to mitigate/reverse their chronic health conditions? Without
feeling like I automatically have to first and foremost prescribe the litany of
drugs dictated by "evidence-based" guidelines? Without excessive fear of
litigation or loss of credibility among my peers? Without having to lie through
my teeth to my patients, and tell them that eating low-fat and heart-healthy
whole grains is the best way (implication also being the only scientifically
proven way) to control their diabetes, lower their cholesterol, etc, etc, etc?

I want my patients to have the full benefit of honest nutrition and lifestyle
information, and medications and surgery as necessary. I'm afraid that there
isn't room for this kind of holistic emphasis in the medical profession today.
Are there residencies that include this kind of training or at least respect
these "unconventional" philosophies? Are there clinics or practice groups that
would allow me to practice with this emphasis, or is there a bias against docs
who do not necessarily conform to the party position? Will I have no other
option but to go it alone under the auspices of my own shingle? How do you
handle these kinds of issues in your professional life?

Sincerely,
Theresa M.


A ray of hope! Perhaps Theresa is just the first among many more medical students who refuse to submit to the brainwashing practices of the pharmaceutical industry, the same mind manipulation that has hopelessly turned most of my colleagues into their unwitting puppets.

I'll be interested in watching how Theresa's experience unfolds. I've asked her to keep us informed every so often.

Comments (43) -

  • Sassy

    10/29/2010 8:16:32 PM |

    I would love to see your answers to her questions.

  • Tara BRIDGES

    10/29/2010 8:24:51 PM |

    Welcome to my world... only as a dietitian it is WAY worse.  Trust me.

    Not only do we have to deal with bogus "evidence-based guidelines," the loss of respect of colleagues, and risk of losing our license... We have to do it all with less than a quarter of the salary that the average physician makes and much, much less respect.

    I'm so frustrated in this field, but I'm at a loss as to what to do...

  • Tommy

    10/29/2010 8:28:25 PM |

    Timely. I was just arguing (discussing) with my cardiologist about coming off my statin (40 mg). I never had a cholesterol problem and still don't, even though I had an MI. I point to niacin and he points to Zocor. I tell him about studies and he claims I'm reading the wrong studies and that it is his job to know these things. He claims the zocor isn't for my cholesterol it is to control inflammation. I again point to studies that dispute statins ability to do that and  again suggest niacin. Again, he says he knows better. She is right...it is a sad state of affairs.

  • Jonathan

    10/29/2010 8:49:12 PM |

    @Tommy
    Maybe your doc needs to watch Tom's latest post.
    http://www.fathead-movie.com/index.php/2010/10/28/video-of-the-big-fat-fiasco-speech/

    And maybe your doc doesn't need to be your doc anymore.

  • Lucy

    10/29/2010 9:54:30 PM |

    Wow-Thank you Theresa. We need more like you!

  • Lori Miller

    10/30/2010 1:28:42 AM |

    Theresa, I'm not a health care provider, just someone who leads an independent life and writes a humble blog on solving one's own health problems, so take this FWIW.

    How do you think for yourself and do things your way? Study the Socratic method. Go by results. Look at how conclusions were arrived at, and weak links in the chain. Don't hang around with people who are dishonest or have stopped thinking for themselves. Always admit your mistakes instead of justifying them.

    If colleagues disapprove of you, check yourself and see if the criticism is valid. Going by what you've said, you'll probably have to choose between professional camaraderie and the best interests of your patients.

    A couple of books that are good tools for thinking for yourself: The Consolations of Philosophy by Alain de Botton and Mistakes were Made (but not by me).

  • kellgy

    10/30/2010 1:35:05 AM |

    I know exactly how Theresa feels. After losing 95 pounds, reversing hypertension, and arrhythmias, I have returned to school for an advanced degree as a FNP. My hope is also to provide an approach of health and wellness through nutrition, education, and exercise.
    I have the feeling that there are going to be more of us than the pharmaceutical companies know what to do with. Maybe I am a hopeful optimist, but the influence of a sustainable evidenced based approach as propagated here is already having it's effects.

  • Valerie LeComte

    10/30/2010 1:43:47 AM |

    I agree with Sassy, I would love to see your answers.  I am a second year medical student and am struggling with similar issues.  
    You aren't the only one Theresa! Good luck!

  • Anonymous

    10/30/2010 1:59:07 AM |

    Theresa,

    The practice model you are seeking already exists.  Check out the Institute for Functional Medicine at www.functionalmedicine.org .  After reading your letter to Dr. Davis, I think you'll find IFM exciting.  Good Luck.

