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I'm a doctor.

Cool.

You mean a multi-billion investment fund will take my advice where to invest their clients' money? I should just email them after having read some books?

Well, they very well might, if they feel like it. In fact, anyone can go and trade their own money whenever they feel like it.

But while I can go and purchase grass seed for my lawn and paint for my house every year, I can't go down to the fix-it-yourself pharmacy and buy whatever drugs I need to fix myself up when I like.

It's weird: I can't decide to self-medicate if I think that doctors charge too much, because... only doctors are allowed to prescribe medicine.

I'm not a die-hard libertarian, but here's a compelling argument that a friend posed to me:
Either the government should let people make their own choices W.R.T. insurance, doctors, application of drugs, etc... or they should provide the whole service, insurance, doctors, drugs and all.

Or perhaps the city will let me design a bridge?

But lots of people use that bridge. I don't have to use you unless I want to...

Or maybe I could learn to fly on Microsoft Flight Simulator and give my airline pilot advice during the next turbulent flight I encounter?

Again, if that plane goes down it affects all the people in the plane and in the crash path of the plane. If you or I go down, it largely only affects you or me.

Heck, we already have laws dealing with DUI, driving while incapacitated, etc... to address the very issue of people misusing drugs.

Maybe I should barge in and tell the magistrate in court what they should do - I've seen Perry Mason do it and read some books.

Again, the magistrate has been elected to that position as it is to the benefit of us all. But if Joe Blow wants to pour some Iodine, Betadine, or high-concentration Caffeine over his open wound, who am I to stop him? (absent mentally unstable people, who I think we already deal with).

It's very good advice. People are not specialists. You can't be a stock broker or a computer programmer and expect to be a doctor too. It's nice to be able to read up information but don't presume you will understand it, let alone be able apply it.

It's not the point that I will apply it. It's that there are so many roadblocks to allow me to even start to get there.

There are many such sites. In the UK the NHS has sites with information for patients. In the US the CDC (among other agencies) has similar sites. There is also WebMD. http://www.webmd.com/ [webmd.com]

Those sites are good starts, but nothing compared to the resources available to doctors. And I've had doctors routinely tell me to disregard whatever I read online...

It's usually helpful to start with your local Health Ministry websites and work from there. As said in the UK, this would be NHS.
There's also the Health on the Net Foundation which 'certifies' sites which contain credible medical information. http://www.hon.ch/ [www.hon.ch]

Good places to start, true.

The knowledge is there already or do you want you doctor to spell it all out for you. Should he also take you down to your local library to point out the right section for you?

I'm a programmer. You and I have the same opportunities to write programs, buy hardware, and rock out with computers. But as a doctor, you have so many more opportunities and resources in medicine...

Here's the biggest thing for me: I hate the fact that Doctors present medicine as so exacting a science -- as if it's something that can explain everything that's wrong with people.

Countless times doctors have admitted that they cannot explain my symptoms. At one point I a

...if Medicine wasn't such a members-only club. There's the "In" crowd and then there's the "Rest" of us.

Take other fields.... writing, education, programming, painting, online stock trading -- anyone can hop online or go down to their local bookstore,

I'm a doctor.
You mean a multi-billion investment fund will take my advice where to invest their clients' money? I should just email them after having read some books?

Or perhaps the city will let me design a bridge? Or maybe I could learn to fly on Microsoft Flight Simulator and give my airline pilot advice during the next turbulent flight I encounter?
Maybe I should barge in and tell the magistrate in court what they should do - I've seen Perry Mason do it and read some books.

"I just feel the Internet brings so much misinformation to the (exam) room that we have to fight through all that before we can get to the problem at hand."

It's very good advice. People are not specialists. You can't be a stock broker or a computer programmer and expect to be a doctor too. It's nice to be able to read up information but don't presume you will understand it, let alone be able apply it.

So here's one for you: Why can't you fight that misinformation before the patient even steps foot in the exam room? Why don't doctors create peer-reviewed, well-written websites to counter all of the confusion and pseudo-science currently available online?

