Categories
Being human Reflections on Life, Being Human, and Medicine

Cherry Season, Youth, Limitless Energy and Further Up and Farther In

Cherry season on the farm was always an “event”. 

There are varying seasons and paces on the farm, but when the tart cherries were ripe, they had to be harvested and that needed to happen quickly. It would become an “all hands on deck” sort of thing.

My father told us the story about how our family first started shaking cherries (mechanical harvesting.) Farming can be a very frustrating business with all the worries about good and bad crops, spring freezes and wind and bird damages. It was a year in the early sixties when they had a bumper crop of cherries. The conditions had been just right and the trees were loaded with cherries.  That should have been a good thing, but it turned out to be a crisis. 

Fruit is a commodity. The price is regulated by supply and demand. In that year the supply was great, but the demand would remain the same. This meant that the price for the cherries plummeted. The people who worked hand picking the cherries would still expect to be paid the same fair wages. But the cannery buying the cherries was paying less per unit of cherries than what the going wage was to pick them.  It was an untenable situation.  

What could they do?  

They had beautiful cherries on the trees that needed to be harvested. At the same time they could not afford to pay the workers more to pick the cherries than they would get paid for them.

That day my grandfather bought a mechanical harvester, and they learned to 
“shake” cherries.[1]  

The process was and is as follows:

  • Set up canvas covered frames around the tree.  
  • Reach a mechanical arm with a claw on the end out to grab the major limbs of the tree (or on more modern types, grab the trunk of the tree.)
  • The arm has a reciprocating device driven by hydraulics that moves the arm rapidly back and forth and by so doing shakes the limb.
  • The cherries fly through the air and then are caught by the canvas frames when they fall. 
  • The cherries funnel down the frames into containers (lugs).
  • Carry the lugs and pour the cherries into a tank of cold water. By cooling them the cherries retain their shape and are not crushed.
  • Pick up the frames and carry them to the next tree and start the process over gain.

By the time I was working on the farm the process had improved a lot.  The frames were now built into the harvester (we called it the cherry shaker.) For our machine, cherry shaker was in two parts and needed two separate drivers.  Each end had a shaker arm and together the two drivers would connect the sections into a whole and shake the cherries.  The cherries would funnel from the frames onto a mechanical conveyer belt that would carry the cherries to where another one of us had driven a forklift to position the tank of cold water beside the cherry shaker. 

We could move quickly from tree to tree, moving all the elements forward each time. One person operated one half of the cherry shaker. Another operated the other half. Another person drove the forklift. And often one more of us would drive the full tanks to the “well” where the tanks would have cool water run through them to keep the cherries cold. 

Sometimes the weight of the cherries would be so much that limbs would break off under the weight. These limbs would have to be cut away and pulled aside so that we could get the cherry shaker under the tree.  As children, one of our jobs was to pick the cherries off the downed limbs. As the youngest I was never very fast at this, but my older brothers and sisters could earn a good amount of extra spending money doing this manual job.

As I grew older, I became adept at driving the forklift (we called it the lift fork). Once my dad or brother had positioned his side of the cherry shaker around the tree I would need to carefully guide the cherry tank under the conveyer and guide the tank so that it pushed against a metal arm that would turn on the conveyer so that it would empty the cherries into the tank.  As they moved to the next tree I would back away, wait for the shaker to be in position again and then pull forward.  When the tank was full, I would put a cover on the tank, load it on the truck, and go get another empty tank (with water in it) and keep the process going.

The breakdown:

The cherry shaker had a lot of moving parts. Mechanical break downs were common, and my father and grandfather always had boxes of tools with them.  One of the hallmarks of living on a farm is a component of mechanical ability and independence. It seemed like they could fix anything. The conveyer had metal slats, and it would be fairly common that a stray twig or branch might get caught and bend one of the metal slats. When we would see this, we would pull the tank away from the shaker to stop the conveyer. Using a wrench we would remove the two bolts that held the slat in place and put a new slat on.

Other times we would have a more significant break down. Sometimes those would be a welcome break in the work. While my father worked on the repair it would give us a chance to sit down and relax or goof around. If the repair required parts, it might even give us an hour or two off while someone (often my older brother) would drive to the farm supply place to get the parts needed for the  repair.

