Divorce court for the doctor-patient relationship?

The doctor-patient relationship has gone sour.

This probably comes as no surprise to most of you, particularly if you've been following conversations here in The Heart Scan Blog:

Who is your doctor? discussing the emergence of the physician-as-hospital-employee phenomenon that causes your doctor to become the de facto portal (seller?) of hospital services to you, a model fraught with conflicts of interest.

Exploitation of trust, my observation that the enormous gap in heart disease prevention between the woefully ignorant (by necessity) level of sophistication of the primary care physician and the procedure-obsessed cardiologist leads to an exploitation of humans-for-heart-procedures because of the failure to institute genuine preventive efforts.

Bait and switch , a description of how a minor test or symptom can reap a bonanza of medical testing; a $20 "screening" test yields $10's of thousands in hospital procedures. If it were entirely due to the imprecision of medical testing and detection of disease, that might be forgivable. But it often is not: It has become utterly distorted by the profit model.



Lest you think that I am a kook ranting off in some backwoods corner (Milwaukee), here are the comments of New York Times' Health Editor Tara Parker-Pope in a series called Doctor and Patient, Now at Odds:

Lately I've been hearing a lot from patients who are frustrated, angry, and distrustful of doctors. Their feelings speak to a growing disconnect between doctors and patients and worries that drug companies, insurance rules, and hospital cost-cutting are influencing the care and advice that doctors provide.

Research shows that even among patients who like their personal physicians, there is a simmering distrust of the medical system and the doctors who work inside it.


(There's also a series of candid video interviews with people who echo these sentiments.)

There are a number of reasons for this increasing "disconnect," some of them articulated by Ms. Parker-Pope, others detailed in my blog posts.

The solutions, however, will not be found by advancing technology: the newest robotic surgery, a better defibrillator, a new statin drug, the next best chemotherapeutic agent. It will not be found by adding a new wing to the hospital. It will not be found by the reorganization of healthcare delivery achieved by converting primary care and specialty practice into an arm of hospital care. It will not be improved by employing "hospitalists." It will not emerge from legislation controlling insurance company practices. It certainly will not come from increasing marketing dollars spent by drug companies (who make $4 for every $1 spent on direct-to-consumer marketing).

The solutions will come from shifting the idea of care from a paternalistic, "I'm the doctor and I'll tell you what to do" approach, to the doctor-as-advocate-and-supporter of the patient. The physician should act as someone with a particular sort of expertise that can advise a patient.

But a caveat: The patient MUST be informed.

Proper information will not originate with the doctor. It will originate with internet-based information portals and tools that help you understand the issues, often with far greater depth than your doctor could ever provide. The physician needs to accept this role, one of advocate, adviser, but not of being in charge, not of viewing the patient as profit-center, not as an opponent in a power struggle.

Sadly, the last few years in online information portals has been dominated by the drug company-dominated websites like WebMD, nothing more than a deliverer of the conventional wisdom with nothing whatsoever aimed towards empowering patients in a self-directed healthcare model.

Some people call the emerging new empowered and information-armed patient Medicine 2.0. Unfortunately, Medicine 2.0 will first benefit the intellectual upper crust of Americans, the web-savvy and motivated to engage in health issues. But, give it 10 years, and we will witness the effects on an unprecedented broad scale. Part of the Information Age is acceleration of information dissemination. Imagine your children, facile with a computer mouse, posting comments on FaceBook, doing homework with Google and Wikipedia, now turning their attentions to health.

It will be a startling change.

In the meantime, be wary. Be empowered. Think increasingly about self-direction in your health.


In a comment to the Bait and switch post, Jennytoo offered an insightful response:

You are getting to the essence of the problem, and it's not just cardiology that is rife with what is, at bottom, malpractice.

There is little incentive for the profession as a whole to know anything about or promote prevention, and many incentives from hospitals, drug and insurance companies to stick with the status quo or to change it in their corporate favor. The formulaic, conventional statements purporting to be guidelines for prevention that are put out by various interest groups and in such publications as hospital-sponsored newsletters ("eat a 'balanced diet', avoid stress, etc.") are useless sops to the concept of prevention.

It is, and I fear is going to remain, up to motivated individuals, both physicians and patients, to reshape the system, and it's going to be a long frustrating struggle.

It's my personal conviction that if just 4 things were promoted to the public, and people actually practiced them, we could change the health profiles of the majority of people in this country for the better within two years or less. They are:

(1) education on and promotion of a true low-carbohydrate, whole foods, diet,
(2) measurement and supplementation of Vitamin D3,
(3) supplementation with DHA/EPA (found in Fish Oils), and
(4) measurement and supplementation of intracellular magnesium.

