Medical education has got it backward. We're front-loading biology and anatomy, then backfilling with the principles of evidence-based medicine. We need to flip this equation, placing evidence-based medicine at the fore, right from the get-go. Patients don't care about the biological mechanisms; they care about what helps them get better, regardless of the underlying science. That's the crux of our argument today.
I believe that medical education has to stop being guided by big pharma. The medical student of the future must fully understand the primary causes of chronic illness -- toxicity, dietary, and other lifestyle problems. The medical student of the future must understand detoxification strategies, nutrition and behavioral interventions addressing other lifestyle risk factors. Instead of focusing on pharmaceutical management of symptoms, the medical student of the future must learn about the cornucopia of healing interventions that can not only arrest chronic illness, but reverse it or heal it.
The medical student must be properly taught the risks of the diagnostic and therapeutic interventions that they are taught and how to assess whether the risks are worth the benefits. Big pharma must be shut out of medical education. Science, including empirical clinical data, as Dr. Prasad says, must rule medical education, not special interest groups. Preventive medicine should be taught to every student, including prevention of cancer, cardiovascular disease, and diabetes. We have a lot of work to do. It will take decades. But it begins with cleaning out the pollution that has contaminated not only medical education, but the entire biomedical system.
Let’s just get back to informed consent & eliminate the DEI & social justice nonsense from current med education. We might want to address the ongoing capture of nearly everyone conducting research also.
Medical education...is that a joke? Most doctors are indoctrinated to be disease and drug pushers, not real healers of the body. Unbeknownst to most of them, the body is an excellent healing mechanism on its own. No drugs required, in most cases.
That is why I always seek alternative practices first and "medically educated" doctors last. And don't tell me it isn't their fault that they do not know how to heal a patient. I am sick and tired off hearing that doctors know not what they do and should be given a free pass for administering deadly drugs and vaccines.
I disagree as a physician myself. Medicine at its very foundation is built on clinical observations. Most of the discoveries in medicine didn’t require RCT but required excellent clinicians. We have sacrificed clinical acumen for ordering diagnostic testing and pill prescribing! Doctors now skip the history and physical and jump to ordering tests that substitute for thinking as a clinician. They think that telemedicine can substitute for an personal interaction with the patient. Evidenced based medicine got us where we are now. I’m not against fact based advice but evidence based medicine is what drives protocol based decision making and not clinical acumen. I would say medical ethics should be top priority and recruiting individuals that already have demonstrated in their personal lives an ethical life style where others needs are more important then you own will take care of a lot of the issues.
Evidence based medicine - when RCT’s aren’t funded by profiteers. We don’t get to see the evidence that “fails” because many pharma funded studies that don’t get desired results never see the light of day. So we really need to define what qualifies as evidence before going further.
As a woman whose mainstream treated hypothyroidism - all based on guidelines and supposed ‘Knowns’ - eventually led to my falling asleep while driving on the interstate (!), which led to FINALLY finding the answer with an addition of T3 to my T4 monotherapy (T4 being standard of care) by way of yet another misinformed endocrinologist, I am now in the no-one-really-knows-a-damn-thing camp.
My symptoms resolution came on the second day, when I experienced a situation much like The Wizard of Oz: I literally saw my black and white world go Technicolor. With just this hormone addition. But then it began to go away after about 3 days bc my T4 was reduced with the T3 addition. However, once I knew that this was possible, I dug in. First, I had to get a better doctor and get better treatment - which means that ALL of mainstream endocrinology has their understanding of thyroid functioning wrong - and then I began to research. Now for 24+ years I search the literature for data. Hours daily. My God, we’re totally stuck and misinformed!! On most everything!
Morons. Seriously. Why? Because T3 creation on site differs among tissues and is not reflected in serum levels. TSH has been used to define thyroid functioning/abnormalities/treatment results. Wrong. Why? Because that issue of T4 to T3 conversion is not reliable nor consistent among tissues and organs (done by deiodinases), and it is not reflected in TSH.
Here’s a funny thing: CAC is the most reliable biomarker of death. A zero CAC translates to a 15 year warranty from death by all causes and risk increases linearly w CAC. T3 made by converting from T4 directly affects how much matrix gla protein (MGP) is created. If MGP created in arteries is activated, then no calcium can deposit. Hence, the #1 cause of death (CVD), and its accurate biomarker (CAC), are directly affected by an essential hormone conversion that no flipping docs even know about. They THINK they know, but they don’t. They’re told conversion rate is consistent and known and, so far, no humans have volunteered to be killed to test this belief.
