Tuesday, November 14, 2023

Doctor in the Tardis

After a decade-long hiatus of not seeing my family doctor, on September 27 I had my first appointment with a new doctor. After taking down some of my personal information we agreed to my doing a blood test and an Ontario Health fecal immunochemical test. In an October 13 phone appointment, he relayed the bad news: My cholesterol was high, which when combined with my family history of stroke (my father had one) suggested medication. When I indicated reticence to go on meds he allowed me a three-month reprieve of diet and exercise followed by a retest. To add insult to injury, the fecal test proved abnormal, inviting a colonoscopy. I suggested that the result was a false positive based on contamination with hemorrhoidal bleeding.

So I spent a month researching the matter and, this afternoon, saw him in order to share my findings. I decided ahead of time not to get into the family-history-of-stroke matter which I saw as confirmation bias on his part (he didn't even know at what age my father had the stroke). The diet-and-exercise bit is of course something to be suggested regardless (as it is generally worthwhile), not as a designed-to-fail antidote to statins. I wasn't going to get into that either as it evidenced a desire to get me on meds and I didn't want to be confrontational. At any rate, the matter was moot as I had found sources that suggested (in the absence of cardiovascular disease, diabetes, etc.) that I had no need to be on meds.

First, I presented Dr. Ian Neeland's (22 Dec 2020) podcast quotation of "10 years on a statin with low LDL cholesterol might decrease your risk [of heart attack, stroke, etc.] by 20 percent" as being (for me) a negligible benefit. Next, I presented Robert M. Kaplan's (3 Apr 2019) opinion piece on preventing heart disease, starting with some absolute risk-of-dying meta-analysis statistics and concluding with "... observations on people over the age of 70 do not show any statistically significant statin-related reductions in deaths from any cause."

Throughout most of the session my doctor seemed overly defensive, mildly angry perhaps. He interrupted me several times, explained that he was following guidelines, and cautioned me on cherry-picking data. He closed the door to the hallway at one point. Much more was said but I choose here to be brief.

I had run out of my 15 minutes and I hadn't yet dealt with the fecal test. I asked for a couple more minutes. I explained my false-positive belief, suggested that it didn't matter anyways because I had "a very low long-term risk of colorectal cancer" based on a (19 Sep 2013) study on long-term colorectal-cancer incidence and mortality. I finished with Michael Bretthauer's "gold-standard trial" that had colonoscopies cutting cancer risk by only a fifth with no significant reduction in colon cancer mortality. How do you like them apples cherries?

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