For those who trust their doctors....

[AJMD429]

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...you might want to see if they're keeping up with the Vitamin D issue...(I'll bet they have no clue about this new issue).

https://www.youtube.com/watch?v=AtoxkK7MeKc ( link fixed - thanks to Rimfire McNutjob...! )

There was an issue with the blood-thinner test ('INR') in the 1980's that was similarly harmful.

[jeepnik]

Well, we used to eat more salt. Most salt was iodized. Still like my

[Pisgah]

I saw a video by Dr. John Campbell this week about the vitamin D fiasco. My physicians cut my D intake last year for no reason other than, "We don't see levels as high as yours in most people..."

Well, duh... I've upped my dosage again and they most assuredly hear about it from me during my next set of visits In January.

Physicians are beginning to sound more like Democrats to me -- believe the opposite of what they say and you're getting close to truth. Of all professions medicine is the one where you should consider yourself a perpetual student... and a disturbing percentage instead become know-it-alls and never read another paper after graduation.

[765x53]

I saw a video by Dr. John Campbell this week about the vitamin D fiasco. My physicians cut my D intake last year for no reason other than, "We don't see levels as high as yours in most people..."

Well, duh... I've upped my dosage again and they most assuredly hear about it from me during my next set of visits In January.

Physicians are beginning to sound more like Democrats to me -- believe the opposite of what they say and you're getting close to truth. Of all professions medicine is the one where you should consider yourself a perpetual student... and a disturbing percentage instead become know-it-alls and never read another paper after graduation.

For many, their on-going education is limited to sales pitches from the pharma rep.

[AJMD429]

I saw a video by Dr. John Campbell this week about the vitamin D fiasco. My physicians cut my D intake last year for no reason other than, "We don't see levels as high as yours in most people..."

Well, duh... I've upped my dosage again and they most assuredly hear about it from me during my next set of visits In January.

There are a few physicians (Campbell has interviewed a couple) who actually think the 'upper limit' should be increased above 100 ng/ml, though they are in the minority. I've had patients accidentally get levels (of 25-OH-Vit D) in the 140's and never seen any issues of 'toxicity'.

Keep in mind the European 'reference range' is in different units than the US one.

One note on 'reference ranges'...

If I called the lab and said "John Doe is here and has a Vit D level of 52 - what should it be...?"

Lab response: "That's your problem; you're the doctor - we just measure stuff; we can't possibly know your patient's individual situation..."

Me calling back: "Can you tell me what the Vit D level should be for a healthy 50 year old male...?"

Lab response: "That would still be practicing medicine, and we're not physicians, we're lab people..."

Me calling back: "OK, Can you at least tell me what the Vit D level typically IS for a healthy 50 year old male...?"

Lab response: "Doc, we get 1,700 tubes of blood in a day to check for Vit D; we have no way of knowing which tubes come from a healthy person, or someone with ricketts, or someone with osteoporosis, or someone who overdosed on a hundred pills of Vit D - so no - we cannot tell you what the normal healthy person's Vit D level is, because we aren't just checking 'healthy' people, and we would have no way to separate them out (and oh by the way, do YOU even really know who is healthy or not - isn't that why you check labs, to see)...?"

Me calling back: "OK - one more question - if you put me in touch with the guy who calibrates your Vit D measuring machine, could he tell me what the typical readings are that come back on any given day...?"

Lab response: "< sigh > Sure doc, why didn't you ask us that in the first place - he has log books going back 27 years, with the daily results, and the mean, standard deviation, and so on...THAT's what we list right there on the lab report, under "Reference Range"...for you to REFER to - but it is definitely not a 'normal' range or a treatment goal - YOU need to work that out with the patient, using your experience and knowledge...you did go to Medical School, didn't you...???"

THAT is the difference between 'reference range' (just referring to what is 'typical' for the population - including sick and well individuals; probably the sick ones being tested a bit more often so over-represented), and 'ideal' range or 'normal' range. NOBODY really knows the latter, and any physician who doesn't realize that the lab's "reference range" is NOT synonymous with 'normal' needs to go back to school.

Sometimes the 'reference range' is closely coupled with 'ideal', but not usually.

Maybe 1/1,000 people is hyperthyroid, and maybe 50/1,000 people are hypothyroid, based on their clinical situation.
But going by the lab test (actually a thyroid evaluation requires at least four separate tests), there would be 25 'high' and 25 'low' vs the 'reference range'.
So going by the labs we would unnecessarily treat 24 out of 1,000 people for nonexistent hyperthyroidism, and we would fail to treat 25 patients who really had hypothyroidism.

Most physicians realize that the 'hyper'thyroidism would be over-diagnosed if just looking at the labs, and would use history and physical exam to clarify the situation, deciding (appropriately) NOT to treat 24 of the 25 who showed 'high'. However most of those same physicians when confronted with history and physical exam indicating 'low' thyroid, would still not treat the patient, using the lab results as justification, unless they were in the 25 lowest.

