Thiamin, Vitamins and Derrick Lonsdale

Continuing the discussion from Thiamin, Vitamins and Derrick Lonsdale:

One thing I am concerned about is how effective supplements are for getting some of those nutrients. My diet is a lot better than it used to be, and I get a decent amount of nutrients in my food, and also take some supplements, but I’m almost certainly still not getting enough of some stuff (I’ve never even really tried to track my intake of 40 different nutrients, even though it wouldn’t be that hard given my food logging habits. I’ve paid some selective attention to stuff like magnesium or the B vitamins). Getting everything naturally seems like it’d be pretty hard (though not impossible). I think that supplements might be less good, but I don’t know how much less or whether it’s worth worrying about.

Supplements are imperfect and their effectiveness varies. Many of them come in multiple forms which are absorbed differently by the body. Dosage can vary by which form of a supplement you use, and some can be more effective than others for particular people depending on the specifics of their genes and current bodily chemistry.

The vitamins we eat are commonly part of a complex molecule – basically attached to something else. And there are multiple different things a given vitamin can be attached to. To actually use vitamins in our body, we generally have to process them with some chemical reactions to change their form. We don’t usually directly eat the form we use. Deficiency can be due to not converting the vitamin to another form within your body correctly, rather than due to inadequate intake. In that case, large doses of the vitamin don’t seem like the right solution, but they do sometimes help.

Thiamin is available in a hydrochloride form (HCL) or mononitrate form, which are water soluble. With those forms, the amount your body actually uses is low. If you inject it, you need around 140x lower dose than if you eat it as a pill.

TTFD is a synthetic version of thiamine which is fat soluble. Your body can use a lot more thiamine from the same dose compared with HCL. TTFD is based on allithiamine which is in garlic. It’s particularly good at getting more thiamine into the brain. Lonsdale studied TTFD and seems to consider it the most advanced or best synthetic, fat-soluble thiamine for general use.

Benfotiamine is a fat soluble thiamine that’s sold by more companies than TTFD, but it doesn’t enter the brain in the same way. You need to ingest lower doses than HCL but higher than TTFD to get around the same amount of thiamin actually used by your body.

I haven’t found very good information about dosing equivalents, but maybe TTFD is 10x more potent than HCL and benfotiamine might be 5x. That’s very rough. I think it depends on your body chemistry and no trivial conversion factor will really be accurate. The good news with dosage is that thiamin and many other nutrients have pretty high limits before doing harm from overdosing. You don’t have to target a really narrow window for the correct dose. This makes sense because our diets vary from day to day, and it’d be good for our bodies to be able to handle 10x or even 100x the daily needs of a nutrient in one meal. A lot may be wasted when you eat a bunch at once, but at least our bodies are pretty good at not getting poisoned by eating too much of a nutrient.

Synthetic, fat-soluble thiamin was mostly invented in Japan where they’ve taken nutrition more seriously, at least regarding some of the B vitamins. Japan and Europe recommend having higher levels of B12 in the blood than the US does, and Japan studied beriberi a lot after having a lot of trouble with it (white rice can provide a lot of calories without nutrients). People say that swallowing B12 isn’t very effective, and it’s better to have a tablet that you dissolve under your tongue.

It’s probably a good idea to eat a nutrient-dense diet with meat and a variety of plants, emphasizing whole foods.

I read that thiamin in food is destroyed by heat. I don’t know how much cooking destroys how much thiamin, but it’s apparently somewhat fragile. I don’t know how to effectively get a lot of thiamin from eating (non-fortified) foods.

We definitely don’t have full knowledge of what nutrients we should eat and in what forms. When you eat real food, you can get important things that are missing from our supplements. It seems to be pretty common that food versions of nutrients are more effective at the same dose because of the forms they come in, though not always (TTFD is synthetic but extra effective per amount, though it is based on an extra-effective food version in garlic, and maybe it’s less effective than real garlic). Effectiveness per amount doesn’t necessarily matter much btw. If you’re using a less effective form, you can just take more. There are presumably some potential downsides and upsides to that, and downsides seem more likely than upsides, but I think it often just doesn’t matter much and is fine.

