May 24, 1999
sacred1

Sacred Beliefs in Medicine!

1. Anecdotal:

This is the worst insult someone can give to one who has just listed a story of a patient in trouble and what helped him/her.

To me if one took a history--i.e. the patient's story of his/her reason for coming to see me then I have always thought this was an anecdote.

If I did not take this anecdote, what would the regulators think? My conclusion is that they would when they found out say that I did not practise medicine to the standard of the area in which I practised.

How then must I not take an anecdote, and take a history at the same time? Is this possible? I doubt it!

Therefore it is my conclusion that anecdotal is not an insult except in the minds of the "scientists" with their noses in the air who think they can judge other people's behaviour, and forget that they have to behave the same way. Admittedly some of them have got themselves into administrative jobs where they do not have to dirty their minds with stories from patients, and only have to read charts and files, and therefore are much better able than the rest of us to "be able to read the minds" of the doctors who wrote the charts, if they did this according to the rules set up by the "scientific" regulators.

I have been the recipient of some of this interpretation, and suffered from it as some doctors who examined my charts, did not believe my diagnoses, and made up their own which were wrong and had no relation to what was written. I wonder if they had suffered from some administrative hallucinatory process, as the patients did not have that disease, or did have the disease they did not agree with.

In 1984, I discussed the problem of keeping records with someone in the Ontario College of Physicians & Surgeons (OCP&S), as they were complaining of doctors' histories of their patients not being complete enough. I suggested that the regulatory hierarchy should take a locum tenens every summer about 200 miles north of Sioux Lookout in Ontario, and see if when they were alone up there without secretaries, computers, consultants, etc. if they could write all the necessary things about their patients. I was told they had "considered this but rejected it". I asked why, and the reply was, "That if they made a mistake, they might have to sit in judgement on themselves".

I wish they would let me sit in judgement on myself, and I wonder just how he would be able to arrange his sitting in judgement on himself!

2. Double Blind Studies, Crossover or otherwise.

One of the members of the OCP&S council who had criticized the OCP&S many times got elected to the council, and after 3 months he wrote an article praising how nice and erudite the other members of the OCP&S council were. I thought that he was being coopted, or brain washed or whatever other word you can think of. Later on he stated that if we stopped believing in the double blind study, that scientific medicine would suffer a lot.

I had a patient whose son had blackouts, and Narcolepsy, and was given Ritalin 20mg tid. The OCP&S forced the doctor prescribing this to do a double blind study. They did a triple blind study, and gave him Ritalin, Tofranil, and Placebos for 2 weeks each. They got reports from the mother, the father, the school teacher, the school nurse, the school principal, possibly the school janitor, and the man who walked past the school yard looking at the kids. Of course, none of these reports were anecdotal, but scientific. They found that the Ritalin worked and the other two has little effect on his hyperactivity. Then the Dr. at the OCP&S asked the prescribing doctor why he was getting so much, and the prescribing doctor said the boy needed that dose. The OCP&S doctor believed him. They do not believe me!!

I got a phone call yesterday from a patient of mine M.A. who takes Ritalin 10mg ii tid, and he stated that his pharmacist told him he was going to have him investigated as this was too big a dose. Here is the same negligent thinking, of people who think they know what dosage of a medication will work for everyone. I other words, they know little or nothing of the practise of medicine!

I am of the opinion that double blind studies are of little use, and only fool one into thinking one is scientific.

I have a patient who has been in my care almost 4 years, due to his depression. He has been on 16 antidepressants. Some of them helped for 3-4 months and then stopped working. What should I do now, give him placebos, and if I did what would that prove, if anything?

I mentioned this patient in a meeting re the treatment of depression and got no advice. I referred the patient to the speaker and filled out all the necessary papers and faxed them back about 1 month ago. I was told by his secretary that they would call the patient and give him an appointment. No phone call has arrived for 6 months. Cute is it not? In the meantime the patient found another psychiatrist.