I am not a health professional, and others may want to add to this list, but I don't think any strong case can be made against any of the items. The wonderful and hopeful thing is that each of us can implement them ON OUR OWN, and thereby take charge of our own well-being. (The Life Extension Foundation is one organization which provides access to lab tests you can request on your own.)

If you have a physician who is willing and capable of being your partner, you are richly blessed, and that is the ideal we all should hope for. But in the more likely event that you do not have such a physician, and if your physician demonstrates little potential for becoming one, think about firing the one you have and finding another.

Sometimes we are forced by circumstances, particularly urgent ones, to deal with physicians who are not ideal, but the main impetus for change will come from us, the patients, and the expectations we communicate to our individual doctors. In the meantime, we can be self-reliant in our own prevention practices.


Wow. A woman after my own heart.

Comments (4) -

  • Anonymous

    8/12/2008 5:44:00 AM |

    It's Tara Parker-Pope.

  • Dr. William Davis

    8/12/2008 11:43:00 AM |

    Oops!

    Thanks. Corrected.

  • Anonymous

    8/13/2008 3:39:00 AM |

    can somebody expand on the thought of supplementation of intracellular magnesium ?
    Thank you

  • Jenny

    8/14/2008 4:13:00 PM |

    Hopefully, Dr. Davis will correct any misinfo in this reply when he moderates. By "intracellular" I was referring in my comment to MEASUREMENT of Magnesium levels, rather than supplementation.  It's my understanding that serum measurement (a blood draw) may not accurately reflect absolute levels of Magnesium in the body.  That is, if a blood test shows low serum Magnesium levels, you can be assured that Intracellular levels are low--but that Intracellular levels may be low without having it reflected in blood testing.  There are other methods of testing available--one is called ExaTest, and is done by testing a smear of buccal cells.  (Can also reveal intracellular levels of other minerals/electrolytes.)  Supplementation can be accomplished in various ways, and ideally would be done with the help of a physician. Magnesium can be delivered by IV,(obviously must be done in a medical setting), by oral supplementation, which can best be done through supplements such as Magnesium Citrate, Taurate,or Maleate or by making and drinking Magnesium Bicarbonate Water (made by combining proper proportions of Milk of Magnesia and Seltzer--google for details, or see
    Mgwater.com)  Some supplementation can also be accomplished by absorption through the skin, which is best done by soaking in Epsom Salts.  I don't know the relative effectiveness of this method, but it certainly is relaxing and soothing to muscles.  Magnesium taken in the evening is said to help some people sleep better, and it seems from personal experience to be true for me.  There is lots of good, reliable  info about Magnesium at mgwater.com, and also on the TrackYourPlaque site if you are a member.  Hope this clarifies my meaning.  It seems to me that  supplementation, no matter how it is done, should affect all reservoirs of Magnesium in the body, if it is in adequate amounts, but IV supplementation would be the most intensive and quickest form.  I believe it can take a few weeks to months to correct deficiencies orally.  People with normal kidney function can  safely supplement Magnesium, but those with abnormal kidney function should consult their physicians.

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Watch your fish oil labels

Watch your fish oil labels

A quick quiz:

How much omega-3 fatty acids, EPA + DHA, are in each capsule of fish oil with the composition shown on the label below:





If you said 1340 mg (894 mg + 446 mg), sorry, but you're wrong. There are 670 mg EPA + DHA per capsule.

Did you notice that the composition, or "Supplement Facts," lists the contents of two capsules? Rather than the usual one capsule contents, this product label lists two capsules.

I don't know why some manufacturers or distributors do this. However, I have seen many people tripped up by this kind of labeling, taking half the omega-3 fatty acids they thought they were taking. This can be important when you are trying to obtain a specific dose of EPA + DHA to reduce triglycerides, reduce Lp(a), control abnormal heart rhythms, reduce bipolar mood swings, or other important effects.

I liken this to pulling up to a gas station where the sign says gasoline for $1.25. Wow! Can't beat that! You then find out that it's really $1.25 for a half-gallon, or $2.50 a gallon.

In truth, the labeling is accurate; it's just very easy to not notice the two capsule composition.

Comments (36) -

  • Jenny

    12/17/2009 2:43:18 PM |

    The supplement business, completely unregulated, is a magnet for scoundrels. The label is nothing compared to the deceptions they practice in what they put into the capsule and pill. Over and over again lab testing shows the pills either don't contain what you are paying for or contain dangerous contaminants.

    This probably explains why so many studies find that taking vitamin supplements increases mortality in large populations. The toxic load of the pills is probably to blame.

