Dr. Nick Riviera
kiwifarms.net
- Joined
- Nov 27, 2023
Freedomland medfag here, and I sure fucking wish we could walk back POTS, hypermobile EDS, CFS/ME, gastoparesis, fibromyalgia, "long covid" and "chronic Lyme," and all this other wackadoo bullshit the munchies love.Thank you for listening to Sunday Deep Thoughts on NPR. I’m your host, dr Zoidberg.
Here’s a question: Do you guys think it’s possible to walk back POTS as a diagnosis (in the US)? I ask this as a Eurofag & medfag - where I live you’d be laughed out of every single doctor’s office, private and public, if you tried to claim POTS was anything other than an inconvenience that is manageable with pretty basic meds and accommodations. I know there are outliers (some first wave COVID patients for example) that suffer a lot but I’ve asked around at a major university hospital here and infusions are definitely not part of the treatment plan, even for them.
I just don’t understand how this medicalization is justified and it must be a strain on an already broken system to enable this too? Is there no regulatory apparatus that is mandated to curb this? (Believe it or not I’m kind of a libertarian but this shit makes me so MOTI I want STASI to step in right now. Reeee!)
The gals in this thread are idiots and deserve what they get, most of them, anyway. But is it necessary to make it so easy for them to be munchies?
ETA: this goes for gastroparesis too btw.
What we have here is a good 'ol culture bound illness. All these stupid "diseases" have the same things in common: subjective symptoms of pain, fatigue, GI stuff, and "brain fog." Each and every one of these symptoms has a major major psychological component and can (and do!!) manifest from depression alone. Each and every one of these things is more common in people with significant psychiatric comorbidity, particularly eating disorders (also, being underweight can cause these symptoms outright). And all of these diseases predominantly affect affluent, overachieving, mostly white women between 20 and 40.
All of these "diseases" are the same goddamn thing. And they're mostly somatization. And all of the sufferers forcibly reject the idea that their brains could be in ANY way responsible for what they are feeling, and they will happily pay out of pocket and travel around the country for every single medical subspecialist except psychiatry. American medicine still loves to split physical health and mental health into very different categories in spite of the fact that your brain is an organ and controls literally everything you do and everything you experience. This stigma against mental illness makes it really easy for these people to believe that they have 15 different chronic diseases, but it's apparently impossible for them to believe their mind is playing tricks on them.
American medicine also prizes intervention over conservative measures. Preventive and conservative care doesn't pay for shit. Big invasive surgeries and devices, however, reimburse VERY handsomely. Capitalism at its finest! An example: The one therapy that has been proven to be effective for chronic regional pain syndrome (aka amplified pain syndrome) is an intensive inpatient conditioning program that basically trains the brain to ignore inappropriate pain signals from the affected body part. It is laborious for patients and medical staff. It is lengthy. It is HARD. It is expensive to run, because it requires a multidisciplinary team of physicians, psychologists, and physical/occupational therapists, as well as the nurses and support staff. But it fucking WORKS. Because it doesn't generate any income for the hospital, few of these programs exist. Instead, you've got these people going to pain clinics run by anesthesiologists who will perform nerve blocks and other interventions that don't work. But hey, that just means return business, right?
Contrast this to the outright quackery of Bolognese, Henderson, and Klinge, whose work is at least tolerated by the hospital systems they are affiliated with, because it brings in millions of dollars in revenue. It's pretty similar to transgender surgeries. Surely - SURELY the folks at UCSF, the place that pioneered fetal surgery and other borderline insane medical procedures that actually DO work,, know that vaginoplasty and phalloplasty procedures don't fucking work. There's no reason on this earth that any sane physician would ever think that they WOULD work! But the cultural zeitgeist supports it and insurance has to pay for it and it reimburses handsomely (including all the inevitable revisions), so here we are.
We're also in this profoundly weird and horrid cultural space where the personal is the political, people's lived experiences are treated as gospel truth, and telling someone that they've got it wrong is MEDICAL GASLIGHTING, which of course is a cardinal sin. Oh, and no one respects professional opinions anymore, they'd rather get their information from randos on the internet. And most doctors are evaluated by their employers based on - I wish I were fucking kidding - customer satisfaction scores. So physicians are heavily pressured to placate patients with a diagnosis, a referral, a medication - whatever it is that they wanted. A diagnosis is seen as something that at least doesn't cause immediate harm. But once one doctor bestows a diagnosis on a patient and enters it into their medical record, it is legitimized. And once someone starts the cascade of interventions, it's really hard to stop. Often these folks will doctor shop for the quack who'll give them what they want, which is always inappropriate meds, procedures, or surgeries, and then once they get the complications of these unnecessary treatments, they can enter the medical system writ large, because you just can't refuse to treat someone with sepsis even if they gave it to themselves.
American medicine also prizes intervention over conservative measures. Preventive and conservative care doesn't pay for shit. Big invasive surgeries and devices, however, reimburse VERY handsomely. Capitalism at its finest! An example: The one therapy that has been proven to be effective for chronic regional pain syndrome (aka amplified pain syndrome) is an intensive inpatient conditioning program that basically trains the brain to ignore inappropriate pain signals from the affected body part. It is laborious for patients and medical staff. It is lengthy. It is HARD. It is expensive to run, because it requires a multidisciplinary team of physicians, psychologists, and physical/occupational therapists, as well as the nurses and support staff. But it fucking WORKS. Because it doesn't generate any income for the hospital, few of these programs exist. Instead, you've got these people going to pain clinics run by anesthesiologists who will perform nerve blocks and other interventions that don't work. But hey, that just means return business, right?
Contrast this to the outright quackery of Bolognese, Henderson, and Klinge, whose work is at least tolerated by the hospital systems they are affiliated with, because it brings in millions of dollars in revenue. It's pretty similar to transgender surgeries. Surely - SURELY the folks at UCSF, the place that pioneered fetal surgery and other borderline insane medical procedures that actually DO work,, know that vaginoplasty and phalloplasty procedures don't fucking work. There's no reason on this earth that any sane physician would ever think that they WOULD work! But the cultural zeitgeist supports it and insurance has to pay for it and it reimburses handsomely (including all the inevitable revisions), so here we are.
We're also in this profoundly weird and horrid cultural space where the personal is the political, people's lived experiences are treated as gospel truth, and telling someone that they've got it wrong is MEDICAL GASLIGHTING, which of course is a cardinal sin. Oh, and no one respects professional opinions anymore, they'd rather get their information from randos on the internet. And most doctors are evaluated by their employers based on - I wish I were fucking kidding - customer satisfaction scores. So physicians are heavily pressured to placate patients with a diagnosis, a referral, a medication - whatever it is that they wanted. A diagnosis is seen as something that at least doesn't cause immediate harm. But once one doctor bestows a diagnosis on a patient and enters it into their medical record, it is legitimized. And once someone starts the cascade of interventions, it's really hard to stop. Often these folks will doctor shop for the quack who'll give them what they want, which is always inappropriate meds, procedures, or surgeries, and then once they get the complications of these unnecessary treatments, they can enter the medical system writ large, because you just can't refuse to treat someone with sepsis even if they gave it to themselves.
Oh Yeah!
Dr. Spaghetti and his famous craniocervical butchery!
I was unfamiliar with Dr. Petra Klinge, and now I have to look into her. I feel confident it won't be hard to find the ties to Henderson and Bolognese - it's one big circle jerk of quackery and malpractice. Wonder how long she's been at Brown. Usually the big names drop these loony tunes at the first lawsuit.