I like to think we went to Medical School to get educated and learn to interpret history, exam, and tests in context, and individualize treatment, but these days I'm not sure WHAT they teach, other than whatever the patient has needs more tax money allocated to a 'program' of some sort...

[earlmck]

I also watched the Vit D video by John Campbell -- it explained the weird prescription I'd received from my surgeon who patched up my shattered arm a few weeks ago. Along with Oxy for pain and muscle relaxer and anti-nausea and stuff I didn't recognize (and wasn't going to allow in my body) was a prescription for Colecalciferol (vit D) 1000 units/day. I wondered why a Vit D prescription barely above the "fighting off rickets" level. Now thanks to John Campbell I know he thought he was almost doubling the "recommended dose" of 600 units/day. Well, at least some M.D. type person did some sort of nod toward Vit. D, which is a first for my experience with the medical profession in this part of the world.

Boy, I did not know of the Iodine thing (much thanks AJ). I wonder where I fall on that? And how to even find out. Sure isn't part of the "blood test" protocols from these parts, where I have to ask for the Vit D level as an "extra" because Central Oregon docs don't care to know about such arcane things. I'm pretty sure if my "primary" doesn't care about Vit. D she sure isn't gonna' give a rip about Iodine. Who ever heard of such nonsense?

[Oldncrusty]

He is my go to Youtube doc along with a few others. It sucks being treated like a mushroom at the local VA.

[Bill in Oregon]

I am exhausted mistrusting everyone. Just saying. I'm really tired of it.

[mickbr]

Me too Bill and I'm getting tired of this darn tin foil hat I find myself wearing these days.

[AJMD429]

.
I think you can trust:

https://www.youtube.com/@FoundMyFitness - great on rational use of supplements and reasonable exercise
https://www.youtube.com/@Campbellteaching - great on covid, cancers, vitamin D, and the political distortions we fight
https://www.youtube.com/@PeterAttiaMD - great on maintaining vigor and avoiding frailty with aging
https://www.youtube.com/@hubermanlab - great on behavioral ways to help sleep, focus, etc

Still not sure who I believe on 'hormone supplementation' but https://peterattiamd.com/caroltavris-avrumbluming/ is a start.

[nwcatman]

i come from a long line of MDs where the AMA was their bible and if a person had MD after their name he/she was a god. i got over that a long time ago. i do have a coupla surgeons i trust impeccably.i just left a GP outfit that has a new dr. about every 1.5-2 months in the group. literally. nowdays my thinking is that the "science" follows the money. as in al gore style. one of the aforementioned surgeons suggested a new group, right across the street from the old one. went there and its like night and day. now after 5 yrs here i have a GP i like and trust.

[nwcatman]

I am exhausted mistrusting everyone. Just saying. I'm really tired of it.

ya know, i grew up with "trust everyone till they prove ya wrong". sad to say, i got burned and learned enough times where its now trust no one till they prove ya wrong. not saying i like it, i don't, but reality sets in. but like you said, gets old sometimes.

[piller]

Some supposed expert pharmacist from my insurance company called me one time with the line about my insurance wanting to help me get healthier. I had upped my iodine, zinc, and Vitamin D3 intake about a year before that due to health issues. When she asked, I told her what I was taking. She insisted that I reduce intake of those threebecause I was getting too much. My health had improved on them, and I explained to her that her degree which had been obtained 2 years ago was insufficient. Since increasing my doses, I haven't had anything more than a minor cold. I no longer take calls from that insurance company.

[Rimfire McNutjob]

Did you link the right video? It's talking about Iodine ... not Vitamin D.

[AJMD429]

Some supposed expert pharmacist from my insurance company called me one time with the line about my insurance wanting to help me get healthier. I had upped my iodine, zinc, and Vitamin D3 intake about a year before that due to health issues. When she asked, I told her what I was taking. She insisted that I reduce intake of those threebecause I was getting too much. My health had improved on them, and I explained to her that her degree which had been obtained 2 years ago was insufficient. Since increasing my doses, I haven't had anything more than a minor cold. I no longer take calls from that insurance company.

Yeah I love 'experts' and bureaucrats who know everything...

In my situation, several of the pharmacy chains refuse to fill ANY of my controlled-substance prescriptions (literally including Lomotil which is a C-V used for diarrhea, and has ZERO abuse potential).

First they claim it is 'for patient safety', because I am an 'outlier' in my prescribing.

I explain to them that ONLY family physicians and a few 'Pain Clinics' even treat chronic pain, as surgeons only treat pain perioperatively and oncologists are usually dealing with metastatic bone pain that is sadly a short-term thing. That, plus the fact that 95% of the primary care physicians are 'employees' of hospitals, and required to refer in-house to the hospital 'Pain Specialists' (I put that in quotes because most of them seem to know little about the real-world treatment of pain), and the fact that at least half of the 'independent' primary care docs are doing 'boutique' aesthetic stuff, means that by definition I'm in the 2% or so of primary care docs treating chronic pain, so OF COURSE I'm an 'outlier'.