There are many such sites. In the UK the NHS has sites with information for patients. In the US the CDC (among other agencies) has similar sites. There is also WebMD. http://www.webmd.com/
It's usually helpful to start with your local Health Ministry websites and work from there. As said in the UK, this would be NHS.
There's also the Health on the Net Foundation which 'certifies' sites which contain credible medical information. http://www.hon.ch/

The knowledge is there already or do you want you doctor to spell it all out for you. Should he also take you down to your local library to point out the right section for you?

I agree. Ads generate mindshare based on emotional responses. People have "heard of" certain drugs and feel that they must be better because it's a "big name" drug; they walk into my office asking for it, and I have to tell them why it's not that great a choice. That precious time could be better spent explaining how to prevent the need for the drug in the first place. Tell a patient that he needs "atorvastatin" or "rosuvastatin", and he'll recoil and exercise his butt off at the gym so he doesn't have to take these horrible meds; but he'll say, "My cousin takes Lipitor and my uncle takes Crestor; why can't I have that?" and I end up running overtime explaining why it's more important to exercise and eat properly instead of getting those big name meds. [1]

A more subtle effect is the idea that patients feel empowered to make decisions because they now have "more information". It's not so much any particular Direct-To-Consumer (DTC) ad as much as the existence of DTC ads themselves. In the US, there is an attitude of "doctors are out to profit at the patients' expense, so we need to mistrust the doctors and take charge", so patients will try to do their own research. Unfortunately, some of them can't tell a HON Certified web site from some circulating email proclaiming that the CA-125 test will save your life or other medical bullsh*t.

The TV ads are designed to give patients an emotional comfort that they have figured out what is the matter, that they are empowered because now there is something they can do about their problem. "Do you sometimes feel tired?" asks the ad. "It could be because of Horrible Disease X!!! But one dose of Placebocillin will cure you!" And the patient feels, "Yes, yes, that's *exactly* what I have! I better demand that drug from my doctor tomorrow!"

I do take the time to explain to my patients, but as a result I'd say that it takes up about 10% of patient time that could be spent on other things. And, yes, I've practiced in a country where there are not DTC ads for prescription medications, and I don't get that sort of questions.

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[1]: Lipitor = "atorvastatin"; Crestor = "rosuvastatin"

• A drug company gets an idea for a new drug. They do some initial tests and take out the patent. They have to patent early because it is impossible to keep things secret once the drug goes into trials.
• At first the drug is tested on animals. However, as was discovered in Great Britain, that is no insurance that it will work properly in humans.
• So the tests on humans are absolutely necessary. They also have to be performed for long enough to see if there are any side effects.
• Another problem is how to produce the drug in large quantities. Scaling up production of complex chemicals is not a trivial problem.
• All this testing etc. etc. takes somewhere between 10 and 15 years and may take longer if the tests do not give a conclusive result. Since a patent only lasts 25 years, that leaves not that much time to recap the expense let alone make a profit.
• All together this means that developing a new drug, from idea to market costs roughly $200 million. And if a drug fails late in the test cycle, the drug company can just wave goodbye to the money spent on it.

Blinded by PRK? Even with RK the chance of being blinded is minimal, if infections are treated. There's about 1/20 chance of minor perforations, which can result in infections with RK (that's RK, not PRK (Lasek) or Lasik) totaling about 1/1000 cases. And those infections are usually easily treatable. The chance of being blinded by RK is almost theoretical.

Some info here: http://www.hon.ch/Library/Theme/VisionFaq/section8 .html

The chances of being blinded by PRK (Lasek) are virtually non-existent, barring accidents. But then there's also the chance of the optometrist putting your eye out while fitting you with new glasses.

I don't know where parent is getting its information, but people marking his post as Informative are sensationalist scare mongers. Wherever you'll look, you'll find that actual failure or long-term negative effects of Lasek (when compared to the situation before the procedure) is very rare.

