Dr. Eileen Consorti and Patient Power

My alternative to Testing Treatments (199 pages), I said recently, is three words: Ask for evidence. Ask your doctor for evidence that their recommendation (drugs, surgery, etc.) is better than other possibilities. A few years ago, I asked Dr. Eileen Consorti, a Berkeley surgeon, for evidence that the surgery she recommended (for a hernia I couldn’t detect) was a good idea. Surgery is dangerous, I said. What about doing nothing?

To reread what I’d written about this  (here and here), I googled her. I learned she has a blog. It contains only one post (June 21, 2011). That post is only seven words long. I also learned she has two very similar websites (here and here). Both use her full name and title where most people would use she. Perhaps I caused the blog and websites.

Here’s what happened:

1. In 2008, during a routine physical, my primary-care doctor finds that I have a hernia, so small I hadn’t noticed it. He says I should see Dr. Consorti. Do I need surgery for something so small? I ask. Ask her, he says.

2. Dr. Consorti examines my hernia. She recommends surgery (that she would perform). Why? I ask. It could get worse, she says.

3. Eventually I realize that’s a poor reason. Anything can get worse. Influenced by Robin Hanson, I speak to Dr. Consorti: Surgery is dangerous. What about doing nothing? Is there evidence that the surgery you recommend is beneficial? Dr. Consorti says, yes, there is evidence supporting her recommendation. She says I can find it (studies that compared surgery and no surgery) via Google.

4. I try to find the evidence. I use Google and PubMed. I can’t find it. My mom, who used to be a medical librarian at UC San Francisco, is an expert at this. She has done thousands of medical searches. She too cannot find any studies supporting Dr. Consorti’s recommendation. Moreover, she finds an in-progress study that compares surgery for my problem with doing nothing. Apparently some researchers think doing nothing may be better than surgery.

5. I tell Dr. Consorti that my mom and I couldn’t find the studies she said exist. Dr. Consorti says she will find them. She will let me know when she’s found them and make copies. I can pick them up at her office.

6. Months pass. I call her office twice. No response.

7. In August 2008, I blog about Dr. Consorti’s continuing failure to produce the studies she seemed  sure existed.

8. A reader named kirk points out “what looks like a relevant hernia study“.  It concludes: “Watchful waiting is an acceptable option for men with minimally symptomatic inguinal hernias. Delaying surgical repair until symptoms increase is safe.” This argues against Dr. Consorti’s recommendation. No one points out studies supporting her recommendation.

9. Two weeks after my post, someone who appears to be Dr. Consorti replies. She’s busy. She has 30 new patients with cancer. She terms my question “scientific curiosity”. She says “I will call you once I clear my desk and do my own literature search.”

10. More than a year passes. In 2010, I receive a call from Dr. Consorti’s office. An assistant asks me to remove my blog post about her failure to provide the studies. Why? I ask. It makes her look bad, he says. He says nothing about inaccuracy. I say I would be happy to amend what I wrote to include whatever Dr. Consorti wants to say about it.  The assistant asks if I have any “further questions” for her. No, I say. The conversation ends.

11. A little later, I realize I do have a question. In 2008, during the conversation when I asked Dr. Consorti for evidence, I had said surgery is dangerous. In response, she had said no one had died during any of her surgeries. By 2010, I realized that such an answer was seriously incomplete. Many bad things can happen during surgery. Death is only one bad outcome. How likely were other bad outcomes? Dr. Consorti hadn’t said. She knew about these other bad effects much better than I did, yet, in a discussion of the safety of surgery, she hadn’t mentioned them. By not mentioning them, she made surgery sound safer than it actually is. Why had she not mentioned them? That’s my question. I call Dr. Consorti’s office and reach the person who had called me. I ask my question. As I wrote ,

He tried to answer it. I said I wanted to know Dr. Consorti’s answer. Wait a moment, he said. He came back to the phone. He had spoken to “the doctor”, he said. She wasn’t interested in “further dialogue”. She would contact a lawyer, he told me.

I haven’t heard from her since then.