(This is not medical advice. Do your own research.)


Continuing the discussion from Thiamin, Vitamins and Derrick Lonsdale:

Thanks again for the informative and detailed reply. One small comment for now:

I googled a bit for TTFD and came across a post, which I didn’t realize immediately realize was written by Lonsdale. Quote:

Although the arrangement of the atoms is different from the thiamine diagram, the important thing to notice is that the thiazole ring (right side) has been opened, creating a disulfide, including what is known as a prosthetic attachment (the part attached to the disulfide). A disulfide is easily reduced (S-S becomes SH) when the molecule comes into contact with the cell membrane. The result is that the prosthetic group is removed and left outside the cell. The remainder of the molecule passes through the cell membrane into the cell. The thiazole ring closes to provide an intact thiamine molecule in the cell. It is inside the cell where thiamine has its activity and so this is an important method of delivering it to where it is needed. It is this ability to pass through the lipid barrier of the cell membrane that has caused allithiamine to be called fat-soluble. It only refers to this ability, however. It is soluble in water and can be given intravenously.

This “fat solubility” is extremely important because dietary thiamine has to be attached to a genetically determined protein, known as a transporter, to gain entry to cells. There are known to be diseases where the transporter is missing. Affected individuals have thiamine deficiency that does not respond to ordinary thiamine and are usually misdiagnosed. Therefore, a disulfide derivative that does not need the transporter is a method by which thiamine can be introduced to the cell when the transporter is missing. There is no difference between allithiamine and thiamine from a biological activity standpoint. It is this ability to pass the active vitamin through the cell membrane into the cell that provides the advantage.

I performed animal and clinical studies with thiamine tetrahydrofurfuryl (TTFD) for many years and found it to be an extremely valuable therapeutic nutrient. Any disease where energy deficiency is the underlying cause may respond to TTFD, unless permanent damage has accrued. Dr. Marrs and I believe that energy deficiency applies to any naturally occurring disease, even when a gene is at fault. For example, Japanese investigators found that TTFD protected mice from cyanide and carbon tetrachloride poisoning, an effect that was not shown by ordinary thiamine (Fujiwara, M. Absorption, excretion and fatal thiamine and its derivatives in the human body. In Shimazono, N, Katsura, E, eds. Beriberi and Thiamine. (pp 120-121) Tokyo, Igaku Shoin Ltd. 1965). They exposed a segment of dog’s intestine, disconnected it from its nerve supply and found that one of the disulfide derivatives stimulated peristalsis (the wavelike movement of the intestine). It is more than likely that TTFD could be used safely in patients with post operative paralysis of the intestine (paralytic ileus).

Sounds like he thinks using TTFD specifically can make an importance difference in certain cases, though knowing whether one falls into the category of potential beneficiaries of TTFD versus a different form of thiamine would require way more knowledge than I have. I will likely try reading his book.

Continuing the discussion from Thiamin, Vitamins and Derrick Lonsdale:

I have read claims that if you start supplement with some nutrient X, you can deplete Y (I guess because your body needs to use Y to make use of X). So getting the benefit of X can be more complicated than just ramping up intake of X, and ramping up X can have unintended side effects. It seems complicated enough that it’d be nice to have a professional consultation with an expert about this sort of thing to help sort things out. But my suspicion is that most doctors and nutritionists mostly would just dispense very basic advice that wouldn’t get into all this nuance.

Yes e.g. various chemical reactions for creating energy use thiamine and magnesium. And other stuff but i don’t know all the details.

Taking thiamine can get your metabolism working better/faster, which can reveal other deficiencies. You had enough of some other stuff when you created less energy due to low thiamin, but when you add thiamin now you don’t. For example, after taking thiamin, more b9 (folate) and b12 may be needed. And it’s apparently dangerous to supplement b9 without b12.

