We shouldn't take expert advice at face value

Zimmey · 26-12-2015 03:44PM

I think a lot of doctors give bad advice on nutrition. I mean, some still advocate the food pyramid, FFS.

Having said that, there's a lot of junk advice on the internet too so I wouldn't advocate relying on that too much either, TBH. It's easy to check the credentials of the person giving you advice in the doctor's office. And doctors have a wealth of knowledge that they can draw on to deal with the nuances in individual cases. You can't get this off the internet.

steddyeddy · 26-12-2015 03:48PM

By the way guys I should have made my OP clearer. I'm not saying you should refute or even second guess your doctors advice. I'm saying you should take expert advice aimed at the mainstream with a pinch of salt.

steddyeddy · 26-12-2015 03:49PM

Zimmey wrote: »

I think a lot of doctors give bad advice on nutrition. I mean, some still advocate the food pyramid, FFS.

Having said that, there's a lot of junk advice on the internet too so I wouldn't advocate relying on that too much either, TBH.

Bingo on the food pyramid. Get nutrition advice from a nutritionist not a doctor unless it's simple advice.

26-12-2015 03:52PM

steddyeddy wrote: »

Bingo on the food pyramid. Get nutrition advice from a nutritionist not a doctor unless it's simple advice.

Do not get dietary advice from a nutritionist. It is not a protected title and nearly anyone could call themselves a nutritionist.

Get nutritional advice from a dietitian, which is a protected title that requires years of study to obtain.

Any half-wit can set themselves up in a Holland and Barratts with some flower remedies and goji berries and call themselves a nutritionist.

There are some who have some qualifications and expertise, but it's by no means a given.

Zimmey · 26-12-2015 03:53PM

steddyeddy wrote: »

The biggest one that scientists are trying to stamp out is the advice some doctors give their pregnant clients "one or two glasses of wine won't or might not hurt".

They mean the last trimester, don't they? I don't think many advocate it before six months.

Zimmey · 26-12-2015 03:59PM

Wibbs wrote: »

The Lancet reported similar recently. Industry pressure and the rush to publish means a lot of nonsense gets through.

Absolutely. There is a notion that everything that ends up in peer-reviewed high impact journals is top notch, but this is so not true. Science is as susceptible to politics as any other area. In third level, science students learn to analyse published, peer-reviewed articles in journal club to figure out if they are any good and, believe me, some if them aren't.

steddyeddy · 26-12-2015 04:01PM

Candie wrote: »

Do not get dietary advice from a nutritionist. It is not a protected title and nearly anyone could call themselves a nutritionist.

Get nutritional advice from a dietitian, which is a protected title that requires years of study to obtain.

Any half-wit can set themselves up in a Holland and Barratts with some flower remedies and goji berries and call themselves a nutritionist.

There are some who have some qualifications and expertise, but it's by no means a given.

Quite right Candie! I stand corrected said the man in the orthopaedic shoes.

26-12-2015 04:02PM

steddyeddy wrote: »

Quite right Candie! I stand corrected said the man in the orthopaedic shoes.

A lot of time is spent on nutrition in med school, it's something of a popular myth that it's not the case.

I suspect older doctors who may not be as well up on the subject may be the ones who peddle the food pyramid.

Muppet Man · 26-12-2015 04:08PM

OP, if you haven't already read it, I would strongly advise taking a look at "bad science" by Ben goldacre. One of the best non fiction books I've ever read, and very accessible for the average punter.... Take a look at the chapter listings here, and you will get a feel for its direction.

https://en.m.wikipedia.org/wiki/Bad_Science_(book)

He doesn't hold back on Gillian Mckeith.... A nutritionist and "doctor"

Muppet man

steddyeddy · 26-12-2015 04:19PM

Candie wrote: »

A lot of time is spent on nutrition in med school, it's something of a popular myth that it's not the case.

I suspect older doctors who may not be as well up on the subject may be the ones who peddle the food pyramid.

Actually that very much depends on the course. Also you'll need to define learning about nutrition. Learning what a calorie is and what percentage of nutritional intake should come from which macronutrient isn't really learning about nutrition.

That's rote learning and bypassing learning about how it actually works. A lot of medical students protest at having to learn about biochemistry which is the fundamentals about how everything works including nutrition.

26-12-2015 04:30PM

steddyeddy wrote: »

Actually that very much depends on the course. Also you'll need to define learning about nutrition. Learning what a calorie is and what percentage of nutritional intake should come from which macronutrient isn't really learning about nutrition.