One year we had a major mechanical failure early in the season. The necessary part was not going to be available for several days. The cherries were not going to wait, however.

My grandfather and father talked through options. Ultimately, they remembered the old cherry shaker (the first one they had bought many years ago).  The old version would bolt to the front of one of our tractors and that was how you would move the shaker from tree to tree. The canvas frames however had to be carried by hand from tree to tree.

We all left the orchard and in short order returned and assembled the equipment in the orchard.  I watched and learned the process as we carried the frames (one of us on each side) up to the tree (one frame on each side).  We carried big plastic lugs and put them under the frames. We then drove the tractor in position. My father then would operate the shaker.  We would then need to empty the lugs into the cherry tank, move the frames, drive the tractor forward and do the process again.

It was a lot of manual labor. By then I was a teen and was stronger. I was no longer just the youngest child that struggled to keep up picking the cherries from the downed limbs. I was a part of the main crew. I ran and positioned myself to move one side of the frame. When I did so I was standing on the side by the other frame and could grab it also and move it forward. I could then run and grab the lugs and get them positioned in place. 

It was a LOT of movement and a lot of running around and lifting. 

But it felt good. 

It is interesting now in my memory to remember those days. I had a young body that could really do things. It felt good to push my body. It gave me a sense of pride inside when I could do a large portion of the work that needed to be done. I was not just a child. I had become a valuable worker in the process. 

By noon that first day I was tired. I remember nodding off on the sofa when we went home for lunch. But in the afternoon, I was back, running back and forth, lifting and carrying and my body rewarded me with the ability to do it over and over and over again without stopping. 

It seemed to me that the more I did it the more I pushed myself. I maybe didn’t need to do as much (or as many elements) of the job that I was doing but I had a young body that could do it and it felt good to do it both physically and mentally.

The strength and energy of youth:

I have an idea that pops into my head sometimes: I am young. I am out in an open field where I can just run and run and run at full speed and feel-good doing so.  It is a memory of a body that has so much energy that it has plenty to spare. 

I look at children sometimes as they bop around with nervous energy climbing up and around and never stop moving. 

It is a wonder. 

I think one of the amazing parts of our world is the vitality and strength of youth. Children can fall and they bounce and not get hurt. They can run and leap and move and everything just works. 

We are fearfully and wonderfully made.

The seasons of life:

I am a much different person than the young man who ran around the cherry orchard that year when the  regular cherry shaker broke down. Sometimes I envy the young. I would love to have that feeling back about being able to do anything I wanted. Instead I often give the “old man grunt” getting up from a chair. I don’t bounce anymore. I move deliberately. 

But it is okay.  We each have our season, and each season has its own joys and struggles. It does me no good to wish for what I don’t have. I can enjoy what this season looks like, but at the same time muse and enjoy the vitality that I see in the young around me. 

As my grandfather aged, he went from a strong man doing everything to a man who worked but moved more slowly. I could see my father and my older brothers helping more and more. He still came to the orchards but moved slowly and didn’t push himself to do the heavy stuff. In my mind is an image of a time picking plums. He was still there with the picking bag on doing his share. But at one point I looked and saw him sitting against the ladder resting. Time was pulling at him.

I was proud of how much my Dad could do. In apple season I remember seeing him pick up two stacked crates of apples and then lift both of them over his head. He did this so that he could get the stack one level higher than he could reach. A bushel crate of apples weights around 45 pounds. That was in essence lifting and pushing 90 pounds over his head. He lifted them because he could and so my grandfather didn’t need to do so. 

In cherry season he would be up early making us breakfast and getting all of his crew (my brothers and I) out to the orchard. He was always there running one half of the shaker and watching all of us to make sure things were going smoothly. 

He could do anything.

And then he too aged. Age, cancer and the treatments for the cancer pulled at his body and made him tired. We all knew that he would be the happiest if he could be out in the fields and orchards working. Instead he had to accept sitting at home. He did it not because he really wanted to but because he knew that just being alive there was important to the rest of us.   