  • Anonymous

    10/30/2010 2:40:22 AM |

    Medicine isn't the only field like that. Clinical & school psychology is just as rigid with its hierarchy of gurus and 'prescriptions for care' that are questionable. I was in the field for 30 yrs. before retiring and I can tell you that if you deviate from the path you'll be drummed unceremoniously. Those smiling faces have knives behind their backs. Where do you turn for straight answers? As always, you have to find them yourself. (My identity is anonymous because my username/password is being rejected. Wonder if 'they' have gotten to blogger dotcom too. JK.)

  • Anonymous

    10/30/2010 3:07:00 AM |

    A typo in my last post; should have read:

    I was in the field for 30 yrs. before retiring and I can tell you that if you deviate from the path you'll be drummed out unceremoniously.

  • Kim

    10/30/2010 4:41:05 AM |

    Theresa, please tell me you will practice in Arizona. I need a doctor just like you. Im sick of being offered bandaids to cover up symptoms instead of figuring out a cause for the symptoms. I wish you the best and hope there are more out there like you and Dr. Davis.

  • moblogs

    10/30/2010 9:09:25 AM |

    Just hearing one account of a student upset with the status quo definitely makes me more hopeful for the future. Eventually these voices accumulate and change happens.

  • Buy Flonase Online

    10/30/2010 11:16:57 AM |

    I was in the field for 10 yrs,Medicine isn't the only field like that, before retiring and I can tell you that if you deviate from the path you'll be drummed out unceremoniously.

  • Anonymous

    10/30/2010 11:25:22 AM |

    I was at the grocery store Meijers yesterday morning.  And when there early, I typically am left having to use the self check out lanes.  I dislike using these machines.  They all to often break while using them, causing a delay as I wait for someone to come fix the problem.  Meijers employees early in the morning are often not motivated to fix much of anything I've come to find in the past.  

    So as is all to often the norm, my self check out machine gave an error.  The machine reported something was on the conveyer belt - while in reality nothing was.  No more items allowed to be checked until the error was fixed though.     I pressed the help button and with little surprise no one came to fix my problem.  So I packed up and was ready to visit another checkout machine.  This simple act apparently is the motivation Meijers employees need!  She came stomping over, full of attitude.  She really let me have it for wanting to leave the machine.  it was kind of funny.  I just smiled as she lit into me, and was working the check out computer to clear the error.  Once done and walking away, I joked, "let me guess you once were a doctor?"  She didn't like that either.  I'll be shopping at Wal-Mart across the street in the future, even though the same setup and type of employees work there.

    Hope you keep up the work doctor Davis!  I've learned a great deal from your sight, as I'm sure many others have too.  I tell everyone about this place.  Having had a life long chronic illness and seen more doctors than i wish, what disappoints me equally about the lack of care in modern medicine, is the belief by most in society that hospitals have all the answers - that taking responsibility for your own health is unreasonable and even dangerous.  I figured out quickly in my quest for an answer to my chronic health problems that I was not going to be cured in a hospital.  All to often rude, even angry doctors would let me know in one way or another all they dealt with is pharmaceuticals or procedures, items that did not work in my case.  Going outside of that was unwelcome territory.  I kept going to see doctors though.  It wasn't for me that I went.  I did it because family and friends believe in modern medical myths.  I even got to the point where I would take  family members to my meetings with physicians so they could hear what was said for themselves.  That seemed to make doctors nervous.  If I brought someone with me, they would bring a colleague with them!  I actually found these "group health gatherings" to be good, not only to further inform disappointed family members, but also for what ever reason I didn't receive the level of lip from doctors.  

    Anyway, not to bash on doctors and hospitals, just my hope is that someday a majority of people come to realize it is alright to take health care into your own hands.  Hospitals don't have all the answers, and all to often the answers that they do provide are inferior to a good proven diet and a few supplements.  I guess there will always be a place for expensive drugs and procedures, they just shouldn't be the first option, when there are other healthier and cheaper possibilities, in my opinion.