Here’s a quote from Why I Left Orthodox Medicine: Healing for the 21st Century by Lonsdale (OCR errors are likely):

What did I learn from this fascinating case? I deduced that her primary deficiency had been that of vitamin B1. When she received large doses of it, she began a process of recovery which unmasked a latent deficiency of folic acid and B12. I believe that it works like this: vitamin B1 deficiency produces a severe drop in the rate of metabolism, equivalent to constricting the gasoline line in a car.

Under these circumstances, she had enough folic acid and B12 to preserve the state of the blood, but as her metabolic rate accelerated under the influence of B1, the folic acid deficiency was unmasked and produced anemia. Without B12, the folic acid produced further damage in the spinal cord, thus assuring that she would continue to be a wheelchair-bound individual.

Lonsdale has some other books which are more directly relevant to thiamin stuff. He also has academic papers.

His collaborator has even more Hormones Matter articles than he does: Chandler Marrs, PhD

Elliot Overton sells thiamin supplements and has an ebook telling people what specifically to do and has a YouTube EONutrition - YouTube I like Lonsdale better but Overton could be useful. Overton also does online consultations but it says he’s not taking new clients currently: has low activity. i haven’t checked facebook groups.


Continuing the discussion from Thiamin, Vitamins and Derrick Lonsdale:

Main downside I can see at the moment (from a layman’s perspective of profound ignorance) is that you have to work your body’s waste elimination system more if you use inefficient methods of supplementation that mostly get wasted. (I’ve noticed this issue with certain supplements in the past). That doesn’t seem super bad, but that waste elimination system does have limits and can develop problems, so it seems ideal to avoid it if you can, especially over a long period of time (though supplementing with a less effective form might be much better in terms of your overall health outcome than not doing so just to not overwork your waste elimination system).

Relevant to my comments about SENS:

Bruce Ames, one of the leaders in nutrient research, proposes a triage theory of nutrient management wherein

…a modest deficiency of one of the nutrients/cofactors triggers a built-in rationing mechanism that favors the proteins needed for immediate survival and reproduction (survival proteins) while sacrificing those needed to protect against future damage (longevity proteins). Impairment of the function of longevity proteins results in an insidious acceleration of the risk of diseases associated with aging.

This is a reasonable, plausible, worth-considering reason that mild nutrient deficiencies would basically accelerate aging, and therefore life extension people should care a lot about this stuff!

The Ames quote is from a peer reviewed 2018 article in a prestigious journal. I’m guessing he had this idea previously and probably wrote it down somewhere previously (and it might not be original to Ames anyway), so SENS people probably could have found out earlier even without directly speaking with Ames.

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Read a bit of Why I Left Orthodox Medicine: Healing for the 21st Century. The story about no one being interested in the blood irradiation for leukemia treatment was really sad and disturbing. So was the story about the doctor who did the controlled handwashing experiment before germs were discovered and then got drummed out of the hospital.

Yeah I remember those stories… :frowning: There are a bunch more in the book. Some others are similarly bad. I really don’t like how people tell him to mind his own business and won’t even try no-downside supplements on their patients who have the same symptoms as his patients that the supplements worked for. Here’s one which I don’t think is a real story but which is similar to many real stories (all my quotes from this book may contain OCR errors):

I will describe a typical example of the kind of thing that happens in this period of transition where nutrient therapy has emerged. Two physicians each had a case of pneumonia in adjacent beds in a hospital. Both were severe and distinctly life-threatening, and both physicians knew it. One of them used intravenous vitamin C in addition to the antimicrobial drug or drugs that he had prescribed. The patient improved rapidly and became well. This physician went to his colleague who was caring for the other patient and suggested that he do the same, since his own patient was doing so well. The other physician was a traditional practitioner who was firmly under the impression that the use of vitamin C in this manner was fraudulent. He told the physician who had been successful in helping the recovery of his patient to “mind his own business” and refused to give the vitamin C. His patient died.

