Collective wisdom


As public consciousness and knowledge about health issues grows, thanks to the internet and other media, I predict that:

1) Hospitals will recede into a role of acute and catastrophic care ONLY, dropping the charade of providing health, which they do NOT.

2) Doctors and other health professionals will begin to see themselves as providers of acute and catastrophic care, also. They will stop providing day to day care, such as treating high blood pressure, cholesterol, breast exams, and other preventive maintenance.

3) Instead, preventive care will be self-provided. The public will have acquired sufficient savvy and know-how to manage issues like blood pressure themselves. They will need the assistance of helpful information resources, web-based for the most part. Much preventive care can, in fact, be algorithm-driven, just like following a simple recipe.

All the worries about runaway health care costs will be much reduced, since excessive testing driven by liability worries will disappear, repeated office visits for day-to-day issues will go away. Yes, you will need a doctor and hospital for a broken leg, car accident, unexpected cancer, or non-compliance or neglect of prevention.

But osteoporosis, high blood pressure, nutrition, weight loss, hormone management, cholesterol issues, minor complaints will all be managed by people themselves with the assistance of web-based knowledge systems.

I already sense this sort of phenomeonon developing, though in its infancy, in venues like the Track Your Plaque Forum and other health portals, places where the information being discussed exceeds the quality of information you can obtain from your doctor. Over and over again, for instance, the sophistication and knowledge demonstrated by our Track Your Plaque Forum discussions shows that the public is capable of far more understanding of health issues than many previously believed. Most of our members could carry on a credible conversation with trained lipid experts. The knowledge base of our members exceeds that of 98% of most of my colleagues when it comes to heart scans, lipoproteins, and nutrition.

I am in awe of Wikipedia, the popular online encyclopedia. Five 20- and 30-somethings have created a knowledge base that has now eclipsed Encyclopedia Britannica in size and scope, with equivalent accuracy, and relatively little cost. I'd like to see the same phenomenon occur in health care information, helping to usurp the current paternalistic "I'll tell you what to do" model.

Comments (5) -

  • wccaguy

    10/13/2007 2:14:00 AM |

    Hey Doc,

    A terrific vision to strive to make happen.

    One problem is...  How are we supposed to rollback the control that doctors have over key elements of our own preventative health programs if all them are devoted to crisis management.

    The intersections Doctors currently control include at least the following

    1) ordering blood tests,

    2) ordering CTAs when required

    3) delivery of CT calcium score scan info to doctors (I've been told no doctor is required to get a CT scan.  Is that true?

    4) prescribing drugs like statins in situations that aren't emergencies but still critical.

    Moreover, if a doctor's approval is necessary to get reimbursement for these more costly tests, how is interfacing with the doctor avoided?

    Thoughts?

  • Gary Greenfield

    10/13/2007 9:17:00 AM |

    I recently came across your blog and I greatly appreciate and agree with what I have read thus far.  It is indeed refreshing to cross paths with an allopathic physician whose views  run contrary to popular brainwashed opinion. It seems as though our culture has removed God from His rightful place in society and replaced Him with physicians.  The average patient today is willing to pay any cost for treatment to prolong his life and hospitals are willing to allow no ceiling on costs to save a life.  In the meantime, what price is a man willing to pay to save his soul and what price are hospitals, (once religious institutions) willing to pay to address the salvation of the soul?  I'm afraid the tables have turned and what you are observing  and writing about is a direct consequence of this delema.

  • jpatti

    10/13/2007 6:44:00 PM |

    It won't happen like this.  

    Sure, motivated patients will largely provide their own health care and manage it themselves.  I just bought an endocrinology textbook and ordered some lab work before coming to your blog today.  But I am not most people; most patients are not motivated.

    There are 6 diabetics in my family.  I'm the only one willing to give up *sugar* let alone wheat and other problematic grains.  I've given copies of Bernstein's book to them, made homemade sugar-free chocolate, etc.  This has almost no impact on their life choices.

    I've sat and listened to my husband's stepmother talk about how much her feet hurt WHILE eating cookies and cake.  I don't choose to be a nag, and have already provided the necessary information, so there's nothing to do for her but sit and listen and be sympathetic.

    This is the reality of the vast majority of patients: they do what they want to do and count on their doctors to fix them.  

    Heart disease is very similar to diabetes, 99% of the outcome is in the patient's hands.  Doctors can't actually do much to effect the course of the disease other than provide recommendations.  

    The doctors you criticize for not empowering their patients have an awful lot of stupid patients too.  Some of these patients *deserve* some of these doctors.

  • Dr. Davis

    10/14/2007 1:41:00 PM |

    Yes, unfortunately, there is a substantial segment of the American population who will never mind their own health. But the "bell curve" will shift to the right over the next 50 years. I don't have illusions that this will happen next week. This is a evolutionary process that will affect our children more than us. But it needs to happen.