  • Anonymous

    10/30/2010 11:26:53 AM |

    I was at the grocery store Meijers yesterday morning.  And when there early, I typically am left having to use the self check out lanes.  I dislike using these machines.  They all to often break while using them, causing a delay as I wait for someone to come fix the problem.  Meijers employees early in the morning are often not motivated to fix much of anything I've come to find in the past.  
      So as is all to often the norm, my self check out machine gave an error.  The machine reported something was on the conveyer belt - while in reality nothing was.  No more items allowed to be checked until the error was fixed though.     I pressed the help button and with little surprise no one came to fix my problem.  So I packed up and was ready to visit another checkout machine.  This simple act apparently is the motivation Meijers employees need!  She came stomping over, full of attitude.  She really let me have it for wanting to leave the machine.  it was kind of funny.  I just smiled as she lit into me, and was working the check out computer to clear the error.  Once done and walking away, I joked, "let me guess you once were a doctor?"  She didn't like that either.  I'll be shopping at Wal-Mart across the street in the future, even though the same setup and type of employees work there.
      Hope you keep up the work doctor Davis!  I've learned a great deal from your sight, as I'm sure many others have too.  I tell everyone about this place.  Having had a life long chronic illness and seen more doctors than i wish, what disappoints me equally about the lack of care in modern medicine, is the belief by most in society that hospitals have all the answers - that taking responsibility for your own health is unreasonable and even dangerous.  I figured out quickly in my quest for an answer to my chronic health problems that I was not going to be cured in a hospital.  All to often rude, even angry doctors would let me know in one way or another all they dealt with is pharmaceuticals or procedures, items that did not work in my case.  Going outside of that was unwelcome territory.  I kept going to see doctors though.  It wasn't for me that I went.  I did it because family and friends believe in modern medical myths.  I even got to the point where I would take  family members to my meetings with physicians so they could hear what was said for themselves.  That seemed to make doctors nervous.  If I brought someone with me, they would bring a colleague with them!  I actually found these "group health gatherings" to be good, not only to further inform disappointed family members, but also for what ever reason I didn't receive the level of lip from doctors.  
      Anyway, not to bash on doctors and hospitals, just my hope is that someday a majority of people come to realize it is alright to take health care into your own hands.  Hospitals don't have all the answers, and all to often the answers that they do provide are inferior to a good proven diet and a few supplements.  I guess there will always be a place for expensive drugs and procedures, they just shouldn't be the first option, when there are other healthier and cheaper possibilities, in my opinion.

  • Anonymous

    10/30/2010 11:32:15 AM |

    Hope you keep up the work doctor Davis!  I've learned a great deal from your sight, as I'm sure many others have too.  I tell everyone about your writings.  Having had a life long chronic illness and seen more doctors than i wish, what disappoints me equally about the lack of care in modern medicine, is the belief by most in society that hospitals have all the answers - that taking responsibility for your own health is unreasonable and even dangerous.  I figured out quickly in my quest for an answer to my chronic health problems that I was not going to be cured in a hospital.  All to often rude, even angry doctors would let me know in one way or another all they dealt with is pharmaceuticals or procedures, items that did not work in my case.  Going outside of that was unwelcome territory.  I kept going to see doctors though.  It wasn't for me that I went.  I did it because family and friends believe in modern medical myths.  I even got to the point where I would take  family members to my meetings with physicians so they could hear what was said for themselves.  That seemed to make doctors nervous.  If I brought someone with me, they would bring a colleague with them!  I actually found these "group health gatherings" to be good, not only to further inform disappointed family members, but also for what ever reason I didn't receive the level of lip from doctors.  
      Anyway, not to bash on doctors and hospitals, just my hope is that someday a majority of people come to realize it is alright to take health care into your own hands.  Hospitals don't have all the answers, and all to often the answers that they do provide are inferior to a good proven diet and a few supplements.  I guess there will always be a place for expensive drugs and procedures - as if I have a choice in the matter - they just shouldn't be the first option, when there are other healthier and cheaper possibilities, in my opinion.

  • Dr. William Davis

    10/30/2010 12:32:36 PM |

    Hi, Sassy--

    This was my simple response. I operate in the real world, too, and do not have perfect solutions. I also invited her to my office to see what it is I do and how I do it.


    Sadly, your criticisms and concerns are right on the money.

    The problem: It will take 30 years and legions of our colleagues before there is a "sea change" of practice patterns and what we do becomes the norm. In the meantime, you have a satisfying and honest career to carve out.

    Training will try to push your round shape into a square hole, forcing you to mimic the thinking of conventional medicine. It may be a compromise you have to draw. I know of few good opportunities to break out of this mold. I believe that University of Arizona offers some sort of holistic medicine training. More of these programs are popping up. While they may not be precisely what you are looking for, perhaps they offer more leeway and less dogmatic training.

    I do sense that more and more of the primary care community are slowly rejecting conventional approaches, but I estimate it's less than 5%. But it used to be practically nobody. So it's a start.

    One good thing to know: I do what I do with little friction from colleagues. Most have no idea what it is you're talking about, but most stop arguing when they see what you can accomplish. Then they kind of turn a blind eye to how you did it, rarely asking why you did worked and their approach didn't.

  • Dr. William Davis

    10/30/2010 12:39:14 PM |

    Anonymous from Meijers--

    I hear you. I agree wholeheartedly that there is a huge and growing role for self-empowerment in health. It certainly will not come from conventional health channels, but from unconventional sources, such as online health information, direct-to-consumer testing, and other growing services.

  • Dr. William Davis

    10/30/2010 12:40:52 PM |

    Hi, Tara--

    I empathize.

