werner@aecom.UUCP (10/19/86)
<<>> I get a lot of mail. In fact, my collected mboxes will soon approach 2 megabytes. Most is positive, some negative, but only very rarely do I get a letter like the following that so offends my sensibilities that I feel I have to share it. In the interest of fairness, I have kept the identity of the perpetrator of the letter anonymous, but if he wants to step forward and take the blame, I certainly have no objection. What follows are excerpts from the letter and my (admittedly lengthy and self-righteous) responses: > Re: Immunogen > > Craig, > > What about all the unproven treatments done by Medical Doctors in this > country every year? What about all the incorrect theories on how various > medical problems work, or ought to be treated? First, there is a difference between unproven and proven not. Calcium to prevent Osteoporosis is unproven, and although tenuous, makes enough sense not to protest about it. Vitamin C's trials with the common cold have been so dissapointing that one has to wonder why people still spend their collective billions to enrich Hoffman-LaRoche (one of the largest drug companies in the world who makes 90% of the world's Vitamin C, including most that is repackaged and sold as HEALTH FOOD). Immunogen, the alleged subject of this letter, has an alleged mechanism so laughably dubious that one truly has to marvel at the fraud being perpetrated. Secondly, I and every good medical student realize that 50% of medical theories are wrong. the trouble is that at any given time, we don't know which half. Thirdly, if a M.D. gives a bad treatment, I will not defend it. At least three times in the past year, I have, with appropriate caveats related to distance, expressed extreme scepticism over actual prescribed treatments, 2 of which were later changed. As another example, when people ask me what to do for a cold, while telling them that Vitamin C is useless, I also mention that going to see a doctor is worse, even detrimental, so have some chicken soup, have someone call you "bubula", and enjoy your 2 days of glorious misery. > > Defend the fact that medical "science" advocated the use of aspirin for > nearly one hundred years before anyone found out how and why it worked. > OK, Simple. First Aspirin was introduced before the era of rational drug design, but that's not the answer you want. The answer is that one doesn't have to know how a drug works to use it. All that is necessary is that it does work, and that it does so at safe doses -- proven safety and efficacy, not necessarily mechanism. Besides, we still don't know how Aspirin works, and if you think we do, you are sadly mistaken. > You *ARE* a pawn of the AMA, and you don't even realize it. The AMA is the > nation's largest lobby. The AMA has proven itself to be an organization > dedicated not to the health and well being of Americans, but the wealth and > well being of medical doctors. > > I strongly urge you to wake up and realize that the AMA does *NOT* hold the > only valid medical way. > Now this really insults my intelligence, and it is amazing how often people use it, not just on me, but on anyone in medicine. It is The Big Lie - but that's not the point. Leaving the AMA aside, and ignoring its motivations, mine have been put in question. I am a medical researcher. The disease I work on had 4 cases in the United States last year. On the other hand, 200 MILLION people are infected in South Asia, more than the population of the U.S. I am not in it for the money, and I could care less about AMA policy on the subject, or on almost any subject for that matter. If I agree with AMA policy more than I disagree (which is probably true), it is because those particular policies make sense. Finally, let me set the record straight. The AMA does not license a physician. The state does. Only about 1/4-1/3 of all doctors are AMA members, and I'm sure most of them (like myself) only join because it publishes an excellent journal (JAMA). > the AMA opposed the warnings on tobacco products (interestingly enough, the > AMA owned (and may yet own) many MILLIONS of dollars in tobacco stocks) > If it did oppose the warnings, it changed it's policy years ago. It divested from Tobacco stocks in the early 70s, it just recently banned all smoking at its national meeting. It official policy is now to get warnings on all smokeless tobacco, and to ban all smoking related advertising. Is this yet another case where the sins of the fathers must be borne by the children. I think not - it has atoned. > The AMA is not an organization *I* would look to for guidance. They have > proven themselves unethical, unreliable and unbelievable too many times. > You don't have to look for them for guidance, as is your wont. Unreliable, I won't quibble. Unbelievable, what's to believe. Unethical, I just can't buy that, especially given the demonstrated paucity of ethics ascribed to a sizable number of alternative health care providers, or to put it in the vernacular, the all-too common quack. Projection, perhaps? Are the sellers of Immunogen ethical? Is Carlton Fredericks ethical when he attacks "orthodox medicine" for banning Chelation therapy for heart disease when there is not only no evidence that it works, but no good reason why it should? JAMA routinely publishes articles that say bad things about drugs that carry full page ads. It didn't cover up the problems with Coronary Bypass, EC-IC anastomoses, Radial Keratotomy despite the fact that the poor results will discourage the operations and cost surgeons doing those operations lost income. In contrast, when was the last time you saw Prevention magazine run anything that said anything bad about a product advertised in it. Did you ever see a book in a health food store that told you NOT to use dietary supplements (such as those available 2 racks over). > So what good are they? As far as I'm concerned, the AMA puts together an excellent magazine (JAMA), an interesting weekly newspaper (American Medical News) and moderately interesting specialty journals (I get Archives of Internal Medicine). It's publishing activities, to me, completely justify its continued existence, and I could care less about its politics. Well, that's my story. Not that it matters. I realize I've violated the cardinal rule of never arguing with a fool because people might not be able to tell the difference, and that what I said is actually as futile as Don Quixote at the windmill to those who already have their minds made up. But it had to be said. And yes, I feel better already. Thank you. -- Craig Werner (MD/PhD '91) !philabs!aecom!werner (1935-14E Eastchester Rd., Bronx NY 10461, 212-931-2517) "I wouldn't have invited me either."
