The COVID 19 pandemic has put enormous pressure on the medical and scientific communities to find answers quickly. The behavior of doctors and scientists under stress reveals cracks that have always been present, but have now become gaping fissures.
We recently reviewed the way hydroxychloroquine illustrates Sir William Osler’s famous observation that “medicine is a science of uncertainty and an art of probability.” The recent retractions of two large observational studies by two widely-respected medical journals highlight the powerful wisdom of Osler’s missive.
Many physicians rely on the information they read in those medical journals. However, many don’t take the time to dissect every study. They rely on experts to do it, and follow guidelines created by those experts to help them make their medical decisions.
The hydroxychloroquine dust-up reveals how even experts may miss critical flaws in research methods. That’s why it’s so critical that you collaborate well with your doctors. You should ask the hard questions they may not have.
Careful review of the benefits, risks, alternatives and unknowns is the powerful tool to fully explore the science behind difficult decisions. Knowing how to ask hard questions about what the experts say will help assure that any medical decision will account for the uncertainty, and apply the probability in a way that respects your own goals and values.
We can help to educate, coach and advocate to help you better collaborate with your doctors. If you would like to learn more, call 203-692-4422, or email email@example.com.
Our health and healthcare have fallen off a cliff, it seems. The current global pandemic highlights the importance of sustaining good relationships in our healthcare system and in our daily lives.
This pandemic will forever change the way we relate to our doctors, and the way health care gets delivered to us. Our social network has crossed a tipping point; just as water seems perfectly serene until the moment it begins to change into steam, new processes will now rapidly and relentlessly emerge in the American health care system.
In the midst of this crisis we have learned the value of good relationships between doctors and their patients. It is much easier to share in uncertain decisions about treatments with unclear evidence when we trust the way our doctors share our medical decisions with us.
If we follow the simple rule of fully examining the benefits, risks, alternatives and unknowns of any medical decision, and fully understating our own goals and values, we can come to a decision that makes sense even in the midst of its stark uncertainty and powerful exigency.
For now, hydroxychloroquine and azithromycin seem to be the simplest and safest alternative for preventing the novel coronavirus from becoming a devastating infection. But even if that turns out to be true, it doesn’t mean it’s the right treatment for everyone. It will take a long time to learn whether or not its safety and efficacy outweigh its risk in widespread use for this disease with such diverse manifestations – from asymptomatic to overwhelmingly lethal. Although one of the most widely used medications in the world as treatment for malaria, rheumatoid arthritis and systemic lupus erythematosis treatment, hydtoxyurea’s use in those settings is so radically different than its use for COVID 19 that we cannot easily use its long safety record to guide its wider application.
Currently, the decision to use it can only be guided by individual goals and values. We must each decide how comfortable we are with unknown risks and unclear benefits when our lives are on the line. We’ve witnessed decisions go both ways. We simply encourage our readers and members to fully explore theirs, and we hope for the best outcomes for all.
If you would like to explore more about how to make good shared decisions with your doctors, or to learn more about the details of various treatments for COVID 19, email firstname.lastname@example.org or call 203-692-4422 for a consultation.
The weight loss drug Belvique has been withdrawn from the market by its producer, Esai Pharmaceuticals After post-marketing studies revealed an increased risk of cancer.
The FDA approved the drug for routine prescription, but only if the maker conducted “post-marketing” study of a potential cancer risk identified in preliminary research. That five year follow up study revealed an increased risk of cancer among those taking the approved drug. This is another example of why “approved” does not mean fully tested.
All medical decisions should be made with your full collaboration and understanding of the benefits, risks, alternatives, and unknowns of the treatment being prescribed.
If you would like to learn more about how we can help educate you about medical facts, or coach you to collaborate better with your doctor regarding your medical decisions, email us or call 203-692-4422 for a free introductory consultation.
Imagine going to your doctor with a problem, and getting a prescription that not only worsened it, but has a one in ten chance of actually killing you instead.
The dramatic cognitive error that led medical experts to overlook an accepted medication as the cause of a serious epidemic is not rare. This essay from Massive Science
details how this kind of medical error has happened more than a few times in modern medical history. We’ve witnessed many of those kinds of episodes over our 42 years in the healthcare field.
The cognitive bias built into the medical paradigm of treating diseases with poisons or clever devices designed to control biological functions (all medications poison some part of the biological system) often leads doctors to fail to distinguish the cure from the disease.
