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-   -   Common ground...less is more (http://board.crossfit.com/showthread.php?t=30033)

Robert Pierce 04-06-2008 05:51 PM

Common ground...less is more
 
After 18 pages of discussion on vaccines, I thought maybe it would be productive to post some results of some recent trials and studies. Each of these is an example of a "less is more" philosophy. Maybe we can find something we agree on. If nothing else, maybe we can agree that physicians, researchers, and public health officials can occasionally produce something useful. Discussion welcome. All links wfs.

This study attempted to compare surgery to conservative treatment of lumbar disk herniation. Improvement with surgery was noted but differences between groups were "small and not statistically significant," casting doubt on the clear superiority of the surgical approach: http://www.ncbi.nlm.nih.gov/pubmed/1...?dopt=Abstract

A series of studies showing no benefit in a variety of outcomes for various nutritional supplements: http://general-medicine.jwatch.org/c...l/2007/1228/10

Can we agree that fat is bad? ADHD came up in the vaccine thread. This study suggests that being fat before you get pregnant might predispose your unborn child to ADHD: http://www.ncbi.nlm.nih.gov/pubmed/17938639

Are we overdoing it when it comes to invasive treatment of heart disease? Stable coronary artery disease, according to this trial, is as effectively managed medically as it is with intervention: http://content.nejm.org/cgi/content/short/NEJMoa070829

Finally this is not a study, but it does follow the "less is more" vein...less data for the drug companies. The link is to the Physician Data Restriction Program, sponsored by the AMA: http://www.ama-assn.org/ama/pub/category/12054.html It implicitly acknowledges the effect of pharma on physician prescribing behavior: http://general-medicine.jwatch.org/c...l/2007/1228/11 It limits the ability of a pharmaceutical rep to obtain physician-specific prescribing information (which is then used to tailor marketing of drugs to that particular physician). BTW, I have opted out.

Robert Pierce 04-06-2008 06:27 PM

Re: Common ground...less is more
 
BTW, if you have a "less is more" story or study, feel free to put it up here.

Dale Kimberlin 04-06-2008 11:09 PM

Re: Common ground...less is more
 
Common knee surgery no better than placebo, according to study:

SOURCE: "A Controlled Trial of Arthroscopic Surgery for Osteoarthritis of the Knee," J.B. Moseley, et. al, New England Journal of Medicine, Vol. 347:81-88, July 11, 2002.
Duke University, exercise as good or better than prozac for depression.

Do you think people can get depressed due to the chemical imbalance associated with movement deficiency? Do you think restoring movement can actually normalize seratonin and dopamine?

A brisk 30-minute walk or jog around the track three times a week may be just as effective in relieving the symptoms of major depression as the standard treatment of anti-depressant medications, according to the results of a Duke University Medical Center study.

Middle ear infections best treated with time and not antibiotics. Government guidlines suggest waiting six months after the onset of the first ear infection .

Manga report, There is an overwhelming body of evidence indicating that chiropractic management of low-back pain is more cost-effective than medical management.

Note: chiropractic was not founded as a treatment of low back pain but as means to remove nerve interference to improve the communication between the brain and the body. A better quality of life follows :pepper:.

Low lipid diet out performs any drug studied.

Effect of diet intervention on long term mortality in healthy middle-aged men with combined hyperlipidaemia. J Internal Med. 2004 Jan;255(1):68-73 Hjerkinn EM et al.

I wonder if the drug companies will start buying up the grocery stores.

People on statins die sooner with lowered cholesterol as opposed to those with high cholesterol. Journal of complimentary and alternative medicine. I will post the date and author tomorrow (from Summer of 2007 anyway).

I like how the establishment was able to change the alternative medicine movement to include the complimentary part. They must not have liked the part where from 1994 more visits were to alternative providers than traditional western medical doctors.

