A response to the response (response-ception?)
A response to the response (response-ception?)
Friday Pulse Check
Good morning everyone and welcome to the Friday Pulse Check. I have a response to a rebuttal to our podcast from last week below, but I want to start, like I usually do, with the news.
The US passes one million COVID-19 deaths
Flags will be flying at half-staff through the weekend in remembrance of all those who have died of COVID-19. Only behind heart disease and cancer, COVID-19 was the leading cause of death for Americans over the last two years. The average daily death toll is now about 300, down from 3,000 in February.
Census undercount may affect federal programs in tribal nations
According to a demographic analysis of the census’ accuracy, the United States’ 325 indigenous nations were undercounted by nearly six percent in the 2020 census. This is a big problem as much of a third of some nations live below the poverty line and rely on federal food and health programs. A similar accusation has been made about the city of Detroit and city leaders there are challenging the 2020 census results.
Study shows inflammation may be necessary for healing
A large body of research points to chronic inflammation as the primary driver of chronic pain. As such, doctors and pain specialists focus on reducing inflammation. Research from McGill University seems to suggest that allowing that inflammation to persist may be the key to overcoming chronic pain. Now, as I’ll discuss mention briefly below, outlier studies like this need to be evaluated by peers and it should be replicated a few times with random, placebo-based studies. Fortunately for us, this process has already gone to work. It had mostly positive reviews, but it was rejected by the New England Journal of Medicine. To quote Stat, one reviewer said, he wanted to see “a randomized, controlled trial testing whether acute patients who receive anti-inflammatories are more likely to develop chronic pain than those who received placebo.” We shall certainly be keeping an eye on this.
A response to the response (response-ception?)
You may recall that on last week’s podcast, Ron and I picked apart an opinion piece written by a physician going by the internet name “Paracelsus.” Ron and I, in short, disagreed with some of his prescriptions about the way patients should choose their doctors. I wanted to offer some quick thoughts on this in a more thorough way (ie, thoughts not limited to the Twitter character limit).
Paracelsus decided to rebut our opinions in his own publication this week.
I want to offer a quick, stylistic suggestion to Paracelsus. If he is going to write a rebuttal to something I said, he should take the time to spell my name right (or at least consistently wrong).
Arbitrary litmus tests are just that: arbitrary. Now, I know he would disagree with this statement because he doesn’t think the health of the doctor is an arbitrary litmus test. He believes that the doctor should always and everywhere practice what he or she preaches.
This is like saying that sinners should not preach the Gospel because they fall short of what it commands and are corrupted by an abundance of sin. If this line of reasoning is to be believed, then no one should be allowed to preach the Gospel because, save Jesus Christ and the Blessed Mother, no one on this side successfully lives their entire lives without sin. Might sound convincing but upon closer look, it’s clear that charity and clarity are the keys to evangelizing.
Don’t like the Christian analogy? That is fine; here is a sports one. Only people who can do what they are asking players to do should coach a sports team. This one might seem a bit more convincing, however, experience is a more important factor here. I would much rather have the multi-Super Bowl winning champ coaching my team of choice (who may have put some weight on in retirement) instead of a random student who just happens to also be able to do the exercises he is directing. After all, just because he can do male synchronized swimming means he should coach it right? (See the video below)
In a perfect world, would all doctors be healthy? Yes, they would, but so would all patients. Eliminating options for your doctor based on weight is an ad hominem attack on that person and an argument from authority for whoever you’re pointing to that happens to be physically fit. “You’re not able to provide sound medical advice because you yourself are overweight. This guy over here though is in peak physical form, never mind he barely passed med school, he can demonstrate by his weight that he’s a better doctor.” Judging a licensed physician’s knowledge and expertise based on his or her weight, tattoo, earrings, or other physical appearances is really no different than judging him or her based on skin tone. Physical appearances (and whatever personal problems they may have) have absolutely no effect on how well they can practice medicine.
For that matter, neither does their adherence to medical guidelines. The implication that Paracelsus makes is that doctors who follow medical guidelines are somehow lazy or blind sheep. I find it laughable that the COVID-19 pandemic has revealed a lot of blind sheep on both sides of this issue.