How about cancer? Maybe close to cause of death w CVD.
Did you know that cancer is addicted to calcium? And that vitamin K2 - an incredibly important nutrient and endogenously made hormone - is a big player in calcium behavior?
Complete response by vitamin K2 analog monotherapy in sorafenib-failure advanced hepatocellular carcinoma: A case report
Sorry to vent…yes, we need reliable data, real evidence…but I have definitively found that we ask the wrong things, misunderstand etiology of most diseases, and chase BS.
It’s cute to cite evidence-based medicine…but we’ve asked the wrong things!
Evaluating the Association Between Low-Density Lipoprotein Cholesterol Reduction and Relative and Absolute Effects of Statin Treatment: A Systematic Review and Meta-analysis
Who among us are really appreciating relative risk v absolute risk and how very manipulative these are?
I mean, cardiogists seem fooled.
Modern medicine faces real issues, but continues with data from incorrect questions. So our evidence is faulty. Almost all the time….
Vintage piece, Dr. Prasad. Like the rest of our education system, medical school needs to be overhauled. Doctors in my family entered med school knowing what a woman is, but now they don’t and display no interest in thinking for themselves or having curiosity about the world. Here is a sad email exchange with them in which they compared their job to car mechanics and deferred to “experts” on any topic outside of their specialty: https://yuribezmenov.substack.com/p/how-to-do-no-harm-part-3
I have to say I disagree with Vinay on this one. In order to understand the underlying basis of medicine, you have to know some basics physiology (including neuroscience), anatomy and biochemistry. That provides one with the tools to think critically which is so crucial when it comes to evidence-based medicine and RCTs. That's especially so when not all RCTs are created equal or done correctly (as indeed Vinay continually points out when it comes to cancer drugs).
A simple question to start your next Dr visit; can men get pregnant? An answer in the affirmatuve or evasion should be a warning to you. This person is clueless or captured by big med dogma. Get up and leave.
Any monkey can follow a protocol and call themselves a doctor or even a mid-level for that matter, but is that the type of provider you want caring for you or your family? Medical providers are automatons; cogs in the systematic wheel....”follow the protocols....quote the current literature...hope the authors got it right and weren’t shilling for a pharmaceutical company, or worried about losing grant money! God forbid they should question and think outside the box. Biology and Anatomy are critical foundations that should absolutely come first lest we all start believing men really can have babies....”’cause it says so in the literature”...biology smology! Keep dumbing it down and that’s who’ll be caring for you in the future!
This piece made me think of a video where the dr was trying to differentiate mds vs mid level providers. This dr said that doctors are different bc they’ve been educated to understand all the mechanisms of how and why things are happening and mid-levels are just “recognizing patterns”, they see things enough to know how to respond in most cases but when something is unusual they lack the deeper understanding of the science behind it and are unable to deal with complex cases. It was a really crappy argument I thought bc it’s assuming anyone knows the scientific mechanisms. I love the idea of starting with the history of medicine - it means presenting what the practice of medicine actually is and where it came from.
CDC has scheduled 3 mRNA covid vaccines for new born babies by the time, they are ten months old. doubt it trump and the rest of the team with gottlieb, fauci, collins, biden and obama have not done their home work ... but we shall see ...
. @Vinay Prasad is completely wrong. Biology and thus UNDERSTANDING MECHANISMs is far more important than RCT based EBM. Medicine today is an abject failure due to lack of such understanding.
In fact, understanding mechanisms would mean clinical equipoise does not exist thus making RCTs unethical.
Aircraft safety is not based on RCTs. Doctors need to learn safety from us engineers.
Even before teaching about evidence-based medicine, medical students need to be taught serious courses in probability and statistics. According to one survey, 97% of the general public and 85% of doctors cannot correctly answer this important question:
Assume that the PSA test used for prostate cancer screening has a sensitivity of 80% and a specificity of 60%, meaning that 80% of people with cancer will test positive and 60% of people without cancer will test negative. Based on his age and race, a man has a 1% probability of prostate cancer before the PSA test. What is his probability of cancer after the test if he tests positive?
An approximate answer to the nearest whole number (in %) is fine.
