Epilogue discussion medical culture
Many thanks for all the comments on the question'Why do NL doctors look down on Thai doctors?' many of which are very educational. They provide insight into what many of you expect from doctors and also the fact that good and bad doctors are a global phenomenon, as we see it in every profession.
Each country has a different medical culture, which does not mean that one medical culture is better than the other. The basis should be knowledge, gained through study and experience and not from the brochures of the industry.
There is a difference between medicine and medicine. The knowledge is found in the books. The art arises from the interaction between patient and doctor. A doctor must understand that the patient is usually his own best diagnostician. That diagnosis is hidden in his or her story. That is why it is so important to listen, something for which there is often no patience. Another part of the art is the experience.
There are countries in which medicine has completely overruled art and countries where art is still paramount. In countries where medicine predominates, such as the US, the same medicine is now the third leading cause of death after cardiovascular disease and cancer.
An example of medicine is the use of HCQ and Ivermectin in Covid-19. Medicine has shown great ignorance by prohibiting it. Medicine is often intertwined with industry, every doctor should be aware of that. Yet a doctor cannot do without it and it is a condition for being a doctor.
An example of medicine is complicated heart or vascular surgery.
Prescribing bags full of medicines is indeed a problem in Thailand. It is often impossible to find what is in that bag. However, you can always ask the pharmacy. Request the generic name.
My experience is that there are often many placebos in between. If you don't know what you're taking, don't take it, even if the doctor gets angry. If you do know, you decide for yourself whether you follow the advice. You can always ask me what's in the bag. Usually you can also find it on the Internet. However, I can't tell from the color of the pills.
Never forget that doctors are ordinary people. There are good, mediocre, bad, corrupt, pocket-filling, and genius doctors. A doctor should always be uncertain about his diagnosis until it has been shown to be correct, or until the patient has been cured. That leads to many sleepless nights. Doctors who don't suffer from this can be downright dangerous.
For the rest, I hope you will accept that life is accompanied by many ailments in various areas.
One of the excesses of medicine is that people have become afraid of diseases that are simply part of that life. This is reflected in the prevention mode, which is sometimes justified, but often not.
Prostate screening and breast screening, for example, hardly yield anything, apart from individual cases. They do cause a lot of stress and a reduced quality of life, which also endangers the length of that life. Vaccinations for serious diseases are a blessing, but when they are also used for less deadly diseases, they are a potential danger.
Our immune system is unique and can handle millions of viruses, bacteria and parasites. Did you know that that system destroys 150.000 potential cancer cells every day? If that system is disrupted, or becomes less powerful as with old age, or certain medicines, then all kinds of diseases are lurking and the body will no longer be able to parry all attacks.
In the end it loses the battle. That's how it works. Doctors can only postpone that process to a limited extent and whether that always leads to more happiness is a question that everyone must answer for themselves.
It would take too long to go into all the details here. That would make a book. Any other opinion is a right.
Yours faithfully,
Dr. Maarten
Fantastically written, in my opinion, the general practitioners in the Netherlands can learn a lot from it, I hope to be able to read your sections and answers for a long time to come
I would like to call on everyone to take control of their own health a lot more seriously!! This is especially useful if you are getting older but do not yet have an excessive number of defects. Take a look at YouTube and get inspired! Dr. Berg, Dr. Ekberg and many others can be found and then choose what appeals to you most! Ignorance is no longer an excuse in this day and age. Adjust your lifestyle and enjoy!
Had open heart surgery 2,5 years ago at Samitivej hospital in Bangkok,
AORTA VALVE AND 3 BYPASS
Thanks again to the team who did this.
Been in the OR for 12 hours.
Became a new person, no complications whatsoever
Had excellent service
They can do it here too
Dear Dr Maarten,
Thank you for the clear epilogue. Many familiar costs and also useful information. I was shocked by the comment that apparently many placebos are also dispensed under the guise of medicine. By official hospitals and specialists? So are people just being fooled out of greed?
I myself have been working for years in a hospital affiliated with a Dutch university.
And can confirm that there is certainly an atmosphere within our hospital that we are the best.
Even though mistakes are made as an organization, it is very difficult to admit them, I have noticed that myself several times, unfortunately.
Maarten, I've always been very curious about how much pressure I have from the pharmaceutical industry on doctors to push the drugs. Those Thai doctors won't do that out of inner conviction, I suppose. My previous GP in NL was also at the door with a box of pills ready before the patient had arrived, so to speak. Can you say something about that?
Dear Kees,
The pressure from the industry is great, although many doctors don't know it. Many guidelines are made by doctors, who are paid by the industry. Those guidelines are then more or less made mandatory.
Most studies into new drugs are also paid for by the industry and in the trials into the effect, it must participate according to EU regulations, which generates a lot of money for hospitals.
With new medicines it should be checked whether they are better (superior) than the old ones. Nu is used as a benchmark, not worse (non inferior), or, in my opinion, superfluous. Moreover, in comparative research, dosages are often tampered with.
On average, a product is added once a year that is better than the previous products.