In my experience, both personally with the doctors I have seen for my own health issues and professionally with the doctors we work with at Fulcrum Strategies, I have never come across a doctor who has said “I’m doing this because this is what the American Heart Association (or insert another society here) says.” Physicians are not intellectually lazy. If they were, they wouldn’t have bothered to get into medicine in the first place.
I am passionate about non-profit radio and I spend a lot of my free time doing things in the non-profit radio world. I used to even work in the non-profit radio world and when I came home, I continued to read, work, and tweak things on the station I worked on. I didn’t do this because I got paid to. I did this because I enjoyed it and I liked to continue to learn more.
Physicians, specialty physicians especially, are similar. Why bother getting into ophthalmology if you don’t care about eyes? Or internal medicine if you don’t care about the heart? If they’re like me with my fascination with radio, they too try to stay up to date on the latest studies and research.
Don’t get me wrong, I am sure there are a handful of physicians out there that are lazy and don’t care, but the exception does not make the rule.
Do you know who also tries to stay up to date on research? The societies that put together the medical guidelines. In his original article, Paracelsus claims without evidence that the societies are bought and paid for by the drug companies. That simply isn’t true. I would be far more worried about where the drug companies are spending their money in Washington than I would the AMA.
This claim is not unlike the claim many young (and not so young) democratic socialists have been making in recent years. They say, “Millionaires and billionaires have so much money because they’re greedy.” I refuse to believe that anyone’s first motivation to earn money is greed. I do not believe that (the majority of) doctors fall into this category either. One who says that doctors who prescribe medications because they get a cut of the profits demonstrates ignorance of how most medical payment systems work.
While not stated explicitly, I have the feeling that Paracelsus believes that medical associations censor and bury studies they don’t like because they believe it would hurt their profit margin or the money, they get from drug companies or the government. If this were true, the scientific community in the US and around the world would go nuts. Just like there is no deep state boogeyman currently running the country from some basement in Arlington, there is no deep state running the “rotting, self-serving medical establishment.”
We assent to authorities above us all the time, most of the time without even realizing it, and it is because of something we call in the theology and philosophy world quotidian faith. Literally, it means daily faith; these are things we must believe in as we go throughout our day. The easiest example of this would be maps. I have never been to the state of Minnesota, but I have a map of one. I must assume that the person(s) who developed the map I will be using to travel around Minnesota know something about the layout and road designs of Minnesota.
In the same way, I do not know a lot about gastroenterology. I must trust that my GI doctor in Ypsilanti knows what she is talking about and what she is doing when she does an upper endoscopy. So how did I come to have faith in her? Well, she was recommended by my primary care physician, she is part of a reputable GI practice, and she has a medical license for her specialty.
So do all the people in the medical societies. There is nothing wrong with physicians trusting in their guidelines.
Finally, I want you to scroll to the top of the article and look at the byline. That is my name. It is verifiable. You can find me on the internet and probably even find national and local newscasts I’ve done in the past. I put my name on this article because I am willing to back up what I’m saying and put my reputation behind it.
Throughout the COVID-19 pandemic, people like Paracelsus (and I am not claiming he is one of them, but other people who carry his tone) have claimed that because they were in the minority, they must be right and there is a vast conspiracy against them. Being in the minority does not make right. Rather, it gives you an incredible responsibility to put up or shut up. Demonstrate to us and your peers that your ideas are better and more effective. When you have the approval and respect of the majority of your peers, we’ll talk about picking doctors based on physical appearance and what guidelines they follow.
Ukraine
This week the World Health Organization says that at least 3,000 people have died in Ukraine since Russia’s February invasion because they were unable to access treatments for chronic diseases. "Forty percent of households have at least one member in need of chronic treatment that they can no longer find, resulting in an estimated at least 3,000 premature avoidable deaths,” said Hans Kluge, the European chief of the WHO. I wonder if these Ukrainians would reject an overweight doctor? The WHO also passed a resolution this week that may result in the closure of their Russian regional office.
For future reference, here is the healthcare equation:
Healthcare can be two of these things, but not all three: affordable, high quality, universal.
I am including this gem from Saturday Night Live because it demonstrates two points I am making. Just because someone has the right physical appearance doesn’t mean they know what they’re doing. Secondly, maybe apologists for male synchronized swimming will one day convince their fellow Olympic aquatic peers that they too belong in the Olympics.
Have a good weekend,
Matthew
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