    I know several very excellent dietitians, all of whom are affiliated with hospital systems (the only ones who hire), who are deeply frustrated as you are.

    I can only hope that we achieve a "critical mass" sometime soon, numbers of dissenters sufficient to be heard and not shunned, criticized, or fired.

  • Anonymous

    10/30/2010 12:47:31 PM |

    My dad is a family physician (MD) for 30+ years and over the past few years has been implementing many more natural approaches to preventing illness. It is a DIFFICULT path to take and one that is fought every day in the exam rooms with the patients and in the hallways with other doctors.

    What amazes me is other doctors willingness to RX medications that JUST CAME OUT ON THE MARKET without having done their due research, yet they very quickly judge and frown upon my dad's approach to medicine which he arrived at after many, many months of reading and researching these alternative therapies.

    While they claim to not doubt his intentions, its clear they disapprove of his methods, even in the face of proven results (less flu, fewer office visits for his patients, improved lab results).

    The reality is, he studies more in one evening (after seeing patients all day) than others study in a year. When he employs a therapy, its because he's researched the hell out of it and he's convinced it's the right approach to take. He understands the science behind HOW it works.

    Taking a preventative approach is difficult enough, but enduring the constant judgment from others who practice big-pharma medicine is what makes my dad the top-notch physician that he is. He doesn't back down from a good opportunity to educate both patients and other physicians alike about why he's decided to prevent disease instead of simply treating it.

    How refreshing to see others (especially younger physicians) who are also enduring this difficult path. It is the right thing to do.

    (P.S. Dr Davis- Vitamin D, Magnesium, Iodine, and now Lipoprotein A....you and my dad are following similar paths. I tried getting him to check lipoprotein As on his patients about a year ago (after studying them on your blog), but he was coming up to speed on Iodine at that time. Now he's embraced lipoprotein A and I know it's going to save lives. THANK YOU!)

  • Anonymous

    10/30/2010 1:30:38 PM |

    If a physician steps outside guideline-based medicine (statins for MI), he/she would open themselves up for the lawyers if the patient had an event.  

    The system is defective, but in some situations, the fear of getting sued is stronger than any influence from pharma.  

    Also, many training programs do not allow interaction with pharma reps at this time (from what I have heard).  This has been a new development in the last 1-2 years.

  • Carolyn Thomas

    10/30/2010 4:45:44 PM |

    Interesting comments from this med student.  Welcome to the wonderful world of marketing-based medicine!

    But we live in hope! Many medical schools are in fact taking action to address the pervasive influence of Big Pharma on medical education.

    For example, here in Canada pharmaceutical companies have long supplied free lunches – and even fridges to store them in – in the student lounges of all Canadian medical schools.

    But if the association that represents Canada’s medical schools has anything to say about it, there really will be no such thing as a free lunch anymore – at least for medical students.

    This also means no more talks given by physician experts paid by pharmaceutical companies. No more unsupervised meetings with drug reps.

    The Association of Faculties of Medicine of Canada say that their aim is to limit the influence that the pharmaceutical industry has on medical students and residents, as well as to address the public’s concerns about the perceived coziness between medical schools and Big Pharma.

    Dr. Irving Gold of the AFMC described the potential impact of drug company relationships on these students:

    “There’s no question that the environment within which you’re trained will have an impact on the way you perceive these issues. The public has to trust that the doctors they see do not have any debts to pay to individual pharmaceutical companies or to the sector as a whole.”

    More on this at "Pens, Pizza, Parties: How Big Pharma Freebies Impact Your Doctor" on THE ETHICAL NAG: MARKETING ETHICS FOR THE EASILY SWAYED - http://ethicalnag.org/2009/12/08/pens-pizza-parties/

  • Larry

    10/30/2010 7:33:19 PM |

    Hang in there Theresa M.
    You have to do what your heart tells you to.

    Anyway.... about Dieticians and Hospital food.
    Does the average dietician really, truly, believe that the food they serve is really nutrititional ?
    Does Monsanto dictate the cirriculum ?
    We've all seen Cancer patients being fed juice, milk, bread, cereal, canned (dead) food, potatoes, cookies, cold cuts, etc.
    How can a dietician with a conscience, be part of this ?
    Not trying to be offensive, I'm just asking, as they have to know the whole paradigm is wrong.

  • Gutted

    10/30/2010 9:32:22 PM |

    Thank you, Theresa, for speaking out! Hopefully, we'll see more and more medical students like you who really care about patients' health versus playing the Big Pharma, imaging and "slice 'em up"  marketing games. Unfortunately, with all the greed I see in this world, I don't have high hopes. But please don't let that stop you!

