White Coat Underground

The great Dr. Sandy Templeton once asked his pathology class, “Why do people go to the doctor?” People came up with all sorts of responses, but to each he gave his best British, “No, no, no, no!” Then he would tell us, “They come to the doctor because they don’t feel well and they want you to make it better!”

So obvious. So simple. And yet, so complicated.

As physicians, we have a number of ways of helping patients, only some of which make the patient feel better. Primary and secondary prevention of disease don’t necessarily make people feel better in the short run, so they can be unsatisfying. And many ways of “not feeling well” aren’t easily fixed. People have complicated lives, lives full of stress, lives full of poor sleep, lives full of inactivity. There is no magic pill to make most people feel better.

Sure, sometimes we get lucky. I had a patient a couple of years ago who came in with the common complaints of fatigue, weight gain, etc., and as usual, I checked her thyroid—and not as usual, her thyroid was significantly low. Not long after I started her on thyroid hormone replacement, she felt considerably better.

Unfortunately, most people who feel generally unwell don’t have a simple physiologic problem such as a hormone deficiency. We can still help them by being good listeners and giving them good health advice, but that only goes so far.

In general, we fail to make everything all better all the time. This failure is accepted by most patients, as most people know that being human comes with various imperfections. But some people are not satisfied to know that feeling lousy can be normal. They will go from doctor to doctor, looking for “the answer.” Sometimes they find it. The third or fourth doctor may be the first one to finally diagnose the hypothyroidism, or celiac disease, or diabetes, but often the doctors say the same thing over and over—reduce your stress, eat better, exercise more. Take better care of yourself.

Which is, of course, not always possible.

Some people will continue to go from doctor to doctor until they finally land at the door of someone with all the answers. This person may have a different way of doing things, a way that somehow has escaped all the previous doctors. Often, a patient is just happy that someone finally listens, finally appears to understand their suffering.

Real doctors often give difficult news. Sometimes the answer to someone’s suffering is, “I’m so sorry. I’ll do whatever I can to help you through this.” Sometimes it’s tempting to give good news, whether or not it’s warranted. It can be very tempting to say to a patient, “You know, all of your troubles are due to a low selenium level, and if only your other doctors had checked it, you would have felt better by now. It’s a good thing you came to me. Here’s some selenium.”

But offering good news without evidence to back it up is self-serving and cruel. To elevate oneself as the only doctor with all the answers is dangerous, not least because you might start to believe it. And the moment you believe in your own infallibility is the moment you lose your way and put your patients at risk.

Comments

  1. #2 DrWonderful
    January 14, 2010

    *yawn* So, uh, not much going here lately. Are you trying to bore me so I don’t come back anymore?

  2. #3 David
    January 14, 2010

    Methinks this post could be put to use as a kind of mild anesthesia. God, I don’t know how Paypal could stay awake even writing it.

  3. #4 rob
    January 14, 2010

    @David:

    lol

  4. #5 spit
    January 14, 2010

    But some people are not satisfied to know that feeling lousy can be normal.

    Well, look. There’s feeling lousy, and then there’s feeling like you’re going to break into tiny pieces if you don’t lie down right this very minute, and having that happen over and over and over. For months or years. I think most patients are realistic enough to be able to comprehend that sometimes everybody feels a little under the weather for a while.

    There comes a point at which a patient is really concerned that they’re feeling so incredibly lousy that there’s possibly something wrong underlying their feeling lousy. Most — not all, but most — patients aren’t coming to the doctor because they’re feeling a little gross from time to time. Frankly, I can think of a million and a half places I’d rather be than sitting in a doctor’s office while he/she asks me questions about my bowel movements. And most patients aren’t looking for a happy BS answer; they’re there because they’re concerned, often for good reason.

    I think, as a patient dealing with a mess of health weirdness, that y’all are misunderstanding what a lot of patients are after. I don’t expect a sudden “answer”, though I’d love a diagnosis, sure. I do expect a doctor to take my symptoms seriously and try to help me figure out what they could be and how to make them more manageable, and talk to me like a real human who is at least curious about my symptoms. “I don’t know” is never the problem, unless it’s also treated like the final answer.

    If what led you to this thought track is some of the absolute crap faux-medicine out there that people go find, I have to say that while I sympathize with your point of view, my experience as a patient with a host of hard to pin down symptoms has also made me completely understand the temptation to give up on “real” doctors — not because they don’t have answers, but because they often don’t even seem to take the questions seriously. Now, I’m a science geek, so I’m not going to run out and try to solve my problems with colonics, but it does get very, very frustrating to go to a doctor who seems uninterested the second it’s clear that this isn’t going to be figured out by a CBC and a TSH test.

    There are many physiologic problems that can lead to feeling very severely lousy that aren’t going to be picked up by a set of a few basic blood tests. It often still takes years for people to be properly diagnosed with anything from apnea to MS. Helping them explore less vague symptoms than fatigue might be a start, but a lot of folks don’t even get there with their doctors. They get treated with dismissive crap, they get frustrated, and they get sick of feeling absolutely awful without even a clue as to why. I think you’re trying to be understanding of that in this post, but you’re still making a few points that just strike me as exactly the same kind of dismissal.

  5. #6 Warren
    January 14, 2010

    “I think you’re trying to be understanding of that in this post, but you’re still making a few points that just strike me as exactly the same kind of dismissal.”

    Yes. However, what he’s saying is, if you bore the patient to death they wont’ notice they’re being dismissed.

  6. #7 CanadaGoose
    January 14, 2010

    I am so grateful that my Canadian doctor didn’t tell me it was normal for me to feel lousy. My thyroid levels were fine but he took that extra step and checked my calcium levels too.
    Turned out I had hypoparathyroidism. A few weeks later, I had a simple surgery and soon stopped feeling lousy.

    As a middle-aged, overweight female, I consider myself lucky not to be soothed and dismissed. (This happened in a country with “socialized” medicine — who woulda thunk?)

  7. #8 CGuy
    January 14, 2010

    Part of the reason patients end up going from doctor to doctor is that so many are dismissive.

    Like the doctors who told me “You can’t have a pituitary tumor, your prolactin is in the normal range. You must not be taking your meds as directed; otherwise your levels would be more stable. Take your meds as directed, take some anti-depressants, reduce your stress, eat better, exercise more. Take better care of yourself, come back in 6 months.” Go back in 6 months with no change and be labeled non-compliant. “You’d be better if you followed my orders and took better care of yourself.”

    Finally one doctor said “Well, not all pituitary tumors raise prolactin, let’s get an MRI…”

    One extra step meant the world of difference to my quality of life.

  8. #9 Kristen
    January 14, 2010

    I guess my take on the matter is; Physicians need to probe to find what the problem can possibly be. Take the patient’s thoughts into consideration and know when to refer to a specialist. If one is a specialist know how to give comforting advice when no therapy is likely to help.

    I do think there are many doctors who could try harder to be compassionate and understanding.

  9. #10 Joshua
    January 14, 2010

    Gee, this blog is wonderful.

  10. #11 The Patient's Perspective
    January 14, 2010

    Palmd,

    I agree with 100% of this:

    “Often, a patient is just happy that someone finally listens, finally appears to understand their suffering.

    Real doctors often give difficult news. Sometimes the answer to someone’s suffering is, “I’m so sorry. I’ll do whatever I can to help you through this.” Sometimes it’s tempting to give good news, whether or not it’s warranted. It can be very tempting to say to a patient, “You know, all of your troubles are due to a low selenium level, and if only your other doctors had checked it, you would have felt better by now. It’s a good thing you came to me. Here’s some selenium.”

    But offering good news without evidence to back it up is self-serving and cruel. To elevate oneself as the only doctor with all the answers is dangerous, not least because you might start to believe it. And the moment you believe in your own infallibility is the moment you lose your way and put your patients at risk.”

    ——-

    I basically agree with this 100%. For what it’s worth, dr crisler has other doctors he recommends and speaks highly of, such as dr mark l gordon, dr eugene shippen, are the first that come to mind. When other people have posted their endocrinologist status & their blood work results on his messageboards, if he thinks they’re doing good work he will say “seems like a sharp guy i would stick with him” and things of that nature. He doesn’t position himself as the only doctor with all the answers, but a doctor with more answers than the average doctor you are likely to encounter by throwing a dart at the phonebook and going to whoever it lands on. He also has no problem revising his own advice when he feels he’s figured something better out or learned something new from a colleague.

    Where I disagree….

    Don’t you think your fundamental attitude that it’s normal to just feel like shit and be miserable is what creates the vacuum that con artists can fill with quackery?

    Most dr’s appear to share this point of view, and many of them are dismissive and have this sort of “ho hum this is just what life handed you, shit on a silver platter, learn to deal with it” demeanor, what is this india where our health problems are just an unchangeable result of our karma? Where’s the science in this idea that it’s just normal and acceptable to feel like shit?

    The biggest problem with this attitude is doctors refusing patients requests for tests like in the post discussed above. If you don’t have any answers and your patient comes in and requests what you consider to be the most wacked out stupid test for a copper deficiency or something, if you don’t have an alternative why not just agree if you don’t have a better idea?

    Doctors hate anecdotes, for good reason. Patients love anecdotes, SOMETIMES for good reason. You stated above that you have a general awareness that sometimes rotating doctors does lead to success, but you can’t imagine the number of times, as someone who is deeply invested in their poor health and has read a considerable amount of patient experience on the internet, I have read about people having these experiences where they insisted upon tests their doctors denied only to be vindicated by another doctor later. Vindicated is really a poor word choice because there’s really nothing to celebrate in someone extending your misery out of complacency and placing a conservative ideology over a patients needs & reasonable (as in low likelyhood of being genuinely harmful) desires.

    The other thing is doctors are highly skeptical and afraid of hormones (for the sake of this conversation), but embrace anti-depressants like it was the beloved and treasured diet & exercise in a pill. The number of guys feeling like crap who doctors refuse to help or test yet dump an anti-depressant or two (or three) on without a second thought seems to be extraordinary.

    It’s hard to believe that’s what behind all of this skepticism about being able to treat “fatigue” and feeling “generally unwell” is really rational process when anti-depressants are so readily dispensed to do so with the thinnest evidence that this has anything to do with depression.

    When i hear all this talk in the healthcare debate about reducing “frivolous testing” i cringe. It seems to me that the goal should be to enhance our healthcare system in such a way that we can accommodate the maximum amount of testing possible without creating a bottleneck (taking into consideration tests that have potential side effects or long term consequences of course). The japanese government worked with toshiba to create a system where MRI’s cost $99. This attitude that we have to live with fewer tests because the potential for misdiagnosis and nonsense becomes greater with the more information you have at your disposal completely stuns me, and although i’m sure many other patients feel the same way although they probably don’t know how to articulate it.

    If you to an auto-mechanic or a computer store and they had the same attitude most doctors do you’d want your money back. Sorry, your car just runs like shit. I checked the oil and rotated the tires, *shrug*. But I’m here for you if you need someone to talk to about it…. try taking ‘er out on the highway and letting her stretch her legs. Hey, fill ‘er up with premium while you’re at it, maybe it’ll work itself out.

    Yes, the human body is not the same as a machine created by humans which is fully understood and can be easily disassembled, but the customer service experience behind that idea is identical and as an analogy of the typical “i did 3 tests and i give up just live with it” doctor it’s pretty accurate.