  • Dr. Davis

    10/16/2007 10:51:00 PM |

    I think the path to self-empowerment will require decades and come from a variety of changes, such as increasing availability of direct-to-consumer laboratory testing; reduced price barriers for imaging tests; more medications transferred into over-the-counter status; more info and more powerful nutritional supplements. Also, the growth of medical savings accounts and similar tools that allow self-directed health care purchasing will introduce greater consumer choice into the equation. But it will evolve over time.

Loading
270 lb man in diapers

270 lb man in diapers

Alex is a big guy: 6 ft 4 inches, 273 lbs.

On 10,000 units per day of vitamin D in gelcap form, his 25-hydroxy vitamin D level was 38.4 ng/ml. One year earlier, his 25-hydroxy vitamin D level, prior to any vitamin D supplementation was 9.8 ng/ml.

According to the latest assessment offered by the Institute of Medicine (IOM):

Vitamin D need for a 13-month old infant: 600 units per day

Vitamin D need for a 6 ft 4 in, 273 lb male: 600 units per day

I paint this picture to highlight some of the absurdity built into the smug assumptions of the IOM's report. It would be like trying to fit a large, full-grown man into the diapers of a 13-month old. Few nutrients or hormones (in fact, I can't think of a single one) are required in similar quantity by an infant or toddler and a full grown adult. However, according to the IOM's logic, their vitamin D needs are identical, regardless of age, body size, skin color, genetics, etc. One size fits all.

Just as the original RDA assessment by the Institute of Medicine kept thinking about vitamin D somewhere in the Stone Age, so does this most recent assessment.

Comments (20) -

  • Geoffrey Levens

    3/4/2011 7:55:02 PM |

    Maybe "size matters" and maybe not so much. I am only 5'3" and 117 lbs yet I require 8000 iu/day to hold steady at around 50 ng/ml.  So small body needs large dose. I have seen the opposite as well.

    I totally agree that the current recommendations are absurd but appropriate dosage for Vitamin D cannot be determined by body size nor any other observable I know of except for blood testing.

  • TedHutchinson

    3/4/2011 7:56:22 PM |

    Grassrootshealth have recently published new data on responses to vitamin D supplementation.
    A 25(OH)D test shows how your body responds to oral supplementation / sun exposure.
    Everyone responds individually, most people require more than expected.
    Remember in the same way our natural production of the anti-inflammatory anti-oxidant cholecalciferol has been disrupted by current lifestyle changes so to most people fail to get sufficient sleep, so production of the other anti-inflammatory antioxidant, melatonin, is disrupted by light at night and insufficient exposure to bright light during the day.
    We make a  very good job of totally wrecking our natural secretion/production of anti-inflammatory anti-oxidant protection.  It's such a shame inflammation and oxidation create dysfunctional mitochondria resulting in metabolic syndrome, diabetes, heart disease cancer and Alzheimer's etc.
    Pity we haven't sufficient common sense to go to bed early and spend time outdoors in the midday sunshine.

  • Might-o'chondri-AL

    3/4/2011 9:24:34 PM |

    Vitamin D supplementation does not work in linear manner.  From International Journal of Cancer Research 2011 (pdf link on request by commentators):

    Starting at the following vitamin D ng/ml participant levels and adding on increments of 1,000 25(OH)D supplement daily:

    10 ng/ml + 1,000 D = 11 ng/ml
    30 ng/ml + 1,000 D = 38 ng/ml
    50 ng/ml + 1,000 D = 55 ng/ml
    90 & above each 1,000 D adds 1.6ng/ml

    * and 10,000 IU D daily put no one over 200 ng/ml "toxic" threshold
    * and 50,000 IU D daily would be required to surpass 200 ng/ml and be toxic

  • rfrancis

    3/4/2011 9:33:31 PM |

    Geoffrey: I completely agree.  I take 10,000 IU/day and at that I STILL only had 41 ng/ml in February.  My GP, who is, well, of substantially lower mass than I am -- probably to the tune of 100 lbs less, at least -- is in pretty much the same boat regarding dosage and results both.

  • Brian Vickerman

    3/5/2011 12:32:47 AM |

    While I don't disagree... we live in a culture were I'm sure their lawyers are telling them not to change their opinion.

    Can we expect these expert associations to change their opinion when they are probably faced with law suits up their ... if they do?

