I agree with the gist of your post. However, there are some things to consider -
When your standard approach to every fire is to put it out with water, then you are in for a big surprise the first time you have a grease fire.
Doctors panicked, and used what had worked before. Patients were collapsing without any underlying explanation and doctors were throwing everything, including the kitchen sink at the problem.
I'll explain it from a different point of view. Imagine that you noticed the that one of your vehicle's tires was low. You put some air in it. The next day it is low again. You put some air in it and check for a leak, maybe check the valve. The air continues to get low, each day becoming worse. At what point would you think that putting air in the tire was causing the problem?
That's what doctors were facing here. The usual V/Q mismatch (ventilation vs perfusion) rules that they normally used to fix someone's oxygen levels just weren't working. Doctors aren't engineers, and different patients have all sorts of differing reactions to treatments, but many of the basics still apply. When those basics aren't working, it's a completely new game with unknown rules.
The one real potential problem here is that they continued to treat primarily with ventilators for so long, after they weren't seeing some of the patients recover in a few weeks. At that point, they should have been questioning all the methods being used, no matter what the methods were.
I dunno perhaps Doctors are too stuck on convention or perhaps their schooling has failed them to see viable alternatives to pharmaceuticals. We exalt them in society but this only leaves us scrambling when they are wrong or have been politically corrupted. They aren't selfless or any of the higher virtues we extoll, most are in it for the money and apparently a hell of a lot of them will drop their oath to their patients to serve an oath to their license holders or against threats to their pocketbooks.
This is a huge part of the problem. Doctors treat patients in ways that are documented to work, because they can point to the documentation and say "look it isn't malpractice, it's universally accepted standard of care!"
Doctors have to do a lot of stupid shit to make sure their asses are covered in case someone doesn't get the result they were expecting and decides to sue.
Are you suggesting that the pharmaceutical industry should be or currently is in charge of health education? Because that's kind of right in that they are. And no, they shouldn't be.
Yeah they indirectly control what is taught through lobbying. They need to sell their drugs so they lobby and get the regs changed. New docs get taught new regs and better treatments are thrown to the wayside because their greed.
I'm a surgery resident. I graduated top of my class in a top 20 college at age 21, and I'll finish all my training at age 37. For many years I raked in debt, and when I wasn't taking in debt, then 50-70k a year raising a family of 3 kids.
I keep in touch with my friends from college - if they didn't pursue training then they were making nearly 6 figures when done, and easily climbed to 100k-200k for the 16 years while I trained.
I'll probably make 500k when I'm done. It'll be a nice reward. But I calculated I'll be 51 before I even out with my friends that started working right after college.
If you think doctors go into this profession to make money, we are either incredibly stupid at making money, or we aren't doing this to make money.
You can also see why people like Bernie that say doctors earn too much are infuriating
Edited to also add... Those training years are lost, you work 80+ hours a week, thankfully I have a supportive wife but you don't get them back
Keep at it, brotha, I know how hard it is (not from personal experience, but my brother). I always chuckle when people rag on doctors, and especially when they say they "do it for the money." Like you, my brother took on massive debt, just recently finished his residency and fellowship, has boatloads of school debt to pay off, and doesn't even make all that much yet, and is just about 40. Won't be a long while before he's "in the green," so to speak on his investment. Just the amount of work the poor bastard had to put in, I don't think I saw him sleep for about 15 years, constantly buried in a book, it's just insane. I've so much respect for anyone that can didicate that much time, effort, money, and just general sacrafice, for something just because it's a calling, in a way. For my brother, he just knew it was what he wanted to do, set his sights on it early in high school, and busted his ass to do it, but he sure as shit didn't do it for the money lol (not to say he won't be comfortable in some time, but it's hardly the route anyone would go if money is the only goal)
Literally nobody attacks doctors compensation not even Bernie. Insurance companies are usually the target of progressive attacks. But even in that argument doctors have a huge part through billing.