  11. #12 The Patient's Perspective
    January 14, 2010

    I think this exchange between dr crisler and one of his patients on his messageboard about this summed up “our” point of view pretty well…

    Here is the patient’s post first, followed by dr crislers response:

    —————————

    These guys just come from a totally different school of thought.

    The way they see it is unless you have been peer reviewed, board certified as a specialist, or otherwise validated by the current establishment then you have no right to claim expertise.

    Patient experience and testimonials don’t matter because dr mercola, mike scally, homeopathic doctors, also have high patient satisfaction because humans are very susceptible to the suggestion and the placebo effect and 80% of problems are self-correcting.

    It’s a valid way of viewing the world but can also be too one dimensional.

    If you have a guy who saw 2 endocrinologists and he felt like shit, and sees dr crisler, who, using the same tests and medications that are available, can make the person feel well, isn’t that notable? The problem didn’t self-correct in the timespan of seeing the other doctors, and they didn’t recover from a placebo created by virtue of seeing the expert endocrinologists, so why would they be now?

    Dr J looks out at the medical establishment and sees only people filled with what he considers to be an irrational fear of hormones, while he’s getting clinical results through aggressive hormone manipulation firsthand.

    In order to create the data necessary for the establishment to consider this type of hormone manipulation ok it would probably take something like a 20 year study of people in groups on standardized dosages of medications.

    But Dr J doesn’t standardize…

    Dr J puts people on initial doses of hormones, then tests, asks about their symptoms, then raises or lower doses, and adds or removes additional hormones or medications, depending on what he sees in the test results and what the patient tells him about their unique experience.

    How exactly is he supposed to design a study around this process? Is there a chance in hell the NIH is going to fund this? They’re not going to fund and study advanced hormone manipulation until they feel it’s met the highest bar of safety, but it can’t meet the highest bar of safety without extensive and aggressive study. So, back to square one.

    So, next, Dr J could submit some case studies to a peer reviewed journals. Let’s say he reports a guy came to him with a horrible quality of life and over 6 months he dosed the guy to the top of the testosterone range, put him on ghrp-6, lowered his estrogen, balanced his preg, dhea, etc, and the guy’s entire life changed and he was doing amazing.

    What journal, considering the way hormone manipulation is viewed right now, is going to publish this as a positive outcome rather than condemn him and claim that he can’t know that doing this was safe or necessary with all of the various independent variables that need to be accounted for to truly prove something?

    The bar is REALLY high in medicine for absolute evidence or even meaningful evidence, but in the meantime people are suffering, and sometimes that suffering can be alleviated through aggressive hormone manipulation. The question becomes is it more ethical to treat it in the meantime unless any red flags appear, or wait decades, allowing patients to suffer or expire in the meantime, until the glacial process of absolute evidence accumulation has completed?

    Dr J has staked his out his side, and they’ve staked out theirs.

    ————–

    Dr Crisler:

    Exactly. What kind of “study” do they want? Heck, they could run it themselves (since they obviously have waaaaaaay too much time on their hands).

    I’m supposed to show I treat well-known medical conditions with medications used all over the world for that purpose each and every day?

    The “art” is in the fine tuning. Finding the “sweet spots” in each patient’s own hormonal milieu. But it’s also in backfilling the hormonal pathways, attempting to normalize as much as possible. And DHEA and PREG are perfectly acceptable to use, as is HCG (a treatment of choice for secondary hypogonadism).

    Thousands and thousands of doctors all over the world use Arimidex to control estrogen in adult males every day. THAT is no news flash.

    Do they want a study showing my patient subjective report is superior? There ARE ways of scaling subjective response.

    Licensed Primary Care Physicians are perfectly acceptable to prescribe TRT. Both BigPharma companies who make T gel target us. So doing so is in no way outside the scope of a PCP practice. IOW, you don’t need to be an Endocrinologist to prescribe TRT.

    I just try to do it with less drugs and better results.

    So what on earth do they have their underwear in a bundle over? Because patients flock here from all over the world? That I make my patients feel too healthy? What?

  12. #13 ginger
    January 14, 2010

    This is making me miss cooler and that Dutch guy who doesn’t believe in germs.

  13. #14 leigh
    January 14, 2010

    imagine how advanced our civilization would be if everyone took this “the science is too hard, so fuck it” attitude. we owe all our progress to date to people who accepted the challenges.

  14. #15 Adam_Y
    January 14, 2010

    When i hear all this talk in the healthcare debate about reducing “frivolous testing” i cringe. It seems to me that the goal should be to enhance our healthcare system in such a way that we can accommodate the maximum amount of testing possible without creating a bottleneck (taking into consideration tests that have potential side effects or long term consequences of course). The japanese government worked with toshiba to create a system where MRI’s cost $99. This attitude that we have to live with fewer tests because the potential for misdiagnosis and nonsense becomes greater with the more information you have at your disposal completely stuns me, and although i’m sure many other patients feel the same way although they probably don’t know how to articulate it.

    Congratulations you have shown a lack of understanding in basic science and medicine. First of all that hand waving involving misdiagnosis is a major problem. No test is perfect. More tests means that you will have greater chances of hitting a bad test meaning that you will in fact have incorrect information. Incorrect information is always bad. Second of all a lot of tests involve [b]COMPLICATIONS[/b]. Some tests require radioactive tracers and exposure to radiation which is obviously bad if you overdo it. Other tests require surgery which always contains a risk of complications no matter how simple the procedure. Third of all you can [b]NEVER KNOCK THE COST DOWN[/b] of some of these procedures. The resources are really exotic. Your advocating more tests and yet in some cases like the radioisotopes there was a dangerous shortage at one point. There are so many other reasons why frivolous testing is just a bad idea.

  15. #16 The Patient's Perspective
    January 14, 2010

    [ Congratulations you have shown a lack of understanding in basic science and medicine. ]

    Congratulations you’re being a hyperbolic dick on the internet for no reason.

    [ First of all that hand waving involving misdiagnosis is a major problem. No test is perfect. More tests means that you will have greater chances of hitting a bad test meaning that you will in fact have incorrect information. Incorrect information is always bad. ]

    Complacent much? “Sorry there’s just nothing we can do, we have to accept incompetence and poor/inaccurate results forever”. After all, it’s just been like this so far, so why should it ever be able to change?

    [ Second of all a lot of tests involve [b]COMPLICATIONS[/b]. Some tests require radioactive tracers and exposure to radiation which is obviously bad if you overdo it. Other tests require surgery which always contains a risk of complications no matter how simple the procedure. ]

    As I stated… “(taking into consideration tests that have potential side effects or long term consequences of course)”

    [ Third of all you can [b]NEVER KNOCK THE COST DOWN[/b] of some of these procedures. The resources are really exotic. Your advocating more tests and yet in some cases like the radioisotopes there was a dangerous shortage at one point. There are so many other reasons why frivolous testing is just a bad idea. ]

    I think it’s ok to handle two concepts at once. There are some tests that are too exotic to be used without a high degree of certainty about their need. That’s fine. This doesn’t cancel out the rest of the tests for which this isn’t the case.

  16. #17 Micawber
    January 14, 2010

    All of this is very interesting. I just want to know who the fatty in the canoe is. I’ve heard the experts say that tipping way over like that is a good thing. Not sure why. But I think it’s quite dangerous and I pray the poor man can swim.

  17. #18 Kristen
    January 14, 2010

    You seem to be obsessed with canoes, Micawber (Bulldog?) I think therapy may help.

    If you haven’t noticed, the topic has changed. Reguardless of what you think of the author, surely you can find something constructive to say about the above post.

  18. #19 Micawber
    January 14, 2010

    Kristen, if I’m obsessed with anything it’s that good man’s safety. That’s all. Aren’t you?

    Btw, I’m not Bulldog. No one knows who I am. Not even me.

    Carry on.

  19. #20 Katharine
    January 14, 2010

    Micawber/David (so you’re THAT small piece of raisin-balled filth!), you’ve apparently stopped contributing any actual discussion to the discussion and you’ve started talking about… canoeing. Which has nothing to do with this.

    You say your girlfriend’s an MIT-educated hedge fund manager, but with an ego that far outstrips your tiny little brain, I’m skeptical.

    Then again, hedge fund managers aren’t that bright either.

  20. #21 Katharine
    January 14, 2010

    “Exactly. What kind of “study” do they want? Heck, they could run it themselves (since they obviously have waaaaaaay too much time on their hands).”

    Does Dr. Crisler know nothing about medical studies? This is not hard.

    “I’m supposed to show I treat well-known medical conditions with medications used all over the world for that purpose each and every day?”

    No, you’re supposed to show you do it safely and ethically.

    “The “art” is in the fine tuning. Finding the “sweet spots” in each patient’s own hormonal milieu. But it’s also in backfilling the hormonal pathways, attempting to normalize as much as possible. And DHEA and PREG are perfectly acceptable to use, as is HCG (a treatment of choice for secondary hypogonadism).”

    Is this ‘art’ supported by science?

    “Thousands and thousands of doctors all over the world use Arimidex to control estrogen in adult males every day. THAT is no news flash.”

    Agreed.

    “Do they want a study showing my patient subjective report is superior? There ARE ways of scaling subjective response.”

    No. We want a study showing it actually works.

    “Licensed Primary Care Physicians are perfectly acceptable to prescribe TRT. Both BigPharma companies who make T gel target us. So doing so is in no way outside the scope of a PCP practice. IOW, you don’t need to be an Endocrinologist to prescribe TRT.

    I just try to do it with less drugs and better results.

    So what on earth do they have their underwear in a bundle over? Because patients flock here from all over the world? That I make my patients feel too healthy? What?””

    No, because apparently you take your patients’ satisfaction as the only cue when there could be other things wrong, which is what, as far as I’m aware, endocrinologists look for first before prescribing gobs of hormones.

  21. #22 Micawber
    January 14, 2010

    Still the same old angry Katherine, eh? Well, I’ve got just the thing for you. A day on the river in a fine, little red canoe. Calms the nerves. Soothes the soul. Steady as she goes.

  22. #23 DLC
    January 14, 2010

    Thanks for the post, Dr Pal.
    I for one, get it.

  23. #24 anyman
    January 14, 2010

    I find it amazing that those most likely to harshly criticize physicians like Dr. Crisler are those not in a position to need his services.

    I am not personally a patient of his, but am way too familiar with the dismissive attitude of what might be deemed “mainstream” medicine to people who’s complaints can’t be neatly dealt with in a 10 minute insurance company approved visit. I’ve seen multiple endocrinologists who appeared to know less about the HPTA than I did, which is sad considering I am not a physician. Worse still, they and too many other doctors I saw were more interested in a quick fix rather than finding the root cause. Too often I thought of an analogy that fit them to a “T”:

    I asked them if, upon walking out to their car, they saw a puddle of oil underneath their car what they would do. Would they A) Keep adding oil or B) Find and fix the leak. Seems to me way too many doctors just add oil. For YEARS I was told various items were “in range”, only to eventually discover some of them were literally ONE over the bottom, with others in the basement.

    Wow, was I PISSED. Range? Who’s range? What about my personal range and how I am feeling? I am highly educated and was floored how the patient was left out of the equation. I don’t GAS what your little paper says. Listen to ME, the live patient in front of you.

    Doctors like Crisler help where too busy pontificating to listen mainstream doctors stay in their narrow little comfort zones, all the while people suffer.

