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What Should We Ask the Doctor?

This post will be a surprise to regular readers, as it isn’t yet another rant on grammar or usage.


I’m a follower of Seth Roberts’ blog, which I recommend, and I’ve been doing some thinking about an issue recently addressed in it.


First, a disclaimer: I am not an expert on any of this, and I haven’t researched any of it. These are just some of my own thoughts, which may not even be original. Please view them as nothing more than my own gropings toward understanding.


It seems to me that there are two kinds of medical “problems”: the first is the kind for which we go to the doctor because it’s negatively affecting our quality of life: restless legs, migraine headaches, irritable bowel syndrome; and we go hoping for a treatment that will get rid of, or at least ameliorate, our symptoms, so as to improve our quality of life.


In these cases, it’s up to us to evaluate the recommended treatment and we are able to do so: first, based on cost, reported effectiveness, and possible side effects, are we willing to try it? second, if we do try it, how effective is it for us? and third, is it effective enough to outweigh any unpleasant side effects we may experience? In other words, we conduct self-experimentation to find the most effective treatment.


The second kind of “problem” is not one for which we seek medical help. Nobody goes to the doctor complaining of high cholesterol, for example. The “problem” of high cholesterol is, rather, brought to our attention by the doctor.


The doctor’s solution to this problem is (usually) a medication that will lower our high cholesterol.


Cholesterol may or may not be a contributing factor to death from heart disease; that’s a different discussion, one I’m not qualified to conduct or take part in. But nobody has ever suffered from poor quality of life, much less died, because of high cholesterol all by itself. Nobody even notices whether they have high cholesterol.


It follows that, for the patient, the lowering of the cholesterol number is not a good to be desired of itself, on a par with getting rid of restless legs or migraine pain or the unpleasant symptoms of irritable bowel syndrome.


The reason for lowering cholesterol is not just to have lower cholesterol; it’s to prevent heart disease and thus prolong life.


We can’t evaluate how effective lowered cholesterol is for us in preventing heart disease or in prolonging our life; therefore, we also can’t decide whether any side effects are worth it. We have to trust the doctor or do our own research (or both: trust, but verify).


Therefore, when the doctor prescribes a medication designed to lower our cholesterol, it seems to me that the question we should be asking is not, “What evidence do you have that  this treatment will lower my cholesterol?” but “What evidence do you have that this treatment will prolong my life?”


And I think our second question should be, “Were any of the studies you cite conducted on people my age?” And, in my own case, “Were any of them conducted on women?”


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