  • Henry Lahore

    3/5/2011 2:21:44 AM |

    Loved his post.
    I have added graphs to IU which should be added for age, skin color, latitude, season, etc.
    http://www.vitamindwiki.com/tiki-index.php?page_id=1460

  • Daniel A. Clinton, RN, BSN

    3/5/2011 3:49:20 AM |

    The real deal with IOM's recommendation is that it is simple minded. It's more than conservative; it was doomed from creation. An RDA is a failed way to attempt to convey helpful nutrition information to the American public. Sometimes it takes more than one number to convey something of value, and sometimes oversimplifying a concept does more harm than the good generated by its discovery.

  • Might-o'chondri-AL

    3/5/2011 4:09:37 AM |

    Size in weight, of different adults, is probably less of a factor in the D levels they each get from the same IU D taken as a supplement . The measurement is of our D in fluid concentration (ng/ml), not kg. of our body.

    A 13 month baby dose of 600 IU/d
    is safe for their blood volume. Adults have more blood volume than infants; the weight difference is a distraction (I think).

    Between "average" adults we've
    similar amount of blood volume.
    Two "average" height adults taking the same dose of vitamin D (like rfrancis describes) are likely starting from a different baseline on ng/ml.

    Data I reported was for 5 years tracking +/- 3,400 non-hispanic white adults : age 52 +/- 13 years; weight 74 kg. +/- 17 kg.; height 1.71 mt. +/- 0.10 mt.; latitude N. +/- 40.2*; women = 2090; men = 1312.

  • Ellen

    3/5/2011 10:25:06 AM |

    For some people who are taking a high dose of D3 and are not getting adequate levels as indicated by 25-hydroxy vitamin D test, 1,25 dihydroxy-vitamin D must be checked as well. They might be hyperconverters.

  • Dr. William Davis

    3/5/2011 3:23:23 PM |

    HI, Henry--

    Wow! Nice work.

    Anyone wanting to see a graphic representation of some thinking about vitamin D, take a look at the graphics commenter Henry Lahore created:http://www.vitamindwiki.com/tiki-index.php?page_id=1460


    Hi, Daniel--

    Well said!

  • Anonymous

    3/6/2011 12:11:57 AM |

    One thing I would like to see noted on Vit D levels is the name of the lab that does the test. I believe there are only 2 labs in the US that do the test: Lab Corp and Qwest Labs. The reference ranges are different (Lab Corp 32-100 and Qwest 18-77)

    I had my D tested in July of 2008 and was found to be low (15.8 Lab Corp). My doctor gave me the standard script for 50,000 units 1x a week. I knew that D3 was suppose to be superior to the D2 that was prescribed. I decided to go with the D2 for the first 8 weeks, then switch to D3 for the next 8 weeks to compare the results and rate of rise in Vit D levels.

    On the D2 my levels went DOWN to 14.9! I was shocked. The nurse pretty much called me a liar and said I hadn't taken the D2. Not only did I take it, I was fanatic about it. I enjoyed the chance to do a small interesting experiment on myself. I then switched to D3 (Carlson Labs brand) for the next 12 weeks at 50,000 units a week. That brought my level up to the low 30s. I quit following the docs advice of 50,000 units per week and increased to 100,000. That got the level up in the 50s. I then read an article by the Iowa bone center in Waterloo, IA that recommended 150,000 units per week. After 4-5 months of that my level was 77. I now take 100,000 per week and am waiting to retest.

    I take 10,000 u soft gels by Carlson Labs, and they are small enough to be easy to swallow. I get them at Vita Cost online, current price is $10.93 for 120.

    (I am not affiliated in any way with Carlson Labs, their products just work well for me.)

  • Miki

    3/6/2011 7:04:11 AM |

    "The Institute of Medicine kept thinking about vitamin D somewhere in the Stone Age"
    If they did we would all be better off. You can gauge the optimal evolutionary level of vitamin D by looking at present day hunter gatherers. I don't have time now to find the link but it is in the 40-50 ng/ml range.

  • D is for don't

    3/6/2011 9:44:12 PM |

    "You can gauge the optimal evolutionary level of vitamin D by looking at present day hunter gatherers. I don't have time now to find the link but it is in the 40-50 ng/ml range."

    Reference please !

    I think you will find that the highest vitamin D levels are found in northern Europe.

  • rhc

    3/6/2011 11:44:00 PM |

    My 71 yo husband's recent test came out surprisingly high at 111! The doctor advised him to stop taking extra vitD. He's been taking 2000IU for at least 2 years and his number was always around 50. Nothing else has changed. He only goes out into the sun maybe once a week for an hour or less.

    Are mistakes common in these test results?  

    I guess he'll have to retest soon to see.

  • Might-o'chondri-AL

    3/7/2011 3:57:03 AM |

    Para-thyroid hormone rises and  the kidney tubules re-absorb calcium; then inactive 25 D is converted into active 1,25 D. If someone can show me cholesterol controls our para-thyroids I'd like to hear.