3. Peer Review:

This seem to be the sine qua non of approval for the paper being printed in any journal.

I sent a paper on the EEG in 500 cases of Head Injury 2-30 years after injury, and it was refused. The editor sent me the criticism--It was juvenile writing, (how else with my first paper), it made a conclusion that the critic did not like or believe, e.g. I has stated that when one of the patients had 2 or more EEGS at intervals, that 50% had more abnormality, and 50% had less abnormality, and I considered each of these findings to mean that some patients brain damage was getting either worse or better. Tough beans! It never got published.

Jan 1, 1996 in the CMAJ of that date there was an article purporting to be able to educate doctors on how to give fewer "bad pills" (Sedatives & Ritalin).

How did they get the "bad" doctors? By going over the computer records of prescriptions given for these drugs and choosing 125 doctors who gave greater than 2SD (two standard deviations) of the "bad" drugs in the past time 6 months.

They watched 18 doctors prescribing without telling them and I note that 2 of these doctors did prescribe fewer "bad pills". I think these doctors either got suspicious of what was going on, or had talked to some of the 18 that had been told they were being watched.

The 18 doctors who knew they were being watched reduced their prescribing of "bad pills" 25% which was not statistically significant. I wonder what those patients felt. Did the patients fell more pain that "was not statistically significant" or did this lack of pills cure their pain? Real Ethics!

The 18 trained doctors reduced their prescribing "bad pills" 33% which was statistically significant. I also wonder if their patients had their pain cured by the statistical lack of pills.

More Real Ethics.

To me: this article was not complete and toward the end of the article they stated they did not know what happened to the patients who had their pills stopped--(with tears in my voice) the authors stated the patients might have had to go to the hospitals and cost the B.C. Government more money. More Real Ethics!

One should consider the planning of this great study! I think the Federated Colleges of Physicians & Surgeons of Canada in about 1993-4 considered the terrible increase in the prescribing of "bad pills", and the College of P&S of B.C. volunteered to study it as they had the operating computer system to spy on all the doctors prescriptions very rapidly, and without any publicity to alarm the doctors or patients in B.C. The Federated COP&S never considered the necessity of finding out what happened to the patients who did not get the pills, and the B.C. planners never considered it either, along with any of the investigators advisors, critics of their paper, the peer reviewers, the editor of the CMAJ, and so the paper go printed which had never really finished its real outcome, which is what happened to the patients.

Now if I send a paper in to a journal such as I mentioned above, and did note the outcomes of the patients, I get refused permission to get it published.

This seems to me for me never to get published, just because the peer reviewers do not like my observations or conclusions or both.

As a result I have little respect for peer review.

Perhaps I should mention the peer reviews of Semmilweiss' work with puerperal fever. I learn that he was ridiculed and became ill as a result. The Stitches magazine this month has a story of what might have happened to the peer reviews of Harvey's theory of the circulation of the blood. I thought this was very accurate and entertaining.

I am very annoyed at the peer reviewers of the article by Dement et al. in1966 on "The nature of the Narcoleptic attack". I when I read it first did not agree that all patients must have sleep attacks 100%, cataplexy 100%, and SOREMPS 100% (Sleep Onset Rhythmic Eye Movement Periods). I realize that these researchers wanted to have a "pure culture" of patients so they could do better research. It is my opinion that they only did "restricted research", and ignored the remainder of the patients. They invented a Classification of Sleep Disorders, which consisted of 84-85 different (so-called) illnesses, separate from Narcolepsy. It is my opinion that the illness should be called Narcolepsy, and the other 83-84 items should be variants of Narcolepsy. not separate diseases.

My surveys I have done since 1985 show me that practically all of the separate diseases have many of the other symptoms of Narcolepsy. Therefore I consider them to be one illness with different presentations.

I have sent 80 patients for Sleep Lab Consultations and testing of 1381 patients that I consider to have symptoms of Narcolepsy. Of the 80, only 35 all night tests and 9 MSLT test were done. Only 5 of these test were positive for SOREMPS. This is only 6.3% of those tested that the sleep lab directors were able to come to a diagnosis of Narcolepsy. Which means that 93.5% are unable to get alerting medications ever.