I believe that medical education has to stop being guided by big pharma. The medical student of the future must fully understand the primary causes of chronic illness -- toxicity, dietary, and other lifestyle problems. The medical student of the future must understand detoxification strategies, nutrition and behavioral interventions addressing other lifestyle risk factors. Instead of focusing on pharmaceutical management of symptoms, the medical student of the future must learn about the cornucopia of healing interventions that can not only arrest chronic illness, but reverse it or heal it.
The medical student must be properly taught the risks of the diagnostic and therapeutic interventions that they are taught and how to assess whether the risks are worth the benefits. Big pharma must be shut out of medical education. Science, including empirical clinical data, as Dr. Prasad says, must rule medical education, not special interest groups. Preventive medicine should be taught to every student, including prevention of cancer, cardiovascular disease, and diabetes. We have a lot of work to do. It will take decades. But it begins with cleaning out the pollution that has contaminated not only medical education, but the entire biomedical system.
When “the science” is corrupted, the “evidence based medicine” is corrupted.
Let’s just get back to informed consent & eliminate the DEI & social justice nonsense from current med education. We might want to address the ongoing capture of nearly everyone conducting research also.
Medical education...is that a joke? Most doctors are indoctrinated to be disease and drug pushers, not real healers of the body. Unbeknownst to most of them, the body is an excellent healing mechanism on its own. No drugs required, in most cases.
That is why I always seek alternative practices first and "medically educated" doctors last. And don't tell me it isn't their fault that they do not know how to heal a patient. I am sick and tired off hearing that doctors know not what they do and should be given a free pass for administering deadly drugs and vaccines.
I disagree as a physician myself. Medicine at its very foundation is built on clinical observations. Most of the discoveries in medicine didn’t require RCT but required excellent clinicians. We have sacrificed clinical acumen for ordering diagnostic testing and pill prescribing! Doctors now skip the history and physical and jump to ordering tests that substitute for thinking as a clinician. They think that telemedicine can substitute for an personal interaction with the patient. Evidenced based medicine got us where we are now. I’m not against fact based advice but evidence based medicine is what drives protocol based decision making and not clinical acumen. I would say medical ethics should be top priority and recruiting individuals that already have demonstrated in their personal lives an ethical life style where others needs are more important then you own will take care of a lot of the issues.
Evidence based medicine - when RCT’s aren’t funded by profiteers. We don’t get to see the evidence that “fails” because many pharma funded studies that don’t get desired results never see the light of day. So we really need to define what qualifies as evidence before going further.
As a woman whose mainstream treated hypothyroidism - all based on guidelines and supposed ‘Knowns’ - eventually led to my falling asleep while driving on the interstate (!), which led to FINALLY finding the answer with an addition of T3 to my T4 monotherapy (T4 being standard of care) by way of yet another misinformed endocrinologist, I am now in the no-one-really-knows-a-damn-thing camp.
My symptoms resolution came on the second day, when I experienced a situation much like The Wizard of Oz: I literally saw my black and white world go Technicolor. With just this hormone addition. But then it began to go away after about 3 days bc my T4 was reduced with the T3 addition. However, once I knew that this was possible, I dug in. First, I had to get a better doctor and get better treatment - which means that ALL of mainstream endocrinology has their understanding of thyroid functioning wrong - and then I began to research. Now for 24+ years I search the literature for data. Hours daily. My God, we’re totally stuck and misinformed!! On most everything!
See this?
https://www.liebertpub.com/doi/10.1089/thy.2022.0397?url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org&rfr_dat=cr_pub++0pubmed
Morons. Seriously. Why? Because T3 creation on site differs among tissues and is not reflected in serum levels. TSH has been used to define thyroid functioning/abnormalities/treatment results. Wrong. Why? Because that issue of T4 to T3 conversion is not reliable nor consistent among tissues and organs (done by deiodinases), and it is not reflected in TSH.
Here’s a funny thing: CAC is the most reliable biomarker of death. A zero CAC translates to a 15 year warranty from death by all causes and risk increases linearly w CAC. T3 made by converting from T4 directly affects how much matrix gla protein (MGP) is created. If MGP created in arteries is activated, then no calcium can deposit. Hence, the #1 cause of death (CVD), and its accurate biomarker (CAC), are directly affected by an essential hormone conversion that no flipping docs even know about. They THINK they know, but they don’t. They’re told conversion rate is consistent and known and, so far, no humans have volunteered to be killed to test this belief.
How about cancer? Maybe close to cause of death w CVD.