  • jtkeith

    12/17/2009 4:27:25 PM |

    This is a good point, and one I've certainly seen.  

    On a side note, 670mg of EPA/DHA  per capsule is higher than pretty much anything I can find.  500 is more like the upper limit.  Can anyone provide brand guidance about where to find these super potent versions?  

    And another thing I've long wondered is if there are any significant differences between one fish oil and another?  For example, some tout that the fish oil comes from wild salmon, which is better because... ?

  • Dennis

    12/17/2009 6:26:10 PM |

    Interesting article. I have some articles that I've written on fish oil too on my website http://myherbalsupplement.com - I'd love if you checked it out.

  • sdkidsbooks

    12/17/2009 7:27:40 PM |

    Dr. D,

    A bit off this topic, but I was wondering what your thoughts are on the latest research posted yesterday on Crestor.  They are now recommending Crestor for those with normal lipids who have "other" factors for potential heart disease.  It was shown to prevent heart attacks and strokes for those participants. Is this another BIG PHARMA scam?

  • gsbuck

    12/17/2009 8:25:17 PM |

    what would be an eqivilant dose of Flax seed oil if one is currently taking fish oil (2,600IU's of EPA+DEA )

  • Kamila

    12/17/2009 11:11:37 PM |

    I've noticed this too, Dr Davis.  There is some justification with regard to splitting doses in order to make the capsule size more palatable.  But, oftentimes there does appear to be deliberate obfuscation in order to make the purchase price appear more attractive.

  • Dr. William Davis

    12/17/2009 11:30:47 PM |

    Gsbuck--

    3 gallons.

    Just kidding. So little of the linolenic acid in flaxseed oil is converted to DHA that it's impossible to raise your blood level of EPA + DHA using flaxseed oil.

    The claims made by some marketers of flaxseed oil as an omega-3 fatty acid source are simply untrue.

    Nonetheless, flaxseed oil is a wonderful oil with benefits all of its own, just not EPA or DHA blood levels.

  • preserve

    12/18/2009 12:59:14 AM |

    "I don't know why some manufacturers or distributors do this."

    Profit optimization / discriminatory pricing.  Charge illiterates a higher price than literates.

  • Hans Schrauwen

    12/18/2009 10:15:14 AM |

    And what about the claims that     Omega3 from algae is just as good ? They claim fish have DHA because they get it from algae anyway, so why not go direct? If nothing else it has less environmental impact, and if cold-subtracted potentially less oxidized :
    http://www.v-pure.com/

    I take it myself and I never have those "fish burps" from it although it tastes exactly like all other fish-oils.

  • Rob

    12/18/2009 3:47:57 PM |

    I've only recently started following your blog and I dunno if this is the most appropriate place to ask, but what (generally speaking) would be a recommended daily EPA/DHA (or total Omega-3) dosage?

    I've been taking a krill oil supplement for several months, but the dosage is a fraction of that offered by the capsule you used for an example in this post.  So that makes me wonder if I'm taking enough of the supplement to even make a real difference.

  • Carolyn Thomas

    12/18/2009 5:47:20 PM |

    This helps to explain my pet peeves about the supplement industry - as Jenny says, it's a completely unregulated industry.

    In fact, there is no legal requirement for what's listed on the label to even match what's actually inside the capsule.  As long as manufacturers don't claim to 'cure disease', they can pretty well say what they like, at least until proposed industry regulation hits in the next two years - unless the industry's very powerful lobby groups are successful in squashing regulation, as they are of course trying to do.

  • Anonymous

    12/19/2009 1:25:49 AM |

    How can one enjoy raw Almonds and Hazelnuts (my fave) without overdosing on Omega 6?

    Also, any thoughts on whether monocytes reflect too much Omega 6?  I read something on this by Dr. Glen Aukerman regarding lipomas.  He claims lipomas and uterine fibroids are caused by excessive Omega 6 and recommends no nuts at all, no flaxseed, no poultry.  My monocytes tested at 10 which was not flagged as abnormal -- he claims 3.5 is ideal.  I have lipomas and fibroids. My CRP is so low it does not register and ESR was zero. I've never heard this monocyte theory before.

  • Dr. William Davis

    12/19/2009 1:32:47 AM |

    The key with nutritional supplements is to be an informed consumer.

    The WRONG response is: Because I can't always trust the supplement manufacturers, I'll turn to prescription agents (like prescription fish oil).

    I'd personally only turn in the direction of prescription fish oil if I were interested in STICKING IT TO MY FELLOW HEALTHCARE CONSUMERS! I am not, so I prefer that we all educate ourselves on what preparations are reliable and safe.