As a result I consider the all night polysomnography as useless to diagnose Narcolepsy and is only useful for the diagnosis of sleep apnoea, which after all is just another part of Narcolepsy.

Randomized Studies, Controlled studies:

One wonders if I personally would like to be randomized and not get the treatment that just might help cure my illness. Is this something that should be considered non-ethical? I had on operation in 1975 to repair an abdominal aneyrysm which was 6cm in diameter. They asked me to sign a consent to give or not give me prophylactic medication in case of an infection. I signed it. After the operation they did not tell me whether or not I had received medication or nothing. Ethics?

Control groups: What can one do with these but ask the same questions, and see how many have the illnesses of the group of patients who one is trying to treat with some medication or surgical method? To me this doubles the work of the researcher. And gives him/her very little time to look after the sick patients. One wonders sometimes just what the researchers were doing for, with, or to the control group while they were researching some form of treatment for the research group.

My patients from 1982 to mid 1999 consist of 1345 Narcoleptic patients and 2427 non Narcoleptic patients with other medical disorders. Should we consider that the latter are a control group to compare to the Narcoleptic patients? I have listed their diagnoses, and in the early days before Windows 3.1 in DOS using dBASE III V 1.1 there were only 128 items one could put in one database, and so I only had 4 fields to use for different diagnoses. Later with Windows 95-98 I used 7 fields for the different diagnoses of each patient. At times I found this was not enough. However there are some interesting percentages of patients who had other diagnoses than the primary one. I will publish this in this web site under the title of comorbidism.

Comorbidism:

This seems to be a new idea to arise and trouble the regulators. I found that while in medical school that the patients presented in lectures seemed only to have a single illness, but when I went to junior internship, the patients seemed to have more than one illness, and when I was doing my course in Army Psychiatry, and got to Christie St. Hospital some of them had over 10 diagnoses. One must consider the ages of the patients, and that as one grows older there are the problems of arteriosclerosis, arthritis, alcoholism, drug addiction, injuries, added to whatever they started with at the younger age.

October 4, 2001 Sacred1
DNA

This was discovered several years ago.

This has been stated that everyone has different DNA

This makes everyone an individual.

Individuality is a poisonous term that upsets all planners who love to have everyone as a clone so the planners can give everyone the same instructions to behave or each illness to have the same treatment, and the planners then can publish guidelines for all doctors to behave the same way and then the planners will be happy and not take the doctor's licenses away because they treated different patients differently because the same guideline drugs did not work for everyone.

Why have the planners not learned from the discovery of DNA that when they insist on control groups to decide on which medication is better, that they can never have exact matching. The next part of their planning, I will predict, will be to do DNA testing on all the patients in a group and in the control group to have similar DNA. This still only leaves the control group to be approximately similar, and certainly not exactly the same, as has been promulgated in the past and the present.

RANDOM TREATMENT

I have wondered if it is ethical to give a patient no treatment or placebos, and lie to him that it may help when he is suffering an illness. I concluded that it is not ethical.

I wonder if the planners who seem to be mainly men would like to be pregnant and then have Semmelweis to randomize their delivery to the doctors who randomly washed their hands after doing autopsies before their confinements.

It is noteworthy that the PEER REVIEW of the work of Semmelweis took a long time to get through the heads of the peer reviewers.

This also applies to the work of Paracelsus, Pasteur, Harvey, Freud, Ewen Cameron (and his idea of treatment to return patients to their childhood and bring them up thinking correctly), and many others. I would like to add the Sleep research group who have, like Freud, insisted on certain illogical conclusions on the diagnosis of Narcolepsy. Read my web site <www.gta.igs.net/~ecahoon>.

Does this assume that all peer reviewers and planners have the same gene to be able to make illogical conclusions?