    Is Crisler perfect? I doubt it. Who is? But, he treads where others don’t. If we all waited for 15 billion redundant studies we’d never get anywhere. Scientists can’t agree on global warming, not to mention we’ve seen things like fat & cholesterol go from good to bad to good and back to bad ad nauseum. I want someone who will listen to me, the live patient, and help me get some relief in this life, not 50 years from now. Mainstream medicine needs to get off its high horse and listen to the people in need right now. I’ve dealt enough with mainstream doctors to know they are FAR from perfect and too often miss what is right in front of them, yet were too busy polishing their preconceived notions to see them.

  24. #25 Adam_Y
    January 14, 2010

    Is Crisler perfect? I doubt it. Who is? But, he treads where others don’t. If we all waited for 15 billion redundant studies we’d never get anywhere

    No. Now you are just letting a mad scientist experiment on you in a manner that proves squat diddly.

  25. #26 Adam_Y
    January 14, 2010

    I asked them if, upon walking out to their car, they saw a puddle of oil underneath their car what they would do. Would they A) Keep adding oil or B) Find and fix the leak. Seems to me way too many doctors just add oil.

    Stupid analogy. The first thing I would do is actually make sure the car is leaking. Oil on the ground is proof that some car leaked oil not yours.

  26. #27 Dazed and Confused
    January 15, 2010

    I realize this sounds strange, but I don’t think dr crisler, or many of his patients, would take issue with him being described as a Mad Scientist.

    I find it next to impossible to believe that you guys would retain your aloof, detached, conservative attitudes if you were ill and treating yourselves.

    You’d try damn near anything that hadn’t been proven harmful or that there wasn’t any compelling reason to view as harmful currently.

    It’s easy to tell someone else you aren’t deeply invested in to eat a bullet, even though you may be feeling some empathy or grief on their behalf. But when it _really_ counts I just don’t buy that you’re saying “Oh, I’m waiting a few decades for the data”.

  27. #28 Kristen
    January 15, 2010

    I know how frustrating it can be to go to doctor after doctor and still not feel better. But you have to consider the risks of the treatment, and to consider such risks, you need to know what they are.

    HRT was prescribed to many, many women. I worked at a pharmacy in college and it seemed like every other prescription the pharmacist filled was for female hormones. Now we have learned that, although fine for some women, HRT can be very dangerous.

    It took many years to find this out because these are long-term effects: Increased risks of breast cancer, heart disease, stroke, and blood clots to name a few.

    My point is; you can’t know the long-term effects of a treatment unless these effects are documented. In retrospect, I am sure there are many women who have had potentially lethal side-effects from HRT, who wish they had not used the treatment.

    That is the whole point, effectiveness of a treatment is only part of the picture.

  28. #29 B
    January 15, 2010

    @28

    What estrogen’s were being used on these women? Were they synthetic estrogen’s created by BigPharma or were they estrogen’s that are chemically identical to those produced by the human body? I’m guessing they were the former.

    Where the patients properly monitored to be sure their estrogen levels (if they were the chemically identical to human variety) were within normal physiological ranges? I’m guessing not since most of what I have read says that most women’s HRT in the earlier days was adjusted based on how they felt rather than a combination of how they felt AND lab results.

    Unless you can prove that they used estrogen’s that were chemically identical to those produced by the human body and that they were monitored properly, I’m not buying it.

    But then BigPharma won’t use chemically identical estrogen’s because they can’t patent them. Which means that they won’t spend any money to study them properly either.

    If the people doing the funding for medical studies were actually interested in the health and well being of the people rather than future profits we would have much more information on hormonal manipulation.

  29. #30 Micawber
    January 15, 2010

    “Now we have learned that, although fine for some women, HRT can be very dangerous.”

    More irresponsible, unfounded assertions from the Woo-Seekers.

    I’m beginning to see what the problem is here. It’s not the lack of canoe skills at all. You people here are suffering from….

    MAD WOO FEVER

    SYMPTOMS of “Mad Woo Fever” include seeing Woo in the every word and gesture of uninfected people, helplessly repeating inane and baseless assertions, exhibiting delusions of grandeur usually manifesting as “we are saving the world from the Woo,” spending large amounts of time on the internet assassinating the character and practice of uninfected colleagues, and for some mysterious reason, a zombie-like persistent effort to spread the fever to others (http://www.youtube.com/watch?v=na2W38tLp_Q)

    Other symptoms include nauseating self-righteousness, moral and intellectual vanity, profound ignorance, and asinine pomposity. Other symptoms may yet be discovered.

    In short, you become a teenager in Mom’s basement.

    WARNING: anyone not infected with this garbage: when at this website, please wear a mask and gloves when approaching your keyboard. They spew a noxious venom as a way of spreading the infection. Use extreme caution.

  30. #31 Kristen
    January 15, 2010

    You just don’t get it. There are plenty of things in our bodies right now that would not be good in larger quantities.

    These things are not foreign to the body, but it upsets the balance. An example I can think of as a runner, is the water/electrolyte balance. Even ‘natural’ things can be dangerous in unnatural quantities.

    I am not saying his treatment is ineffective, or even dangerous. Just that it has not been proven to be safe for the long term, or even the short term. Unproven is just not how science works.

    If you are not willing to listen, I am not going to continue to labor the point. I am trying to be reasonable and have dialogue. Isn’t that what you claimed you wanted?

  31. #32 B
    January 15, 2010

    @31

    I agree that things in “large quantities” can be a problem regardless what it is. But apparently you are missing the point I was trying to make. Hormones that are chemically identical to those produced in the human body, although introduced exogenously, that are kept within natural ranges should be fine if monitored properly. We don’t have people dropping dead from the same chemical substances in their bodies, at similar levels, when they are produced naturally, so why would this be any different? Just because we are introducing them exogenously? Why? It’s the same chemical substance at the same natural levels. Why on earth would this same chemical substance at the same levels suddenly become cause for concern?

    You cannot, I repeat, CANNOT compare BigPharma created synthetic hormones to hormones that are chemically identical to those produce by the human body. What is it about this concept that you don’t understand?

  32. #33 Perky Skeptic
    January 15, 2010

    I totally applaud this post, PAL, ’cause I am in the middle of just such a scenario with my own health. My internist has been a great science-based guide to helping me determine why I feel crappy all the time, and I am so happy for that! But, because of marginal and negative test results, I pretty much came to the same conclusion that this blog entry brings up– that sometimes we just have to understand that life isn’t perfect and we can’t always feel great, and if this last test comes up with nothing, I’m just going to have to deal with it!

    People scream that doctors aren’t gods, and then turn around and expect them to be just that. Then, when the best the medical practitioners in their lives can do doesn’t help them feel all-the-way better, they call it useless. Utopia fallacy, anyone?

    Yes, inform yourself about the scientific process. Yes, explore your treatment options. And then use logic to come to a good decision!

    I feel grateful that I am essentially a Worried Well in a first-world country with vaccinations and copious healthy food, so no matter how badly I feel, I’m better off than the majority of the world’s population, and it’s good to appreciate that. It puts a lot of things into perspective.

    Also, I’m pretty sure that because of all the science-based tests that have ruled out other potential causes of Feeling Crappy, that my upcoming sleep study is going to reveal a wicked case of sleep apnea, which is easily rectified with a CPAP machine. Again– yay science!

    Sorry for the rambling post– apparently I need to socialize more. :)

  33. #34 Dazed and Confused
    January 15, 2010

    Hey Kristen, I actually read all about the women’s health initiative before I started TRT and took it into consideration. Here’s what I came away from it all with:

    1) The increase in across the board mortality came from wyeth’s combination estrogen + progestin combo pill

    2) The combination estrogen + progestin pill was virtually automatically prescribed to 2/3rds of all women around menopause age.

    3) There were dr crisler-like “mad scientist” hormone
    enthusiasts who were saying not to use estrogen + progestin in combination like this, and to break progestin out into it’s own pill to be used only during the second half of the month (which was later vindicated in european studies)

    4) Estrogen alone had a far lower risk profile than the estrogen + progestin combined pill which if i remember correctly only raised stroke risk

    5) The risk profile increased by between 1 and 4 per 10,000 in the estrogen + progestin group than the control group in the various disease outcomes. Meaning, if 5 out of 10,000 people in the control group had heart disease, 7 out of 10,000 on the estrogen + progestin pill had heart disease. When you say “it raises your heart disease risk by 75%” it sounds like an intimidating staggeringly high number. But we all know most medications come with a risk/benefit profile that must be always considered.

    Let’s compare this to the chance of dying on any given year in an automobile accident. According to the national safety council your chance is 1 in 6500. Your lifetime probability of dying in an automobile accident based on a 78 year life expectancy is 1 out of 83.

    Most women go on HRT for 20 to 30 years.

    6) Followup studies of similar or larger size have been released in europe since then as well. While they found the same data for the wyeth estrogen + progestin pill, they found estrogen actually produced it’s previously-assumed benefits, ie reducing some disease incidences, if used through topical administration on the skin (cream or gel) or in the vagina (gel). Breaking up progestin into it’s own pill which was cycled on and off the last 2 weeks of the month also significantly lowered the risk profile of the persistent estrogen + progestin combination.

    For decades doctors were so convinced estrogen + progestin was so safe and effective based on the available research that 2/3rds of older women were on it. It took a herculean effort 12 year long study with 16,000 women just for the estrogen plus progestin vs placebo part of the study to determine there were some risks with this method which was probably entirely improper to begin with.

    After this it appears virtually every doctor who was pushing these lifestyle medications on their patients by default instantly decided hormones were bad and scary and will never be prescribed again other than in extremely low doses in the most extreme circumstances to fight severe hot flashes and whatnot. Despite new research showing estrogen applications which are safer, and perhaps actually beneficial as far as the usual co-morbidities go, the attitudes remain the same as medicine as always advances at a glacial pace.

    So regarding the WHI, undoubtably thousands of women died from this particular brand of HRT over several decades. However, if you felt your health was compromised enough, taking on the risk profile of let’s say the the estrogen + progestin combo pill (between 1 and 4 additional people per 10,000 in each category of disease) may seem acceptable to you. If you then take it, and feel you are receiving significant benefit from it, you may feel yet further emboldened to accept this risk profile.

    Now, us men on testosterone, some on topical creams and gels, some on injections, some on implanted pellets, we have no men’s health initiative. If I knew my risk profile was the worst-case-scenario risk profile of the women’s health initiative i would probably find that acceptable in my case for the trade off on quality of life. But I don’t. For all i know, perhaps I’m extending my life by 2,000 years. Or perhaps I’ll die from a heart attack today? The meta-analysis by the mayo clinic and harvard and others and the various smaller studies have yet to raise any red flags for me. I also just take pure unadulterated “bioidentical” testosterone from a compounding pharmacy. It’s not a combination pharmaceutical or absolute synthetic that has been slightly modified to make it patentable. Does this really matter? Is all of the “bioidentical” hoopla just woo, much ado about nothing? I don’t know, I’d like to say yes, but at the same time I feel safer going with a generic compound that is as close as possible to the real thing than putting my faith into wyeth who has blown it with hormone replacement multiple times.

    Also, low testosterone is associated with many health risks, it’s far from just a quality-of-life or erectile dysfunction treatment. Low testosterone is associated with cardiovascular disease cancer stroke and the whole lot. High testosterone has the inverse relationship to all of these diseases of civilization that low testosterone does, it appears to be protective. How strong will these associations prove to be in the future? How can I know? In the meantime, based on what I know so far, the risk/benefits seem like they are probably acceptable and the risks probably quite low.