Did you know that cancer is addicted to calcium? And that vitamin K2 - an incredibly important nutrient and endogenously made hormone - is a big player in calcium behavior?
Get this: https://pubmed.ncbi.nlm.nih.gov/30051950/
Complete response by vitamin K2 analog monotherapy in sorafenib-failure advanced hepatocellular carcinoma: A case report
Sorry to vent…yes, we need reliable data, real evidence…but I have definitively found that we ask the wrong things, misunderstand etiology of most diseases, and chase BS.
It’s cute to cite evidence-based medicine…but we’ve asked the wrong things!
e.g. statins
https://pubmed.ncbi.nlm.nih.gov/35285850/
Evaluating the Association Between Low-Density Lipoprotein Cholesterol Reduction and Relative and Absolute Effects of Statin Treatment: A Systematic Review and Meta-analysis
Who among us are really appreciating relative risk v absolute risk and how very manipulative these are?
I mean, cardiogists seem fooled.
Modern medicine faces real issues, but continues with data from incorrect questions. So our evidence is faulty. Almost all the time….
Vintage piece, Dr. Prasad. Like the rest of our education system, medical school needs to be overhauled. Doctors in my family entered med school knowing what a woman is, but now they don’t and display no interest in thinking for themselves or having curiosity about the world. Here is a sad email exchange with them in which they compared their job to car mechanics and deferred to “experts” on any topic outside of their specialty: https://yuribezmenov.substack.com/p/how-to-do-no-harm-part-3
I have to say I disagree with Vinay on this one. In order to understand the underlying basis of medicine, you have to know some basics physiology (including neuroscience), anatomy and biochemistry. That provides one with the tools to think critically which is so crucial when it comes to evidence-based medicine and RCTs. That's especially so when not all RCTs are created equal or done correctly (as indeed Vinay continually points out when it comes to cancer drugs).
Teach the proper method for discovering the truth before teaching what is currently believed to be true.
A simple question to start your next Dr visit; can men get pregnant? An answer in the affirmatuve or evasion should be a warning to you. This person is clueless or captured by big med dogma. Get up and leave.
Any monkey can follow a protocol and call themselves a doctor or even a mid-level for that matter, but is that the type of provider you want caring for you or your family? Medical providers are automatons; cogs in the systematic wheel....”follow the protocols....quote the current literature...hope the authors got it right and weren’t shilling for a pharmaceutical company, or worried about losing grant money! God forbid they should question and think outside the box. Biology and Anatomy are critical foundations that should absolutely come first lest we all start believing men really can have babies....”’cause it says so in the literature”...biology smology! Keep dumbing it down and that’s who’ll be caring for you in the future!
This piece made me think of a video where the dr was trying to differentiate mds vs mid level providers. This dr said that doctors are different bc they’ve been educated to understand all the mechanisms of how and why things are happening and mid-levels are just “recognizing patterns”, they see things enough to know how to respond in most cases but when something is unusual they lack the deeper understanding of the science behind it and are unable to deal with complex cases. It was a really crappy argument I thought bc it’s assuming anyone knows the scientific mechanisms. I love the idea of starting with the history of medicine - it means presenting what the practice of medicine actually is and where it came from.
CDC has scheduled 3 mRNA covid vaccines for new born babies by the time, they are ten months old. doubt it trump and the rest of the team with gottlieb, fauci, collins, biden and obama have not done their home work ... but we shall see ...
. @Vinay Prasad is completely wrong. Biology and thus UNDERSTANDING MECHANISMs is far more important than RCT based EBM. Medicine today is an abject failure due to lack of such understanding.
In fact, understanding mechanisms would mean clinical equipoise does not exist thus making RCTs unethical.
Aircraft safety is not based on RCTs. Doctors need to learn safety from us engineers.
https://twitter.com/SynthIge/status/1645560307291688960
Even before teaching about evidence-based medicine, medical students need to be taught serious courses in probability and statistics. According to one survey, 97% of the general public and 85% of doctors cannot correctly answer this important question:
Assume that the PSA test used for prostate cancer screening has a sensitivity of 80% and a specificity of 60%, meaning that 80% of people with cancer will test positive and 60% of people without cancer will test negative. Based on his age and race, a man has a 1% probability of prostate cancer before the PSA test. What is his probability of cancer after the test if he tests positive?
An approximate answer to the nearest whole number (in %) is fine.