This story illustrates a big change. As recently as twenty years ago, the doctor-patient balance of power was heavily weighted toward the doctor, in the sense that the doctor exerted considerable influence on the patient (e.g., to have surgery). One reason, Robin Hanson has emphasized, is human nature: The more fearful we are, the more we trust. Patients are often fearful. Another reason for the power imbalance was information imbalance. The doctor knew a lot about the problem (had encountered many examples, had read a lot about it). The patient, on the other hand, knew almost nothing and could not easily learn more.

During the last twenty years, of course, this has changed dramatically. Patients can easily learn a great deal about any health problem. Google, PubMed, on-line forums, MedHelp, CureTogether, and so on. The story of Dr. Consorti and me illustrates what a difference the new access to information can make.

Personal science (science done to help yourself) has two sides. One is: collect data. My self-experimentation is an example. To improve my health, I gathered data about myself.  It worked. My skin improved, I lost weight, slept better, improved my mood, and so on. The other side is: use data already collected. That’s what I did here. My search for data (including my mom’s search) showed that data already in existence (including the absence of evidence supporting surgery) contradicted Dr. Consorti’s recommendation. My search was not biassed against her recommendation. I didn’t care whether she was right or wrong. I just wanted what was best for me.  As Feynman said, science is the opposite of trusting experts — including doctors. My first glimpse of the power of self-experimentation was when it showed me that one of the two medicines my dermatologist had prescribed didn’t work.

Overtreatment is an enormous problem in America. Overtreated by Shannon Brownlee and Overdiagnosed by  H. Gilbert Welch, Lisa Schwartzl and Steve Woloshin are recent books about it. Overtreatment could easily be why Americans pay far more for health care than people in any other country  yet die earlier than people in many countries. A large fraction of our health care may do more harm than good. A common view is that the incentives are wrong. As one commenter put it, pay for treatment, you get treatment. The solution, according to this view, is to change the incentives. That’s a good idea but will not happen soon. I believe overtreatment can be reduced now. You can (a) ask for evidence (as I did) and (b) search for evidence (as I did). The difference in lifespan between America and other countries suggests this might add years to your life.

I would like to find out what happens when people ask for evidence and/or search for evidence. Please send me your stories or post them in the comments.

More Two days after I posted this, Dr. Consorti replied to this post and the earlier one with essentially the same comment, which is here.

33 Responses to “Dr. Eileen Consorti and Patient Power”

  1. Jim Purdy Says:

    What about doctors who refuse to accept the evidence from patients sitting right in front of them?

    I was amazed a few years ago when a very highly regarded medical specialist actually told me that it would be malpractice for him to pay attention to his patients. He said he had to treat patients according to national guidelines, even if his patients said the treatments weren’t working.

  2. Brian Says:

    A little over two years ago, I was “depressed”. My psychiatrist wanted to prescribe an SNRI. I related, once again, my poor experience with an SSRI and asked for evidence that an SNRI would be any more effective. He said there was evidence that SSRIs worked. I pointed out the 2004 meta-analysis that showed no meaningful difference between SSRIs and placebos. Then I asked whether there was any better evidence for SNRIs. Since he wasn’t able to provide any, I told him that since we know that extremely low Vitamin D blood levels, poor diet, no exercise, and no social life can cause depression, (all things I had at the time), we’ll try fixing those things first and then resort to drugs if that fails. It did not fail and I quit seeing him.

  3. Rachael Says:

    I want to thank you for posting this and re-posting it now. Around the time you were having those experiences my son’s pediatrician recommended a tonsillectomy for recurring strep. The Ear Nose and Throat specialist also said it would help. I searched pub med and found research that suggested most children who receive a tonsillectomy have one fewer strep infection in the following year than those that don’t. The time, expense, and risk of surgery vs. one strep infection, hmmm, not a tough choice.

    I don’t believe that either doctor was motivated by any thing other than a desire to help my son, but their education pre-dated the meta-analysis I had read, and their training was in conflict with more recent research. No doctor can be as motivated to stay current as someone who will be directly impacted by the decisions. I think it should be standard procedure to e-mail patients the top ten search returns relating to any suggested treatment and discuss those studies before taking action. Government funding to remove pay-walls to all government supported research wouldn’t be a bad idea either.