Only robust doctor-patient collaboration to relentlessly analyze the benefits, risks, alternatives and unknowns of medical decisions can mitigate this powerful limitation of medical science and culture.
The essay vividly illustrates 2 critical problems that impede such shared health care decisions.
First, the frequency of unknown effects of many treatments after they are approved for use but not adequately tested for all adverse effects.
Second, the cultural blindness many experts and doctors have to those unknown possibilities.
The essay reviews some deadly illnesses that were attributed to diseases rather than to the side effects of their treatment that were causing those illnesses. It reveals the cognitive biases built into the medical paradigm of treating diseases with approved medications but not considering the unknown possibilities of the adverse effects of the treatment on the patient.
It also reveals how difficult it is for even the best doctors to avoid that trap. We at Operam have witnessed the effect over our long careers in healthcare, and we are dedicated to helping you ask your doctors the kinds of questions that can help them avoid the trap as they make medical decisions with you for your care.
If you would like to learn more about how we can educate and coach you to better collaborate with your doctors, call us at 203-662-4422, or email email@example.com for a free introductory consultation
Over our long careers, we at Operam Healthcare have promoted sensible weight training and cardiovascular exercise as one of the most fundamental self-management practices for staying healthy and preventing a multitude of illnesses and their complications.
And so as we all collectively celebrate the symbolic end of one run around the sun and set off on a new adventure in orbit, we would like to share this Joyful report from NPR
describing the benefits of exercise, and providing some simple, sensible advice on how to engage in it.
We would add one thought, which is to take every opportunity to lift, push, and pull some weight around in your everyday life; gardening, yard work, taking stairs, carrying groceries, doing some cleaning chores, hiking up and down hills, and even working small weights at your desk can engage those muscles that will keep your mind-body strong and in a healthy and harmonious biological rhythm.
Then, when you visit your doctor, be sure to review how exercise fits into any treatment plan they have for you. That will often change the balance of your medical decisions. It is a powerful way to collaborate with your doctor for your health.
And so Happy New Year. Let’s hope it’s a good one.
If you would like to learn more about how to take charge of your health and healthcare, e-mail firstname.lastname@example.org, or call 203-692-4422 for a free introductory consultation.
A recent dangerously misleading headline and report on NPR does not accurately reflect the content of the story, and reinforces the need for critically reading media reports to skillfully taking charge of your own healthcare. Don’t let the media mislead you.
The report is about a conference on how blood sugar metabolism in the brain might predispose people to Alzheimer’s disease. The headline claims that controlling blood sugar could prevent Alzheimer’s disease. But it could be very DANGEROUS to try to lower your blood sugars without using great caution in how you do it.
And simply lowering blood sugars using current methods, even just lifestyle change, has not been proven to help reduce your risk of Alzheimer’s disease.
Though the participants in the conference did discuss how “keeping your blood sugar in check could lower your Alzheimer’s risk.”, the key conclusion was that while their findings advanced the science of brain glucose metabolism, and found potential links between how the brain metabolizes glucose and how it could develop Alzheimer’s disease, no clear causal conclusions could be drawn.
Importantly, the current methods of controlling blood sugar were not tested for their safety and efficacy in preventing the development of Alzheimer’s disease.
A key disconnect in the data not mentioned in the report was that while Alzheimer’s disease only affects one percent of people in the US, there are many more diabetics than that who have poorly controlled blood sugars.
Much work needs to be done before the interesting findings presented by these scientists can be translated into a safe and effective plan for treating diabetes to prevent it from causing Alzheimer’s disease.
An important caveat was stated clearly in the article; Low blood sugar could cause problems that lead to Alzheimer’s disease. That means exerting caution in how patients control their blood sugar to avoid low, as well as high levels.
Also of note, the apoE enzyme mentioned that normalized brain sugar metabolism and brain cell function in rats worked in rats with high blood sugars. That suggests that the blood sugar itself is not the problem, but rather that how the brain cells handle blood sugar causes trouble.
We repeat, do not try to change your diabetes treatment plan without first talking to your doctor. But by all means talk to your doctor about doing the best you can to keep your weight safely down and your blood sugar safely controlled. As the report does mention, there are lots of reasons to do those things for yourself.
At Operam we help you learn how to ask and answer important questions about your health, and work well with your doctors to make the best decisions about your health care and disease management. Call us at 203-692-4422, or email us at email@example.com for a free consultation.