Shortly after we were married, Sarah’s parents went with us to help us move into our new apartment. I had heard that it was smart to get an upper floor apartment because then you would have less risk of noise (no one above you).  It didn’t seem like such a great idea when it came time to move in!  The upper floor meant that we had to carry all of our things (our beds, dressers, sofa, table, chairs, and my heavy slate top desk) up a flight of stairs. We also had boxes of books. Mine were mostly medical but Sarah had a great collection of novels and mysteries and other types of books. 

I wonder what my father-in-law thought about my great idea to get an upper floor apartment!  As we started to unload the rental truck, I set a goal for myself that I would do two trips for every one trip that Sarah’s father made.  I did this to protect him but also because I could. My young body could stoop and lift and climb and carry and then spring back down the stairs for another load. I was tired at the end of the day, but I was fine. 

More recently, we were moving some boxes with JJ and Sam. Sam would pick up two boxes stacked to each one that I carried. I would pause and lean against the car and rest between loads as Sam zipped back and forth. As I rested my mind raced back to the plum orchard and my grandfather sitting on the step of the ladder. It went to my father heaving heavy apple crates above his head and then his decline. And it went to a time 30 years before moving into a 2nd floor apartment in Virginia.

Glimpses of heaven:

In “The Last Battle” C.S. Lewis gives a great depiction of heaven. Peter, Lucy, Edmund and others see broad green areas. They along with scores of beloved friends and family are encouraged to run, “further up and farther in.” They run with joy discovering more and more wonders, always moving and running. 

It is that same feeling of youth. 

It captures the idea of excitement and energy that makes you want to just jump and run and move. “Further up and farther in!” 

What am I saying?

  1. We are wonderful and amazing creations. As I age, I appreciate the strength and energy of youth more and more. Sometimes I think I should tell the young, “Enjoy your strength and flexibility and energy!” but to do so would make me sound so old and honestly, I don’t think it would change anything for them. It wouldn’t have made a difference if someone had said it to me (and I think people did) when I was young.  Instead, I choose to just look and enjoy watching the young and their energy. I marvel at God’s creation and how new life keeps coming in wonderful and vital ways.
  2. Everyone has their seasons. I too had the years of being able to run around and do things for those older than me. I could “run the world” and enjoyed doing it. I had my chance and time. Like a rider getting out of my seat on my favorite roller coaster, I free up the space for those who climb into the seat after me. It is their turn now. Don’t get me wrong, I do still have strength and energy. There are still things that I can do to help those around me including those older and more frail. I can enjoy the life that I have even as I acknowledge the bounce that I don’t have.
  3. When I reach the end of a day with muscles aching and fatigue pulling me to the easy chair, I think about “further up and farther in.” I picture the big hill behind my parent’s house and imagine it covered in green grass and how much fun it would be to just run and run without stopping not because I have to but just because I have the energy to do so. I can imagine the joys of heaven and what it will be like for all of us to feel young and strong again. I look at the young and my faith is strengthened. God has made a wonderful creation and even though it is now fallen, He has plans for me that are worth looking forward to. 

I have thought back to that cherry season when we had to carry the frames by hand. I remember pushing myself to run and carry the frames and to do so much work. At the time I didn’t know why I was pushing myself. I understand better now. I did it because I could. I did it because to use the youth and strength God has given is a wonder and a joy. 

Regardless of the season we are in, life is a gift and God wants us to enjoy the good gifts he has given. 

And if you feel tired, join me in reading this passage from C.S. Lewis’ “The Last Battle” and marvel at the wonders that are in store for us in the future. In this passage they have their first glimpses and experiences of the “new Narnia”:

It is as hard to explain how this sunlit land was different from the old Narnia as it would be to tell you how the fruits of that country taste. Perhaps you will get some idea of it if you think like this. You may have been in a room in which there was a window that looked out on a lovely bay of the sea or a green valley that wound away among mountains. And in the wall of that room opposite to the window there may have been a looking-glass. And as you turned away from the window you suddenly caught sight of that sea or that valley, all over again, in the looking glass. And the sea in the mirror, or the valley in the mirror, were in one sense just the same as the real ones: yet at the same time they were somehow different — deeper, more wonderful, more like places in a story: in a story you have never heard but very much want to know. The difference between the old Narnia and the new Narnia was like that. The new one was a deeper country: every rock and flower and blade of grass looked as if it meant more. I can’t describe it any better than that: if ever you get there you will know what I mean.

