The Stephan trial and evidence-based healthcare

[Azure]

Originally Posted by Reaper

Go on...

What more is there to say? Parents who don't vaccinate their kids are creating a health crisis. It might take some time before it becomes a bigger problem but it will become a problem at one point. Instead of being politically correct, lets make a law right now that if you don't vaccinate your kids, the government can send you to jail.

Might as well just get it over with and save us from issues down the road.

[cracher]

Originally Posted by Slava

Sure doctors carry malpractice insurance, but its pretty well known that if there is a hint of a suit against them they basically circle the wagons and no one will testify against the others. I get it, but even in clear cut cases if you can't find an expert (i.e. another doctor) to testify or give evidence you don't have a case. Malpractice insurance isn't paying, and no one is.

Categorically untrue. You can find someone to support any angle, no matter what the variance is from the community standard of care. It's a field of competing egos, not the fraternity you describe.

[Slava]

Originally Posted by cracher

Categorically untrue. You can find someone to support any angle, no matter what the variance is from the community standard of care. It's a field of competing egos, not the fraternity you describe.

Well I'm not sure how either of us could ever prove anything here. I just know from what amounts to anecdotal cases that this has happened in many cases. You can't build a case against someone without an expert, which in this case is another doctor, who is willing to give evidence. They're largely not willing to do that because they're worried about potentially being on the other side down the road. The only potential option is to get someone from a completely unrelated jurisdiction to come in and give that evidence.

It absolutely happens. I know that there are some lawyers on this board and maybe one of them could chime in and add their thoughts. While I'm not a lawyer and never have been, I've definitely seen this in action. You have to cross a few bridges to make a case happen in terms of medical malpractice that I've seen; first you have to find someone willing to give the evidence (usually a doctor from somewhere else in the world), then that doctor has to agree with your position that there is something to the case. This isn't like one doctor is going to be more than happy to go after his competitor across the hallway at all. Its very difficult.

[Cyclops]

Originally Posted by cracher

Categorically untrue. You can find someone to support any angle, no matter what the variance is from the community standard of care. It's a field of competing egos, not the fraternity you describe.

Seems like you might be wrong.

http://www.theglobeandmail.com/life/...service=mobile

[cracher]

Does it prove me wrong? 4000 lawsuits between 2005-2010. You don't even start one of these unless you have a dissenting opinion from someone else.

The 2% verdict for the victim rate. Sure, it's low. But the article doesn't give any information on the specific cases. How many settled out of court (which, when insurance is involved, happens a ton). How many are malingerers that had their game called?

I remain unconvinced. This actually makes my case of being able to find contrary opinions in the field.

[Slava]

Originally Posted by cracher

Does it prove me wrong? 4000 lawsuits between 2005-2010. You don't even start one of these unless you have a dissenting opinion from someone else.

The 2% verdict for the victim rate. Sure, it's low. But the article doesn't give any information on the specific cases. How many settled out of court (which, when insurance is involved, happens a ton). How many are malingerers that had their game called?

I remain unconvinced. This actually makes my case of being able to find contrary opinions in the field.

Like I said I have no idea how either of us could prove out side here. There no real statistics to show anything that would be convincing either way. I just don't think its the cakewalk you seem to think it is.

[cracher]

Yeah, we represent two polarized views, the truth is usually somewhere in the middle. What I can see, personally, is that after practicing for 10 years without any claims against, my insurance has never gone down. In fact, I'm 40% higher than 2006. Somewhere, someone is winning suits.

[troutman]

Is Canada’s medical malpractice system working?
http://healthydebate.ca/2014/11/topi...al-malpractice

Only one in 10 cases make it to trial; 35% to 40% of legal actions will lead to a settlement or an award.

http://news.nationalpost.com/news/na0413-tb-malpractice

[NuclearFart]

Originally Posted by Slava

Like I said I have no idea how either of us could prove out side here. There no real statistics to show anything that would be convincing either way. I just don't think its the cakewalk you seem to think it is.

He's a physician so he probably knows more about this than you do. If you really want answers call the CMPA.

Being a expert medical witness on the medical legal side can pay quite well for little time invested, so there are certainly mercenaries for hire. They also aren't hard to find - just google it. People in the industry have their go to guys.

Speaking with other physicians it would seem the vast majority of cases are just settled out of court, that's why so few go to trial. Ambulance chasing lawyers know this, and it's quick easy money for them, so I would suspect many just push their clients in that direction under the fear mongering protectionist BS that "doctors circle the wagons"....etc.

[Slava]

Originally Posted by cracher

Yeah, we represent two polarized views, the truth is usually somewhere in the middle. What I can see, personally, is that after practicing for 10 years without any claims against, my insurance has never gone down. In fact, I'm 40% higher than 2006. Somewhere, someone is winning suits.

Well now you're just into a discussion of insurance though; my rates are higher today for E&O with no claims and really the same applies for other lines of coverage that I both own personally and sell. Inflation in general accounts for some of that.

I suspect at least part of reason why we have this disconnect in our opinions is that the truth lies somewhere in the middle as you suggest, and another piece is likely that it depends on the type of case. More specialized cases, where there are fewer experts in general, are going to increasingly difficult as opposed to what could be a "run of the mill" GP kind of case.