  4. dearieme Says:

    Here’s a question that I asked that, rather unexpectedly, stumped a specialist. “Your coronary arteries are normal” he said. “Ah”, I said “do you mean ‘normal’ as in ‘desirable’ or ‘normal’ as in ‘average””?

  5. Tom Says:

    You did cause those websites, and there are tons more than the ones you mentioned. She’s hired a firm to do online ‘reputation repair.’ It’s a big business, very expensive, and it doesn’t really work. The company she hired told her that they can push your posts about her off the first page, yet you’re still #2 for searches about her.

    But it’s a good business, as people in her position will pay anything.

  6. PJ Says:

    About five years ago, I had been hospitalized when I simply couldn’t breathe anymore, following what I called ‘chronic recurring bronchitis’ and my body apparently called ‘chronic lung infection from reaction to gluten’. After getting out of the hospital, carting around an oxygen tank until the little alveoli in my lungs regrew etc., I went to see the Respiratory Specialist that had been assigned me.

    Now, he was a handsome guy, very charming as well, seemed very knowledgeable. He prescribed me three kinds of inhalers.

    “What specifically do these do to prevent the severe asthma?” I asked.

    He frowned at me in surprise.

    “Well they {yada yada, make it so you can breathe better}” he says.

    “But isn’t that kind of after the fact?” I say. “I mean, at that point the problem’s already in place. Do they do something toward preventing the problem in the first place?”

    “No,” he says. “That is not curable.”

    “So these are ONLY for symptoms,” I insist on understanding.

    “Right,” he says.

    Ok. I had no health insurance and they were a good chunk of extra single-mom budget but hey, you’d be surprised how selfish one is about being able to breathe.

    Time passes. My cardiologist–assigned me also in the hospital for an event that actually was just about days of steroid, pain and stress combined, I don’t actually have a heart problem aside from enlargement from obesity — prescribes me the PPLP low-carb book. After reading it, I decide to do a trial. Just a trial. Without realizing the association at the time of course, I didn’t just drop carbs, I dropped gluten. (Back then, LC bread, tortillas, bake mix, etc. didn’t much exist–fortunately!)

    3 weeks later my “severe asthma” has vanished. My “severe allergies” are gone. My “severe OMFG I’m gonna die” nightly acid reflux is gone. And a lot of less extreme things.

    I had a follow up appointment, and with shining eyes I told him of this miracle. I thought he’d be as excited about it as I was. So I made a mistake (or not).

    “Doc,” I say, “You’re a specialist in this stuff. I wonder if this could help other people. Have you not seen a change in eating affect respiratory problems?”

    “So you aren’t taking the medication I prescribed?” he answers instead.

    “I — uh — well no of course not, not anymore. You told me they were for symptoms. I don’t have any symptoms anymore!”

    “It’s not appropriate for you to be my patient if you can’t follow medication direction,” he says, looking at me as if I have just confessed to secretly being Evil in some truly egregious way.

    I was still saying, “but — but — ” when he left the room. The nurse finished that appointment and told me not to bother making another.

    I left feeling like the really smart handsome charismatic guy had told me I sucked, and feeling like I’d done something bad and got caught in it.

    And then I thought: what am I talking about?! This is the best thing that ever happened to me!! He’s an idiot!

    That’s just the way it is I guess. I mean this wasn’t even about surgery or something major, it was nothing more than expensive inhalers for symptoms I no longer had any of at all. Yet still the doctor was bizarrely… what’s the word. Resistant?

    I might add I used to study with a doc who worked in psychoneuroimmunology (a long word that in his case mostly meant using stuff like biofeedback). He had cases where people had carpal tunnel and were about to have surgery that would forever remove their ability to use their hand (which they already couldn’t), leaving them a sort of minimal claw effect. He would talk them into putting off the surgery and working with him using biofeedback and hypnosis, and they would go back to their docs showing him hands that worked again. (It’s a muscle stressed induced displacement so there isn’t any reason why this can’t be reversed.) The doctors would be angry. The patients were always bewildered.

    I think there is some control psychology in play with a lot of medical professionals. They have a hammer. They see you as a nail. They don’t really care or want to know what better tools might be applied.