    Low magnesium in circulation stops para-thyroid up-regulation.
    Adequate magnesium is desireable for down the line active 1,25 D production.

  • Anonymous

    3/7/2011 4:05:48 AM |

    I'm 6'2'' and 200 and so far I haven't been able to get my level above 31. I went from 3,000 to 5,000 units and picked up maybe two points. I switched to carlson oil based capsules and bumped it up to 8,000 a day. Wondering if I should push it to 12,000 (caps are 4,000 apiece). I plan on re-testing in August.

    Kenneth

  • Geoffrey Levens

    3/7/2011 4:36:24 PM |

    "I believe there are only 2 labs in the US that do the test: Lab Corp and Qwest Labs."

    Single test:
    http://www.zrtlab.com/vitamindcouncil/home-mainmenu-1.html?page=shop.product_details&flypage=flypage.tpl&product_id=4&category_id=1

    If you trust the accuracy of blood spot tests for Vit D (and the Vit D Council seems to!)--
    4 test kit:
    http://www.zrtlab.com/vitamindcouncil/home-mainmenu-1.html?page=shop.product_details&flypage=flypage.tpl&product_id=5&category_id=1

  • Might-o'chondri-AL

    3/7/2011 6:44:48 PM |

    For some, when the level of (inactive) 25 D hits 30 - 40 ng/ml the para-thyroid feedback loop kicks in. The hormone secretion diminishing then causes  a 25 D production down shift.

    When the (active) 1,25D is being generated in the kidney tubules it draws down on the pre-cursor 25 D. For some individuals they might see measured blood level of 25 D drop then; if liver synthesis or fat storage slow to respond.

    One commentator M.D. here made the point that we want to measure 25 D and not 1,25 D. It seems what's available on demand is more significant than what got activated already.

  • Jeff

    3/8/2011 10:06:10 PM |

    In November 2010, my vitamin D level was tested with the 25(OH)D, twice. The first result was 12 ng/ml and the second results (a week later) was 7 ng/ml. My doctor prescribed 50,000IU/week. I took that for about 8 weeks and through some more in-depth research which led me to this blog, I discovered the difference between D2 and D3 and, of course, my prescription is Ergocalciferol. At that point, I bought the Kirkland-brand 2,000IU D3 gelcaps and have been taking them (4 per day = 8,000IU or 56,000IU/week) since early- to mid-January. My levels were re-tested again on February 18, 2011 and it is 46 ng/ml.

    Is that a quicker-than-normal increase in the 25(OH)D? It seems very quick for the level to rise 34-39 ng/ml. Should I reduce the dosage at this point or maintain it at 8,000IU/day for the next 3 months to see what the level does?

    Thanks in advance for any advice or guidance those in the know can provide!

    Jeff

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Angioplasty Special: Get it while it's hot!

Comments (6) -

  • Jim Purdy

    11/21/2009 11:36:58 AM |

    I've already been an angioplasty victim ... excuse me, I mean angioplasty patient ... and doctors want me to go through a second angiomutilation ... I mean angioplasty.

    Ain't no way they're gonna do that to me again. Even though they would get big bucks from my insurance.

  • TedHutchinson

    11/22/2009 3:42:13 PM |

    Angioplasty is being promoted as a cure for Multiple Sclerosis Based on Paolo Zamboni's work.
    Free download here
    Venous Collateral Circulation of the Extracranial Cerebrospinal Outflow Routes
    Candian TV program on the subject.
    The Liberation Treatment: A whole new approach to MS

    I'd be very interested to know if any Track Your Plaque users have MS and whether they have seen improvements in venous blood flow and reduction of MS progression as a result of the program.

    Higher levels of vitamin D may well have an impact on the damaging consequences of iron.
    By raising adiponectin levels would vitamin D improve bloods anti coagulating properties?
    High omega 3 intake should improve blood flow.
    Would Niacin also act as a vasodilator and improve blood flow?

  • shel

    11/22/2009 7:59:32 PM |

    "get that feeling of doing something"

    says it all...

  • Anonymous

    11/23/2009 9:12:30 AM |

    Angioplasty is not completely useless. As the poster points out "proven useless unless you are in the middle of a heart attack...". It can save lives in such cases.

  • buy jeans

    11/3/2010 9:53:50 PM |

    Say someone switches to a high-potency preparation of 360 mg EPA and 240 mg DHA, providing a total of 600 mg omega-3 fatty acids per capsule, or twice the dose of the low-potency preparation. Would you expect double the effect?

  • Hetal Patel

    11/9/2010 12:43:07 PM |

    There are  thousands of websites which provides information  about  
    how is angioplasty done.
    But dilseindia is one  of the websites where one can get good info about the  angioplasty.

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