The article quoted only goes into clinics claiming that there's an immediate success rate of 99.9% or better. That's not true, many need a second and even a third treatment before the desired result is achieved. Any decent clinic will offer these additional treatments for free, since they're actually part of the treatment as a whole. Just the fact that the doc with the laser has to go in 2 or 3 times to get it right doesn't make it a dangerous procedure, it just makes it a lengthy one and a moderately painful one at that, if you're unlucky.

Like going to the dentist for dentures. No walk in the park, but the end result is almost always an improvement of quality of life. People may even have died, in isolated cases, from infections following the removal of their teeth. Doesn't stop people from getting dentures though, nor does it inspire the kind of scare hype displayed here.

"People consider themselves excellent drivers, even when they are not, because they think they are so good they are actually really bad."

C.f. Unskilled and Unaware Of It . It has been widely reported that most drivers consider themselves above average, although I can't find any primary reference in a quick Google search. I did find a report on a study of driver's education, though, that reached the surprising conclusion that advanced driver training is basically worthless. Go figure.

I would just tell you to Google yourself, but you're being annoying, so here:

It was actually smallpox.

Whenever a large population of non-immunes exists, epidemics happen.

The model does not aim to predict the emergence of new strains of influenza, but it does suggest that a short-lived general immunity to the virus might affect the virus's evolution.

The model takes into account the effects of specific immunization against viral strains, but also infectivity randomness and the presence of a short lived strain-transcending immunity recently suggested in the literature.

A pandemic is possible when an influenza A virus makes a dramatic change (i.e., "shift") and acquires a new H or H+N. This shift results in a new or "novel" virus to which the general population has no immunity... Since, by definition, a novel virus is a virus that has never previously infected humans, or hasn't infected humans for a long time, it's likely that almost no one will have immunity, or antibody to protect them against the novel virus. If the novel virus is related to a virus that circulated long ago, older people might have some level of immunity.

Most of this seems really obvious to me, but what the hell do I know...

An immune system has to be _reactive_.

But not too reactive. The suggestion has been made that the problem isn't that our immune systems don't react to H5N1, it's that it reacts too vigorously, as per, for example, this article, Bird Flu Triggers Immune System 'Storm'.

Michael T. Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota School of Public Health is quoted in that article as saying that this might be why the young and healthy get stricken more severely (presumably he's referring to H5N1, but perhaps that happened with the 1918 flu as well):

"This is basically a cytokine storm induced by this specific virus, which then leads to respiratory distress syndrome," Osterholm said. "This also makes sense of why you tend to see a preponderance of severe illness in those who tend to be the healthiest, because the ability to increase the production of cytokines is actually higher in those who are not immune-compromised. It's more likely in those who are otherwise healthy."

Marijuana Linked to Schizophrenia, Depression
Study finds young users especially vulnerable

By Adam Marcus
HealthScoutNews Reporter

THURSDAY, Nov. 21 (HealthScoutNews) -- As many as one in seven cases of schizophrenia could be prevented by eradicating marijuana.

That's the contention of a new study of Swedish soldiers that found smoking pot increases the risk of the psychiatric disorder by about 30 percent.

The Swedish study is one of three reports in this week's British Medical Journal linking marijuana to emotional problems, including depression and anxiety, as well as schizophrenia.

Some scientists believe marijuana doesn't cause psychiatric illness. Rather, they argue, people smoke it as a way to self-medicate. However, the authors of the Swedish study say their evidence suggests that now seems unlikely.

"It's not as good an explanation than the possibility that cannabis itself causes schizophrenia," says Dr. Stanley Zammit, a psychiatrist at the University of Wales College of Medicine in Cardiff and lead author of the new paper.

Zammit and his colleagues compared schizophrenia rates and marijuana use among more than 50,000 Swedish conscripts who participated in a 1969-1970 survey. Of those, 362, or about 0.7 percent, had been hospitalized with the disorder by 1996.

Of the 11 percent of the entire group that admitted ever trying marijuana, 73, or 1.4 percent, went on to be hospitalized for schizophrenia. The odds of having the disease grew as pot use climbed, reaching nearly a sevenfold increase in the men who used it 50 times or more but tried no other illegal drugs, the study says.