  34. #35 Calli Arcale
    January 15, 2010

    You cannot, I repeat, CANNOT compare BigPharma created synthetic hormones to hormones that are chemically identical to those produce by the human body. What is it about this concept that you don’t understand?

    We’re off the topic, but I have to ask for some clarification anyway. What do you mean by “chemically identical”? I admit my reading is a bit colored by my college chemistry coursework. (Was going for a chem degree before falling in love with computers and switching majors.) “Chemically identical” to me means that it is the same actual compound, so the only chemically identical estradiol would be actual estradiol. (“Estrogen” isn’t actually a substance but rather a class of substances that will trigger the estrogen receptor. Estradiol is the stuff the body makes.)

    I did a little Wikipedia looking and found an article about ethinylestradiol, stating that it is a commonly prescribed synthetic estrogen, so this would be what you’re talking about. It’s in many modern contraceptives, and was first synthesized in 1938. It is chemically very similar to the estradiol manufactured by the ovaries and testes, though not precisely identical. (Only estradiol itself is precisely identical.)

  35. #36 Vicki
    January 15, 2010

    The other thing patients go to the doctor for is an explanation, which can also be a form of reassurance.

    For example, quite a few years ago I fell getting off a train (mind the gap!), hit my head and wound up with some impressive bruises, and probably had a mild concussion. People in that state aren’t always thinking clearly, and I didn’t go to the doctor until the next day, instead continuing with my plans for the day and just putting some ice on the bruises. Hence the probably.

    A few months later, I noticed that I was being bothered by bright lights. I went to a neurologist. He did a low-tech workup (“look at this light,” “toss me a rubber ball,” etc.) and then sent me for an MRI. That wasn’t to get the Greek-derived label “photophobia” for my condition (I’ve had a liberal education, I could do that part myself). The neurologist visit and MRI were to rule out the (very unlikely) possibility of a brain tumor, which is no less likely to develop around the same time as a concussion as it is at other points in a person’s life.

    Reassured that no, I didn’t have anything fatal or even terribly serious, I bought some serious sunglasses, started avoiding flash photography, and basically went on with my life.

  36. #37 Chris Rock
    January 15, 2010

    MANNN I DON’T KNOW THAT SHIT! I LOOVEEE NOT TO KNOW !

  37. #38 Michael Ralston
    January 15, 2010

    But then BigPharma won’t use chemically identical estrogen’s because they can’t patent them. Which means that they won’t spend any money to study them properly either.

    Whoops, your entire argument falls apart if this is false, which it is, because Big Pharma can patent processes to produce “chemically identical” estrogens.

    And Big Pharma can make plenty of money from medicines that have generics anyway, as per the numerous ads on TV.

  38. #39 A. Noyd
    January 15, 2010

    Dazed and Confused (#27)

    I find it next to impossible to believe that you guys would retain your aloof, detached, conservative attitudes if you were ill and treating yourselves.
    You’d try damn near anything that hadn’t been proven harmful or that there wasn’t any compelling reason to view as harmful currently.

    Nope, sorry. That’s not a hypothetical for me, and I haven’t thrown science out the window. I can’t speak for anyone else here, but my attitude comes from valuing my health and well-being. Maybe I’d be desperate enough to try dubious (but scientifically plausible!) treatments if I suffered from things immediately life threatening, but even then I would retain my aloof, detached, conservative attitude enough to refrain from making unsupported claims based on my own experience. It’s one thing to find relief after trying unproven treatments and another to assume that the treatment worked and was safe just because it seemed to help.

    But maybe you just don’t understand where PalMD and people on this blog are coming from. Maverick doctors and health gurus are a dime a dozen. They all claim their treatment works, they all squawk about closed minds and persecution if they’re challenged to produce evidence, they all have an army of supporters who believe they were helped by the treatment, they all brag about going the extra mile for patients, they all sneer at “the establishment,” and, one by one, nearly all of them are eventually shown by science to be frauds who’ve fooled themselves as well as their patients. Frequently, they and their supporters will decide that science is somehow wrong or not advanced enough or there’s a conspiracy suppressing the real results. Again, while Dr. Ye All Shall Bow To My Awesomeness might be an exception, so long as he behaves just like a quack, it’s impossible to distinguish him from the flock.

  39. #40 Dazed and Confused
    January 15, 2010

    No, on the contrary I _completely_ understand where palmd and the people on this blog are coming from. I’ve been a reader of sciencebasedmedicine for quite awhile and love steven novella.

    As I’ve said many, many, times at this point, he is not using new, unconventional, untested, or unproven medications.

    He’s not using reiki. He’s not using pyramids. He’s not using applied kineseology. He’s not using iridology.

    He’s using the same hormones, medications, etc, that endocrinologists and urologists use. No one has thrown science out the window.

    http://www.endo-society.org/guidelines/final/upload/AndrogensMenGuideline053006.pdf

    Nothing about anything in his clinical practice is scientifically implausible, or as far as I can tell even “dubious”. Note, his treatments are for proven conditions using medications which are proven to treat them, yet not only have I not made unsupported claims based on my own experience I also did not state anything you implied about safety.

    If you took the time to read my longer posts you might have less use for all this irrational hyperbole and rush to judgment that you coolly avoid in all of your personal health and scientific considerations. *ahem*

  40. #41 A. Noyd
    January 15, 2010

    Dazed and Confused (#40)

    He’s using the same hormones, medications, etc, that endocrinologists and urologists use. No one has thrown science out the window.

    You apparently assume I was speaking specifically of Dr. My Butt Is Red From Being Kissed So Much and his treatment in my first paragraph rather than “damn near anything that hadn’t been proven harmful.”

    Nothing about anything in his clinical practice is scientifically implausible, or as far as I can tell even “dubious”.

    Now, I do think Dr. Super Duper Wonderful Times Ten Thousand is likely basing his treatment on valid science. But to whatever degree he sticks with science in treating people, he does sneer at science when he responds to questions and criticism exactly as quacks do. Combine that with how he links himself to known quackery, like when he mentioned osteopaths in opposition to “their allopathic counterparts,” and there’s legitimate reason for concern. It’s not like scientifically sound treatments can’t be used ineffectively or irresponsibly. It’s not like a doctor can’t draw an erroneous conclusion from his own practices.

    yet not only have I not made unsupported claims based on my own experience I also did not state anything you implied about safety.

    I didn’t say you had. You’re chastising people by comparing us to those who are doing that, though, saying we would probably feel differently that we do now if we were suffering ourselves. I’m saying even terminal illness wouldn’t reduce me to their level of credulity.

    If you took the time to read my longer posts you might have less use for all this irrational hyperbole and rush to judgment…

    What irrational hyperbole? What rush to judgment besides assuming you were unfamiliar with medicine blogs? Which seemed reasonable given your assumption about our attitudes. After all, it’s an odd thing to suppose when enough people talk about how their skeptical attitude came from or was maintained through dealing with illness or watching others deal with it. I certainly never pegged you for one of the darling doctor’s thuglings, if that’s what you think.

  41. #42 Dazed and Confused
    January 15, 2010

    Prometheus/A.Noyd, I’ve found you very amusing and clever throughout all this especially your ability to generate a creative new nickname with each mention of dr crisler on the fly, despite the fact that I support him, funny is funny. Your points are well taken.

  42. #43 Dazed and Confused
    January 15, 2010

    I just wanted to correct one thing in regards to this:

    “You apparently assume I was speaking specifically of Dr. My Butt Is Red From Being Kissed So Much and his treatment in my first paragraph rather than “damn near anything that hadn’t been proven harmful.”

    Admittedly in retrospect that was a poor choice of words and too glib. When I wrote that I was thinking more in terms of “something which could have scientific validity which also appears unlikely to be harmful” with the specific example in my head of the endrocrinology document for testosterone treatment in men which says if you exceed “mid-normal” to lower the dose, not chelation or something like that.

    My thoughts were more along of the lines of being hypogonadal and your testosterone going from 150 to 650 and you’re still symptomatic. The top of the reference range is 1100, and men with higher testosterone levels (at least _naturally_) have superior health profiles. Many endos would tell guys at this point “sorry charlie, this is what life is for you”. If there are no other diagnosable issues, what is the fear (or even evidence against) slowly raising the dose just like doctors do with every other form of medication to see if you can find a place in the upper range where the symptoms subside? I don’t personally have this problem as when my testosterone gets above normal I feel worse, but i had _sky_ _high_ estradiol 5 times the reference range and i’m sure about 2% of endos would take this seriously, yet my biggest relief came from lowering my estrogen with arimidex, it’s been better for me than the testosterone is.

    I know, shit anecdotes that suck, etc. I’m just clarifying what I mean by “I don’t believe these same guys wouldn’t try xyz if it affected them” and that it wasn’t a woo-inspired accusation you would all turn to homeopathy because it was safe.

  43. #44 anyman
    January 15, 2010

    “Adam”is either dense or deliberately obtuse.

    I posted this in an effort to show how too many doctors treat only symptoms & ignore the cause:

    “I asked them if, upon walking out to their car, they saw a puddle of oil underneath their car what they would do. Would they A) Keep adding oil or B) Find and fix the leak. Seems to me way too many doctors just add oil.

    “Adam”, a person apparently more interested in bickering or trying to appear far smarter than he is or ever will be responds:

    “Stupid analogy. The first thing I would do is actually make sure the car is leaking. Oil on the ground is proof that some car leaked oil not yours.”
    Posted by: Adam_Y | January 14, 2010 11:12 PM

    To which I say:

    Adam, don’t be a putz. My post is a serious one, albeit an analogy. Why would anyone go to a doctor for someone else’s problems? Are you here to debate the merits or try (yet fail) to appear clever? The meaning of my post is clear, at least to anyone with at least a room temp IQ. Too many doctors chase symptoms. Far to few seek root causes. Fewer still can find them. Far less can repair them.

    Care to add to the discussion, or are obnoxious and snide all you have to offer?

    Like I said, I am NOT a patient of Dr. Crisler, but I understand why people seek him out. Years of getting nowhere with closed minded doctors unwilling or unable to think past a sheet of lab results can do that to a person. I experienced this first hand and saw too many doctors who looked only at the end symptom and never the cause. For me, a highly educated person, this was unacceptable. Why take medications for the rest of one’s life if a repair is possible? If YOUR car was leaking oil would you keep adding oil or would you fix that leaky gasket once and for all?

    No snide answers, please.

  44. #45 Vicki
    January 16, 2010

    Anyman,

    Even in the terms of your analogy, checking “is the oil really coming from my car engine?” makes sense, because “oil on the ground” isn’t a car problem. The car not running properly is a car problem. The engine leaking oil is a car problem, because it leads to the car not running properly. But oil under the car might be unrelated, or only distantly related: for example, a can of oil you were carrying in the trunk might have spilled, and then leaked through a hole in the trunk. Yes, easy to check, but worth checking before you pay a mechanic to fix your engine.

    If we get a bit less literal about the analogy, the point is that “testosterone level xxx” is not the patient’s complaint. It may be a useful diagnostic, and it may be something to treat, but the complaints are things like fatigue. As you note, there is a range of normal testosterone levels in adult men; if the patient is healthy, fiddling within that range is probably not worth doing. And even if he isn’t, his testosterone level may not be the cause of the problem.

  45. #46 B
    January 16, 2010

    Vicki,

    Your missing the point that the owner of the car already new that the oil was leaking from the engine of the car. You all keep throwing things into the analogy that weren’t part of it. Was there oil on the ground before he parked his car there? Maybe a can of oil in the trunk tipped over and leaked out? Reeeaaalllyyy?????? Give me a break.