Just to emphasize: stuff I’m saying in this thread is broadly conditional on Lonsdale and some other sources being correct. Maybe he’s wrong. Lots of people apparently disagree with him. I’m interested in counter-arguments. I haven’t searched for them thoroughly yet. When I did an initial search for counter-arguments I found some stuff worth reading that was on the same side as Lonsdale but I found no substantive counter-arguments yet.

Apparently Andrew Cutler criticized TTFD specifically and said benfotiamine is better. I don’t know if that’s the reason that benfotiamine is more readily/widely available for purchase. I found that out from this rebuttal (which I haven’t read much of yet):

I’m particularly interested in this topic because I’ve had a suspicion something is “off” with my metabolism for a while. I have had low hunger and moderate weight gain despite being very active and not eating a ton. (Low hunger wouldn’t be so bad if I was losing weight, but that doesn’t seem to be what’s happening). “Calories burned” trackers have always seemed exaggerated for me, but they seem super mega incorrect now (exaggerating my amount of calories burned hugely), whereas before they were just mildly off. I suspect that my diet, while causing various positive changes, may be revealing (creating?) some sort of problem or issue. It’d be great news for me if it was something simple like a thiamine deficiency. Worth investigating for sure. Thanks for writing about this and giving me a lead to investigate.

I’ve found myself thinking of some of my own recent health stuff in reading Lonsdale’s book. His views regarding the importance of vitamins and nutrition are apparently really counterintuitive for most doctors (enough so to be derided as quackery). One specific thing I thought of is my discovery that vigorous exercise could not only prevent migraines but apparently cure an attack in progress. It was really, really counterintuitive to me that vigorously running outside could cure, at least in my case – and within 20 minutes! – an episode of a condition I associate with a pounding head and an aversion to light that could last all day or multiple days. I only discovered that out of sheer stubbornness in following an exercise routine and not out of any conscious effort to conduct an investigation. I thought of the migraines as basically something I’d be stuck with indefinitely, especially given that I endured them for a quarter century. I thought they were a Big Problem that could only be managed, and that fancy drugs were needed to help with the management. But my fitness routine is such now that I don’t get them anymore.

I think what Lonsdale says about stress is interesting. His model, if I understand it, is that certain genetic problems can cause biochemical problems in the body which can flare up if there’s some external stressor that the body reacts to. I think it has relevance for migraines. If you read lists of things that are said to trigger migraines, it’s stuff like sleep disruption, caffeine, (emotional) stress, alcohol, food additives, and other things. Big list of potential stressors. But lots of people have some of those things and don’t get migraines. So there’s some issue that causes people to be sensitive to migraines when they encounter one of those stressors. It’s not about some particular stressors per se, I don’t think. There’s not some master list of 59 things that specifically cause migraines and we just have to determine what the triggers are and that will fix the problem. It’s some problem that’s causing a vulnerability to stress which manifests in migraine form, which is why the list of triggers is so long (and apparently in my own case, exercise and possibly dietary changes reduce the vulnerability enough to mitigate the problem pretty completely). In my own case, even relatively small disruptions to sleep schedule (like waking up an hour early or sleeping an hour late) used to be very high probability triggers. It’s really difficult to manage and avoid all potential small triggers like that IRL; you need to solve the underlying issue to have an actual robust solution.

Lonsdale made some comments about the resistance his view faces:

It takes a generation to make a
paradigm shift, and this is what nutritional medicine is, a paradigm shift. The
history of medicine is crammed with such stories. Virtually all the major
benefits that we accept today such as anesthesia and sterile surgery have been
fought over and the proponents have had to prove their cases, invariably
receiving some form of persecution similar to that endured by religious
converts throughout history.
The surprising thing is that a doctor may be confronted with the facts
very forcibly and refuse to recognize them because they do not fit in with his
training and the current thought of the majority. Peer pressure is also a very
powerful force, and to escape from it can be dangerous to the livelihood of the
escapee. Official forces come into play that might never have been suspected,
such as licensing boards and county medical societies.

