Doctors and misinformation

[pellicle]

in the light of so many calls to "always listen to your doctor"

https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2808358
Personally I'd love to see a study of how many doctors spread misinformation about anticoagulation (IE VKA based Warfarin) therapy and are literally decades behind what's being published in literature.

Here's a good example of one scientific study that called out a very common bit of misinformation.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4998867/

Educational advice is often given to patients starting treatment with vitamin K Antagonists (VKAs). A great emphasis is made on nutritional information. Common belief is that dietary vitamin K intake could counteract the anticoagulant effect by VKAs and for many years, patients have been discouraged to consume vitamin-K-rich foods, such as green leafy vegetables.​

​

The objective of this study is to summarize the current evidence supporting the putative interaction between dietary vitamin K intake and changes in INR with the VKAs.​

...​

In conclusion, the available evidence does not support current advice to modify dietary habits when starting therapy with VKAs. Restriction of dietary vitamin K intake does not seem to be a valid strategy to improve anticoagulation quality with VKAs. It would be, perhaps, more relevant to maintain stable dietary habit, thus avoiding wide changes in the intake of vitamin K. Based on this, until controlled prospective studies provide firm evidence that dietary vitamin K intake interferes with anticoagulation by VKAs, the putative interaction between food and VKAs should be eliminated from international guidelines.​

an appreciative nod to the gentleman who started this conversation with me earlier. I thought I'd just bring it here and flesh out a bit more why doctors provide guidance, and are not Oracles.

 

[Protimenow]

One source of this misinformation was the original maker of Coumadin - perhaps as a way to cover their butts.

They went so far as to create a 'Coumadin Cookbook' with recipes that didn't include sources of Vitamin K. I may have one of these relics somewhere around the house.

I don't think that any of the medical training about VKA does much to do with anticoaguation, diet, or anticoagulation management. I suspect that once many of the doctors 'learned' about coumadin management, they stopped learning.

I've had to 'educate' a few doctors. I showed one doctor that labs aren't always accurate. I've shown another that it's possible to self-test and self-manage. The next thing will be showing my doctor what INR test 'accuracy' really means.

I've gone to a clinic that used an ancient protocol, convinced that if my INR has been consistent for a month or two, I could go two months between tests.

I went to another clinic where this egomaniacal pharmacist 'expert' tried to give me dosing advice without asking WHY I was taking Warfarin.

This is a case where modern knowledge of the REAL facts, and advocacy for yourself (and not always trusting the 'experts') is the best way to handle YOUR anticoagulation management.

 

[tom in MO]

One source of misinformation is this forum. Take all science information with a dose of skepticism; that's whether it comes from doctors, nurses, specialists and especially untrained autodidacts who believe they are experts.

 

[Superman]

So what we’re down to is trust nobody but yourself.

Which would include trusting that you’ve chosen to place your trust in the right people. Including this forum.

 

[pellicle]

So what we’re down to is trust nobody but yourself.

I'm going to say this instead of the polar view : trust but verify

Which would include trusting that you’ve chosen to place your trust in the right people. Including this forum.

it certainly would Ollie

 

[Protimenow]

Trained autodidacts are very dangerous if their 'training' is inaccurate, or they base their educated opinions on wrong or out of date information. So can those who put blind trust in the 'experts' who shouldn't be experts.

Untrained autodidacts shouldn't be dismissed out of hand - they may do more research on a subject than 'trained' 'experts' and may have more current, more accurate information than the 'trained' experts. A medical license is no guarantee that you'll get accurate advice or information.

 

[tom in MO]

I've had 5 surgeries and for me a second or third medical opinion holds the most weight. For my OHS, first opinion was the cardio, second was the surgeon, then I went my internist, then back to the cardio and again to the surgeon. I even snuck in a colorectal surgeon's opinion on warfarin and piles. A $20-40 dollar copay in insignificant when it comes to going under the knife. This forum was very helpful in educating me so I could fully understand the real experts. However, the consensus among some that a higher than prescribed INR is not a problem, >60yo is good to go for tissue valves, that warfarin is a not a pita when it restricts access to NSAIDS, complicates later surgeries and ulcers is pretty strong evidence that the autodidacts might not be as expert as some believe.

 

[Protimenow]

I don't know what you're saying -- are you saying that the autodidacts are giving advice that 'complicates later surgeries and ulcers?'

I don't see how low, occasional doses of NSAIDs will cause problems - although they DO make platelets less 'sticky.' As far as complicating 'later surgeries,' reversal of high INRs is easy - Vitamin K. If there's no time for the Vitamin K to work, packed platelets can also reduce INR. For most minor surgeries, I don't think an INR between 2 and 3 is a major complication.

And as far as ulcers are concerned, it's frequent (or chronic) use of NSAIDs that help to cause ulcers (although there's also a bacteria implicated in causing ulcers). I don't think that any of the 'autodidacts' you refer to EVER advocated for chronic use of NSAIDs.

Second and third opinions may be valuable as long as the doctor GIVING the opinion knows about anticoagulation and other issues related to your situation and is more up to date than what was taught in Med School or in an ancient medical journal article.

 

[pellicle]

Trained autodidacts are very dangerous if their 'training' is inaccurate, or they base their educated opinions on wrong or out of date information.

as we are "learning" (as if it wasn't obvious) is the case with AI

So can those who put blind trust in the 'experts' who shouldn't be experts.

basically Jung got it right

(*I just meddled a bit to make it clear)