    It doesn't help that I was victimized by the medical profession in a big way. My ob/gyn of 20 years rushed me into surgery for possible ovarian cancer. Despite a benign frozen section, he proceeded to remove all my female organs. I suspect part of the reason was to train two gyn residents. This experience has shown me how corrupt the medical profession can be. Many things in the oncologist's records gave the appearance of collusion with my ob/gyn. I now realize that the oncologist was protecting his referral base to the permanent detriment of my health. A complaint to my state's medical board resulted in no disciplinary action. The outcome of a complaint I filed with my insurance company was confidential but the doctor is still in their network.  

    After many problems from the assault on my endocrine system amd anatomy (aging 15 years overnight along with profound depression and anxiety which I'd never experienced), I started frequenting hysterectomy forums. That's when I discovered that my story is quite common. If women were getting informed consent from their gynecologists, 1 in 3 women would not be hysterectomized by age 60 (1 in 2 by age 65). 73% of women are castrated at the time of hysterectomy. These women have a much greater risk of all-cause mortality. Yet, the carnage continues to the tune of a hysterectomy every minute in the U.S.  

    The book "The Treatment Trap" is a real eye-opener into the dark side of medicine. I highly recommend it.

    Here's an article - Lies, Damned Lies, and Medical Science - about the flaws of medical studies:

    http://www.theatlantic.com/magazine/archive/2010/11/lies-damned-lies-and-medical-science/8269

    Per the article, a leading expert in medical research credibility estimates that up to 90% of published medical information is flawed.

  • Tara

    10/30/2010 11:43:40 PM |

    @ Larry

    I work in outpatient, but I can go ahead and tell you that the inpatient dietitians don't actually "serve" the food, nor do the prepare it or even choose it.  The food service company (typically Aramark or Morrison) is responsible for the selection, preparation, and serving of food to patients.  An inpatient dietitian's job is to oversee patient care related to nutrition in various disease states, calculate needs, educate, and in some cases order/manage TPN or tube feedings.

    Many of us HATE the awful food that is served in hospitals, but we have no say in the matter.  Hospitals are run like businesses, so the quality of food is not as important as the cost.  When my dad had his bypass surgery, I cooked and brought him food from home.

  • Dr. William Davis

    10/31/2010 2:34:52 PM |

    Hi, Tara--

    You know, the plight of enlightened dietitians today reminds me of the way the German people must have felt when the National Socialism movement coerced them to follow their dictates on pain of imprisonment.

    The whisperings of neighbors was all it took to have the Gestapo knocking on your door at night.

    Your experience, by the way, would be a great conversation for this blog. Please tell us more.

  • blogblog

    11/1/2010 6:42:05 AM |

    I was friends with two Indonesian medical graduates. In Indonesia medicine is a six year undergraduate degree. Students spend the entire first year studying anatomy and physiology in considerable depth. They then spend the next five years working full-time in a hospital or small clinic. They begin to perform circumcisions after their first year of studies. Before graduation they must deliver a minimum of 100 babies!

  • blogblog

    11/1/2010 7:14:29 AM |

    Hi Tara,
    with respect being a dietitian or other health practitioner is simply not comparable with practising medicine. I should know because I studied exercise physiology as a postgraduate. My academic workload was probably less than 1/4 that of a medical student.

    The fact is that allied health degrees like nursing, dietitics and exercise physiology are actually quite easy.

    The amount of underlying theoretical knowledge, the workload and responsibility is vastly greater in medicine than in any other health related profession.

    The reality is you get 1/4 the pay of a doctor because your job is 1/4 as hard. You don't have to work nights, weekends and public holidays. You also don't have to be on call, work 36 hour shifts, make instantaneous life and death decisions or deal with grieving relatives like doctors do.

  • Anonymous

    11/2/2010 1:03:07 AM |

    "In Indonesia medicine is a six year undergraduate degree. Students spend the entire first year studying anatomy and physiology in considerable depth. They then spend the next five years working full-time in a hospital or small clinic. They begin to perform circumcisions after their first year of studies."

    But only on adults who ask to be circumcised, right?

    I certainly hope the mutilation of nonconsenting infants is not the standard of care in Indonesia.

  • blogblog

    11/2/2010 5:55:28 AM |

    Hi Anonymous. Indonesia is a Muslim, country so circumcision is routine for babies.

  • buy differrin online

    11/2/2010 3:52:18 PM |

    I was just arguing (discussing) with my cardiologist about coming off my statin (40 mg). I never had a cholesterol problem and still don't, even though I had an MI. I point to niacin and he points to Zocor. I tell him about studies and he claims I'm reading the wrong studies and that it is his job to know these things. He claims the zocor isn't for my cholesterol it is to control inflammation. I again point to studies that dispute statins ability to do that and again suggest niacin.