Reminded me of Roark’s courtroom speech in The Fountainhead (it even mentions anesthesia, interestingly enough):

“Throughout the centuries there were men who took first steps down new roads armed with nothing but their own vision. Their goals differed, but they all had this in common: that the step was first, the road new, the vision unborrowed, and the response they received—hatred. The great creators—the thinkers, the artists, the scientists, the inventors—stood alone against the men of their time. Every great new thought was opposed. Every great new invention was denounced. The first motor was considered foolish. The airplane was considered impossible. The power loom was considered vicious. Anesthesia was considered sinful. But the men of unborrowed vision went ahead. They fought, they suffered and they paid. But they won.

I noticed from some comments early in the book that Lonsdale seems to be a liberty-minded person and liked that.

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The results sound really interesting! Should I try high dose thiamine?

Again (and I hate to berate the message), all of this clinical research has been open label. We really need to see a randomised, placebo-controlled, double-blind study before we jump to conclusions.

Can anyone please find a better attempt at a rebuttal to thiamin or Lonsdale than this sort of “no ideal evidence for that specific use case yet” viewpoint?

This reminds me of people who said there was no evidence that masks reduce the spread of COVID because, although there was plenty of previous evidence about masks being effective for various things including viruses, there were no ideal studies of masks being tested for COVID specifically. Some people seem to want the exact issue in question to be studied, and won’t think conceptually about how the mechanisms work (like if a mask works on ten airborne viruses, and you can’t think of any reason it won’t work on another virus, then presumably it’s going to work on the new virus for the same conceptual reasons it worked on the others).

Also these people don’t seem to care much that something is safe and cheap, so it’s reasonable to try it based on explanations, arguments, and non-ideal evidence (there are’s a bunch of success in non-placebo-controlled studies, and also success in a randomized, placebo-controlled study for a different but kinda similar disease – but his response to that is that that study is a good start but we need more studies like it including with more patients). The article I quoted form acknowledges that thiamin is safe but still discourages people from trying it, even though continuing with their lives as normal is definitely not safe because they have a serious illness that is well known to get worse over time (Parkinson’s).

Also I’ve seen people complain that a lot of the evidence about thiamin is either really new and not well established yet or else too old. It was studied more in the like 30’s through 50’s and then there was a big gap before some renewed interest recently. Why was there a gap? What does that say about research funding problems? The “no (ideal) evidence yet” people don’t seem to complain about the lack of research and blame the funders. They act like there just haven’t been enough doctors who thought it was a good idea to try it or something. If that was the cause of low research, then low research itself would be a bad sign. But there were doctors like Lonsdale who thought it was promising and demonstrated positive results that should be good enough to get research funding in a rational world, but were denied funding.

Also FYI the sort of double-blind randomized placebo-controlled trials that many people want to see cost tens of millions of dollars. And a big pharma company isn’t going to be able to make that money back selling vitamin b1 supplements. They’re too cheap, too available, and it’d be too hard to get them changed to a prescription-only drug.

Lonsdale said in some cases he thought a placebo trial would be unethical because b1 is safe and he didn’t want some people to get the placebo and suffer when he believed b1 had a high chance to help them.