It was the Unicorn who summed up what everyone was feeling. He stamped his right fore-hoof on the ground and neighed, and then he cried:

“I have come home at last! This is my real country! I belong here. This is the land I have been looking for all my life, though I never knew it till now. The reason why we loved the old Narnia is that is sometimes looked a little like this. Bree-hee-hee! Come further up, come further in!”

He shook his mane and sprang forward into a great gallop — a Unicorn’s gallop, which, in our world, would have carried him out of sight in a few moments. But now a most strange thing happened. Everyone else began to run, and they found, to their astonishment, that they could keep up with him: not only the Dogs and the humans but even fat little Puzzle and short-legged Poggin the Dwarf. The air flew in their faces as if they were driving fast in a car without a windscreen. The country flew past as if they were seeing it from the windows of an express train. Faster and faster they raced, but no one got hot or tired or out of breath.[2]

[1] https://www.gasenginemagazine.com/tractors/friday-tractor/

[2] C.S. Lewis, The Last Battle, HarperTrophy, 2000, pp. 195-197.

Categories
Reflections on Life, Being Human, and Medicine

Science, Politics and Disease

It was really bad.

An epidemic had hit. Everywhere it seemed like people were dying. The population was terrified. They were desperate to find a solution. 

And then politics got in the way. 

Instead of the leaders coming together to work to find the best solutions available based on the best knowledge available, politics drove the leaders to become obstinate.  People became definite in their opinions and argued from one of two extremes. And instead of working to find the best solutions each side just argued ever more strongly about how they were right and the other side was wrong.

Sound familiar?  But I am not referring to the COVID 19 pandemic, or the more current health issue related debates. This was 1793 and the problem was yellow fever.

In a few short months, one out of every 10 persons in the city of Philadelphia was dead from yellow fever. 

We now know a lot about yellow fever: 

  • Yellow fever is caused by a virus that is transmitted from person to person by mosquitos. About 15% who get it will develop severe disease. In those persons 50% will die.
  • The best short-term fix in 1793 (if they had known):
    • Reduce mosquito exposure. Get away from wet areas. Use mosquito netting. Give supportive care with fluids and rest for people who are ill and shield them from mosquitos that can spread the disease to others.
  • In the 1930s an effective vaccine was developed. A single shot provides lifelong protection.

But they did not know that in 1793.  They understood so little about what was going on. Their therapies made no sense – and actually – caused great harm.

I wonder what I would do if I were able to go back in time to try to help them. How would I get them to listen to me? When I think about what the medical leaders did, I cringe: Bleeding and purging.

The brightest and most respected doctor in Philadelphia at the time was Benjamin Rush.  Medical theory at that time was based on Galen’s theory. This stated that illnesses came due to an imbalance in the humors. The human body was thought to be made of four humors:

  • Blood
  • Phlegm
  • Yellow bile
  • Black bile (also called melancholy)

According to Galen, disease is caused by an imbalance in these humors. Doctors would then use emetics (medicines to cause vomiting), laxatives and bloodletting to shift the balance of the humors and restore health.  When persons became sick with the yellow fever, Dr. Rush and the other physicians would be called. They would then administer noxious substances to make the patient vomit and develop diarrhea. They would give large doses of mercury. They would also cut them to drain them of blood. 

Some of his patients recovered. 

From our vantage point now, we can realize that these patients would have recovered without him. Indeed they recovered in spite of him. But Dr. Rush and his colleagues didn’t know that. They embraced these “anecdotes” of the patients who recovered. They reinforced their belief that they were doing good.

Alexander Hamilton entered the scene.  