I was randomized once when I was going to have a repair of my abdominal aortic aneurysm in 1975. I was going to get or not get prophylactic something to prevent infections during the operations or after.

I recovered, but, being a patient, did not deserve any information re this randomization. Ethical?

Further what sort of information is given to the patient about this randomization and the treatment involved or not. It this not done or how could he/she understand all the complications of it, to be able to give an "informed consent"?

I often think that this is like believing in religion or psychoanalysis, communism, the Taliban, doctors should not marry a patient unless the doctor has not treated the patient for 2 years and not talked to each other in the meantime, and other forms of confused thinking by people who insist that their silly idea is the 11th commandment.

A classmate of mine told me 3 years ago that my classmates did not understand me when in medical school. I said all they had to do was to ask me questions. He did not answer. This year he told me that I had not believed anything told to us by our professors. I answered that if I waited 6 months they told us a different theory and I would also have to not believe it at some future time. I mentioned this to another classmate, who had read my manuscript (The Mask of Wakefulness), who thought I was a genius, and he struck his forehead, and said, "What was wrong with me, I believed everything they said"? I did not answer, because I would have had to tell him that he did not think for himself..

Another time at a dinner I mentioned that I has sent 300 copies of my Manuscript to doctors, patients and friends, and that of those who answered, in the three groups, 90% said it was good, made sense, and I should publish it. This doctor immediately said he would not believe it until there were 3 articles in the literature that agreed with me. I likewise did not tell this man that he did not think for himself, or believe his own thinking.

Yesterday I got the latest issue of the Medical Post, in which, Ken Pole in his item on the editorial page stated that in Ottawa the planners think that Medicare is failing and should be changed, but they don't have any ideas of how to do it.

Of course, that is because there is little wrong with Medicare, and since they have the idea of it costing too much, they are just looking for a cheap way to treat patients. e.g. doctors to work for nothing, delist types of treatment, don't pay for medication that works to prevent more illness, don't operate on people too old to go to work and pay more taxes, use nurse practitioners who will quickly (?) refer patients to supervising doctors, etc.

This latter is interesting, and is supposed to save money. However what will happen? I suggest that the nurses do not want to work with doctors (just see the comments in the past by the non-medical midwives who wanted to be independent), and will have an office, a computer, need a secretary to do filing, typing, appointments, a car to make house calls, and then she/he will want an apartment, house, and food. She/He just might marry and have children and this means She /He will need more pay and possibly another nurse practitioner in the office to help. This makes it obvious that the nurse will want to be paid money for her services to the patient (now a client or customer), and that this w ll amount to almost the same amount as paid to the doctors. Then since they will need more nurse practitioners this price will go up higher than paying the General Practitioners, and just who will they want to get rid of then–the more expensive doctors. It is interesting that recently it has been published that the nurse practitioner will be paid $65,000.-$85,000. per year. I never made that much money in my practice!!

To me this is as obvious as the nose on my face.

CONTINUING EDUCATION.

I note that the school teachers, now have to take courses, and take examinations every 5 years to see if they are up to date.

Did the Ont Government get this idea from the Royal College of Physicians and Surgeons in Ottawa? This Ottawa group seem to think they did not have enough work to do

Oct12,2002

MIDWIVES:

These seem to be a new invetion:

1. They need2 years training.

2. They must not have any medical education as it would confuse their training.

3. They must not be nurses.

4. After training they will be allowed 40 deliveries a year to begin with.

5. They must refer patients with complilcations of delivery to obstetricians.

6. They are paid $55,000.00 per year for 40 confinments. This amounts to $1375.00 per confinment. It is noteworthy that an Obstetrician gets $275.00 for precare, after care, and confinment per delivery. This must be a cheaper method of delivery of a child!!

7. After 1-2 years experience a midwife is allowed an increased number of deliveries, and also increased pay.

There must be a cheaper method of delivery of medicare!

E. B Cahoon, M.D., D.Psych., F.R.C.P.C.