They then tell me that my dosing and regimens are 'unusual', although I've had ZERO fatalaties (unusual in the area of complex medicine, whether 'pain' treatment or diabetes, or congestive heart failure, or whatever), and never even an ER visit resulting from my opioid or benzodiazepine Rx's (in contrast, like ALL physicians, I've had numerous patients have to hit the ER over the years due to reactions from insulin, blood pressure regimens, or even antibiotics that backfired).

At that, they tell me that it's the pharmacist's "responsibility" to monitor for 'safety', and that they know way more than physicians do about complex pain medication regimens (to which I agree, at least in theory, although BOTH the medical and pharmaceutical professions are so dumbed-down by DEI now that I don't think most of the younger ones know much of anything - my OR nurse patients tell me that young surgeons often lack the most basic skills and the CST's have to talk them through many cases...!).

What I think is funny (and to their irritation, I TELL these bureaucrats), is that if the pharmacist is so much smarter than the physician that THEY should decide on what medication to use, what dose, whether or not imaging needs to be re-done yet, which kind of physical therapy should be used, and all sorts of other things I though were more the realm of the physician than the pharmacist, then I guess I'm ok with ceding those decisions to a pharmacist....

....however, as one who IS (also) a pharmacist, and happened to graduate number one in my class, wouldn't that make ME also capable of determining which patients should get what medications, who needs another MRI, which type of physical therapy is likely to help, and so on...??? One would think so. However, evidently all those smarts from being a pharmacist evidently get CANCELLED OUT by four years of medical school (only in the top 5% of my class there), three years of residency, and 35 years of experience.

Funny how that works.

When I call out these sphincters-masquerading-as-bureaucrats, they retreat to the whole 'patient safety' thing, and yet when I point out that they NEVER object to far more dangerous things I might prescribe (if 50 units of insulin is the right dose and I prescribe 100 units, it is HIGHLY likely to kill the patient, yet if 5 milligrams of oxycodone is the right dose, and I prescribe 40, and the patient takes 80, they will likely just be constipated and drowsy), and that they NEVER seem to know all that much about the patient's past medications, past surgeries, family situation, history of drug or alcohol use, or any other thing that has a HUGE effect on what medication is best, these sphincters say "Well, it's your responsibility to inform the pharmacist of all those things so they can advise you on the best regimen." I point out that they don't "advise" - they "demand" - and if I don't comply, they report me for "dangerous prescribing". Never mind the fact that on several occasions when I've been forced to abandon what was working for 10 years on a patient without any problems, and the pharmacist makes us switch to the 'safer regimen' the pharmacist demanded, the patient DIED shortly after that from clear side effects from the 'safer' medication (and I have EAGERLY provided the records to the next-of-kin in hopes they sue the stuff out of the pharmacy chains).

Of course just like in politics "follow the money" - in medicine, "follow the money" AND "follow the regulations". It turns out that these noble sphincters running the chain pharmacies do NOT care about individual patient safety, NOR do they care about individual patient outcomes. No - they only care about their store's aggregate prescribing data. They don't want to fill prescriptions for 'outliers', lest THEY become 'outliers', because the DEA punishes outliers with arbitrary fines and license restrictions (kind of like they did during covid for physicians who dared to recommend vitamin D, zinc, and ivermectin or hydroxychloroquine).

So I certainly understand why the patients out there are highly mistrustful of most healthcare providers. Physicians seem to be the worst - most eagerly sold their souls the moment hospitals waved dollars in front of them. Pharmacists (and physicians) who can manage to stay independent seem to mostly have kept their integrity, but survival is difficult (in my case I took an 80% pay cut to do independent practice versus the glamorous path of hospital 'in-network physician', with all their free marketing and glitz and pension/insurance stuff in addition to the quintuple pay). Nurses mostly have kept their integrity somehow, even though most are hospital or corporate employees.

But by and large the 'system' is corrupt. Unfortunately, if you get outside the 'system' into the 'alternative', 'naturopathic', 'functional' or whatever other name-of-the-week the outsiders call themselves, there is ALSO a great deal of smoke-and-mirrors, and cost-shifting, and so-on. However, at least it is more transparent, and the free-market capitalist system of these 'direct-pay' practices pretty much results in the best ones surviving ('best' may be best outcomes, or just a fancy waiting-room and patient-flattering marketing, but that's no different than any other legitimate business does). When the government and/or insurance is involved, is when things get lousy real fast.

[AJMD429]

Did you link the right video? It's talking about Iodine ... not Vitamin D.

LINK FIXED...! Thanks.