That's rote learning and bypassing learning about how it actually works. A lot of medical students protest at having to learn about biochemistry which is the fundamentals about how everything works including nutrition.

Thats a big generalisation there. Understanding in context is a big part of medical biochem.

I'm sure some med students don't enjoy biochemistry (or any other part of the course), it doesn't mean it's not taught well.

Tipperary Fairy · 26-12-2015 04:32PM

Candie wrote: »

Do not get dietary advice from a nutritionist. It is not a protected title and nearly anyone could call themselves a nutritionist.

Get nutritional advice from a dietitian, which is a protected title that requires years of study to obtain.

Any half-wit can set themselves up in a Holland and Barratts with some flower remedies and goji berries and call themselves a nutritionist.

There are some who have some qualifications and expertise, but it's by no means a given.

Dietitian is not a protected title in Ireland, yet. But I understand your point. However I would also point out that many people go to counsellors, career guidance counsellors, physiotherapists, psychologists etc etc etc, and I'm sure many benefit from them.

Zimmey · 26-12-2015 04:35PM

Candie wrote: »

Thats a big generalisation there. Understanding in context is a big part of medical biochem.

I'm sure some med students don't enjoy biochemistry (or any other part of the course), it doesn't mean it's not taught well.

And doctors simply don't need to know biochemistry to the level of detail that biochemists do. And they wouldn't have time to learn it to that level either, their course is jam-packed as it is!

26-12-2015 04:37PM

Tipperary Fairy wrote: »

Dietitian is not a protected title in Ireland, yet.

That's interesting. However, only dieticians can be employed by the HSE in Ireland according to this:

https://www.indi.ie/what-is-a-dietitian/dietitians-nutrition-experts.html

The advice still stands, get your dietary advice from your doctor or a dietician with qualifications that can be verified and checked and provide demonstrable vigorous knowlege and training.

Consult a nutritionist at your own risk, as they may be unhelpful, untrained, or downright dangerous.

steddyeddy · 26-12-2015 04:38PM

Candie wrote: »

Thats a big generalisation there. Understanding in context is a big part of medical biochem.

I'm sure some med students don't enjoy biochemistry (or any other part of the course), it doesn't mean it's not taught well.

Ha ha I taught it so it's taught well. I'm saying biochem is about understanding as opposed to rote learning. Understanding context does not equal understanding. You may understand the context in which alcohol is metabolised during pregnancy for instance but you need to understand the mechanism too.

gctest50 · 26-12-2015 04:40PM

Tipperary Fairy wrote: »

Dietitian is not a protected title in Ireland, yet. But I understand your point. However I would also point out that many people go to counsellors, career guidance counsellors, physiotherapists, psychologists etc etc etc, and I'm sure many benefit from them.

The title "Registered Dietitian” and "Dietitian" are now protected by law

.

steddyeddy · 26-12-2015 04:40PM

Zimmey wrote: »

And doctors simply don't need to know biochemistry to the level of detail that biochemists do. And they wouldn't have time to learn it to that level either, their course is jam-packed as it is!

No they wouldn't at all. Saying that they should know the principles of biochemistry and enzymes.

Zimmey · 26-12-2015 04:43PM

steddyeddy wrote: »

Ha ha I taught it so it's taught well. I'm saying biochem is about understanding as opposed to rote learning. Understanding context does not equal understanding. You may understand the context in which alcohol is metabolised during pregnancy for instance but you need to understand the mechanism too.

I don't really think a doctor needs to know the mechanism. Doctors aren't scientists and vice versa. If a doctor was getting involved in research a particular area, then they'd need to know. And they'd be fine then. Biology isn't that hard to learn, in my experience.

Tipperary Fairy · 26-12-2015 04:44PM

Candie wrote: »

That's interesting. However, only dieticians can be employed by the HSE in Ireland according to this:

The advice still stands, get your dietary advice from your doctor or a dietician with qualifications that can be verified and checked and provide demonstrable vigorous knowlege and training.

Consult a nutritionist at your own risk, as they may be unhelpful, untrained, or downright dangerous.

I'm not advocating for unregulated professions, not at all. I'm just making the point that just because something isn't regulated, doesn't mean that people can't benefit from them. Also being regulated doesn't guarantee good quality professionals.

26-12-2015 04:44PM

Tipperary Fairy wrote: »

Dietitian is not a protected title in Ireland, yet. But I understand your point. However I would also point out that many people go to counsellors, career guidance counsellors, physiotherapists, psychologists etc etc etc, and I'm sure many benefit from them.

I would hope that no one goes to any of these people without researching their qualifications first.