  46. #47 amyman
    January 16, 2010

    Vicki-

    You somewhat miss the point and look for holes where none exist. My point is that WAY too many doctors look at 1-3 symptoms and go no further without even trying to find the root cause.

    This is exactly what happened to me and several others I personally know. My complaints of fatigue, malaise & more were answered with “you need an anti depressant”. When I pushed for more tests lo and behold more clues arose. Too bad all that did was immediately lead to more snap judgments. Never was there an effort or interest in FINDING the root cause. Some were more interested in getting my out in 5 mins, others wanted me to participate in studies, while more still were clearly puzzled. Very, very frustrating. The more educated I became, the more ticked I got. I learned there were several possibilities, many of which could be remedied with a little effort. I also saw that too many doctors went with the “You’re in range” BS even when, as in my case, a person was literally ONE point over the minimum, with clinical symptoms all pointing to something amiss. I traveled quite a bit to find people who who at least TRY to look beyond the obvious and listen to the patient rather than rely on a 1 point over minimum lab result. At first I avoided anything beyond full mainstream. After finding little, even in large, nationally known teaching facilities, I looked further.

    In time, I found other slightly less rigid doctors willing to listen and at least try to look further. I now consult with a few doctors, all willing to listen and work together. Is it perfect? Nope. But at least I am making progress.

    My situation is hardly unique. A local friend complained for some time about ED, fatigue and more. All he got was drugs and, finally, a test for low T. At first this sounded like progress, but I soon realized it was the same BS all over again. Did they check to see if he was primary or secondary? No. Check for FSH/LH? No. Check pituitary issues? No. Thyroid? Cortisol, etc? Metabolic syndrome/insulin issues? All no. All he go was a script for Androgel and a pat on the back. God forbid they actually might have dug a little deeper to see if his low T was the cause of his symptoms or the result of something else!

    That wasn’t all. They forgot to mention Androgel comes with testicular atrophy, a lifetime of dependence and, in some case, can spike estrogen to bad and very unpleasant levels in some people.

    Yes, I am ticked at the establishment. It took people like me, who although not doctors are very educated, to dig deeper and say “Hey, this is MY life, enough with the cursory BS. If you can’t or won’t practice real medicine and seek to be the equivalent of a “parts changer” in mechanical terms as opposed to a diagnostician then find someone else to ignore. I’m outta here”.

    You can defend the status quo all you like. I am glad there are some willing and able to dig deeper and heal as opposed to cranking out scripts.

  47. #48 a trained scientist who can also overhaul an engine
    January 16, 2010

    for fuck’s sake already people, an oil leak is (a) the simplest thing ever to diagnose to anyone who has worked on an engine before because it produces a reliable set of symptoms (b) is the most simplistic comparison of a human function i have heard in my life (except for perhaps a comparison to urination?) – certainly useless to apply to something as nuanced as “malaise” and (c) we don’t take people apart to replace head gaskets with expectation of a near-zero risk of damage and 120k miles of further service.

    biology is more complex than your engine, and using an oil leak as your analogy to a medical problem betrays your ignorance.

    btw, use of arimidex is not addressed in that endo society guideline document and they are extremely conservative when it comes to testosterone replacement treatment. just sayin’

  48. #49 not a trained scientist but someone who can also overhaul an engine
    January 16, 2010

    @48

    biology is more complex than your engine, and using an oil leak as your analogy to a medical problem betrays your ignorance.

    The oil leak analogy was perfectly fine for the point he was trying to make, and you thinking otherwise shows your stupidity.

  49. #50 MonkeyPox
    January 16, 2010

    Yes, because this discussion is all about how to construct analogies.

  50. #51 muteKi
    January 16, 2010

    @#49:

    No, I think he has a point. If we want something a bit on that level of obvious, we’re looking at a situation where someone is in the hospital for a compound fracture. (That is, the bone has poked through the skin.)

    The medical staff will NOT be giving him some pain medication and sending him on his way. The patient will get surgery and possibly some antibiotic medication.

  51. #52 anyman
    January 16, 2010

    Your unrestrained arrogance makes my point, “trained scientist”, as you address everything but the point of my post. No wonder I experienced what I did and still do. Your hubris and pride don’t allow you to see and address the problem of too many doctors unwilling and/or unable to find a root cause and fix it. Too many are all too willing to treat only symptoms. Patient depressed? Why bother finding out WHY, when a quick script for paxil gets him out in 5 mins and the next drone in the door. Gotta make that 3pm tee off!

    You have yet to address my point that too many doctors, apparently you included, just can’t get over themselves and think the world revolves around them. Guess what? I am a person and a patient. I don’t want drugs that merely mask the symptoms. I want a true diagnostician, not a mere parts changer. If you’re not up to the task then fine, point me in the direction of someone who is.
    I’ve known guys diagnosed with low T and put on who knows what, when all the while they had a thyroid or other issue. I once had a urologist tell me that he doesn’t always test FSH & LH when dealing with low T. All I could think was “WTF?– Don’t you WANT to know if primary/secondary? What other issues could cause low T?” It was sad and pathetic, but befitting the arrogance too many medical people are known for. Thanks for proving my point.

  52. #53 scientist, engine rebuilder, etc
    January 16, 2010

    I want a true diagnostician, not a mere parts changer.

    um, this is exactly the reason for my very strongly felt opposition to the “hey let’s swap out the gasket, fix the leak and call it a day” analogy. in biological systems, there could be infinite different causes for the same outcome, some interacting processes making it worse, some others compensating, etc. homeostatic regulation is an amazing process in and of itself.

    comparing that to a simple point-and-look “your vcg is pissing oil down the side of your engine and it’s all over the ground” is ridiculous.

  53. #54 A. Noyd
    January 16, 2010

    Dazed and Confused (#43)

    I know, shit anecdotes that suck, etc. I’m just clarifying what I mean by “I don’t believe these same guys wouldn’t try xyz if it affected them” and that it wasn’t a woo-inspired accusation you would all turn to homeopathy because it was safe.

    Yeah, that’s a much better way to explain it, thanks. I did suspect you weren’t talking homeopathy level woo, at least, and my mention of “scientifically plausible” up in #39 was meant to acknowledge that. I’m not out to knock anyone for trying out what Dr. Oh Sorry Did My Entourage Trample You has to offer* so much as their premature insistence it worked. I noticed a lot of the goons seem to be impressed by a certain level of personal attention they got which is something that draws people to realms of definite quackery like homeopathy and acupuncture. Would this treatment lose any of its supposed effectiveness without that element of appeal? That’s one question among many that ought to be settled. And their belligerent defensiveness is just inane. Real medicine thrives and improves under criticism. It’s to everyone’s benefit to encourage the dear doctor to put publishing before publicizing (and certainly before juvenile vendettas).

    ……………………………
    *I would still personally avoid a doctor making this many duck noises, so to speak, unless the stakes were more dire.

  54. #55 Anyman
    January 16, 2010

    I found “Mr. Noyd’s” quote amusing:

    “Real medicine thrives and improves under criticism. It’s to everyone’s benefit to encourage the dear doctor to put publishing before publicizing (and certainly before juvenile vendettas)”

    Did the author at all investigate before launching into criticism? Or, was it a knee jerk reaction? Besides, what is it with you and “publication”? There is academia and then there is the real world.

    Like I said, I am NOT one of Crisler’s patients and do not agree with all that he does. But, he has helped many, some I know personally and who are generally rather educated persons. Too many are tired of getting nowhere with traditional doctors who are more interested in cranking out billing or resting on what they learned long ago to explore other options. Many are tired of being given what is easy as opposed to what is right. Can you deny my experience as noted above happens, much less too often? I personally experienced doctors all too willing to “publish” via drug company funded studies who cared far more about getting people into the study then finding them a cure. Saw it first hand.

    The peanut gallery can yammer all it wants to, but in the interim there are people in need of help who are sick of being prescribed anti depressants for low T or thyroid issues and who want someone who will listen. You criticize some doctors for listening, almost like such is a bad thing. It isn’t.

    Me? I see a spectrum of people in the hopes that a cross section of ideas will help. I don’t hide this from them. So far, so good. Nobody has all the answers, me included.

  55. #56 A. Noyd
    January 17, 2010

    Anyman (#55)

    I found “Mr. Noyd’s” quote amusing:

    I find the constant assumption that I’m a male to be amusing. I find the sexism directed my way the second I let on that I’m female to be a lot less amusing.

    Did the author at all investigate before launching into criticism? Or, was it a knee jerk reaction?

    Many have made it plain the guy just shouldn’t be criticized, not because criticism is unfounded (I’m not saying it is or isn’t) but because he’s too awesome to deserve it, which is ridiculous. If he’s legit, criticism will help show that.

    Besides, what is it with you and “publication”? There is academia and then there is the real world.

    Do you not understand how medicine is advanced?

    I personally experienced doctors all too willing to “publish” via drug company funded studies who cared far more about getting people into the study then finding them a cure. Saw it first hand.

    Oh, I guess this answers my question above. No, you have no idea what you’re talking about. Are you into alternative “medicine” or are you just ignorant of the importance and methods of determining which drugs and treatments are effective and which are not, and which are safe and which are not?

    in the interim there are people in need of help who are sick of being prescribed anti depressants for low T or thyroid issues and who want someone who will listen.

    And here’s the crux of it. If there are so many people who need help, and if Dr. When I Walk By Everyone’s Nipples Go Hard has the solution, why wouldn’t he be publishing so that other doctors can test and vindicate the efficacy of his treatments and start using them on more of those needing help? Any quack can listen to patients. It doesn’t necessarily mean one is doing something effective, and it can make people feel they’re being helped more than they actually are. The same goes for personalized treatments. If he’s for real, maybe he can help a few guys with what he’s doing now. But he could potentially help many more by publishing.

    You criticize some doctors for listening, almost like such is a bad thing. It isn’t.

    Where has anyone criticized any doctors for listening? It’s almost like you’re inventing an argument because you don’t understand what’s really at issue.

  56. #57 Anyman
    January 17, 2010

    You totally miss the point, “Ms. Noyd”, not that it matters to me if you’re male or female. Whatever.

    I don’t GAS about how many people some local drone can shove into a study that I quickly realized wasn’t in MY best interests. Local doctors were all too willing to get me into a variety of extra strength T-gel studies and were too busy lining up subject to be bothered with seeing if it were in my best interests. They didn’t GAS why my T was low-all that mattered was that it was low, meaning they could get paid for another subject. If this is your idea of how medicine is advanced, then you can keep it. Speaks volumes about your ethics, or rather the lack thereof.

    You keep insulting this Crisler guy ad nauseum, yet forget I am NOT a patient of his and readily state I don’t agree with all of his methodologies. But, people I know have gotten results from him, in this lifetime and without being a guinea pig for large pharmaceutical companies. I know several reps and hear first hand the crap they pull to generate sales. Again, if that’s your idea of ethics and progress you can keep it. I’m also familiar with pharmaceutical litigation to a modest extent and see again what they do.

    You keep harping on Crisler and publication, but have you looked at the various guides & the like he has made available? Doesn’t he also travel far and wide giving lectures? Why, then, would you criticize him? Is what he does not in your proper form? Sounds to me like you criticize that which you don’t understand without bothering to look into it first. I am reminded of the axiom that doctors are often down on that which they’re not up on.