I can imagine that if you stay on the straight and narrow as a doctor you may not become as rich as possible. But since there's so much opportunity getting that pharma money I'm pretty sure it's skewed the ethics for your entire profession from top down.
Where are the voices of health professionals speaking counter to propaganda against treatments like hydroxychloroquine, ignoring studies that directly counter claims the misleadia makes or speaking out for the patients who are waiting for cancer or surgeries they need but can't because the hospital cancelled electives? I feel there should be an ethical requirement that you temper down inflammatory disinformation and try to be less alarmist for everybodies sake, something in your bed side manners etiquette. I see the articles here and while that's helpful our cause really needs your accredited voices speaking directly against politicized organizations giving this distorted health advice. Write a letter to your newspaper and speak out against politicized health and science policy. I dunno something more than following orders, please do the right things here.
Doctors are not that smart. I've gone to school with many of them and have had enough contact with doctors to know this. They stop learning as soon as they're out of school it seems. Most of them I think, do not have the ability to assimilate newer medical information on their own.
The problem with this profession is you are trained to memorize information rather than logical thinking.
Eh... plenty of pulmonologists definitely noticed the odd aspects of the patient presentation that varied from traditional ARDS. Your everyday critical care doc might not notice though
People used to argue with me when I claimed that the only continuing education doctors get is from pharma reps on golf junkets. Now they finish my thought when I bring it up.
Logical thinking doesnt work that well with the human body - we aren't as smart as God our creator - I can think of many examples when logic failed us. we need to do research and study our outcomes
The logic part is for problem solving. That is how they found that Hydroxycholoroquine helps. Problem is DEM/SM is fighting tooth and nail to keep solutions away from this problem. The lack of logic on the part of health care providers make a lot of them follow in the footsteps of DEM/SM. The good thing is there are some that have critical thinking skills, and would actually look at and comprehend the data provided instead of dismissing everything as anecdotal evidence. What is a case study.
If you can't see that pharma has taken over the healthcare industry with dangerous consequences to humanity as a whole then you've just not been looking or you're shilling for financial interest. There a reason the worlds richest man left his money maker computer software operation to suddenly turn to marketing and manufacturing vaccines. Individuals deserve to have access to whatever healthcare they need but HEALTHCARE POLICY AND EDUCATION should not be wholly funded by Merck, DuPont, Pfizer and their like and their medical authority absolutely should be questioned.
Also the use of hydroxychloroquine is obviously being pushed back by the medical industry, would you compare it to healing crystals? Because that's what the generalized healthcare industry would seem to be saying. Why are you here in this forum again?
I have been reading that 90-95% on ventilators die anyway for at least a month now. And reading from doctors saying that the ventilators make it WORSE. They actually stress your lungs more when they are already sore/hurting.
I don't think every doctor goes around trying to kill people but goddamn has this ever exposed how useless our medical systems generally are...
You realize that the point of ventilators is to deliver oxygen right? Rona causes ARDS which essentially fills the tiny sacks in your lungs with junk and decreases the surface area to absorb oxygen. Not all to much to do for that
Your lack of understanding masquerading as condescension is staggering.
You realize that the point of ventilators is to deliver oxygen right?
The point of ventilators is to deliver a pressurized gas. In most cases that gas is actually just room air because your alveoli are fine, they're just obstructed, as you say. They can be modified to deliver pressurized oxygen instead of just room air. This is important because:
Rona causes ARDS
Yes.
which essentially fills the tiny sacks in your lungs with junk
No. That is only one of many possible reasons for ARDS. In the case of corona, that does not happen. Corona causes ARDS through low oxygenation due to hemoglobin destruction. Your lungs don't have gunk in them. It's your blood that doesn't have what it needs to carry oxygen. So pressurized ventilators pushing room air didn't help at all.
On top of that, hemoglobin breakdown leads to free iron in your blood, which damages the alveoli that are already delicate as hell. When they are damaged, a pressurized ventilator can cause them to rupture, which is why ventilators are actually doing more harm than good and you have such high death rates with ventilated patients. The ventilators are making the problem worse.