Despite risks, M.D.s still use high-dose estrogen to suppress growth in tall girls:

A research article in the Journal of Pediatric and Adolescent Gynecology revealed that many M.D.s are still engaging in the controversial practice of suppressing the growth of tall, adolescent girls through the use of high-dose estrogen, according to Neal D. Barnard, M.D., president and founder of the Physicians Committee for Responsible Medicine, lead author of the study.

A survey of 411 pediatric endocrinologists practicing in the United States found that one-third of them (137) continue to offer estrogen treatment to suppress growth. In a typical case, a girl who appears to be headed for an adult height of six feet or more is treated with high doses of estrogen for two to three years. Estrogen causes the bones to mature and stop growing.


SOURCE: Media advisory, Physicians Committee for Responsible Medicine, February 5, 2002.

Finally, with keeping with the less is more, Which I am a big fan of, when medical doctors go on strike the death rate drops.

Does aspirin prevent heart attacks? Don't believe it!
The drug companies that make and market aspirin have tried hard to convince people that "an aspirin a day keeps the heart attack away."

But, another study has come along to blast a hole in that myth. According to British researchers, the daily aspirin regimen might actually do more harm than good.

Researchers at the Wolfson Institute of Preventive Medicine in London identified more than 5,000 U.K. males, between 45 and 69 years-old, who were at increased risk of coronary heart disease but had not previously had heart trouble.

The men had been randomly divided into four different treatment groups to accurately establish the effect of aspirin.

The men with higher blood pressure not only weren't protected by the aspirin, but they risked possible serious bleeding. Even in men with low blood pressure, the benefit did not necessarily outweigh the risk of bleeding.

In 1988, a research study found that some high risk men who took daily aspirin had fewer heart attacks -- but more strokes. Even the researchers never recommended the once-a-day aspirin regimen.

However, the pharmaceutical industry immediately began a massive press release campaign which distorted the research report. The press releases gave the impression that the daily aspirin was a sure-fire way to prevent heart attacks. The news was picked up by most newspapers and even medical doctors began "prescribing" aspirin as a preventative measure.

Thanks in part to this deceptive marketing campaign, Americans now take more than 25 million aspirin tablets every day, despite the fact that:

1,600 children die each year from allergic reactions to aspirin;

patients with blockage of arteries to the brain are three times more likely to have a stroke if they are taking aspirin;

dyspepsia and gastrointestinal hemorrhage occur in 31% of those taking 300 mgs. of aspirin per day;

even low doses of aspirin can increase the risk of brain hemorrhage; and

other side effects can include anemia, bleeding ulcers, confusion and dizziness and numerous other problems.

SOURCES: "Determination of who may derive most benefit from aspirin in primary prevention: subgroup results from a randomised controlled trial," British Medical Journal, July 1, 2000.

Doctors Strike ... Deaths Decrease
It's not the first time it's happened, but many observers were stunned to learn that a strike by medical doctors in Israel actually resulted in a decrease in the death rate.

According to a news article in the British Medical Journal, (BMJ) "Death rates have dropped considerably in most of the country since physicians in public hospitals implemented a programme of sanctions..."

Israeli medical doctors went on strike in March to protest a proposed four-year wage contract. They canceled hundreds of thousands of patient visits and many people expected a health crisis.

However, a survey of burial societies found that the death rate actually went down since the strike. The number of funerals in May dropped to 93 compared with 153 during the same month last year.

One funeral parlor manager told the BMJ reporter, "There definitely is a connection between the doctors' sanctions and fewer deaths. We saw the same thing in 1983 [when the Israel Medical Association applied sanctions for four and a half months]."