    I have but one life to live and am not about to squander it making some SOB more money by participating in studies that tell them more than I am helped. Maybe the XL strength T gel they were pushing would have helped me. Maybe not. But —-and most importantly of all– none of that BS would have EVER addressed, explored or help me find out WHY I was feeling as I did or if there was a simpler fix that didn’t involve being on drugs for the rest of my life and that, oh yeah, they “forgot” to tell me would irrevocably shrink the testes and result in a lifetime of dependence. Screw them and anyone who supports this. Medicine may “advance” in that way, but not on my body. Too typical of the damned drug companies– why find a cheap cure when we can sell some poor bastard a lifetime of expansive meds?

    Unlike you, I fully understand what is at issue: MY HEALTH. As a person who goes to some lengths to research what can help me I want to find a cure, not a band aid. Why didn’t you–and why don’t you–take the time to look into what guys like Crisler is doing before you bash the crap out of them?

  57. #58 B
    January 17, 2010

    Why didn’t you–and why don’t you–take the time to look into what guys like Crisler is doing before you bash the crap out of them?

    They won’t look into it because to them it is “unusual”. So in their minds that makes it wrong and/or unethical.

    That’s OK with me though. To each their own. I’m also pretty confident that one day they will look back and say “shit, they were right!”.

  58. #59 A. Noyd
    January 17, 2010

    Anyman (#57)

    You totally miss the point, “Ms. Noyd”, not that it matters to me if you’re male or female. Whatever.

    Well, I’m glad it doesn’t matter to you. I’m not a doctor, either, just FYI. I know, I know. “Whatever.”

    They didn’t GAS why my T was low-all that mattered was that it was low, meaning they could get paid for another subject.

    And you know they were motivated by greed and not their desire to help you get what they thought was your best shot at relief because…? Oh, right, you don’t!

    If this is your idea of how medicine is advanced, then you can keep it. Speaks volumes about your ethics, or rather the lack thereof.

    Applying ideas to reality and vice versa is how we gain knowledge. Not everyone is served by it in the initial stages, but ultimately everyone is. Denigrating that process and lifting up those who offer apparent cures but who refuse to participate in the actual advancement of knowledge is idiotic. The bottom line is, we’re ill served when we put assumptions above investigation.

    But you seem rather biased against conventional (science-based) medicine. I repeat my question from above: “Are you into alternative “medicine” or are you just ignorant of the importance and methods of determining which drugs and treatments are effective and which are not, and which are safe and which are not?” Your standards as expressed so far would require us to accept the efficacy of things like homeopathy and reiki. Surely, even if you’re into that sort of thing, you don’t think it all works? So what do you use to decide what works and what doesn’t? (If you could actually answer these questions, that would be great.)

    You keep harping on Crisler and publication, but have you looked at the various guides & the like he has made available? Doesn’t he also travel far and wide giving lectures? Why, then, would you criticize him?

    You mean where he promotes himself and lectures to people in the woo-tastic realm of “anti-aging medicine”? Right. That’s so not something to point to if you want to show off how legit Dr. You Can Go Blind Staring At My Brilliance is. Seeing where and how he “publishes” himself, I have to make a special effort to remember he might be on to something despite his association with quackery. Why criticize? I already answered this: “Real medicine thrives and improves under criticism.”

    Unlike you, I fully understand what is at issue: MY HEALTH.

    Sorry to disagree, but it’s my health at issue. Oh, hmm. Maybe we need some system that weighs that issue equally as it applies to every individual? Except, well, we have it already in the science-based approach to medicine. Golly!

    Why didn’t you–and why don’t you–take the time to look into what guys like Crisler is doing before you bash the crap out of them?

    What have I said that bashes him besides calling him by silly names (which is only a reference to his obvious and rampant egotism)? My point is: What is he doing? How can we know when he avoids putting his treatments to the only sort of tests that could give them scientific legitimacy? (By the way? Scientists do agree on global warming, just like they agree on evolution.)

  59. #60 HRB
    January 17, 2010

    (By the way? Scientists do agree on global warming, just like they agree on evolution.)

    Global warming is a sham. We don’t even have enough data to know the true heating and cooling cycles the earth has gone throgh to know if it is currently “warming” at an unusual pace.

    The theory of evolution is believe to be true by most scientists. But it is only a theory and it has many flaws. And just because it is believed to be true by most scientists doens’t make it true. And since there are many flaws in the theory I’m wondering why all these scientists who believe in it aren’t saying “show me the data so that we can prove without a doubt that this theory is true!”. I guess they don’t want to do that because if they prove their own theory to be false then not only does it make them look bad, but then they have somone to answer to for their deception of the other people of the world….wouldn’t want that now would they?

  60. #61 anyman
    January 17, 2010

    OK, “Noyd”, I’ll answer your question, although I thought I did. You ask:

    “”Are you into alternative “medicine” or are you just ignorant of the importance and methods of determining which drugs and treatments are effective and which are not, and which are safe and which are not?”

    Actually, until I experienced a few health issues I was quite possibly one of the least likely to consider anything even remotely deemed “alternative”. But, after seeing first hand the inability of too many doctors to look past rigid preconceived notions like “you’re in range” (really? who’s range we talkin’ about? My personal range or a generic one?), I am “into” whatever will help me ID the root causes at play to the extent possible, fix them to the extent possible and minimize my dependence on anything external. If there is one thing I despise it is dependence. And, no, I don’t have 3 lifetimes to wait. I value quality of life over quantity. Life, to me, must be more than a test of endurance. I don’t have 20 years to wait. I just watched a man die of cancer in his 30s. Did he have another 40 years to wait? Ask his widow & young children. Of course, I value the scientific method, but when presented with choices that range between “clueless” and “ineffective” I became willing to stretch a bit and see what those with more of an edge are doing, provided it appears to be more than snake oil and hype. As I said, I am not a patient of Crisler, but have seen others who use somewhat similar methods, although I personally add in some newly discovered local traditional doctors with a slightly more open minds as a balance of sorts.

    What standards do I use? Mostly my own research and analysis. I have nothing but respect for the scientific method, but when confronted with the personal realities I face am willing to expand my search a bit. Case in point: Adding HCG to a testosterone regimen has prevented testicular atrophy. Maybe if science discovers a fix I’ll be better positioned to benefit insofar as I have not experienced atrophy. To some, this is unacceptable because it hasn’t been around for 300 years or discussed to death. For me, I found sufficient research and evidence to support giving it a shot. Beats the hell out of shrunken balls, to be blunt. I’ll take a few chances, provided there is real evidence & science behind an educated guess. I am not a risk taker, but realize that in some circumstances taking a mild chance is the lesser evil. Were I to even suspect I was the victim of snake oil, the perpetrator thereof would have far more to worry about than mere legal action, and I do not say this lightly.

    As for the local doctors and if I “know” their motivation? Let’s just say I developed an inside source. Add that to their inability and/or unwillingness to help me find the root cause of my ailment and I have what I need to know. If they were motivated to help me find the root cause and fix it they would have done more then try to push me into a study without FIRST determining if I was a suitable candidate and if the drug they were pushing was or even could be appropriate for me. They could have taken the simplest steps, like seeing where my LH & FSH levels were. Now, if we’re charitable we can say they’re just stupid and somehow forgot. Or, we could say they didn’t GAS and saw only another name for the study. I went to them to see if there was a permanent fix. Such was not on their agenda, either due to incompetence or other motives. Either way, my goal of attempting to find & fix the root cause wasn’t in their repertoire. One more thing, and which partly accounts for my anger–they could also have warned me about the nasty side effects I discovered on my own. Most people might want to know that testicular atrophy and lifetime dependence are expected results.

    Getting back to Crisler, yeah, he has an ago. Haven’t met any doctors who don’t. Such doesn’t concern me as I too have an ego. I just want something that works. My point with you and him is that you bash him without taking the time to see what he is saying. Why not engage the man and inquire to your heart’s content without insults and disparagement? What does that accomplish? I don’t know many of his supporters, but I do know a few personally who have proven to be educated, intelligent and generally not likely to fall for BS. I doubt he eschews scrutiny, but like anyone responds when attacked. I don’t much doubt your stated intent to protect the scientific method, but wonder if you realize just how abrasive and condescending your posts are. Would you say what you do in person to hi or others? If no, then re-think what you say. Antagonizing people and creating personality conflicts does not advance your cause.

    I respond at this length since I sense, perhaps wrongly, that you do care and seek the truth–as do I. But, where we differ is that I must worry about my health and issues in the here and now. I can’t wait 50 years. Hope this helps.

  61. #62 Rrr
    January 18, 2010

    @ A. Noyd: Let me just express my admiration for your erudition and perspicacity in analysing where the other guy’s arguments come from. Most impressive. Congratulations.

  62. #63 Kristen
    January 18, 2010

    @HRB

    Global warming is a sham. We don’t even have enough data to know the true heating and cooling cycles the earth has gone throgh to know if it is currently “warming” at an unusual pace.

    Actually we do have evidence. The historical changes of surface temperature of the earth are well documented. I believe the data is gathered through taking cores of the antarctic ice.

    I won’t debate you on evolution because that discussion is way too heated for me (but I know evolution is fact).

  63. #64 Kristen
    January 18, 2010

    Sorry, broken link. Here it is again. http://www.epa.gov/climatechange/science/pastcc.html

  64. #65 HRB
    January 18, 2010

    Actually we do have evidence. The historical changes of surface temperature of the earth are well documented. I believe the data is gathered through taking cores of the antarctic ice.

    Sorry, but if you believe the earth has been in existence for more than a million + years (as I’m sure you do from your previous posts), that little 2,000 year blip on the radar doesn’t mean squat. Personally I don’t think it’s been around that long. But even then their “data” from 2,000 years ago is just a best guess and is not based on actual scientific readings. So I’m not drinking that cool aid.

    (but I know evolution is fact)

    Really? I have seen too many flaws in that “theory” to convince me that it is true. Have you scrutinized that theory just as you scrutinize anything else that is discussed on this site. If there is even one flaw in that theory then the whole thing basically falls apart. I have seen enough flaws to convince me that it is hogwash. But I guess that’s for each individual to decide.

  65. #66 History Punk
    January 18, 2010

    What “flaws” in evolution have you found and why haven’t you published your findings? Dare I say it’s because your a pompous dumb ass who’s going to repea some creotard nonsense?

  66. #67 Rrr
    January 18, 2010

    @ HRB:

    (but I know evolution is fact)
    Really? I have seen too many flaws in that “theory” to convince me that it is true. … If there is even one flaw in that theory then the whole thing basically falls apart.

    See, there’s a FACT of evolution (as in common descent with hereditary modifications under selection pressure), and then there’s a THEORY (look it up in a dicktionary, why dontcha) which tries to explain how it works, all the while considering the enormous (and ever growing) mass of findings from all sorts of different science fields, so far amazingly perfectly coherent, and with surprising predicting power (cf the discovery of Tiktaalik). Whoever wants to launch a rival THEORY is free to do so, provided they also explain all those pesky data points even better. Well. Do you feel lucky? < &lt>/DirtyHarry< &gt>

    So I’m not drinking that cool aid.

    Take care the cool aid you do drink is not sourced from Jim Jones’ supply…

    But I guess that’s for each individual to decide.

    My opinion exactly. Best when based on reliable evidence.

  67. #68 Mu
    January 18, 2010

    These guys are still here? I will never be able to watch a “Hans and Franz” SNL rerun again and think these guys are funny in their exaggeration.