Also it’s hard to get people to sign up for a trial with a placebo group when they can just cheaply buy the treatment without being gatekept. One of the main reasons people participate in those trials is that maybe getting the drug is better than definitely not getting the drug if they don’t participate. But with b1, they can definitely get the drug by staying out of the trial, so if they are convinced the trial is promising and that thiamin is safe, they’ll probably want to just take thiamin outside the trial…

I podcasted about the “no evidence” thing a while ago. I’ve been noticing it comes up a lot. It’s a really different epistemology than looking for arguments and conceptual explanations. They put a positive burden of proof on things that aren’t already mainstream/normal/popular and require pretty specific types of positive, support arguments (“evidence”) and discount most evidence that I consider relevant. Rebuttals like “there is no evidence that thiamin does NOT cure that disease” don’t impress them. There are cases where we tried something and found no evidence it works, and cases where we just didn’t try it yet (or tried it initially and found a bunch of less perfect evidence that it does work), and a lot of people don’t seem to differentiate those.

There is no evidence that anyone has telepathic powers – despite a bunch of tests. Many people tried to prove their powers and failed. That is totally different than the situation with thiamin, which hasn’t failed and also has all kinds of evidence that people discount as not the exact form of evidence they wanted to see (that costs a fortune, which they usually don’t mention and don’t seem to know is the blocker – only accepting very expensive evidence means basically only listening to people funded by the government or big pharma because who else is going to be able to do the super expensive trials you want? and those groups don’t just automatically fund anyone who does initial cheaper trials and gets good results.).


This is a good example of the relevance of epistemology to life in a life-or-death kind of way. Potential treatments are not sufficiently investigated due to bad epistemology.

Yeah. It might work better for something more mild. Like if you were investigating b1’s effect on some mild chronic fatigue or something like that, it seems like you could more likely get people to sign up than for an investigation of something really serious.

Why I Left Orthodox Medicine: Healing for the 21st Century :

I attempted to carry out double-blind studies and found that they did not
work, for several reasons. First, TTFD makes the urine turn a tell-tale bright
yellow, for completely harmless reasons

I wonder if you could put something in a placebo pill that would have the same effect, and then let all participants know you did that, so they can’t use urine color as an indicator.

I think Lonsdale’s book is interesting but there are some claims or views I am skeptical of. Seemed worth mentioning one of those:

We have mentioned the daily rhythm of the computer, but it also has
a twenty-eight-day rhythm, at least in the female. It is not known whether the
twenty-eight-day cycle is coincident with the lunar cycle or whether the
gravitational force of the moon does have an effect upon the menstrual cycle.
It is fairly well-known that emergency rooms are filled with patients when the
moon is full, so this gravitational force does affect the human computer

I’m skeptical about the moon’s gravity affecting the brain computer, and I’m skeptical of the factual claim about emergency rooms.

Regarding emergency rooms:

A full moon occurred 49 times during the study period. There were 150,999 patient visits to the ED during the study period, of which 34,649 patients arrived by ambulance. A total of 35,087 patients was admitted to the hospital and 11,278 patients were admitted to a monitored unit. No significant differences were found in total patient visits, ambulance runs, admissions to the hospital, or admissions to a monitored unit on days of the full moon. The occurrence of a full moon has no effect on ED patient volume, ambulance runs, admissions, or admissions to a monitored unit.

They’ve studied psychiatric facilities as well, similar results.

The prevailing scientific evidence says no. Researchers in a 2017 studyTrusted Source analyzed emergency room records at a 140-bed hospital and found that people visited the ER because of a psychiatric condition in roughly equal numbers during all four phases of the moon.

A 2019 reviewTrusted Source of nearly 18,000 medical records from different facilities found the same thing: no relationship between lunar cycles and the length of hospital stays or the number of inpatient admissions or discharges at psychiatric facilities.

Apparently they’ve found some relationship between the lunar cycle and sleep, though, which is interesting.

Interestingly, one 2021 studyTrusted Source found that people fell asleep later and slept less overall on the nights before the full moon.

Other research suggestsTrusted Source that the full moon may be associated with less deep sleep and increased REM (rapid eye movement) latency.

Sleep latency is the period between when you first fall asleep and when you enter the first stage of REM sleep. So, increased latency means it takes a longer time to get to REM sleep.