  • Tara

    11/3/2010 2:12:06 AM |

    @blogblog

    I think you missed my point... My post wasn't to complain about the difference in our salaries.  My point was that because we are in a lower position, we have an even tougher fight ahead.  It's hard to make a change when your grassroots efforts are poorly funded and your profession is not respected.

  • blogblog

    11/3/2010 7:28:16 AM |

    Tara,

    I'm sure that you are well intentioned and wish to help people but you aren't in a position to do that within the conventional dietetics framework.

    The only really influential and widely respected professionals in health care are senior medical specialists working in teaching hospitals. The opinions and knowledge of others is often deemed irrelevant.

    I am speaking from the Australian perspective so my comments may not be relevant to you.

    The dietetics profession has an extremely unethical relationship with the food processing industry. Many food manufacturers employ dietitians primarily as effective PR personnel to give their extremely unhealthy products some credibility.

    The Dietitians Association of Australia actively endorses the type of unhealthy products manufactured by their commercial partners. In the recent past the DAA has even actively promoted confectionery as part of a 'balanced' diet for children.

  • Rogue Dietitian

    11/6/2010 5:26:05 PM |

    @Tara -- you're not alone! I too am a "rogue" dietitian and am so frustrated with my colleagues. I am lucky in that I work at a naturopathic practice where my nutritional point of view is in sync with the doctors I work for. So, I am not expected or criticized for straying from the ADA/USDA grain-dairy model. I hear your frustrations with the field. Luckily, there is so much you can do with it though. I had to find my own way.

    During my internship, I had reservations about having to give diet advice I didn't believe to be prudent -- eat a low fat diet, drink lots of milk, etc. Instead, I changed the script and focused on other pieces of advice. For example, for heart patients I focused on getting them to eat more vegetables, and ditching the margarine, and "forgot" to mention the parts I don't agree with. Or for diabetics, eating fewer carbs and focusing on gluten-free sources like potatoes, brown rice, etc. My preceptors were thrilled I was getting people to eat more vegetables, and I didn't feel like I sold out. Good luck to you.

    Dr. Davis, I have only recently discovered your blog but am enjoying it. I have some non-traditional ideas on heart health I would love to dialog with you about sometime.

  • Dr. William Davis

    11/7/2010 3:59:52 PM |

    Hi, Rogue--

    That's great! A clever, "stealth," way to say what you believe.

    You are welcome to post recipes here or to go to www.trackyourplaque.com and use the "contact" link. I look forward to seeing what you've come up with.

  • rangojigi

    11/11/2010 9:21:37 AM |

    I would love to see your answers to her questions.
    buy viagra online

  • Anonymous

    11/13/2010 3:27:27 AM |

    I learned a long time ago that 99.9% of doctors are worse than useless. I don't plan to ever see a doctor again. Sadly, I'll soon be forced into the medical system, like most Americans.

  • 2medicure

    12/10/2010 4:57:30 AM |

    Well after reading your blog and the comment from all the expert i will love to visit this blog to get update about good healthy habits

  • Dana Seilhan

    12/11/2010 9:35:44 AM |

    Anonymous, no one's being forced into the medical system. They're being made to pay for insurance.  No one says you have to go to the doctor.

    I was startled to learn there are actually sound economic reasons for making everyone buy into health insurance in a given country.  Too long to explain here but the book I learned this from, well predated the "health care reform" debate.  In a nutshell, if you didn't want to have to buy a health insurance plan, you should have supported the idea of single-payer coverage.  But you didn't want that, because it was "socialist," if you are like most Americans.  So this is the alternative everybody gets to live with, since they decided it was more important to have health insurance companies than to fund health care like we do police and fire departments.  Dem's de breaks.

  • dr cate

    9/19/2011 12:48:11 PM |

    HI Tara
    I work with a dietician who, like you, has a real passion for her job. She told me that she feels like she has participate in "tragedies unfolding every day" when the doctors send patients to her expecting the usual advice. She is fighting back, though. She has a health radio show you can listen to: http://www.wkxl1450.com/site/index.php?option=com_content&task=view&id=4182

    I encourage you to seek out doctors who think outside the box in your area. I have been so grateful to have Chris available for my patients, and I know other doctors would be grateful for someone like you, too!
    (PS I am relocating soon to Napa, CA, you don't happen to be there...?)

  • Barb

    10/5/2011 12:20:23 AM |

    Not meaning to be a s*&t disturber, but then why do an alarming number of doctors seem to only know 1/4 of what other allied health practitioners do?? Are they being taught too much 'feather' and not enough chicken??

  • jpatti

    5/31/2012 3:29:00 PM |

    I have a sister who doesn't understand much about biochemistry.  She asks me for advice all the time with various issues/problems.  Vast majority of my advice is dietary/supplements.  Sometimes, my advice is for prescription meds, which I can usually locate without a doctor (not talking narcotics or anything).