    PJ

  7. Shawn Says:

    Doctors aren’t always right, that’s for sure. While it’s good that people have more access to information now then ever before, a lot of people simply are not capable of looking up that information. A lot of old people or mentally challenged people do not know how to use the internet and are not able to read complex studies and understand their implications. The best argument of socialized health care is that the incentives are more properly aligned.

    My mom was misdiagnosed with epilepsy (I was about 7 years old at the time). She was told she had a petit mal seizures (after supposedly experiencing one on front of her mother) and was put on anti-seizure medications, including depakote. This drug caused her brain to shrink, memory & emotional problems, coarsening of the features, depression, and sleep problems (she would fall asleep during the day at random times). She was kept on all those meds because her “blood levels” supposedly were not where they were “supposed” to be at. 18 years later after talking with a doctor at the Mayo who said she did not need to be on all those medications she cut back until she was not taking any and never had a seizure. She described them as being in a “cloud all those years;” all those years she felt miserable. After she got off them she felt a 1000x better. She ended up getting pancreatic cancer and died from that. We don’t know if all the drugs contributed/caused that they could have.

  8. Jim Says:

    I think many doctors would say they are too busy to look for or provide the type of research you were asking for.
    I think Dr. Consorti’s mistake was when she told you there were plenty of studies on point.
    In retrospect, she should have just said “I don’t know of any such studies. Practicing medicine is part science, part art. Research can’t always help, and doctors often have to go with standard practice, gut instincts and experience.”
    You may not have been satisfied with her answer, but at least she would have put the issue to bed instead of prolonging it by having to try to save face each time you followed up.

  9. Alex Chernavsky Says:

    This kind of stuff isn’t limited to doctors.

    About fifteen years ago, I had conducted some complicated financial transactions during the year, so I hired a tax specialist to prepare my income tax return. He made a big mistake that would have cost me thousands of dollars, had I not spotted it on the draft. When I pointed out his mistake, he initially refused to acknowledge it. Eventually, he admitted that he was wrong.

    The sad truth of the matter is that you can’t trust anyone to be competent, and you always have to do your own homework on matters of any importance.

  10. Jim Purdy Says:

    PJ’s story is very powerful, and all too common.

    I propose a zero-based “Rick Perry Rule” for health care. In a recent Republican presidential debate, Rick Perry said his foreign aid budget would start at zero, and every country wanting foreign aid would have to justify every dollar.

    I’m not a Rick Perry fan by any stretch of the imagination, but I wish the government and insurance companies would start all health care budgets at zero, and require at least a little bit of evidence for every treatment, every drug, every device, and every surgery.

    I suspect that thousands of lives would be saved, millions of lives would be improved, and billions of dollars would be saved, if America were taken off 90 percent of all drugs and surgeries, and doctors were required (and re-trained) to work with patients on lifestyle changes.

    When I try to talk with most doctors about lifestyle, they look like I’m speaking in Klingon. All they want to do is print out prescriptions and move on to the next patient every 5 minutes.

  11. Jay Says:

    I think a major reason why doctors are so disapproving of patients experimenting with their own solutions is the fact that they mostly only get to see the results when it doesn’t work.

    Patient A and Patient B go off the reservation and decide to try something different than what the doctor thinks is the way to fix their problem.

    Patient A manages to figure something out and doesn’t visit the doctor anymore since the problem has resolved itself.

    Patient B doesn’t manage to figure something out, or makes things worse with their self-experimentation.

    Patient B then goes to the doctor, tells him* of the self-experimentation and the doctor thinks “People who aren’t listening to me are really fouling themselves up — the problem is that they are not listening to me.” This is repeatedly reinforced.

    The doctor never gets to see patient A. The doctor sees all the downside, and none of the upside — given the data he is receiving, his viewpoint makes sense, but the data is self-selected and skewed.

    *or her

  12. Seth Roberts Says:

    Jim Purdy, you wrote:

    “it would be malpractice for him to pay attention to his patients. He said he had to treat patients according to national guidelines, even if his patients said the treatments weren’t working.”

    Wow. I am also amazed. That doctors aren’t trained to have a more reasonable response when treatments don’t work.