SOURCE: "Doctors' strike in Israel may be good for health," British Medical Journal , June 10, 2000.
Also happened in Las Angeles california and columbia

Less medicine is more life

I will qualify that with this. Emergency crisis intervention definately have benefits that outweigh the risks. At that point what else does someone have to lose? I have relatives who were saved form MI's with drugs and emergency procedures. Those extreme circumstances warrented extreme measures. After the crisis when they stableized the cocktail of beta blockers, ace inhibitors, daily aspirin and statins began. The heart condition was not from a lack of drugs in the system but rather a poor lifestyle. How do drugs account for poor living? they don't, they just add toxicity and other problems down the line. The medical people should do the right thing and refer these people to those who are trained in diet, exercise and PMA.

enough for now, thanks for the thread

Brandon Oto 04-07-2008 04:02 AM

Re: Common ground...less is more
 
Quote:

Originally Posted by Dale Kimberlin (Post 287158)
Finally, with keeping with the less is more, Which I am a big fan of, when medical doctors go on strike the death rate drops.

The lesson being, of course, that all elective surgery has some risk associated with it, which I hope anyone getting liposuction or a coronary bypass is already aware of.

Susie Rosenberg 04-07-2008 05:41 AM

Re: Common ground...less is more
 
I'm a physician, too; but I was a nurse before I went to medical school, so I speak two professional "languages" and I am familiar with two different professional "cultures."

I think that helped me be something of a "participant-observer" of my own medical training and education.

Here are my observations about it all:

1. For conditions that are life or limb-threatening, go to an emergency department and see the emergency team.

2. For guidance about how to live a healthful lifestyle that will prevent heart disease, stroke, diabetes, and cancer, do not consult 99.9% of your physicians. For one thing, even if they know, they do not have the time to sit with you and educate you, much less design individualized interventions for your unique situation. Physicians are trained to diagnose and treat DISEASE. A very small percentage of our education is devoted to the study of HEALTH.

3. For guidance about how to live a healthful lifestyle, educate yourself widely. Read about nutrition, exercise, complementary and alternative medicine practices, the role of happiness and purpose, and then implement these practices, one by one, into your own life.

4. For treatment of non-emergent, chronic conditions like diabetes, heart disease, etc, consult both allopathic (mainstream) physicians and well-recommended alternative and complementary medicine practitioners, and use common sense and the black box approach to your wellness. (Try it and see how you do!)

5. Drugs: When all you have is a hammer, everything looks like a nail. So don't be surprised when you consult a physician to get a prescription. Honestly, most people who go to the doctor ARE DISAPPOINTED when they don't get that little piece of paper for a drug. Physicians prescribe drugs and surgery, those are our hammers. If you need a needle-and-thread and not a hammer, see a tailor!

6. Learn to weigh the risks of benefits of a proposed treatment against the risks and benefits of NO TREATMENT, or alternative treatment.

7. Remember, we are all going to die. That's a given. So, how do you want to live?

Cal Jones 04-07-2008 08:39 AM

Re: Common ground...less is more
 
One of my big bugbears is the amount of antidepressants that are prescribed. I knew a young man of 19 who had been on every med under the Sun and was no better for it. He should never have been put on meds in the first place. He should have received counselling. The drugs actually made him worse - they left him spaced out and weird.

I suffered from clinical depression in my late teens until my mid twenties. I never sought help from a doctor. I went to the gym. I utterly believe that going to the gym is why I'm still alive. Doctors should prescribe exercise, not drugs.

As for aspirin, it makes me vomit, so I never take it.

I hate going to the doctor and will only do so if I either have something I recognise that needs medicine (eg antibiotics for bad cystitis, or steroid ointment for a bad allergic reaction to some perfume which wasn't fixed by an OTC cream), or if I have something I don't know that scares me.

Anything else I either let run its course or I attempt to treat myself. I've even cut out my own verucca, as I mentioned on the plantar wart thread, though I don't recommend this to most people. :) I also removed my own stitches once because I couldn't make the appointment I had to get them taken out. I don't see the point in wasting doctors' time with stuff you can handle yourself.

Dale Kimberlin 04-07-2008 01:39 PM

Re: Common ground...less is more
 
Time to get scientific: let's scrap the diet-heart-cholesterol hypothesis. The public has been fed a pack of lies about the real causes of heart disease. Dr Natasha Campbell-McBride, MD, Mmedsci (Neurology), Mmedsci (Human nitrition) CAM journal March 2007

This was the reference I said I would post.

lots of good evidence in this paper.