However, low pressure ventilators that are modified to push oxygen at low pressure rather than room air at high pressure work very well, especially combined with blood transfusions.
Or you could just use anti-malarial medication early coughhydroxychloroquinecough and prevent the hemoglobin breakdown in the first place.
Old news. The virus has a completely different effect on the lungs than the classic pneumonia.
At first, the lungs are +- alright if somewhat damaged by Covid, but people are still hypoxic. The latest news from post-mortems in Germany and Switzerland is that the micro-circulation is all fucked in the alveoles, meaning that the oxygen is getting into the lungs, but isn't getting into the blood and you need to improve that instead of pumping in air that can't go into the blood anyway.
Russia is testing breathing really hot helium to try and unfuck the circulation. Others are trying NO gas. Other still are trying hyperbaric chambers.
We don't know if it works yet, but we do know that the ventilators don't really work in this first stage of the disease when your lung tissue isn't too far gone yet but the blood oxygen level is already really low.
Fyi, This is grossly oversimplifying things. Ventilators absolutely work to treat hypoxia, which is why they were picked in the first place. There are many causes of hypoxia though, and traditional ARDS strategy was the wrong choice for this disease process that still isn't fully understood. There are characteristic lab abnormalities that happen and major concerns of DIC. Some initially claimed it was a hemoglobin binding issue, but that fails to explain low PaO2/FiO2 ratios - since PaO2 is the dissolved O2 in plasma and doesn't involve hemoglobin as a factor. There is clearly a perfusion related V/Q abnormality
You might have missed it but there are a bunch of posts on here with information from some of the few doctors that are actually smart.
The muscles that control breathing work fine, they do not need the ventilator for that purpose. Yet doctors are setting them at a pressure to breathe for them, thus crushing aveoli. Damaged lungs folks.
The virus decouples heme group from hemoglobin, so now your blood has less ability to transport oxygen. You have to wait for new hemoglobin to be created now. (It takes cancer patients a couple weeks to recover levels after a treatment) The decoupling of heme causes another problem since free roaming metals poisons organs.
Hydroxychloroquine/zinc will stop the virus from replicating, giving your immune system time to fight off the virus before it sends the patient into organ failure.
IT IS A CRIME WHAT DEM/SM IS DOING TO DISCREDIT THIS DRUG.
We are losing more lives than necessary because of this political bullshit.
I saw a physician interviewed on OAN last night, who was saying there's a big problem with blood clotting in COVID-19 patients, and that this wasn't recognized at first. Sometimes it's causing strokes -- in a few cases that was the first thing that sent a patient to a hospital -- but also causing clotting elsewhere (I would assume including lungs, but I didn't catch the whole segment). A couple of days ago, I read about an actor who had a leg amputated due to a clot which developed while he was hospitalized for coronavirus.
Yes, and all physicians know that. This is something different. In addition to seeing unusual clotting in already hospitalized patients, they're seeing it in young healthy people upon admission, including a couple of cases where a stroke was what prompted them to be taken to a hospital, and they had not yet had any other symtpoms of COVID-19.
Some were and are quietly using it. One doctor I know said at the very beginning "That shit works, and I'm using it for my patients. If they want to fire me, then go ahead, I don't care."
I agree with the gist of your post. However, there are some things to consider -
When your standard approach to every fire is to put it out with water, then you are in for a big surprise the first time you have a grease fire.
Doctors panicked, and used what had worked before. Patients were collapsing without any underlying explanation and doctors were throwing everything, including the kitchen sink at the problem.
I'll explain it from a different point of view. Imagine that you noticed the that one of your vehicle's tires was low. You put some air in it. The next day it is low again. You put some air in it and check for a leak, maybe check the valve. The air continues to get low, each day becoming worse. At what point would you think that putting air in the tire was causing the problem?