Psychologists at least have to have a degree in psychology, not so for a psychotherapist. Likewise with physiotherapy, unlike a physical therapist.

Counsellors and life coaches and the like may have a qualification, but the quality of it might not be up to much.

The only important thing to do is to make sure you're putting your trust in someone trustworthy, someone who fudges their qualifications will never be someone to trust.

(see 'Dr' Gillian McKeith, as mentioned earlier)

Zimmey · 26-12-2015 04:45PM

steddyeddy wrote: »

No they wouldn't at all. Saying that they should know the principles of biochemistry and enzymes.

I'm sure they learn that in the first few years, just like science students who don't specialise in biochemistry do.

Diamond Doll · 26-12-2015 04:48PM

steddyeddy wrote: »

The other one that gets me relates to drinking during pregnancy. We seem to have some doctors telling people a few glasses of wine is OK.

Science says there is no safe level of alcohol for a fetus.

Actually the generally accepted truth is that no alcohol can pass to the foetus until the placenta is formed, at 5-6 weeks. So if someone were to go on a bender before then, no harm done!

Foetal Alcohol Syndrome (FAS), if it occurs, occurs in the first trimester (but after the first 5-6 weeks.) So it's best to abstain from alcohol for that time.

Moderate amounts of alcohol in the second and third trimester are not known to cause any damage.

I had one West Coast Cooler at around 7 months pregnant. I'm not concerned that it caused my baby any harm whatsoever. I also probably got drunk a few times before I knew I was pregnant, hence me doing so much research into it, and I was reassured that by the time I found out (before four weeks) it was too early for me to have done any damage to the baby.

Smoking is far more dangerous than drinking during pregnancy - it is never safe and will damage the foetus to some extent at any stage. Careful moderate drinking is fine though.

steddyeddy · 26-12-2015 04:53PM

Zimmey wrote: »

I don't really think a doctor needs to know the mechanism. Doctors aren't scientists and vice versa. If a doctor was getting involved in research a particular area

On a separate issue Zimmy that's one of the reasons biochem is taught to medical students. Unfortunately it becomes a problem when they go into research. It's a public secret that scientists are warned off doing PhD's with clinicians for that reason. I don't think training with a consultant is good enough for research anymore.

then they'd need to know. And they'd be fine then. Biology isn't that hard to learn, in my experience.

I do think doctors should know about biochemical pathways, enzyme inhibition ect. They underlie all disease and treatment.

One of the things I taught was the metabolism of alcohol and the effect of alcohol on pathways. That's what I teach to medical students. If I was to teach that to biochems I would tell them how to determine the metabolic pathways. So it really is the basics being learned and there's no excuse not to know it.

For instance do you think a doctor saying one or two glasses are fine during pregnancy should need to know how ethanol is metabolised?

Tipperary Fairy · 26-12-2015 04:58PM

Candie wrote: »

I would hope that no one goes to any of these people without researching their qualifications first.

Psychologists at least have to have a degree in psychology, not so for a psychotherapist. Likewise with physiotherapy, unlike a physical therapist.

Counsellors and life coaches and the like may have a qualification, but the quality of it might not be up to much.

The only important thing to do is to make sure you're putting your trust in someone trustworthy, someone who fudges their qualifications will never be someone to trust.

(see 'Dr' Gillian McKeith, as mentioned earlier)

But how do you make sure someone is trustworthy? Let's face it, the majority of people going to see someone who they need for any of those reasons don't know what qualifications they should have even if they were to look them up. Would you? I wouldn't.

I don't understand why you're saying a psychologist must have a degree, must by whose rules?

Zimmey · 26-12-2015 04:59PM

steddyeddy wrote: »

Zimmey wrote: »

I don't really think a doctor needs to know the mechanism. Doctors aren't scientists and vice versa. If a doctor was getting involved in research a particular area

On a separate issue Zimmy that's one of the reasons biochem is taught to medical students. Unfortunately it becomes a problem when they go into research. It's a public secret that scientists are warned off doing PhD's with clinicians for that reason. I don't think training with a consultant is good enough for research anymore.

I do think doctors should know about biochemical pathways, enzyme inhibition ect. They underlie all disease and treatment.

One of the things I taught was the metabolism of alcohol and the effect of alcohol on pathways. That's what I teach to medical students. If I was to teach that to biochems I would tell them how to determine the metabolic pathways. So it really is the basics being learned and there's no excuse not to know it.

For instance do you think a doctor saying one or two glasses are fine during pregnancy should need to know how ethanol is metabolised?