Dr. Rush and Hamilton were already political opponents. It seems that Hamilton had a way of rubbing people the wrong way. Hamilton, however, had grown up in the Caribbean where yellow fever was a big problem. In the Caribbean, the population had abandoned the practices of purging and bleeding. The treatments instead focused on rest, supportive care and time. 

Hamilton felt that Dr Rush was wrong and advocated for the “French” or “West Indies” cure. He and others told the patients and families to stop the purging and bleeding. What they needed was fresh air, hydration and time, not the loss of fluids and blood that were weakening them.

This was an insult to Dr. Rush and his colleagues. 

Debate ensued in the city. Dr. Rush had observed that a large number of his patients died with his treatments. But he also remembered the ones who survived. What was he missing if some were “cured” and some not? He decided that the problem was not that his treatments were wrong, but that he was not pushing hard enough. He intensified his efforts and did even more extensive purging and bleeding.

Double down[1] (intransitive verb): to double the original bid in blackjack in exchange for only one more card

Often a poker player when he is extended out very far on his bet will double down hoping to rescue his position. There is a tendency in politics to “double down”. Rather than an introspective look to think that you might be wrong, politicians often instead argue their point even more vigorously.

In science the opposite is demanded. Scientists must hold their theories lightly. Truth matters more than whether their current theory is correct. If the data contradicts their theory, they must sacrifice their theory or modify it. They must do this even though their theory might be prized by them and even something they had staked their name on.

Dr. Rush’s patients were dying. The treatment advocated by Hamilton was seeming to help. What did he do? It was before the scientific method was embraced by medicine (this did not enter medicine until the late 1800s)[2]. And politics had gotten involved.  

Dr. Rush doubled down. 

I remember my first day in residency when I came back from the Navy. My first rotation was in the ICU and there were a lot of very ill patients.  One patient “crashed” in front of us. We rapidly put him on life support and then proceeded to do a number of procedures to “save his life.” It was very exciting. 

Then one day, I learned a profound lesson. It came from one of the most experienced intensive care physicians. I can still picture the scene. He was standing in the doorway of a very ill patient’s room. He was not acting. He was thinking. He said to me, “Don’t just do something. Stand there!”

His twist on the usual statement went against my instincts. It seemed so ironic but within it was profound wisdom. When we see a crisis, we all feel driven to act. We want to rush in and be the hero. What he was teaching me was that in medicine we commonly can do as much harm as good. 

Benjamin Rush was an amazing man worthy of our respect. He meant well and he put his own life at risk and pushed himself to exhaustion in his efforts to “save” his city. He was, however, sincerely and profoundly wrong. In his efforts to act he caused harm. The city would have been better off without him.  Furthermore he allowed himself to become influenced by his politics and his bias. He fed off of his “successes” = the patients he treated who survived and got better.  We call stories about individual patients, “anecdotes.”  Dr. Rush had accumulated anecdotes which drove him to ignore the evidence that contradicted his claim.  

Philadelphia in August 1873, would have been better if he had said, “Don’t just do something. Stand there!”

George Washington was dying. On December 12, 1799 he kept to his routine and rode his horse around Mount Vernon despite the cold weather and a heavy snow. He became ill with a respiratory infection afterwards. His illness progressed quickly and by December 14 he was in trouble. His throat was swollen and he was struggling to breath. 

What could they do? 

Washington believed in bloodletting. He had seen others recover from illness after bloodletting. He had his workers drain some of his blood. When he worsened further, they called his physician.  Dr. James Craik arrived and  applied a preparation of dried beetles to blister his throat and then bled him more. 

But this was George Washington. 

Dr. Craik needed to be extra careful. He sent for more help. He requested that Dr. Gustavus Brown be sent for. He worried that Dr. Brown would not arrive in time and so he also asked that Dr. Elisha Cullen Dick be sent for (one of my ancestors!)  Both doctors arrived and all 3 consulted together. Drs Craik and Brown felt that he had quinsy[3] and they advocated for further purging and bleeding. Dr. Dick felt that he had epiglottitis which is a critical and often fatal inflammation of the throat. He advised that Washington’s only hope was to undergo an emergency tracheotomy and that they needed to stop bleeding and purging him to preserve his strength. 