That's what doctors were facing here. The usual V/Q mismatch (ventilation vs perfusion) rules that they normally used to fix someone's oxygen levels just weren't working. Doctors aren't engineers, and different patients have all sorts of differing reactions to treatments, but many of the basics still apply. When those basics aren't working, it's a completely new game with unknown rules.
The one real potential problem here is that they continued to treat primarily with ventilators for so long, after they weren't seeing some of the patients recover in a few weeks. At that point, they should have been questioning all the methods being used, no matter what the methods were.
I dunno perhaps Doctors are too stuck on convention or perhaps their schooling has failed them to see viable alternatives to pharmaceuticals. We exalt them in society but this only leaves us scrambling when they are wrong or have been politically corrupted. They aren't selfless or any of the higher virtues we extoll, most are in it for the money and apparently a hell of a lot of them will drop their oath to their patients to serve an oath to their license holders or against threats to their pocketbooks.
This is a huge part of the problem. Doctors treat patients in ways that are documented to work, because they can point to the documentation and say "look it isn't malpractice, it's universally accepted standard of care!"
Doctors have to do a lot of stupid shit to make sure their asses are covered in case someone doesn't get the result they were expecting and decides to sue.
Guess who teaches the doctors what techniques to use? Who influences doctors treatments?
This is why I make my own artisan, small batch, copper still organic methamphetamine from ephedra plants and mine-fresh lithium to treat my ADHD
Interesting, a craft stimulant!
Are you suggesting that the pharmaceutical industry should be or currently is in charge of health education? Because that's kind of right in that they are. And no, they shouldn't be.
Yeah they indirectly control what is taught through lobbying. They need to sell their drugs so they lobby and get the regs changed. New docs get taught new regs and better treatments are thrown to the wayside because their greed.
I'm a surgery resident. I graduated top of my class in a top 20 college at age 21, and I'll finish all my training at age 37. For many years I raked in debt, and when I wasn't taking in debt, then 50-70k a year raising a family of 3 kids.
I keep in touch with my friends from college - if they didn't pursue training then they were making nearly 6 figures when done, and easily climbed to 100k-200k for the 16 years while I trained.
I'll probably make 500k when I'm done. It'll be a nice reward. But I calculated I'll be 51 before I even out with my friends that started working right after college.
If you think doctors go into this profession to make money, we are either incredibly stupid at making money, or we aren't doing this to make money.
You can also see why people like Bernie that say doctors earn too much are infuriating
Edited to also add... Those training years are lost, you work 80+ hours a week, thankfully I have a supportive wife but you don't get them back
Keep at it, brotha, I know how hard it is (not from personal experience, but my brother). I always chuckle when people rag on doctors, and especially when they say they "do it for the money." Like you, my brother took on massive debt, just recently finished his residency and fellowship, has boatloads of school debt to pay off, and doesn't even make all that much yet, and is just about 40. Won't be a long while before he's "in the green," so to speak on his investment. Just the amount of work the poor bastard had to put in, I don't think I saw him sleep for about 15 years, constantly buried in a book, it's just insane. I've so much respect for anyone that can didicate that much time, effort, money, and just general sacrafice, for something just because it's a calling, in a way. For my brother, he just knew it was what he wanted to do, set his sights on it early in high school, and busted his ass to do it, but he sure as shit didn't do it for the money lol (not to say he won't be comfortable in some time, but it's hardly the route anyone would go if money is the only goal)
Literally nobody attacks doctors compensation not even Bernie. Insurance companies are usually the target of progressive attacks. But even in that argument doctors have a huge part through billing.
I can imagine that if you stay on the straight and narrow as a doctor you may not become as rich as possible. But since there's so much opportunity getting that pharma money I'm pretty sure it's skewed the ethics for your entire profession from top down.