Doctors involved in setting official medical guidelines should have deep scientific knowledge. I don't believe all doctors need to have it, no. They just need to follow the guidelines.

steddyeddy · 26-12-2015 05:01PM

Candie wrote: »

I would hope that no one goes to any of these people without researching their qualifications first.

Psychologists at least have to have a degree in psychology, not so for a psychotherapist. Likewise with physiotherapy, unlike a physical therapist.

Counsellors and life coaches and the like may have a qualification, but the quality of it might not be up to much.

The only important thing to do is to make sure you're putting your trust in someone trustworthy, someone who fudges their qualifications will never be someone to trust.

(see 'Dr' Gillian McKeith, as mentioned earlier)

Saying that Candie someone who does a nutrition degree B.Sc. will have more nutrition education than a medical student would.

A lot of the public seem to buy into doctors of medicine claiming to be nutritionists lately and telling people how to lose weight. A doctor is not a nutritionist as Ben Goldacre spells out.

KomradeBishop · 26-12-2015 05:02PM

Herb Powell wrote: »

The fact of the matter, lads, is that doctors (real ones, at least) know more than anyone who hasn't gone through the rigourous study and training that they have, and should be trusted above anyone else.

We can all point out past instances where the doctors were wrong, but at any given time, medical professionals are the authority. The average person, thanks to internet echo chambers, has been given an inflated sense of intelligence, importance, and pretty much any other bad thing you can think of. Aside from exceptional geniuses, the average person knows fucck all about medicine.

I agree with your main point OP, that you should be sure anyone you are taking medical advice from is a real doctor, but some people seem to be missing that. There's some real dangerous anti-intellectual stuff being said, and it's how we ended up with the anti-vaccine nonsense and a whole host of other problems.

This is only being made worse by the internet with every idiot thinking they know better than the doctors.

That's a dangerous level of faith to put in anyone really - doctors are just human, and make massive fúckups all the time - nobody should ever put full trust in an 'authority' like that, that is what is anti-intellectual.

People should always try to inform themselves, and if it's something particularly serious with a doctor that's going to be a long term issue, making sure to inform themselves and get second/third/etc. opinions, rather than just trusting, is important.

People should know by now, that 'experts' in pretty much any field, are just as fallible as any other human, and should never be treated as an absolute unquestioned authority - even if you can't adequately inform yourself on a topic of concern, if it's something serious enough, should always seek multile professional opinions.

26-12-2015 05:04PM

Tipperary Fairy wrote: »

But how do you make sure someone is trustworthy? Let's face it, the majority of people going to see someone who they need for any of those reasons don't know what qualifications they should have. Would you? I wouldn't.

I'd certainly ask about them, and research them online to see how rigorous the study involved is. Anyone worth their salt would be completely transparent about these things. Its a red flag if they aren't.

As with anything else, it's a case of buyer beware. It's better to do some research into anything you're going to spend your money on than blindly trust.

gctest50 · 26-12-2015 05:04PM

steddyeddy wrote: »

.....Doctors aren't scientists and vice versa.

this one was dedicated to science

The driver, referred to only as Roberto, protested his innocence and argued the only way he could have failed the routine drugs test was because he had a cup of “delisse alla coca” tea the day before

His doctor asked him to bring the tea bags to his office, after the bus driver claimed the drink made him feel more alert at the wheel.
After drinking a cup, the doctor tested himself and also tested positive for cocaine.

http://www.independent.co.uk/news/world/europe/tea-containing-cocaine-has-been-on-sale-in-italy-for-years-a6785876.html

steddyeddy · 26-12-2015 05:09PM

Zimmey wrote: »

steddyeddy wrote: »

Zimmey wrote: »

I don't really think a doctor needs to know the mechanism. Doctors aren't scientists and vice versa. If a doctor was getting involved in research a particular area

Doctors involved in setting official medical guidelines should have deep scientific knowledge. I don't believe all doctors need to have it, no. They just need to follow the guidelines.

Zimmy I'm not trying to bash doctors. They do a very tough job and are very knowledgeable.

If for instance they talk about weightloss or alcohol tolerance for their foetus they really should know what they were talking about. A friend of mine is a GP and tells (reassures) some of his clients that one or two glasses were fine. He's really just afraid to disagree with them IMHO. I jokingly asked him what enzyme breaks down alcohol and what levels where needed to breakdown a glass of wine and finally what levels of alcohol dehydrogenase the woman had in her system. He didn't know but he would have to know before being able to say that one or two glasses is ok.

We shouldn't take expert advice at face value

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