  68. #69 A. Noyd
    January 18, 2010

    HRB (#60)

    Global warming is a sham. … [Evolution] is only a theory and it has many flaws.

    Not really the time or place to discuss your obvious ignorance in these subjects. I only broached it to tell anyman that his examples of disagreement in science were false. Why don’t you inflict your oh-so enlightened mind on some of the blogs that deal with those subjects. Take a box of bandages, though, so you can patch up your ass after the kicking it’ll get.

  69. #70 A. Noyd
    January 18, 2010

    anyman (#61)

    I am “into” whatever will help me ID the root causes at play to the extent possible, fix them to the extent possible and minimize my dependence on anything external.

    I hope you understand that I’m not against the very understandable desire to feel well. The problem is, the farther away you get from rigorously tested medicine, the closer you get to people whose only product is a feel-good sham. In an ideal world, you get feel-good, genuinely effective medicine and ailments with known causes and straight-forward solutions. Alternative “medicine” sells the lie that we live in that ideal world. Science is constrained by the real world which is messy, impersonal, and harder to figure out. But the benefits are well worth the discomfort of dealing with reality.

    And there’s nothing wrong with criticizing doctors who are dismissive and rude, but I’m guessing a lot of times you’re encountering doctors who are simply overworked, a situation that’s not going to be fixed by expecting them all to trawl the fringes of medicine for the few substantive innovations. Which leads back to the importance of supposed mavericks contributing their knowledge via the established channels.

    To some, this is unacceptable because it hasn’t been around for 300 years or discussed to death.

    You say you respect the scientific method but you constantly exaggerate like this, so it leads me to wonder if you really know what the scientific method is. It’s hard to tell frustration and bitterness from ignorance. At least you seem to have a better sense of scientific plausibility that many, and I respect that you would use that as one check against woo.

    Either way, my goal of attempting to find & fix the root cause wasn’t in their repertoire.

    But you don’t really know. It’s possible, but the assumptions read to me like you want someone to blame and you’re falling for the idea that conventional medicine is fraught with conspiracies, incompetence and adherence to dogma. You’re biased by your failure to get help. But how many people are helped by the system that you abhor?

    My point with you and him is that you bash him without taking the time to see what he is saying.

    I might be more inclined to address this if you answer my question: “What have I said that bashes him besides calling him by silly names…?” For now, I’ll say that what he says he’s doing is not very useful. Known quacks claim they’re doing any number of things, from curing cancer to identifying the one true cause of disease. What matters for anyone is what they are doing, which is not something we can determine just by what they claim to do.

    I doubt he eschews scrutiny, but like anyone responds when attacked.

    Responding when attacked is fine. Responding to criticism in a manner that resembles that of quacks (calling criticism “libel,” referring to MDs as allopaths, the Galileo gambit, etc.), not so much.

    I don’t much doubt your stated intent to protect the scientific method, but wonder if you realize just how abrasive and condescending your posts are. Would you say what you do in person to hi or others?

    Substance over style is the general rule for this (science/skepticism promoting) corner of the internet. I find most of the Crisler Crew’s posts to be belligerent and condescending, but I’ll only bring that up when they cry about my tone because I don’t give a shit minus the hypocrisy. There’s a far more serious lack of substance coming from your side. Just like I try to follow the “be nice” rules on blogs and boards I visit, the proper thing for visitors here is they step up and provide what’s expected. If you spot a problem with someone’s argument, focus on the argument, not the tone.

    And yes, if someone tries to start something, I’m just as blunt in person so long as I don’t have to keep my mouth shut for the sake of family, friends and cowokers. No doubt I’ll get shot someday by someone who figures guns win all arguments.

    If no, then re-think what you say. Antagonizing people and creating personality conflicts does not advance your cause.

    Do you mean rethink what I say or rethink how I say it? I’m not being pedantic; people so very often get offended over any suggestion they’re wrong no matter how it’s delivered. Everyone has different standards and what antagonizes one opponent might evoke respect in another. This being the internet, people always have the option of not engaging. As for personality conflicts, I’m not a fan of moderating my personality just to avoid clashing with someone else’s. It inevitably turns out to be an uneven sacrifice where the other person takes my humility as a signal to exercise his or her own overbearing personality more vigorously.

    I respond at this length since I sense, perhaps wrongly, that you do care and seek the truth–as do I. But, where we differ is that I must worry about my health and issues in the here and now.

    Right, but my point is that “truth” rarely goes with “here and now.” If you’re content to say “this treatment seems to work and should be investigated further,” I’ve no problem with that. But realize that criticism is the thing that will push that “seeming” into “truth” if it is, in fact, true. It’s not something to discourage or take offense at. It is the very essence of science in action.

  70. #71 Dazed and Confused
    January 18, 2010

    Noyd, do you have a blog or some kinda web presence?

  71. #72 Dazed and Confused
    January 18, 2010

    To be completely clear a “Theory” is a collection of facts.

    A large number of things must be objectively proven true to create a theory.

    Denying the theory of evolution is _exactly_ the same as denying the theory of gravity, and can only result from not objectively reviewing the evidence or not understanding it.

    There’s been a book released this year by richard dawkins on all of the current evidence for evolution for those who have become confused with all the propaganda like HRB.

    http://www.amazon.com/Greatest-Show-Earth-Evidence-Evolution/dp/1416594787/ref=sr_1_1?ie=UTF8&s=books&qid=1263860044&sr=8-1

    My sense is that HRB doesn’t REALLY care about the evidence because he thinks if he admits evolution he’ll go to hell and this is really a trick being played humanity by god as a test. He has probably also been lead to believe that it’s more noteworthy and virtuous to disregard any evidence that may provide even the most superficial contradiction to something that’s in the bible, so by refusing to accept revolution he is automatically currying favor with god just on principle of his unshakable faith he presumes evolutionary theory is trying to test.

    I am from crisler’s messageboard (obviously) and I can state with total certainty the evidence for evolution is approximately 100,000,000,000,000,000,000,000 stronger than the evidence for benefits of hormone manipulation, that’s how evidence based, NOT opinion based, evolution is.

  72. #73 Anyman
    January 18, 2010

    Ok, “Noyd”, Let’s see if I can address your comments in something approaching order.

    You say:

    “The problem is, the farther away you get from rigorously tested medicine, the closer you get to people whose only product is a feel-good sham. In an ideal world, you get feel-good, genuinely effective medicine and ailments with known causes and straight-forward solutions. Alternative “medicine” sells the lie that we live in that ideal world.”

    I do not disagree with this in the least, but IMO have a perhaps more flexible definition of “rigorously tested”. If I am likely to suffer for years or more waiting for the next great thing my willingness to try other things rises proportionately. Better to die with honor trying something then slowly wither away, at least to me.

    You say:

    ” Science is constrained by the real world which is messy, impersonal, and harder to figure out. But the benefits are well worth the discomfort of dealing with reality.”

    Totally agree. Unfortunately, there weren’t any benefits to me, since it became readily apparent that the full scope of reality, i.e determining exactly what it is that ails me and if there is a fix would not be happening locally or with most “traditional” doctors. I actually had a Harvard professor/research Dr. ask me “Why do you want hcg if you don’t want any more kids?”. Here’s a clue: Because I don’t like the idea of my balls shrinking into withered husks, not to mention perhaps they make things my body still needs, but science hasn’t yet figured out and, of course, maybe it might be a good idea to keep them running in the event a cure is someday found!

    You say:

    ” there’s nothing wrong with criticizing doctors who are dismissive and rude, but I’m guessing a lot of times you’re encountering doctors who are simply overworked, a situation that’s not going to be fixed by expecting them all to trawl the fringes of medicine for the few substantive innovations. Which leads back to the importance of supposed mavericks contributing their knowledge via the established channels”

    As much as I intellectually understand their overwork, such cannot impede my personal need for progress. Rudeness with competence is fine. Rudeness mixed with cluelessness is not. Time after time I heard “Oh, so you’re tired and feeling down? How about Paxil?” No!!! I don’t want a band aid or mere palliative measures. I want a CURE if possible.

    I also heard “Well, your T is close to range” Yeah–its where it might be for a man 40 years my senior, followed by “We could give you testosterone if you want”. Never, unless pushed, was there ANY interest in seeing if the root cause could be found. I could understand trying and failing, but the patently obvious unwillingness to go beyond the simple was one constant I just wasn’t comfortable with. Most didn’t even bother to see if it was primary or secondary. They just wanted to do whatever would get me out in 5 minutes. Sorry, but that’s not for me. I loathe dependence on medication and want to fix the root cause if at all possible.

    You say:

    “You say you respect the scientific method but you constantly exaggerate like this, so it leads me to wonder if you really know what the scientific method is. It’s hard to tell frustration and bitterness from ignorance.”

    Well, of course its an exaggeration and done to make a point. I don’t have years upon years to see what might develop. I have kids who need a parent NOW and obligations to meet NOW. Do I rush blindly into the unknown? Of course not. I do what research a layman, albeit an educated one can do and then chose the lesser of available evils. Case in point: Adding hcg to my personal med list. “Traditional” medicine doesn’t yet do this, yet anecdotal evidence I found says it works. So far, so good. Does this mean I am about to start buying magnetic bracelets and pyramids? Um….not likely. And, yes, I AM both frustrated and bitter. I’m frustrated at the lack of knowledge and willingness among too many doctors to just put a patch on rather then heal and i’m bitter at whatever power in the universe decided to butt hump me with a stupid affliction, without giving my body at least a rudimentary ability to self diagnose and heal., but I digress.

    You say:

    “It’s possible, but the assumptions read to me like you want someone to blame and you’re falling for the idea that conventional medicine is fraught with conspiracies, incompetence and adherence to dogma. You’re biased by your failure to get help. But how many people are helped by the system that you abhor?”

    I don’t think there are “conspiracies”, but do think there is a tendency to cling too long & hard on dogma. Too often doctors are down on what they’re not up on. Saw that first hand. I readily admit many people are helped, but as selfish as it may seem I must concern myself, at least in part, with my own progress.

    You say:

    “I might be more inclined to address this if you answer my question: “What have I said that bashes him besides calling him by silly names…?”

    Calling names has no place in a discussion of this nature. IMO, you miss the generally very dismissive and condescending tone of your posts. Comes through loud and clear. Science is science, but people react the same all over. Ever hear of IQ vs. EQ? Well, there you go……

    You say:

    “Do you mean rethink what I say or rethink how I say it? I’m not being pedantic; people so very often get offended over any suggestion they’re wrong no matter how it’s delivered. Everyone has different standards and what antagonizes one opponent might evoke respect in another. This being the internet, people always have the option of not engaging. As for personality conflicts, I’m not a fan of moderating my personality just to avoid clashing with someone else’s. It inevitably turns out to be an uneven sacrifice where the other person takes my humility as a signal to exercise his or her own overbearing personality more vigorously.”

    I’d rethink HOW you say it. Your inquiries are not only good, but quite welcome. I too want to know the truth, but don’t see the need to automatically assume the worst and then loudly proclaim such for all to hear. Seems counterproductive. For what it is worth, I came hear to serve as a counterbalance to the blind loyalists posting before me. I have no other interests here besides the truth and getting to the bottom of my personal situation. Yes, there are plenty of overbearing internet blowhards, but they do that since in real life most are wimps. As a science blog I was kinda hoping this would go beyond the “My dick is bigger than yours” nonsense the permeates too many boards.