Emily Mattes 04-07-2008 02:40 PM

Re: Common ground...less is more
 
A few embarrassing problems I struggled with all but disappeared when I stopped running to the doctor for every little thing and started using a couple of non-pharmaceutical treatments. I would be more specific if this wasn't my real name. :o

And I wish all non-emergency patients with depression/ADHD/various mental health issues (i.e. patients that are not suicidal, entering psychosis or a manic phase, etc) would be required to undergo a six-week monitored diet-and-exercise program before being allowed to go on meds. Sadness is not depression!

Susie, your advice is spot-on.

Robert Pierce 04-07-2008 08:26 PM

Re: Common ground...less is more
 
The heart/cholesterol hypothesis took a bit of a hit this week with the publication of the ENHANCE study in the NEJM. It suggested that despite having lower levels of LDL cholesterol, patients treated with Zetia had no change in the carotid intimal media thickness (generally recognized as a marker of plaque stabilization and lower risk of CAD) than did patients with simvastatin (Zocor) alone. HOWEVER...

...there are lots of qualifications spelled out very well in the editorial that accompanies the article. Several other studies using statins and other drugs have suggested that lower IS better. Mind you, we're not talking about your average CrossFitter here, we're talking about prevention of heart disease in those with risk factors. We cannot throw out the baby with the bathwater here. Statins have clearly and repeatedly demonstrated a hefty double digit reduction in secondary events in those who have coronary artery disease. Whether it is a cholesterol lowering effect or some other effect is a matter of some debate, but the effect is proven nonetheless.

Actually, several interventions have been shown to reduce second events in those with coronary artery disease by double digit percentage points. Those are aspirin, statins, beta blockers, ACE inhibitors in some patients. However, docs should be very quick to add that cardiac rehab (read: structured exercise) and fish oil/omega-3 FA supplements each have an effect of equal magnitude. Fish oil is standard of care in Europe after you have a heart attack, and it has been since the GISSI study was released in 2000. Why is it not standard of care here in the US? You can blame the FDA for that, it should be.

Aspirin as primary prevention? Absolutely right, it really doesn't work that well and I would say that it is not the standard of care.

Antibiotics for ear infections? Agree, same.

Exercise for depression? Agree, standard recommendation, has been for years.

Dale, even with the reference I was unable to find the Campbell-McBride article. The Hjerkinn study, while quite small (n=104) is very interesting, thanks.

I agree that drugs cannot make up for poor living. Good living can eliminate the need for drugs, I have half a dozen diabetics in my practice who have each lost 50+ pounds to prove that. But I would urge people to view complementary and alternative therapies with the same skepticism you have shown for vaccines and other traditional or allopathic therapies. It seems that every year, a study casts significant doubt on the effectiveness of one or another alternative therapies (wfs): http://general-medicine.jwatch.org/c...l/2006/1228/12 We should be holding researchers in all areas of health study to the same high, rigorous standards.

Dale Kimberlin 04-07-2008 10:08 PM

Re: Common ground...less is more
 
Richard I am happy to hear that daily aspirin and SSRI's are not the standard in your practice and nice job on the diabetics you have been working with. far too many people practice daily aspirin (increased pancreatic cancer risk as well as stroke by the way) and take SSRI's for depression for me to agree with that. I recall a legislative proposal to mandate pregnant woman to take SSRI's prophylactically for post partum depression (I guess they want to get a prophylaxis in there somewhere).

I am all for more research on both ends but not all things are well defined with RCt's. Anecdotes are quick to be minimized or considered placebo.

Some sharing of the money (grants) would be nice to get that all important research on both sides but it seems one side controls most of it. That's your side. In the end sickness and disease are big business and is in the best interest of those profiting for it to stay that way. Why else is fish oil not the standard of care?

Is Phillip Morris really interested in people quitting smoking?

Best,


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