Other causes of REM sleep latency can includeTrusted Source:

  • sleep apnea
  • alcohol use
  • some medications

The deepest sleep occurs just before REM sleep begins.

Some comments I found talking about ER admissions (and assuming that maybe the moon-ER admission relationship was true) said perhaps the relationship was full moon → more light → more people doing stuff → more admissions. Kinda like how crime goes up in the summer (I think that one is real?) because people can be outside more.

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Lonsdale has brought up the idea that doctors going on strike reduces mortality. I was skeptical. I found some stuff online. First, here’s a study abstract:

A paradoxical pattern has been suggested in the literature on doctors’ strikes: when health workers go on strike, mortality stays level or decreases. We performed a review of the literature during the past forty years to assess this paradox. We used PubMed, EconLit and Jstor to locate all peer-reviewed English-language articles presenting data analysis on mortality associated with doctors’ strikes. We identified 156 articles, seven of which met our search criteria. The articles analyzed five strikes around the world, all between 1976 and 2003. The strikes lasted between nine days and seventeen weeks. All reported that mortality either stayed the same or decreased during, and in some cases, after the strike. None found that mortality increased during the weeks of the strikes compared to other time periods. The paradoxical finding that physician strikes are associated with reduced mortality may be explained by several factors. Most importantly, elective surgeries are curtailed during strikes. Further, hospitals often re-assign scarce staff and emergency care was available during all of the strikes. Finally, none of the strikes may have lasted long enough to assess the effects of long-term reduced access to a physician. Nonetheless, the literature suggests that reductions in mortality may result from these strikes.

I don’t follow their point about the reassignment of staff. Are they saying that e.g. maybe higher quality staff were available to do emergency care cuz of the strike? Anyways, this seems to say there is some relationship. Also the point about elective surgeries is interesting. I don’t think a random member of the public would typically assume that a postponement of elective surgeries would have a significant increase on mortality, so I think there’s some disconnect between what people assume is the typical risk profile of an elective surgery and what it actually is.

Here’s a more hostile/biased write up that gives some details about specific examples.

They go through some specific examples and say either the effect is minor and driven by elective surgery postponement, based on anec-data, or non-existent.

But they start off with:

As we’ll see below, Jacob, it’s not really so surprising that mortality statistics sometimes show a drop during a doctors’ strike. What’s staggering is that a reasonable person could see such stats and for even an instant think: Holy crap, those doctors are killing us. Sure, there’ll always be a few alternative-medicine fringe dwellers who genuinely see the medical establishment as some sinister cabal presiding over a high-density feedlot of human misery. But the way this “fact” about doctors’ strikes gets passed around suggests that a lot more people are a little more nuts than you’d want to imagine.

This is rhetoric attacking people asking certain questions and strawmanning alternative views (you don’t have to think the medical establishment is a “sinister cabal” to wonder whether it is using the best methods/approach).

The end of the article says:

So despite media suggestions to the contrary, doctors’ going on strike doesn’t seem to have much effect on the death rate one way or the other, and any reduction seen is probably the result of postponed or canceled nonemergency surgeries. And that figures: any surgery is risky, and some common procedures (like coronary bypass or aneurysm repair) have a death rate you just can’t ignore. But leaving the tummy tucks out of it, most elective surgeries boast a pretty serious payoff, either in quality-of-life improvement right now or in medical trouble avoided down the line. If 600 people die each year as a result of hip-replacement surgery, does that mean the 200,000-plus patients that pulled through were fools to go under the knife? You’re welcome to calculate the odds however you like, and in certain cases it may well make sense to question the value of surgery. As a general proposition, though, if my health is on the line, I’m glad to hear that the doctor is in.

The article defends the general value of elective surgeries, which is fine, they can make that argument. But they started off attacking as nuts people who wonder whether treatment from standard doctors might be causing deaths. But their defense of the statistics is, yes, elective surgeries cause deaths, but it’s worth it. They don’t seem to consider that maybe people don’t realize how risky any surgery is, and that it might be good that people are wondering about this doctor strike/mortality relationship since explaining that might allow people to update their model of medical procedure risk in a way that allows them to make better decisions. I have a family member who just had some serious complications from elective surgery, so this sort of biased framing on this topic particularly troubles me.