The effect was strongest among soldiers who developed schizophrenia within five years of entering the military. It held after the researchers accounted for use of alcohol and other drugs.

"You would expect that if there was a common reason for using substances, that would have eliminated" the influence of marijuana, Zammit says.

The second study in the British Medical Journal , of 759 New Zealanders, found that those who started smoking pot by the time they were 15 years old had quadruple the risk of non-users of being diagnosed by age 26 with schizophrenia and related disorders. That risk didn't hold for people who began taking the drug at age 18 or later. The study also found that 10 percent of the young smokers went on to develop psychosis, compared with 3 percent of the rest of the study group.

Louise Arseneault, a psychiatrist at King's College, London, and a co-author of the study, says marijuana use "predisposes" children to schizophrenia later in life.

"It's part of a complex group of causes. You don't need to smoke cannabis to have schizophrenia," Arseneault says. "A lot of people have it who didn't smoke, and a lot smoke but don't get it."

In the third study, scientists in Australia found that teens who smoked marijuana at least once a week were twice as likely as less frequent users to suffer depression or anxiety over the next seven years. Girls who used the drug every day had between five and six times the rate of these conditions as non-users.

The study also found that teens with emotional problems at the beginning of the study weren't more likely to take up marijuana in the future -- suggesting that self-medication wasn't a factor.

Michael Lynskey, a psychiatrist at Washington University in St. Louis and a co-author of the Australian study, says he "wouldn't want to make a definitive statement either way" about whether marijuana causes psychosis or depression. Even a doubling of the risk of depression is considered a relatively small increase, he says. So the effect of marijuana is probably modest.

However, research shows that people who take THC, the active ingredient in pot, to control nausea are more prone to depression, Lynskey says. He considers that "strong evidence" that marijuana can play a role in depression.

Recent studies (such as this one I found on google) have shown that fruit juice is one of the main causes of childhood obesity.

Giving children such an unhealthy drink like fruit juice is just plain irresponsible in the light of recent issues in children's health in developed nations. This has nothing about being thin "get the boys", this is about the health of children during their development and possibly for the rest of their lives. I agree, children need plenty of fluids, but there are far more healthy fluids out there, such as water and to a lesser extent, milk. If children refuse to drink such things because of their bland flavour that is symptomatic of a much larger problem with children's diets and not a reason to give them things in quantities that may harm them in the long term.

Juice isn't some kind of inalienable human right, it's simply a liquid that is sweet and taste's nice, but unfortunately doesn't do anyone's health any good to drink it. If there is a problem with children's diets, it's a great place to start cutting back.

The term 'hypoallergenic' is not meaningful in any scientific sense whatsoever.

The FDA states that "There are no federal standards or definitions that govern the use of the term 'hypoallergenic'." Back in 1973, they tried to establish definitions for the use of the term hypoallergenic, but the regulation was overturned in court.

A little bit of googling returns this

It's a nonsense marketing claim, with no scientific standard or basis. People can be allergic to anything... even themselves.

Anyway white rice is fucking awful for you

Again, it is a staple in Asian diets. Not brown rice, either. And I don't think it's simply a matter of smaller portions or genetics -- when I lived in Asia I didn't notice the portions being significantly smaller than what I eat now. Why wouldn't we see a large amount of diabetes sufferers in the Asian population if white rice was so bad for the human body?

I fixed my propane BBQ

Mmmmm... ribs. You do know that meats wreak havoc on your digestive system, and in large quantities contribute to heart disease (though eating lean meats, as you mention, can avoid this), diabetes and gout.

So you know, I'm a carnivore and always will be. But let's not kid ourselves: if you just ate soy, vegetables and fruits for the rest of your life, you'd probably be much healthier overall (but a lot more miserable).

Not only that, but a Google search for ".net" will also turn up things that don't even have the dot in them. For example, Health on the Net and MedicineNet.com to name a few.