booth@princeton.UUCP (Heather Booth) (10/21/86)
In article <525@aecom.UUCP> werner@aecom.UUCP (Craig Werner) writes: ><<>> >I get a lot of mail. In fact, my collected mboxes will soon approach 2 >megabytes. Most is positive, some negative, but only very rarely do I >get a letter like the following that so offends my sensibilities that I >feel I have to share it. In the interest of fairness, I have kept the >identity of the perpetrator of the letter anonymous, but if he wants to >step forward and take the blame, I certainly have no objection. What >follows are excerpts from the letter and my (admittedly lengthy and >self-righteous) responses: Offends your sensibilities??? That letter just asked the reasonable questions any person who doubts doctors and American medicine would ask. The only *possible* insult was calling you a pawn of the AMA. You must not read the net very often, this is the mildest "offensive" letter I've ever seen. What your response says to me is that you are not capable of looking at the holistic vs. traditional medicine issue impartially. (And, yes, I too am a heretic. I don't have faith in doctors.) Heather Booth
wjc@mtuxo.UUCP (w.cambre) (10/21/86)
Craig responded with a lengthy article defending himself (not really the AMA) as an MD (or is it an MD-to-be? I wish you'd let me know). One point which I found quite interesting is as follows: > Secondly, I and every good medical student realize that 50% of > medical theories are wrong. the trouble is that at any given time, we > don't know which half. > I don't think I've ever heard any doctor say this before. Maybe all the one's I've ever known about weren't good medical students. Do they really teach this to you up there at Albert Einstein? Just remember this when (if) you start practicing on the average American out here. It would seem (especially in the case of Obstetric MD's in New Jersey) that there are few doctor's who practice as if they believed your above statement. And Craig, do you really belong to the AMA ONLY because of its publications? Come on, you may not pay attention to what the AMA tries to tell its MD's to do, but don't you think there is some good in the AMA and you belong 'cause you want to support it? (there's nothing wrong that). As for my comments on the AMA. I don't think there is a plot to make doctors richer or anything like that. I just think the AMA has too much power, for two reasons. First it is too tightly coupled with the medical insurance business. Thus the AMA's guidelines tend to conform to the insurance companies wants and also the insurance policies tend to conform to the AMA's guidelines. This has the effect that if you don't follow the AMA's guidelines, its harder to get insurance. Secondly the AMA is too tightly coupled with the legal system. When a doctor goes on trial for malpractice, her guilt is determined not by what is right and what is wrong, but rather by what is 'standard practice'. And the AMA's guidelines are often what is considered standard practice. So if you don't follow the guidelines, you are more apt to be sued and to lose, right or wrong. Now I don't have the slightest idea how to change any of that, but it does seem to me to be the problem. Of course, if only 2% of medical theories were wrong, then it wouldn't be much of a problem. - Bill Cambre
don@opal.berkeley.edu (Don Curry) (10/23/86)
I personally find Craig Werner's postings to be incisive, well-written and
furnishing cogent information on those aspects of medicine about which he
writes. I would like to offer him a rousing vote of confidence, and beg
that he ignore the idiots who write stupidities about his postings, his
motives, or whatever sets them off.