EDIT: Anyways, bottom line, just based on a quick googling, seems like there’s some kind of relationship here between doctors strikes and lower mortality, when even the defenders concede that elective surgeries may be a driving factor.

That claim stood out to me too. Lonsdale mentioned it more than once (possibly I read it outside the book, too). I hadn’t looked it up yet though.

In Lonsdale’s narrative – which makes sense to me – a significant portion of non-elective treatments are harmful. There are various reasons which I’m not going to cover in this post besides mentioning that Lonsdale said something about a study showing thiamin deficiency rates went up during hospital stays (you test thiamin for people right when they’re admitted, and after they’ve been in the hospital a while, and compare).

I knew some stuff about that previously too. Hospitals have some dangers and should be avoided if you don’t have a compelling reason to be there. Some people overly trust medicine to be super advanced instead of somewhat crude – to be much more like the House TV show than it is – so may seek a lot of (non-elective) treatments where the cost/benefit isn’t actually worth it. For example, I think a lot of people just aren’t skeptical enough about surgery in general (including lasik laser eye surgery as a good but elective example, btw), and a lot of doctors are overly willing to do surgeries that are too often ineffective and have significant downsides. They often don’t understand the condition they are treating well enough to actually know the surgery is the right approach and is worth the downsides.

Doctors have wonderful miracle cures for some things, but they also don’t for a lot of other things, so there’s a much higher risk of ineffective bumbling in those other cases. More humility to admit when they don’t know would help here (doctors absolutely do admit they don’t have answers sometimes, but sometimes they say “it’s all in your head” and send the patient to a psychiatrist rather than admit to not knowing, and sometimes they try treatments when they don’t know). Also medical culture seems to dismiss a ton of “side effects” as not that big a deal while not placing an appropriately high value on clearly safer (and cheaper) options like taking some vitamins. They’d do less harm if they were actually trying to calculate cost/benefit ratios more, but they don’t always seem to do that because they’ll suggest drugs with clear risks that they know don’t have much chance of working over vitamins.

Anyway, would doctor’s non-elective mistakes outweigh the beneficial treatments? Perhaps not. But if they counter-weighted the majority of the benefit, then it’d set the stage for the elective stuff to weigh things down to net negative.

Maybe that’s unclear so I’ll make up some numbers to illustrate.

Suppose 1/3 of treatments are elective and they have an average health value of -30 (I’m ignoring other non-health benefits like looking younger). Multiplying those two numbers we get a negative weight of -10 .

If the 2/3 non-elective are almost all beneficial and the average benefit is +30, then the positive weight there is +20. The overall weight is 20-10 = 10, a positive number.

But now let’s split the non-elective procedures into half beneficial (+30 on average) and half are negative (since a lot of treatments doctors try don’t work). We’ll give the negative ones an average of only -15 (closer to neutral than the +30 or -30 stuff). Now we have +10 from the good treatments, -5 from the bad non-elective ones, and -10 from the elective ones, for a total sum of -5. The non-elective treatments contributed only +5 instead of +20 in this case, which was now close enough to 0 to let the elective procedures push things negative. It isn’t just elective procedures that are doing some harm.

Another issue is some treatments have a small risk right now but could be fatal (e.g. many surgeries, or also just a new med has a small chance at a very negative reaction which could kill you, especially if you’re already old/sick/frail). But that treatment is to help with a condition that was unlikely to kill you within the next year even if ignored. That doesn’t mean those treatments aren’t worth the risk, but it could mean doctor strikes lower short term mortality even if they raise mortality over longer time frames. A lot of medical treatments have risks immediately but aren’t aimed at preventing imminent death.

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