  • Anonymous

    12/19/2009 2:57:36 AM |

    Dear Author heartscanblog.blogspot.com !
    Clearly, I thank for the help in this question.

  • Healthy Oil Planet.com

    12/19/2009 5:26:49 PM |

    It's really important to look closely at the labels to determine exactly how much ingredient you're getting per dose.  The same applies to food labels as these can be misleading if one doesn't analyze the label closely.

  • homertobias

    12/20/2009 7:44:57 PM |

    Dr Davis

    It is worse than that.  Alot of brands, (Costco is the worst), not only trip you up on serving size but also do the following: Total omega 3: (including DHA/EPA) 375mg.
    So how much DHA/EPA here?  Who knows!  When you look down at the ingredients you will find anchovies, Vit E, and SOY.  Which is cheaper, anchovies or ALA from soy.  And who knows how much Omega 6.

  • Anonymous

    12/20/2009 9:23:45 PM |

    Also be on the lookout for labels that don't mention the EPA/DHA ratios. I've seen some cheaper brands just list 'Omega 3s', with no breakdown.  And if interested in form used (ethyl ester vs triglyceride) you'll have to read the label closely too -- but quite often this isn't even mentioned.

    Although that leads to another point: what is the optimal EPA/DHA ratio as far as reducing heart disease risks?  I don't think this has really been studied that closely.

  • Mindscaper

    12/21/2009 6:00:22 PM |

    I read so much on nutritional interventions for CHD and atherosclerosis that I sometimes lose the source of my information. Sorry if this is the wrong attribution but I think it was Art Ayers (might have been Stephen Guyenet) who blogged about the dangers of using fish oil as a source of Omega 3s. One caveat is that  fish oil oxidizes very easily on the shelf and is likely to also do so in the warm temperatures within the body--therefore it could contribute to inflammation rather than prevent it. If this is true, it is a serious consideration for those who already have atherosclerosis and are attempting to reverse it by using anti-inflammatory foods and supplements. What do you think about this? Should we be getting our omega 3s and 6s from other sources? If so, which?

    I also wonder about disturbing the appropriate balance of omega 3s and 6s by eating either walnuts, almonds, or sunflower seeds daily to help eliminate excessive plaque. So many conflicting ideas--what is one to believe and do?

    Thanks for all the information you generously provide.

  • Judy B

    12/22/2009 2:00:31 AM |

    Is there a search function on this site?

  • Mindscaper

    12/23/2009 3:05:39 AM |

    Ted, Thanks very much for your detailed and informative post. I intend to follow-up by reading your suggested list. Your post is very helpful in clearing up some confusion I was experiencing.Just rereading Stephan's posts go a long way to solidify my understanding of inflammatory processes resulting from chronic overindulgence in excess omega 6s, refined carbs,etc. Ironically, I have been conscientiously attempting to follow the best advice and practices concerning CVD since my father died in the 1970s at the age of 48 after 2 heart attacks and a series of strokes.

    Unfortunately, it turns out that the "best advice" was almost all certainly wrong and in some cases fraudulent. I succumbed to the very disease I thought I was avoiding by my "healthy" lifestyle. The best thing I had going for me had been a  complete  avoidance of doctors until my totally unexpected heart attack last year. At that point my life was saved by Western medicine but I was literally hijacked by the medical system. Because I had insurance I was given an unnecessary $17,000 helicopter ride, two angioplasty procedures, a week's confinement in a hospital and 4 stents--(one of them to replace a botched procedure that caused a vessel dissection). Subsequently, I was placed on statins,plavix, ace inhibitors, and beta blockers for at least a year.

    My intent is to get off of these as soon as possible and to that end I'm seeing an integrative medicine D.O. at the University of Maryland in addition to my cardiologist. She is supportive of my anti-inflammatory diet, antioxidents, vitamin D3  and amino acids, Q-10, and  NO enhancers. I've made her my primary care doctor so she can help me communicate with my cardiologist who I overheard saying (while I was being wheeled in on a gurney "here's a person who should never eat another egg for the rest of her life". How can these MD's be so indoctrinated and misinformed? It is mind-boggling to me. However, once a captive within the system it is extremely difficult to extracate oneself. I was told before I left the hospital that if I missed one dose of Plavix I could cause a clot to form and could die. I was not told that there are other natural platelet anticoagulants that work very well. I was also told that it is virtually impossible to reverse atherosclerosis by nutracueticals and lifestyle changes. It has been an eye opening process to learn differently from doing my own research.
    Again. . . thanks for the information. It will keep me busy for the next little while. Cee

  • Adolfo David

    12/23/2009 6:40:02 AM |

    Dear Dr Davis, I have seen some people criticize your TC scan program because of this might increase cancer risk. So I believe you may be interested in an opposite view, since low dose radiation can be healthy and good based on the phenomenon of hormesis – "a dose response phenomenon whereby a substance that in a high dose inhibits, or is toxic to, a biological process will, in a much smaller dose, stimulate (or protect) that same process."