Keep up the good work, Craig!! Your postings are a bright spot in what is
generally a wasteland of ill-founded argument and misinformation (i.e., usenet
as a whole, and those newsgroups not dealing with technical aspects of CS in
particular).
don@opal.berkeley.edu
Don Curry
Computer Facilities & Communications,
University of California,
Berkeley CA 94720 (415) 642-0587
"Dh' aindeoin co theireadh e!"hankb@teklds.UUCP (Hank Buurman) (10/24/86)
In article <1489@jade.BERKELEY.EDU> don@opal.berkeley.edu.UUCP (Don Curry) writes: >I personally find Craig Werner's postings to be incisive, well-written and >furnishing cogent information on those aspects of medicine about which he >writes. I would like to offer him a rousing vote of confidence, and beg >that he ignore the idiots who write stupidities about his postings, his >motives, or whatever sets them off. I must agree 100% with Don. Craig's postings are the most knowledgeable, well researched, and accurate by far, on the net. Not to mention the poignant articles he takes time to share with us, and the Medical Puzzles we all scratch our heads about. This group would be a sorry one, without Craig Werner. Thanks, Craig. Shalom, Hank "I loved her with a love thirsty and desperate. I felt that we two might commit some act so atrocious that the world, seeing us, would find it irresistable." Hank Buurman Tektronix Inc. ...tektronix!tekla!hankb
terry@nrcvax.UUCP (Terry Grevstad) (10/24/86)
booth@princeton.UUCP (Heather Booth) says: >In article <525@aecom.UUCP> werner@aecom.UUCP (Craig Werner) writes: >><<>> >>I get a lot of mail. In fact, my collected mboxes will soon approach 2 >>megabytes. Most is positive, some negative, but only very rarely do I >>get a letter like the following that so offends my sensibilities that I >>feel I have to share it. In the interest of fairness, I have kept the >>identity of the perpetrator of the letter anonymous, but if he wants to >>step forward and take the blame, I certainly have no objection. What >>follows are excerpts from the letter and my (admittedly lengthy and ^^^^^^^^ >>self-righteous) responses: > >Offends your sensibilities??? That letter just asked the >reasonable questions any person who doubts doctors and >American medicine would ask. The only *possible* insult >was calling you a pawn of the AMA. You must not read the >net very often, this is the mildest "offensive" letter I've >ever seen. What your response says to me is that you are >not capable of looking at the holistic vs. traditional >medicine issue impartially. (And, yes, I too am a heretic. >I don't have faith in doctors.) Looks to me like Heather didn't quite read Craig's article. He did state that these were excerpts from the letter. For all we know the part left out may have been very "offensive". Craig, I would like to thank you for answering some rather nebulous questions that I (as well as the "offensive letter writer") had. I, for one, appreciated your article. -- _______________________________________________________________________ ----------------------------------------------------------------------- without a Terry Grevstad ECNALG Network Research Corporation ihnp4!nrcvax!terry {sdcsvax,hplabs}!sdcrdcf!psivax!nrcvax!terry _______________________________________________________________________ -----------------------------------------------------------------------
james@reality1.UUCP (james) (10/27/86)
In article <2150@mtuxo.UUCP> wjc@mtuxo.UUCP (w.cambre) writes: >Craig responded with a lengthy article defending himself (not really the AMA) >as an MD (or is it an MD-to-be? I wish you'd let me know). One point which I >found quite interesting is as follows: | Secondly, I and every good medical student realize that 50% of | medical theories are wrong. the trouble is that at any given time, we | don't know which half. >I don't think I've ever heard any doctor say this before. Maybe all the one's >I've ever known about weren't good medical students. Do they really teach >this to you up there at Albert Einstein? Just remember this when (if) you >start practicing on the average American out here. It would seem (especially >in the case of Obstetric MD's in New Jersey) that there are few doctor's who >practice as if they believed your above statement. If you really believe someone who tells you "I know all the answers", I would prescribe a healthy dose of skepticism. Would you rather have a doctor who a belief that "the book" was always right, or one who realized that s/he *might* be wrong (and maybe risking your life on the diagnosis)? Why do you think that medical theories are so accurate? As an obvious case I recall the swine flu vaccination problems. If medical science & theories were very advanced I would not have expected everyone to be so surprised when it had such harmful side-effects. -- James R. Van Artsdalen ...!ut-ngp!utastro!osi3b2!james "Live Free or Die"
abc@brl-smoke.ARPA (Brint Cooper ) (10/28/86)
As someone already pointed out, Craig would rather us discuss things
other than himself. Except for the following question, I shall honor
that wish:
Craig, where do you get those great tag lines that you place at
the ends of your postings?