There are also many substances that do not work, but do have a nocebo effect, which means that people think that they have a beneficial effect due to the side effects. You see that a lot with psychiatric drugs, such as antidepressants. The side effects of these drugs are severe.
Cholesterol inhibitors, such as statins, are also in the “no need with side effects” class.
If you are interested in this, I advise you to read the books of the following doctors. They are written in understandable language.
https://www.youtube.com/watch?v=D5Wnmhu8_5c
Dr. Dick van der Bijl has complete integrity.
Also dr. Peter Gøtzsche has written a lot about this. The formerly reliable Cochrane Institute has fired him and is now funded by the industry: https://www.youtube.com/watch?v=GxTgxCr1RUU
About the prostate: Dr. Richard Ablin 'The Great Prostate Hoax'.
Ablin is the discoverer of PSA
Then we have Ben Goldacre, who has written the books Bad Science and Bad Pharma, among others. Worth the effort.
Of course there are also many good medicines with the emphasis on "cure".
Antibiotics are one of them. Stomach antacids, such as Omeprazole, have prevented millions of stomach bleeding.
The main criteria for "new" drugs should be: NNT (Number Needed to treat) and NNH (Number Needed to Harm), or how many patients have to take those drugs in order to make one of them better and how many people have to take those drugs swallow to deal damage to one. Many products have an NNT of more than 500 and an NNH of less than 25. So you simply should not administer many products.
For Covid injections, for example, the NNT is so far around 190, or you have to vaccinate 240 people to prevent 1 case of Covid 19. The NNH has so far been around 6. These are figures from the end of 2020. https://www.thennt.com/review-covid-analysis-2020/
And here: https://www.researchgate.net/publication/348691034_Title_What_is_the_efficacy_of_a_Covid-19_vaccine_A_viewpoint
Here is a more detailed explanation of NNT and NNH.
https://www.youtube.com/watch?v=lyMvsbiXT1c
You understand that the industry is not very happy with these criteria, because they are difficult to manipulate statistically. They often try to hide these figures
It is difficult to say exactly how big the influence of the industry is on medicine, but I estimate it at more than 60%.
Dr. Maarten
What a beautiful and good analysis. My compliments.
Thank you doctor Maarten. My wife was fortunate enough to learn the difference between “medicine and ART” through a doctor like you. Thanks to that doctor, she refused to undergo further irradiation and to take medication after a minor operation for breast cancer. Result: she is now 7 years cancer free! Despite the fact that the medical team at the hospital accused her of “playing with her life”. We are lifelong grateful to our family doctor for his healthy insight. Had things gone wrong, we would not have blamed that man, but we would still be grateful.
Thanks also to Dr. Maarten for your sensible and sensible responses to the many questions on the blog.
Craftsmanship is what makes the difference in any profession and I think the big money from big pharma and its political lobby play a very ugly role in the madness of getting “old”.
The medicinal herbs and their use in NL and seen as very vague because people have been brainwashed for 60 years, so people happily take a pill every day against high blood pressure or sleeping problems. The government and health care system played in NL provide millions of pill addicts while the solution can be found in something else and that is clarity. High blood pressure and sleeping problems are not a disease and should not even be treated by the health care system. Both are disorders that have been built up, so it can also be reduced again, but yes then the mentality comes up.
Wonderful piece, written from the heart. What I dislike the most is that the health organization simply bans a product, which has helped several people very well. I think even donald trump has been treated to this, given his statement. How deep can one sink
Good story, totally agree, thanks.
Whatever you think about placebos (or suggestion), they do work. And that's because our brains can be programmed or reprogrammed. Unfortunately (or not), medicine still knows very little about how the brain works. But research shows that suggestion works and that this principle can also be used in healthcare. No more fantasy just facts, backed by research.
One of my favorite Ted talks (recommended):
https://www.youtube.com/watch?v=0tqq66zwa7g.
Indeed, chris, placebos are the western version of prayers, mantras and other rituals. I once heard the story that a doctor prescribed a 'placebo' and the pharmacist mistakenly wrote 'placebo' on the pill box. He had to pay 20 euros for it. The patient went looking for what was actually a 'placebo' and became very angry. Placebos save the doctor time.
The best placebo is a good doctor-patient contact with a good, empathetic and complete explanation.
By the way, in politics there are also placebos! And suggestions!
Experience and common sense are decisive, especially with a general practitioner.
Example: About 15 years ago I suffered from painful lumps in the soles of my feet.
Didn't pass. I go to the doctor. My older, trusted GP was on a well-deserved vacation.
His very young replacement once squeezed my foot and referred me to the hospital for an ultrasound.
Diagnosis: Ledderhose disease, a benign proliferation of connective tissue in the foot. Can also occur in hand or penis, but then it is called differently.
The young doctor immediately started talking about surgical intervention. I couldn't get very excited about that and decided to wait until my own GP got back to work.
He immediately ruled out surgical intervention and advised me to wear flexible sneakers instead of my sturdy, stiff shoes. In addition, he suggested that I do less with heavy squats.
I followed his advice and the problem is 95% gone. No medicine or surgery involved