    CT Scans May Reduce Rather than
    Increase the Risk of Cancer
    http://www.jpands.org/vol13no1/scott.pdf

  • TedHutchinson

    12/25/2009 1:47:43 PM |

    @ Judy B
    If you go to the Heartscanblog home page you will find on the left hand side of the black bar at the very top of the page, a searchbox.

    But that only searches Dr Davis blogs.
    It doesn't search the comments.
    Some of the readers here are very informed and often there are interesting points raised in the comments that add to the valuable information in the blog.
    So to search the blog and the comments I use
    Google advanced search and enter the Heartscanblog URL
    http://heartscanblog.blogspot.com/
    in the search filter box
    Search within a site or domain:

    If you are searching for a post or comment that was recent then select an option from the
    Date, usage rights, numeric range, and more filter menu.

    To speed up searching through the results for the information you want then using you keyboard keys
    Ctrl F brings up a new searchbox, enter the word/phrase you are looking for in this box and then you can quickly skim through each of the occasions that word/phrase appears here.

  • bestrate

    1/4/2010 6:53:02 PM |

    Regarding Rob's question (way up at the top) about fish oil dosages, I too have been wondering about that.  I did find a very fascinating compilation summarizing the opinions of experts on proper dosages which I have bookmarked at (see http://www.buy-fish-oil.com/how-much-fish-oil-dosage-per-day-should-i-take/ )  It was particularly instructive to learn how fish oil has been used in extreme cases of brain failure, heart failure, kidney failure and liver failure such as the treatment and remarkable recovery of the coal miner who survived the Sago mine disaster.  Fascinating.

  • Health Test Dummy

    1/13/2010 7:41:20 PM |

    I recently bought one out of necessity. It has Caramel Coloring added!!!! CARAMEL COLORING???!!!!

    I am indeed perturbed.

  • Anonymous

    1/26/2010 1:36:39 PM |

    "The supplement business, completely unregulated, is a magnet for scoundrels. The label is nothing compared to the deceptions they practice in what they put into the capsule and pill. Over and over again lab testing shows the pills either don't contain what you are paying for or contain dangerous contaminants."

    As a recent subscriber to http://www.consumerlab.com/ I find that for the most part supplements have in them what they claim...and are free of contaminants.  You COULD generally buy supplements from certain dependable sources and be safe doing so.  I don't work in the industry.

  • Term papers

    1/26/2010 3:42:22 PM |

    I notice that the composition, or "Supplement Facts," lists the contents of two capsules Rather than the usual one capsule contents, this product label lists two capsules.

  • Marek Doyle

    2/6/2010 9:23:22 PM |

    Definitely worth buying a good quality fish oil supplement from a manufacturer you trust - and, ate least, taste the oil thats in your capsule before gobbling them down.

    Reference gsbuck's question above, it is difficult to create an exact equivalent between fish oils and flaxseed oils because of the way they are handled in the body. Flaxseed provides a lot of ALA, a plant omega-3s, which needs to be converted in the body into EPA/DHA, the 'active' omega 3s. In healthy people, around 16% of ALA is converted into EPA/DHA. So if you take 10g flaxseed oil, thats 8000mg of ALA, converts to 1280mg EPA/DHA. This is what you would find in around 4 grams of normal fish oil. But... older people, those with chronic disease, those with nutritional deficiency, etc, will never convert very effectively and require fish oils.

    I have discussed the benefits of fish oils vs flaxseed oil here.

  • Anonymous

    2/10/2010 6:04:09 AM |

    nice post. thanks.

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  • buy jeans

    11/3/2010 7:33:52 PM |

    I don't know why some manufacturers or distributors do this. However, I have seen many people tripped up by this kind of labeling, taking half the omega-3 fatty acids they thought they were taking. This can be important when you are trying to obtain a specific dose of EPA + DHA to reduce triglycerides, reduce Lp(a), control abnormal heart rhythms, reduce bipolar mood swings, or other important effects.

  • Serdna

    2/14/2011 10:01:50 AM |

    Well, it seems to me that this is the label of the fish oil I consume. Maybe I am a little naive, but I just interpreted this label as a strong recommendation to take 2 softgels a day at a minimum and that they would have done a twice greater softgel if it could still be swallowed.

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