    But my advice to her in a ACUTE situation is... don't wait to ask me, do what the doctor says.  IMO, if you have a broken bone, or are actively having a heart attack, or have a big infected boil, mainstream medicine is OK, pretty much the best we've got.  

    When you have a CHRONIC disorder, or are trying to preempt having one, that is when taking your health into your own hands is good.  That is when you look up all the prescribing info for the drug they want to put you on before taking it.  That is when you become more of an expert on your disease than they are.  

    I had a CABG several years back, I've been a T2 diabetic for years, I had a bad rT3 problem, and adrenal insufficiency (reversed both the rT3 and adrenal issues and am weaned off meds), I have low sex hormones (E, P and T), I have systemic yeast.  I know more about my COMBINATION of diseases than any doctor cause I'm more INTERESTED and have GOBS of time to research each issue and the endocrinology (which includes nutrition. since cholesterol and vitamins A, D3 and K2 all profoundly effect hormones) and of how they all interact.  I can spend hours looking at a diagram of steroidogenesis and trying to figure out myself.

    So... if a doctor wants me to use more insulin for tighter control, I know I need more K-Dur to counteract the K loss from insulin else my BP will go skyhigh.  They don't.  They just see my BP go high and want to put me back on Lisinopril (which never lowered it, after 2 years of increasing doses).  I know niacin fixes my lipid panel better than statins - and that I can climb stairs on niacin.  I know that high omega 3 intake, and high vitamins A, D3 and K2, and lots of CoQ10 are absolutely required for my health.

    I DO know more than they do about my chronic stuff, and my sister's chronic stuff, and my daughter's and husband's issues.  If it's anything chronic, I WILL know more in a few weeks time than any doctor treating me.  Cause... no one can be an expert on EVERYTHING and I CARE more when it effects me or mine than they do.  I'm one of 30 patients they are seeing today; I'm the only me I've got.  I just flat out CARE more.

    But in an acute situation, I trust them.  My sister needs an MRI on her back, I agreed she needs it, and just said, "Do whatever they tell you if it's based on the MRI."  Cause... I can't become an expert in 10 minutes, and the acute stuff, they are mostly pretty good at.  Someone has to decide in those situations, and you don't have time to become an expert.

    There's other stuff mainstream medicine has gotten right.  Antibiotics as an example... though the overuse of them is what they got wrong.  Similarly, while I think we overdo vaccinations, the fact is that when polio came through a town and killed or crippled most of the children, that was some bad stuff.  Mainstream medicine gets some things right.

    The problem with medicine is that it is not evidence-based, though they say it is.  At BEST, it takes 10-15 years for good research info to change the practice of medicine.  At worst, if there is no profit motive, good research info may NEVER change the face of medicine.  

    IMO, with mainstream medicine, you take what is good and leave the rest.  But throwing out the baby with the bathwater makes no sense.  Doctors do have their uses.  No matter how we rant against their stupidity, there is some worthwhile stuff there.

    One of MY reasons for hanging out here is that Dr. Davis changes.  When I started hanging on this blog and his website and bought his first book, he wasn't discussing thyroid, or K2, and his dietary ideas were quite a bit different than today (though the anti-wheat stuff was there even then).  

    Not that I agree with him 100% about everything, but... he DOES change the way medicine does not; he actually DOES do evidence-based medicine, based on actual evidence, not just evidence provided by pharmaceutical studies.  And since evidence changes over time, and he keeps learning, his recommendations change.  That gives me confidence in his latest ideas, to go research them for myself.  

    And for those who can't really research for themselves, without a solid science background and an understanding of how to read studies, if they have cardio issues, I just tell them to go do what he says.  I've told people to read his books, sent them to the blog and website, I've even sent a few people to see him, cause they were local to him and able to get there.  Cause even if I don't agree 100% about everything, he's the only cardiologist I know who is actually reversing CHD.  

    Granted, Dr. D is a maverick and himself rants against mainstream medicine.  But... he rants agaisnt specific stupidity.  I'm sure if you were having an actual MI right now, he'd recommend a procedure to save you.  Just... he'd rather you not have the MI in the first place, which is why he rants.

    But... baby and bath water...

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How Not To Have An Autoimmune Condition

How Not To Have An Autoimmune Condition


Autoimmune conditions are becoming increasingly common. Estimates vary, but it appears that at least 8-9% of the population in North America and Western Europe have one of these conditions, with The American Autoimmune Related Diseases Association estimating that it’s even higher at 14% of the population.