  13. Lisa Wainer Says:

    Hi Seth,
    Your interaction with this doctor is a really illustrative example of something I have experienced multiple times, having suffered from a serious health condition (Crohn’s disease) and self-experimented my way off all medications and avoided of surgery for 20 years. In my view it is a rare to find a doctor who is a thinker, and they are certainly not trained/encouraged to be thinkers.
    I just wanted to mention a couple of books I read a while ago that you may be interested in (you may know of them) that sound like they are related to the books you mention here. The first is Medical Nemesis by Ivan Illich – a short book noted as a medical classic. I think he first coined the word ‘iatrogenic’ to mean disease caused by medical intervention. The other one is The Death of Humane Medicine by Petr Skrabanek (available as pdf online) which rallies against ‘healthism’ and state based health promotion. It is a little harsh on alternative medicine (it was written some time ago) but it is quite a read.

  14. Seth Roberts Says:

    “I think Dr. Consorti’s mistake was when she told you there were plenty of studies on point.”

    I think that when she discovered my blog post, which apparently bothered her, she should have done the search, told me the result, and asked me to amend the post. [More After I wrote that, she did so -- see above]

    “Many doctors would say they are too busy to look for or provide the type of research you were asking for.”

    I agree. One doctor said this in the comments on a previous post. Keep in mind that Dr. Consorti would be paid a considerable amount of money for doing the operation she had recommended.

  15. threepipeproblem Says:

    Thank you for having the courage to call out someone who acts more like a high priestess than a woman of science. My suspicion is that most doctors are more like priests than scientists.

  16. Seth Roberts Says:

    “My suspicion is that most doctors are more like priests than scientists.”

    Yeah, that’s a good question: What fraction of what doctors do is priest-like, and what fraction scientist-like?

  17. Seth Roberts Says:

    The Death of Humane Medicine can be downloaded here:

    http://bradtaylor.files.wordpress.com/2009/06/death-of-humane-medicine.pdf

  18. Lisa Wainer Says:

    I just found the introduction chapter of Medical Nemesis online which can be downloaded here:
    http://www.digitallibrary.kcci.com.pk/bitstream/32417747/155/1/MedicalNemesisIntroduction.pdf

  19. Carlson Says:

    New to your blog, but your thinking paralells what my wife and I have been figuring out over the last few years. One of the things that bothers me about “Obamacare” or any ‘one size fits all’ healthcare ‘fix’ is the idea that the current healthcare system is too reliant on pharmacological and surgical solutions. We’ve known many people who are too quick to seek solutions to their health problems via surgery or drugs. Surgeries ARE dangerous and drugs almost always have side effects. The benefits of surgery and or prescription drugs need to be seriously weighed against the downside (not to mention the ongoing expense).

  20. Grundle Says:

    Many of you are quick to excoriate doctors while discounting the bewildering amount of knowledge they have to keep track of. Classifying doctors as “non-thinkers” is disingenuous and untrue.

    The biggest problem I see with doctors is either arrogance or greed. When either of those two get in the way it clouds their ability to provide the best care to patients. An arrogant doctor obviously won’t listen to a patient because he “knows better”. It is easy to see how someone’s view can become so jaundiced when they have to sacrifice four grueling years to medical school and another four to residency. I imagine that many doctors resent a patient who really doesn’t know anything, but what they read from some article. In truth, I think the cases where self-diagnosis and self-treatment are successful happen to be the minority. Remember that the body is so complicated that we still don’t completely understand how it works. Just understanding cellular metabolism is a challenge. That is only a small percentage of the entire corpus of knowledge a doctor is expected to master.

    The second case is the greedy doctor that is only in it for the money. This is how I see the physician in this article. She probably knows that the condition is minor, but the accepted approach is always surgery and that means she gets payed to perform that surgery. Every surgery is a paycheck and if someone is greedy enough they will line as many up as possible without worrying about monitoring the condition to see if it gets worse.

    There is a third type of doctor that is there for their patients. They listen to what the patient says and strive to provide the best care possible. I have met many of these doctors, and although they are not infallible, they constantly work to make sure they are giving the best and most up to date care possible.