[NuclearFart]

Originally Posted by Cyclops

A person needs an appointment to refill a prescription which they continuously take. This is so they can get paid for the visit. I see a specialist every 6 weeks, my doctor insists I see him after. Nothing is ever discussed other than how the appointment went. He already knows this as the specialist sends everything to him. It's a business, and it seems most doctors are in it for the money rather than to help people.

This is my personal experience anyways.

Quite the bitter and ignorant view so typical of chronic medical patients.

Do you know what the most common cause of medical error is? It's miscommunication/loss to follow up. Having your GP (who quarterbacks your overall health picture; the specialist wants nothing to do with this) actively involved in your care with frequent follow ups would be view as a positive thing by the reasonable person.

I can understand how you superficially see this as low lying fruit, but you have to put that in the context of all the other garbage GP's have to deal with for minimal compensation, so it does even out. You should also recognize running a medical office requires quite a high overhead, so yes it is a business and bills have to be paid. I fail to see how you equate this to only being in it for the money.

[troutman]

Should alternative healing be more tightly regulated?

http://www.cbc.ca/radio/checkup/shou...ated-1.3557679

Two hour episode, Cross Country Check Up

Live Blog:
http://www.cbc.ca/radio/checkup/shou...79#Live%20Blog

[Minnie]

Originally Posted by NuclearFart

Quite the bitter and ignorant view so typical of chronic medical patients.

Not all chronic medical patients act like dillholes.

Do you know what the most common cause of medical error is? It's miscommunication/loss to follow up. Having your GP (who quarterbacks your overall health picture; the specialist wants nothing to do with this) actively involved in your care with frequent follow ups would be view as a positive thing by the reasonable person.

I can understand how you superficially see this as low lying fruit, but you have to put that in the context of all the other garbage GP's have to deal with for minimal compensation, so it does even out. You should also recognize running a medical office requires quite a high overhead, so yes it is a business and bills have to be paid. I fail to see how you equate this to only being in it for the money.

Can't say enough good things about our GP. That woman has gone above and beyond as a GP, more times than I can count. During the early days of the multiple medical issues my child faced, she was often our best source of information. She's called us on days off, to give us test results - she doesn't have to, we never have asked her to, but she's done it so we don't have to wait long for results. She's advocated with specialists for us. She came to visit us in the hospital a couple of times - never had a GP do that before. She's even given us her private/personal cell phone # - we've used it exactly once in almost 6 years, only because she left a message and asked us to call her back on her cell phone, lol. She refuses to charge her patients to fill out forms. So if I have to come see her after any specialist's appointment, by frank, we'll be there with bells on. We drive 45 minutes to see her because she's stupendous. Good GPs are hard to find these days, given the shortage, so we'll keep ours as long as absolutely possible. She's been through thick and thin with us for almost 6 years.

[Azure]

My problem with 'doctor recommended' is that doctors can sometimes be a few years behind when it comes to certain things. Example, Vitamin D intake. Almost all research is showing that most people in Canada have a deficiency, and that supplementation of up to 4,000 IUs per day is needed in order to get optimal blood levels. My family doctor is still recommending nothing more than 1,000 IU per day.

Not that hard to go read some recent research and put what they taught you in med school on the back burner as things tend to change.

[Knut]

^ Source ?

http://www.skepticalraptor.com/skept...ent/#more-8480

Vitamin D research seems very mixed and how many studies have been done with long term dosages of 4000IU ?



This is a classic J curve

This shows an increased mortality with higher amounts of serum Vitamin D. It is a large study. http://press.endocrine.org/doi/10.12..._pub%3Dpubmed&

[Azure]

Originally Posted by Hes

^ Source ?

http://www.skepticalraptor.com/skept...ent/#more-8480

Vitamin D research seems very mixed and how many studies have been done with long term dosages of 4000IU ?

http://examine.com/supplements/Vitamin+D/

But seriously, skeptical raptor? That is what you are going with?

[Knut]

Originally Posted by Azure

http://examine.com/supplements/Vitamin+D/

But seriously, skeptical raptor? That is what you are going with?

Right in your link it says "safe upper limit is 4000IU". That is not the recommended amount.

Skeptical raptor is a good site to weed out the noise from studies.

Science based medicine website better for you?

https://www.sciencebasedmedicine.org...not-to-screen/

Caveat : I take 1000IU / day in winter/fall.

[rubecube]

Originally Posted by Hes

^ Source ?

http://www.skepticalraptor.com/skept...ent/#more-8480

Vitamin D research seems very mixed and how many studies have been done with long term dosages of 4000IU ?



This is a classic J curve

This shows an increased mortality with higher amounts of serum Vitamin D. It is a large study. http://press.endocrine.org/doi/10.12..._pub%3Dpubmed&

Not to mention the amount of actual vitamin D in over the counter supplements isn't actually verified.

[Knut]

Originally Posted by rubecube

Not to mention the amount of actual vitamin D in over the counter supplements isn't actually verified.

Plus if you get more in your food + outdoors are you then over the 4000 upper limit

[Bill Bumface]

Also not to mention it isn't determined what 'deficient' is and one school of thought is that people originating from northern latitudes have adapted to have lower levels of vitamin D, and the 'deficiencies' that are discovered by comparing to equatorial populations aren't deficiencies at all.