--
Brint Cooper
ARPA: abc@brl.arpa
UUCP: ...{seismo,unc,decvax,cbosgd}!brl-smoke!abcgary@ethos.UUCP (Gary J. Smith) (11/02/86)
In article <2150@mtuxo.UUCP> wjc@mtuxo.UUCP (w.cambre) writes: >... the AMA is too tightly coupled with the legal system. When a doctor >goes on trial for malpractice, her guilt is determined not by what is right >and what is wrong, but rather by what is 'standard practice'. And the >AMA's guidelines are often what is considered standard practice. So if >you don't follow the guidelines, you are more apt to be sued and to lose, >right or wrong. The trouble with your comments is that you assume that it is easy to judge a universal "right and wrong" in medical practice. It simply isn't so. Another thing any medical student worth her salt learns is that "No two cases are alike." In a discipline that draws heavily on scientific generalizations and probabilities, this is a particularly troubling (but true) maxim. So even in the best of all worlds, medical "right and wrong" is never a clear "black and white" judgment. We do not live in the best of all possible worlds. The standards of practice must be different depending on where the patient lives, and the availability of medical resources in his geographical area. The standard of care for a patient in Alakanak, Alaska, (where there is no full-time physician) is going to be different than the standard of care in New York City. It is for this reason that the courts have rightly judged malpractice suits on the basis of the standard of medical care in the patient's local community. I have never been fond of the AMA, mainly because my politics are vastly different than the AMA's. But I have never thought of the AMA as setting forth guidelines for the standards of medical practice. That is a much more subtle thing--standards develop from articles published in medical journals (NEJM, Lancet, or sometimes JAMA) which slowly work their way into textbooks and medical school curriculum. The AMA is not a conspiracy to hamper the progress of medicine. The AMA is just a collection of old-boy physicians with less than an imaginative view of their profession. -- Gary J. Smith {ihnp4,mcnc,duke}!ethos!gary 919/493-9575 5802 Garrett, Durham, North Carolina 27707
jsdy@hadron.UUCP (Joseph S. D. Yao) (11/06/86)
In article <2150@mtuxo.UUCP> wjc@mtuxo.UUCP (w.cambre) writes: >Secondly the AMA is too tightly coupled with the legal system. When a doctor >goes on trial for malpractice, her guilt is determined not by what is right >and what is wrong, but rather by what is 'standard practice'. And the >AMA's guidelines are often what is considered standard practice. So if >you don't follow the guidelines, you are more apt to be sued and to lose, >right or wrong. Interesting point. Whether or not the AMA is in bed with the lawyers (and, for the most part, I rather think not), the fact is that the law (as I was taught it) does have a doctrine of negligence, which measures liability by whether a person meets his responsibilities according to a certain standard of care, and whether there was any injury as a result. This came first, before the AMA. Now, who's to judge the standard of care? Shall we hold a vote on the net? Certainly not -- or if so, we should only give a vote to people who are active medical practitioners. All right, in the USA, what's the biggest single organisation of practitioners? The AMA? And, if we don't have the people in practice deciding what's "right" and "wrong", how d o we decide it? I think, though, that part of the problem is in that last sentence. One does not automatically get sued every time one strays from the thin high wire. Or should not. For most conditions, there is more than one accepted method of treatment. But people with the attitude that the doctor can take a look at you and know just what the problem is and what to do, end up suing the doctor when their unrealistic expectations are not fulfilled. Granted that there are some doctors out there who wholy need and deserve it, the rate of lawsuits has been getting quite out of hand. So much so, that many times when a health practitioner would very much like to do something to help a person -- even something as simple as making aspirin or acetaminophen available to a person requesting it -- the possibility of a lawsuit makes it difficult or impossible. (*sigh* Midnight passed while I wasn't looking, and I'm rambling. The point is that doctors et al are mostly in it to help. The sentiment that a lockstep attitude is required to prevent lawsuits does not help.) -- Joe Yao hadron!jsdy@seismo.{CSS.GOV,ARPA,UUCP} jsdy@hadron.COM (not yet domainised)