    My point is that if you have questions and your doctor cannot answer them satisfactorily then find a physician who will take the time to sit down and answer your questions, and tell you why his approach may be better In every profession there are idiots who will make the entire group look bad, however shunning the entire group because of those idiots is not an adequate response either.

  21. Seth Roberts Says:

    Grundle, is what you say here based on something that happened to you? Or something that you saw?

    I would like to present a balanced view of doctors. I agree with you that my experience is not the whole story.

  22. David Harmon Says:

    I’d say there’s an even bigger factor than arrogance involved, which is interference from the health insurance companies. A doctor who doesn’t toe their line can be dropped from coverage, which for most types, basically puts them out of business. Naturally, this will get worse with ObamaCare’s mandatory insurance…. “It’s very difficult to make a man see something, when his salary depends on his not seeing it”….

  23. Lisa Wainer Says:

    Grundle, I have met a lot of doctors in my capacity as a sick person and a few as a healthy person. I have yet to meet one who is happy to accept that my self-experimentation has made me healthy. Some even find it hard to believe that I actually am healthy – i.e. refusing to believe my experience and wanting to do expensive, invasive medical tests to ‘check’ that what they are seeing with their own clinical judgement is true. That is what I mean by not being able to think. But that is only my experience.

    This is not to say that I have not met nice doctors or doctors who genuinely care about their patients. Being caring and nice and wanting to do the right thing does not necessarily result in effective treatment (although it can be extremely helpful and supportive) – especially if a doctor does not listen to the patient and think for themselves.

    I often think of this as an agency problem. Doctors in the UK don’t work for the patient – they work for the NHS. But similarly, the doctor that Seth encountered has also lost her agency. She doesn’t understand that she should be working for her patient (as her patient pays her directly) and the reverse of personal recommendation happened to her – which risks her livelihood (evidenced by how much spent on reputation repair). Her extra bad luck that her patient had an influential blog.

  24. Alex Chernavsky Says:

    There are a couple of funny things about this. If Dr. Consorti had just admitted her mistake and eaten a little crow, she probably could have avoided the whole issue. Instead, she has to spend a lot of money to hire a firm to restore her on-line reputation.

    The other funny thing is that I wonder whether her “reputation consultants” actually know what they’re doing. Note to Dr. Consorti: You’d be better off using hyphens in the URLs to separate your names: i.e., instead of eileenconsorti.wordpress.com use eileen-consorti.wordpress.com. Similarly, use eileen-consorti-md.com instead of eileenconsortimd.com. If you use hyphens, search engines will treat the names as separate words. (No charge for my advice.)

  25. Nansen Says:

    Why didn’t you ask for a second opinion? I had two hernia repairs in Berkeley, by two surgeons, and both made it very clear that watchful waiting was an option. (One repair was in 1998, so it wasn’t a matter of the doctor needing new research.)

    I’m not discounting the value of what you’re saying, but in this case you might have saved a lot of effort by just doing what many patients commonly do already.

  26. Seth Roberts Says:

    Why didn’t you ask for a second opinion? I had two hernia repairs in Berkeley, by two surgeons, and both made it very clear that watchful waiting was an option.

    Because a literature search established there was no good reason for the surgery. That was more conclusive than anything a doctor could say. It was also much easier to search the literature (and ask my mom to do so) in the comfort of my apartment than travel to a doctor’s office, wait, etc.

  27. Grundle Says:

    @Seth – Sorry to wait so long to get back to this. I am not sure this is based on anything specific. To be fair, I do a lot of volunteering at a free medical clinic as an interpreter which gives me an advantageous viewpoint of seeing both the viewpoint of the doctors and the patients. Since I effectively become the path of communication between them it is a perfect vantage point to be able to observe and make conclusions on what is happening.

    Because it is a volunteer clinic run in association with a medical school there are also students learning there, so I get to see the entire gamut of attitudes from the doctor’s perspective and since it is a general clinic it is like playing the lottery on knowing what kind of malady the patient will have.