Dr. Dick was however younger than the other two physicians. The other two rejected his advice. Tracheostomy was new and they would not venture to try something new on such a prominent patient. They fell back to their usual strategy. They drained him of even more blood. The historians estimate that over the course of that day, Washington had been drained of more than 5 pints of blood (40% of his total blood volume). Shortly thereafter he died.

Dr. Craik and Dr. Brown’s analysis: They did their best. Despite their best efforts he died. At least his death wasn’t for a lack of treatment. People die, even famous persons. His disease was so severe that he died even with the best treatment.[4]

What would have happened if they had listened to Dr. Dick? What would have happened if they had not treated him at all? There is a chance that he might have survived without the doctors and the treatments they subjected him to that weakened him so much. There would have been a greater chance if they had allowed Dr. Dick to do the tracheostomy.

They were sincerely wrong.

What can we learn from all of this?  There are several very important concepts:

  1. Fear and need can drive error and harm.
  2. We need to acknowledge that it is a broken world. Our knowledge and capabilities lag behind our needs. We all lose loved ones. Many endure chronic debilitation. It is tempting to offer “cures” based on speculation and stories of others. We cannot just by force of will or extremity of need come up with the correct answers. We still do not have enough knowledge. Our knowledge in this fallen world will continue to lag behind our need. Bad things happen and it is overly optimistic and naive to think we are going to explain all of them.
  3. Anecdotes drive theories but do not prove the effectiveness or safety of treatments. We need anecdotes as we struggle to learn and discover. In those stories and experiences we may find hints at truths that can help us. But we must be careful because many persons get better in spite of the treatments rather than because of them. Medicine is full of examples of therapies that seemed to work but in the end were proven to be ineffective (at best) or often even harmful. Anecdotes can be quite dangerous. Much harm is done when people grab onto anecdotes assuming that “association proves causation.”[5] This thinking aborts the process to find truth. It can deprive patients of other effective treatments or expose them to side effects from unproven and ineffective treatments.
  4. The scientific method is our primary way to sort out what is truth. 
    • Hypothesis = A guess based on hints and concepts. For example, a specific treatment will improve survival for a condition. Anecdotes can drive hypothesis formation.
    • Test = A carefully designed test. In medicine this is a double blind randomized placebo controlled trial so that all bias is excluded.
    • Analyze = Objectively review the data from the tests. Did the results prove or disprove the hypothesis?Abandon or revise the hypothesis based on the results of the test. 
    • Start over.
  5. Politics frequently causes more harm than good in science. Let’s be clear: The process of politics is quite different from the process of scientific investigation. The process of politics is that of debate and argument. It encourages adoption of bias to be able to more effectively argue your point.
    • The goal of politics is to win people over to your views and your argument.
    • Science instead embraces self-criticism of your hypothesis and constant questioning about whether or not you could be wrong.
    • Politics cannot tolerate this degree of weakness where “only the strong survive.”

And so I become distressed as I read the news each day.

If you could get in a time machine and travel back to 1793 Philadelphia or 1799 Mount Vernon, what would you tell them? If someone could travel back from 2125, what would they think of what we are doing now?  And how are we going to get the truth? How are we going to find the answers to the problems that plaque us today? 

It isn’t going to come through politics, polarized debates, or your opinions no matter how strongly you hold them and no matter how sincere you are.  

It also isn’t going to come as quickly as you want. I am sorry but we’re still victims of the knowledge gap today just as our ancestors were in the 1700s. We have many wonderful cures, but we do still suffer and die.

Force-of-will alone cannot drive answers. Just because you “must” have an answer doesn’t mean you will find one. Dr. Rush was determined. He “had” to find answers. People were dying in his arms every single day. The knowledge was just not there. Sometimes you cannot just declare that you are going to solve this and then do so.

We must continue to use the scientific method. We must reject what is not proven and objectively accept what has been proven. We have to ignore what persons of bias want to thrust into the discussion or how politics skews data away from truth. We have to continue to seek truth and humbly acknowledge that all of us are likely at least partially wrong.

This is not a pessimistic endeavor, however.