Where are the voices of health professionals speaking counter to propaganda against treatments like hydroxychloroquine, ignoring studies that directly counter claims the misleadia makes or speaking out for the patients who are waiting for cancer or surgeries they need but can't because the hospital cancelled electives? I feel there should be an ethical requirement that you temper down inflammatory disinformation and try to be less alarmist for everybodies sake, something in your bed side manners etiquette. I see the articles here and while that's helpful our cause really needs your accredited voices speaking directly against politicized organizations giving this distorted health advice. Write a letter to your newspaper and speak out against politicized health and science policy. I dunno something more than following orders, please do the right things here.
Doctors are not that smart. I've gone to school with many of them and have had enough contact with doctors to know this. They stop learning as soon as they're out of school it seems. Most of them I think, do not have the ability to assimilate newer medical information on their own.
The problem with this profession is you are trained to memorize information rather than logical thinking.
Eh... plenty of pulmonologists definitely noticed the odd aspects of the patient presentation that varied from traditional ARDS. Your everyday critical care doc might not notice though
They noticed it but do not have the ability to do anything with that information. That is what we are seeing.
People used to argue with me when I claimed that the only continuing education doctors get is from pharma reps on golf junkets. Now they finish my thought when I bring it up.
It really opens your eyes when you need a doctor for something and they don't have any answers.
Logical thinking doesnt work that well with the human body - we aren't as smart as God our creator - I can think of many examples when logic failed us. we need to do research and study our outcomes
The logic part is for problem solving. That is how they found that Hydroxycholoroquine helps. Problem is DEM/SM is fighting tooth and nail to keep solutions away from this problem. The lack of logic on the part of health care providers make a lot of them follow in the footsteps of DEM/SM. The good thing is there are some that have critical thinking skills, and would actually look at and comprehend the data provided instead of dismissing everything as anecdotal evidence. What is a case study.
If you can't see that pharma has taken over the healthcare industry with dangerous consequences to humanity as a whole then you've just not been looking or you're shilling for financial interest. There a reason the worlds richest man left his money maker computer software operation to suddenly turn to marketing and manufacturing vaccines. Individuals deserve to have access to whatever healthcare they need but HEALTHCARE POLICY AND EDUCATION should not be wholly funded by Merck, DuPont, Pfizer and their like and their medical authority absolutely should be questioned.
Also the use of hydroxychloroquine is obviously being pushed back by the medical industry, would you compare it to healing crystals? Because that's what the generalized healthcare industry would seem to be saying. Why are you here in this forum again?
I'm with you. How anyone can have any respect for the western medical system after this is beyond me.
Let me introduce you to this wonderful thing called "homeopathy", my friend!!!
I have been reading that 90-95% on ventilators die anyway for at least a month now. And reading from doctors saying that the ventilators make it WORSE. They actually stress your lungs more when they are already sore/hurting.
I don't think every doctor goes around trying to kill people but goddamn has this ever exposed how useless our medical systems generally are...
Yes they needed oxygen, not ventilators
"...And reading from doctors saying that the ventilators make it WORSE. They actually stress your lungs more when they are already sore/hurting"
You realize that the point of ventilators is to deliver oxygen right? Rona causes ARDS which essentially fills the tiny sacks in your lungs with junk and decreases the surface area to absorb oxygen. Not all to much to do for that
Your lack of understanding masquerading as condescension is staggering.
The point of ventilators is to deliver a pressurized gas. In most cases that gas is actually just room air because your alveoli are fine, they're just obstructed, as you say. They can be modified to deliver pressurized oxygen instead of just room air. This is important because:
Yes.
No. That is only one of many possible reasons for ARDS. In the case of corona, that does not happen. Corona causes ARDS through low oxygenation due to hemoglobin destruction. Your lungs don't have gunk in them. It's your blood that doesn't have what it needs to carry oxygen. So pressurized ventilators pushing room air didn't help at all.
On top of that, hemoglobin breakdown leads to free iron in your blood, which damages the alveoli that are already delicate as hell. When they are damaged, a pressurized ventilator can cause them to rupture, which is why ventilators are actually doing more harm than good and you have such high death rates with ventilated patients. The ventilators are making the problem worse.