    @David Harmon brought up a good point when he mentioned doctor’s toeing the line with respect to insurance. The fact is, it is even more convoluted than that, because they also have to be aware of swindlers/hypochondriacs who want to get a quick fix of pain killers etc. Doctors have to be on the lookout for not only physical illness but mental illness and respond accordingly. If they work in a hospital they are also required to treat anybody that comes in regardless of their Insurance status. That is a fact.

    @Seth I think your reaction was correct in your case. You had knowledge of research and asked her to respond to it, which she could not. I do not think that she acted in an ethical manner and as such I would be leery in seeing a doctor of that caliber. Like anything, the relationship between a doctor and patient is predicated on trust and when a physician breaks that bond there really is no way for them to provide adequate care for that patient.

    @Lisa Wagner – I do not know a doctor that would be happy with self-experimentation either. I know tons of doctors that would be willing to take your ideas into account, sit down with you and try to come up with a plan to tackle the issues. Basically when you throw the doctors advice away for your own self-experimentation you are saying that you know more than they do, which from the perspective of human biology and the scientific approach of treating human illness you are way behind, but I am sure they are lacking in your knowledge of self-awareness. Self-experimentation without guidance is dangerous. As for the issue of “invasive” procedures, I also agree with you that many times this isn’t the best approach, but once again doctors have been bound by legal issues. They are basically required to rule out a number of things based on the symptoms, and this precedent has been established due to any number of malpractice lawsuits that have been filed over the years. It is really a no-win for the doctors if you think about it. At least that is how it is here in the US, I can’t speak for the UK.

  28. Seth Roberts Says:

    Grundle, thank you for your helpful reply. Here is what is to me the most interesting part:


    I do not know a doctor that would be happy with self-experimentation either. . . .Self-experimentation without guidance is dangerous.

    This is a fascinating state of affairs. What if a teacher said they were unhappy if a student learned on his/her own? Learning without guidance is dangerous, the teacher might say. If doctors knew 100% of the relevant info, then there would indeed be no need for self-experimentation. You would just follow the doctor’s orders. But what if doctors knew only 10% of the relevant info? Or less? Which is not to be critical of doctors. They are merely the part of the health care system that has the most contact with the rest of us. It is deep inside the system that ignorance is dressed up as wisdom.

  29. Grundle Says:

    Seth,

    I understand what you are saying, but I think you are taking too lightly the complexity of the human organism. I don’t view self-experimentation on the human body as a simple research project, because there can be some very real and even fatal consequences. I have no problem with learning, and I think it should be encouraged, but let us take your example and expand it. If you were learning about efficient synthesis of Nitro Glycerin, or Serin gas would you go off and try to experimentally come up with a solution or would you seek guidance from already established knowledge before tackling it? One misstep in either of those scenarios could bring disaster.

    This is where I have a problem with the over prescription of medications in this country. I think doctors are too quick to prescribe when many drugs are going to have an impact on the balance of the overall organism. At the root of everything, we are really just a giant set of complex chemical reactions, but they feed off each other with feedback mechanisms and “on off switches” based on which enzymes become activated and inactivated. Throwing a drug or chemical into that mix will upset the balance.

    The self-experimentation I would advocate is common sense and good health that can be obtained through a good diet and regular exercise. Of course I could be overthinking your definition of self experimentation. I suppose I should read more of your blog now ^^

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  31. Timothy Says:

    Doctors are clueless :( they start off with a decent education, next they get real hands on training and get their license… they are good, honest doctors. But then they get visits from drug reps daily… the so bombarded by propaganda and sales bullshit and out right lies. Then on top of all this they have to run a business, dealing with all the insurance with what they will pay or won’t. This “system” that these good doctors are put through would drive anyone crazy. They don’t practice medicine anymore because they can’t!!! they are not allowed to :(

  32. Tonsillectomy Confidential | The Health Care Blog Says:

    [...] was easy. “The time, expense, and risk of surgery vs. one [sore throat],” Rachael wrote on my blog, “Not a tough [...]

  33. Tonsillectomy Confidential | Health Care Jobs In Connecticut Says:

    [...] the decision was easy. “The time, expense, and risk ofsurgery vs. one [sore throat],” Rachael wrote on my blog, “Not a tough choice.”Rachael believes “when things are going badly with your body, nutrition [...]