In my own field of heart failure, I see success stories every single day. I tell my patients that I do what I do because of the privilege of being able to guide them to effective therapies. I cherish the amazing persons of science who led the way to these discoveries. Please understand, that because of science how I practice today is different than what I did at the beginning of my career. Science serves me well as we all constantly question, look and investigate how to best help our patients. 

How do we know what is true then?

Take heart. This is a question that all of us spend our careers teasing out. We have huge infrastructures in place to work through this including peer reviewed literature and international society consensus documents and guidelines. We meet together regularly as experts. We debate and argue and scrutinize data. Truth is king and we pursue it aggressively. It may not move as quickly as any of us would like but it does work.

Are we just supposed to blindly accept what we are told? No.

A questioning attitude is a key part of finding real truth. But be careful in what you read and believe.

There is now an entire industry focused around getting “clicks” and garnering public opinion. The more sensational something is, the more profitable it is. Sadly, grabbing your attention and getting your click is often more important than the truth.

Dr. Rush meant well.  He had no idea what was really going on and the impacts of his treatment. He was wrong. Fear and dogma drove action that caused harm. I suppose if that happened today we would have competing podcasts touting Rush vs Hamilton based approaches. But understand that while such ventures may get your attention they generally don’t get us closer to the truth.

Be careful in what you read. There is a rigor to reviewing scientific articles to not jump to false conclusions. Peer review also is designed to reduce bias and error from publication. Sometimes it misses. In recent years there has been a dramatic increase in articles which upon post-publication review were found to be fraudulent and were later withdrawn. Unfortunately many of these often still circulate on the internet. Some of these are cited by podcasters to support their views in spite of the articles having been debunked.

What do you do?

Know that there are vast numbers of us who have committed our careers to discovering and applying scientific truth. Within our respective fields we review and debate and review again the available science in a relentless search for the truth.

Seek out experts. These experts should be well embedded in a robust scientific process. I belong to multiple different organizations (ACC, HFSA, ISHLT) at significant personal expense each year. I do this as an obligation to my patients and as a commitment to the truth.

Beware the extreme or sensational. They may be just seeking fame or finance. They might also be sincerely wrong.

Go ahead and get a 2nd or even a 3rd opinion if you need to. Personally I love it when patients do this because if I am wrong I will take any help I can get to find that out.

And please know that most of us who are physicians went into healthcare to help. We really do honestly want to help you and your loved ones get better. I don’t know as much as I need to. But I am, like most in healthcare, willing to try to do our best to navigate these things with you.

[1] https://www.merriam-webster.com/dictionary/double%20down

[2] https://pubmed.ncbi.nlm.nih.gov/10487407/ – Johns Hopkins was established in 1876 and was one of the first centers to embrace the scientific method and apply it to medicine. 

[3] Quinsy was the term for a peritonsillar abcess. This is in of itself a serious condition that we would now treat with antibiotics and surgical drainage. But in 1793 they did not understand about infections. They thought the only control they had was to “rebalance the humors.”

[4] In a letter to Dr. Craik on 2 Jan. 1800, Dr. Brown was high in his praise of Dr. Dick, and wrote: “You must remember he was averse to bleeding the General, and I have often thought that if we had acted according to his suggestion when he said, ‘he needs all his strength—bleeding will diminish it,’ and taken no more blood from him, our good friend might have been alive now” (quoted in a note in Ford, Writings of Washington, 14:257).  https://founders.archives.gov/documents/Washington/06-04-02-0406-0001#GEWN-06-04-02-0406-0002-fn-0006-ptr

[5] Does ice cream cause drowning? One study showed that an increase in ice cream sales was associated with an increase in drownings. More thorough study however then showed that both were related to atmospheric temperature. In other words, when it is hot outside, more people eat ice cream and more people go swimming. If more people go swimming there are going to be more drownings. There is no data that eating ice cream causes drowning. https://www.techno-science.net/en/news/more-ice-cream-sold-more-drownings-why-N27193.html  An additional example during COVID showed the persons who watched one television show had a higher death rate than persons who watched a different television show. Would we conclude that television shows can cause death? Or is there a different explanation for the observation?