    You say:

    “my point is that “truth” rarely goes with “here and now.” If you’re content to say “this treatment seems to work and should be investigated further,” I’ve no problem with that. But realize that criticism is the thing that will push that “seeming” into “truth” if it is, in fact, true. It’s not something to discourage or take offense at. It is the very essence of science in action.”

    Agree, but in my lifetime I MUST focus to a greater extent on the here and now. I don’t have forever to see what future generations might use. I have zero issue with criticism, but constrain it to USEFUL criticism, not the elevation of personality conflicts or form over substance as this soon degraded into. Case in point: My analogy using the finding of an oil leak and decision to either keep adding oil or find the leak. Too quickly the smarty pants brigade launched into “well, how do you know it was your car” or “maybe you had an open can in your trunk that spilled”.

    All I could think was “how silly”. Instead of addressing the merits of my post, i.e that in my experience treating symptoms took precedence over fixing the cause, those trying to prove how clever they are turned the discussion into a tit for tat debate on the merits of the analogy! Foolish and wasteful, IMO.

    I took the time to post all this to illustrate how a non physician, non scientist looks at things and as a balance to the geek squad, for lack of a better term. Science in medicine is wonderful, but there is a human element which I sought to remind those here of. Isn’t the cardinal rule “do no harm”? To my way of thinking the failure of many to even think of the root cause and over willingness to prescribe medications that would have quickly resulted in irreparable testicular atrophy and a lifetime of dependence was coming a little too close to harm for my liking. I’d rather hear a doctor say “I don’t know” rather than pretend he/she does.

    Hope you took this all in the spirit intended…… Never thought I’d post so often or so long here.

  73. #74 HRB
    January 19, 2010

    @72

    Sorry, this is way off topic but if you take into account the possibility that a cataclysmic flood may have actually occurred, then everything in their theory would have to change due to the affect the flood would have had on the earth. There are many signs that it is quite possible that a cataclysmic flood did in fact happen, yet they are ignored by those who believe in evolution. Why? Because then they would prove themselves wrong. Not to mention that the simple lack of “missing links”, as Darwin expected to be found, is a GIANT hole in their theory. The supposed links they have tried to push have pretty much all been a joke.

    There are several definitions for “theory” by the way. You might want to look at some of the other ones because they fit “evolution” much better than “a collection of facts” does. Evolution falls more into the category of “a hypothesis assumed for the sake of argument or investigation”. Just sayin’.

    Now back to your regularly planned atheist discussion. ;o)

  74. #75 A. Noyd
    January 19, 2010

    Dazed and Confused (#71)

    Noyd, do you have a blog or some kinda web presence?

    Besides commenting various places, no. Why?

    (#72)

    There’s been a book released this year by richard dawkins on all of the current evidence for evolution…

    Definitely a good read. There’s also Jerry Coyne’s Why Evolution Is True, which I think is a little more to the point. I enjoyed Dawkins’ tangents and anecdotes, but I could see them being distracting for a beginnner looking for a crash course in the evidence. Of course, given the evolution-deniers’ resistence to learning, either book is probably most effective when thrown at their heads.

  75. #76 A. Noyd
    January 19, 2010

    Anyman (#73)

    Unfortunately, there weren’t any benefits to me, since it became readily apparent that the full scope of reality, i.e determining exactly what it is that ails me and if there is a fix would not be happening locally or with most “traditional” doctors.

    And you were privileged to be able to look into other things, one of which you feel was a cure. All I’m saying is don’t assume that medical knowledge has in any way been advanced by whoever devised or provided the treatment.

    I don’t think there are “conspiracies”, but do think there is a tendency to cling too long & hard on dogma.

    I wish you would put aside your bias enough to stick your feelings into the continuum of all those who feel they were helped by unconventional things, most of which turn out to be shams. Whether or not you managed to get an effective treatment, to outward appearances, you look like someone certain he was “cured” by chiropractic or Ayurveda. This isn’t helped in the least by male HRT’s associations with life-extension quackery. What would set the treatment you received apart is if it bears up under testing. Most doctors aren’t clinging to dogma–they have a responsibility not to guess at which treatments within that vast continuum, dubious for lacking oversight and not being tested rigorously, are safe and worth recommending to a patient.

    Calling names has no place in a discussion of this nature.

    Oh, and why not? It’s not like Dr. My Shit Smells Better Than Chanel No. 5’s ego doesn’t deserve a jab or fifty. As for the goon squad, I think making fun of people, however belligerent, for their medical problems is going too far, but making fun of people’s belligerence is more than fair. As long as there’s a coherent argument under it all, why not have a little fun?

    IMO, you miss the generally very dismissive and condescending tone of your posts.

    I don’t miss it, I just don’t worry about reigning it in when egoes are out in force. Even you, with your “balanced” perspective, haven’t been shy about slinging accusations and expressing your scorn for supporters of “mainstream” medicine. But other than the name calling which I fessed up to, you still haven’t shown me where I’m bashing Dr. Superdupermanlyman.

    but don’t see the need to automatically assume the worst and then loudly proclaim such for all to hear

    Unless it’s against the doctors you feel failed you and greedy pharmaceutical companies and the people schooling you over your analogy, right? But if the hypocrisy doesn’t bother you, maybe you could point to a specific place where I’ve gotten carried away with an assumption.

    Too quickly the smarty pants brigade launched into “well, how do you know it was your car” or “maybe you had an open can in your trunk that spilled”.

    Which was to illustrate your simplistic understanding of causality in medicine. This is something I’ve noticed throughout your posts, actually. Even if you give lip service to the complex reality by saying “if possible,” you still want to know “the cause” of your problem and you want “the cure.” But bodies and biology mostly don’t fit the oversimplified cause/cure paradigm of your analogy.

    those trying to prove how clever they are turned the discussion into a tit for tat debate on the merits of the analogy

    Your analogy seemed a good platform to show you the actual complexity of the diagnostic situation minus the benefit of hindsight.

    Science in medicine is wonderful, but there is a human element which I sought to remind those here of.

    Understand that science relates to knowledge, and knowledge is the focus of most medical science blogs. In your first post up at #24 you said, “Doctors like Crisler help where…mainstream doctors stay in their narrow little comfort zones, all the while people suffer.” So your supposed message about the human element is tangled up in an unwarranted claim of knowledge. People will rightly confront you for the latter until you can separate the two. In this corner of the internet, the inability to properly frame and support an argument is a far bigger concern than being rude or dismissive.

    I’d rather hear a doctor say “I don’t know” rather than pretend he/she does.

    A great principle. Take care you don’t apply it unevenly.

  76. #77 Dazed and Confused
    January 19, 2010

    HRB, It doesn’t have anything to do with darwin at this point. You think in terms of the fact that you believe in jesus and he’s your prophet so if anyone else comes to a conclusion it must be based on what their prophet told them as well, and darwin must then be the prophet of people who believe in evolution.

    This idea of “darwinists” and “darwin’s ideas” doesn’t really mean anything. Science doesn’t work that way. All evidence has to be open and accessible to everyone to examine for themselves and draw a conclusion, it’s not revelation based like when jesus says something. It doesn’t matter who the first person was to discover an idea, science is merit based and the evidence has to speak for itself. Really you could say one of the largest driving forces behind modern science is based on undoing this sort of cult of personality.

    Darwin also died over 100 years ago, around 7 decades before even the discovery of the structure of DNA. it’s like saying because you live in america and believe it exists you must be a follower of christopher columbus. Darwin has very little to do with evolutionary science at this point, he was just a pioneer. It’s just as absurd as giving ben franklin credit for your computer, and considering yourself a ben franklin devotee.

    The usage of “theory” in science isn’t the same as theory used in colloquial language, such as “I have a theory that charlie sheen is gay”. A theory is possibly the highest scientific designation something can get, a “scientific theory” is a collection of things which have been conclusively proven. Saying “it’s just a theory” is exactly the same as saying “I have no exposure whatsoever to scientific thought”.

    Again, i know this all falls on deaf ears because you probably think this is all a trap and god’s going to punish you, just clarifying for it’s own sake.

  77. #78 Calli Arcale
    January 19, 2010

    HRB @ 74

    Sorry, this is way off topic but if you take into account the possibility that a cataclysmic flood may have actually occurred, then everything in their theory would have to change due to the affect the flood would have had on the earth. There are many signs that it is quite possible that a cataclysmic flood did in fact happen, yet they are ignored by those who believe in evolution.

    Flood has nothing to do with evolution, true or false. Evolution is about how species change over time; whether or not there were global catastrophes is a separate question (though global catastrophes can certainly affect the course of various species).

    One of the theories which I find most plausible for the flood described in Genesis is the flooding of the Black Sea. It’s the right general part of the planet, and it would have seemed like the entire world at the time. Also of note is the unrelated but interesting fact that humans have unusually restricted genetic diversity. For all we complain about those who are different than ourselves, we’re more alike than most species are. Also, we are the sole survivors of our genus and even our family — the only hominids. That strongly suggests some sort of global catastrophe which killed off a large proportion of the hominid population on Earth. So there is probably truth behind the Noah story, and the Epic of Gilgamesh, and probably also other disaster stories, such as the radically different tale of Sekhmet (who purged the world with fire at the behest of Ra, save for a few humans and animals allowed to repopulate it afterwards).

    This doesn’t disprove evolution. No more than evolution disproves God.

    There are several definitions for “theory” by the way. You might want to look at some of the other ones because they fit “evolution” much better than “a collection of facts” does. Evolution falls more into the category of “a hypothesis assumed for the sake of argument or investigation”. Just sayin’.

    Actually, “hypothesis” has fewer definitions than “theory” does, and you are not using it correctly in the scientific sense. A hypothesis is a specific statement which can be tested, usually formed as a prelude to scientific experimentation or other research to test the hypothesis. For instance, “planets move at the same speed throughout their orbits” would be a hypothesis. (And if you tested it, you’d find it false.) This hypothesis is one that would be formed during the process of evaluating (or even formulating) a theory of orbital motion. I picked that one because it was the “aha!” moment for Johannes Kepler — he was the one who first thought that maybe planets didn’t move at the same rate across their orbits but instead swept out the same number of degrees around the Sun during a specific amount of time. He tested this hypothesis by computing how fast they should appear to move across the sky if this were true, and found that he was able to correctly predict their motion.

    You appear to be using the word “theory” as synonymous with “hunch”. This is neither the scientific definition nor a reasonable description of the current state of the evidence with respect to the theory of natural selection. (That’s your other problem: you’re confusing “natural selection” for “evolution”. Even Intelligent Design proponents favor evolution. They just think God did it.)

    I liked the concise way They Might Be Giants described theory, as the word is used in science:

    “A scientific theory isn’t just a hunch or guess
    It’s more like a question that’s been put through a lot of tests”

    I also like this quote by Lord Macaulay:

    “My honourable and learned friend talks very contemptuously of those who are led away by the theory that monopoly makes things dear. That monopoly makes things dear is certainly a theory, as all the great truths which have been established by the experience of all ages and nations, and which are taken for granted in all reasonings, may be said to be theories. It is a theory in the same sense in which it is a theory that day and night follow each other, that lead is heavier than water, that bread nourishes, that arsenic poisons, that alcohol intoxicates.”

    Now back to your regularly planned atheist discussion. ;o)

    For whatever it’s worth, we’re not all atheists here. I, for instance, am a Christian. (Protestant, if that matters.)

  78. #79 HRB
    January 19, 2010

    Thanks for sharing views D&C and Calli. I’m always open to other’s view of things and will think about your comments.

    Again, sorry to go off topic.

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