However, low pressure ventilators that are modified to push oxygen at low pressure rather than room air at high pressure work very well, especially combined with blood transfusions.
Or you could just use anti-malarial medication early coughhydroxychloroquinecough and prevent the hemoglobin breakdown in the first place.
Old news. The virus has a completely different effect on the lungs than the classic pneumonia.
At first, the lungs are +- alright if somewhat damaged by Covid, but people are still hypoxic. The latest news from post-mortems in Germany and Switzerland is that the micro-circulation is all fucked in the alveoles, meaning that the oxygen is getting into the lungs, but isn't getting into the blood and you need to improve that instead of pumping in air that can't go into the blood anyway.
Russia is testing breathing really hot helium to try and unfuck the circulation. Others are trying NO gas. Other still are trying hyperbaric chambers.
We don't know if it works yet, but we do know that the ventilators don't really work in this first stage of the disease when your lung tissue isn't too far gone yet but the blood oxygen level is already really low.
Ventilators totally work for hypoxia. Why would you want iron ?
Fyi, This is grossly oversimplifying things. Ventilators absolutely work to treat hypoxia, which is why they were picked in the first place. There are many causes of hypoxia though, and traditional ARDS strategy was the wrong choice for this disease process that still isn't fully understood. There are characteristic lab abnormalities that happen and major concerns of DIC. Some initially claimed it was a hemoglobin binding issue, but that fails to explain low PaO2/FiO2 ratios - since PaO2 is the dissolved O2 in plasma and doesn't involve hemoglobin as a factor. There is clearly a perfusion related V/Q abnormality
You might have missed it but there are a bunch of posts on here with information from some of the few doctors that are actually smart.
The muscles that control breathing work fine, they do not need the ventilator for that purpose. Yet doctors are setting them at a pressure to breathe for them, thus crushing aveoli. Damaged lungs folks.
The virus decouples heme group from hemoglobin, so now your blood has less ability to transport oxygen. You have to wait for new hemoglobin to be created now. (It takes cancer patients a couple weeks to recover levels after a treatment) The decoupling of heme causes another problem since free roaming metals poisons organs.
Hydroxychloroquine/zinc will stop the virus from replicating, giving your immune system time to fight off the virus before it sends the patient into organ failure.
IT IS A CRIME WHAT DEM/SM IS DOING TO DISCREDIT THIS DRUG. We are losing more lives than necessary because of this political bullshit.
Outside of surgery techniques, medical science is barely above the Middle Ages as far as knowledge of biophysics and pharmaceuticals.
Medical science still relies on “Double blind trials” which is another way of saying “We have no clue how this shit really works.”
Imagine living in a skyscraper or flying on an airplane designed with “Double blind trials.”
I saw a physician interviewed on OAN last night, who was saying there's a big problem with blood clotting in COVID-19 patients, and that this wasn't recognized at first. Sometimes it's causing strokes -- in a few cases that was the first thing that sent a patient to a hospital -- but also causing clotting elsewhere (I would assume including lungs, but I didn't catch the whole segment). A couple of days ago, I read about an actor who had a leg amputated due to a clot which developed while he was hospitalized for coronavirus.
Clots are common in hospital stays, many patients who are admitted are put on blood thinners for that reason
Yes, and all physicians know that. This is something different. In addition to seeing unusual clotting in already hospitalized patients, they're seeing it in young healthy people upon admission, including a couple of cases where a stroke was what prompted them to be taken to a hospital, and they had not yet had any other symtpoms of COVID-19.
They were throwing every thing (except HydroxyChloroquine cuz TDS) and the kitchen sink at the problem....
Just a little insertion there pede!!
Some were and are quietly using it. One doctor I know said at the very beginning "That shit works, and I'm using it for my patients. If they want to fire me, then go ahead, I don't care."