The 200 or so autoimmune diseases that afflict modern people are conditions that involve an abnormal immune response directed against one or more organs of the body. If the misguided attack is against the thyroid gland, it can result in Hashimoto’s thyroiditis. If it is directed against pancreatic beta cells that produce insulin, it can result in type 1 diabetes or latent autoimmune diabetes of adults (LADA). If it involves tissue encasing joints (synovium) like the fingers or wrists, it can result in rheumatoid arthritis. It if involves the liver, it can result in autoimmune hepatitis, and so on. Nearly every organ of the body can be the target of such a misguided immune response.

While it requires a genetic predisposition towards autoimmunity that we have no control over (e.g., the HLA-B27 gene for ankylosing spondylitis), there are numerous environmental triggers of these diseases that we can do something about. Identifying and correcting these factors stacks the odds in your favor of reducing autoimmune inflammation, swelling, pain, organ dysfunction, and can even reverse an autoimmune condition altogether.

Among the most important factors to correct in order to minimize or reverse autoimmunity are:


Wheat and grain elimination

If you are reading this, you likely already know that the gliadin protein of wheat and related proteins in other grains (especially the secalin of rye, the hordein of barley, zein of corn, perhaps the avenin of oats) initiate the intestinal “leakiness” that begins the autoimmune process, an effect that occurs in over 90% of people who consume wheat and grains. The flood of foreign peptides/proteins, bacterial lipopolysaccharide, and grain proteins themselves cause immune responses to be launched against these foreign factors. If, for instance, an autoimmune response is triggered against wheat gliadin, the same antibodies can be aimed at the synapsin protein of the central nervous system/brain, resulting in dementia or cerebellar ataxia (destruction of the cerebellum resulting in incoordination and loss of bladder and bowel control). Wheat and grain elimination is by far the most important item on this list to reverse autoimmunity.

Correct vitamin D deficiency

It is clear that, across a spectrum of autoimmune diseases, vitamin D deficiency serves a permissive, not necessarily causative, role in allowing an autoimmune process to proceed. It is clear, for instance, that autoimmune conditions such as type 1 diabetes in children, rheumatoid arthritis, and Hashimoto’s thyroiditis are more common in those with low vitamin D status, much less common in those with higher vitamin D levels. For this and other reasons, I aim to achieve a blood level of 25-hydroxy vitamin D level of 60-70 ng/ml, a level that usually requires around 4000-8000 units per day of D3 (cholecalciferol) in gelcap or liquid form (never tablet due to poor or erratic absorption). In view of the serious nature of autoimmune diseases, it is well worth tracking occasional blood levels.

Supplement omega-3 fatty acids

While omega-3 fatty acids, EPA and DHA, from fish oil have proven only modestly helpful by themselves, when cast onto the background of wheat/grain elimination and vitamin D, omega-3 fatty acids compound anti-inflammatory benefits, such as those exerted via cyclooxygenase-2. This requires a daily EPA + DHA dose of around 3600 mg per day, divided in two. Don’t confuse EPA and DHA omega-3s with linolenic acid, another form of omega-3 obtained from meats, flaxseed, chia, and walnuts that does not not yield the same benefits. Nor can you use krill oil with its relatively trivial content of omega-3s.

Eliminate dairy

This is true in North America and most of Western Europe, less true in New Zealand and Australia. Autoimmunity can be triggered by the casein beta A1 form of casein widely expressed in dairy products, but not by casein beta A2 and other forms. Because it is so prevalent in North America and Western Europe, the most confident way to avoid this immunogenic form of casein is to avoid dairy altogether. You might be able to consume cheese, given the fermentation process that alters proteins and sugar, but that has not been fully explored.

Cultivate healthy bowel flora

People with autoimmune conditions have massively screwed up bowel flora with reduced species diversity and dominance of unhealthy species. We restore a healthier anti-inflammatory panel of bacterial species by “seeding” the colon with high-potency probiotics, then nourishing them with prebiotic fibers/resistant starches, a collection of strategies summarized in the Cureality Digestive Health discussions. People sometimes view bowel flora management as optional, just “fluff”–it is anything but. Properly managing bowel flora can be a make-it-or-break-it advantage; don’t neglect it.

There you go: a basic list to get started on if your interest is to begin a process of unraveling the processes of autoimmunity. In some conditions, such as rheumatoid arthritis and polymyalgia rheumatica, full recovery is possible. In other conditions, such as Hashimoto’s thyroiditis and the pancreatic beta cell destruction leading to type 1 diabetes, reversing the autoimmune inflammation does not restore organ function: hypothyroidism results after thyroiditis quiets down and type 1 diabetes and need for insulin persists after pancreatic beta cell damage. But note that the most powerful risk factor for an autoimmune disease is another autoimmune disease–this is why so many people have more than one autoimmune condition. People with Hashimoto’s, for instance, can develop rheumatoid arthritis or psoriasis. So the above menu is still worth following even if you cannot hope for full organ recovery
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