Today on the Doc On The Run Podcast we’re talking about the difference between a doctor and a librarian.
Now, I’m going to tell you a story. There was a time when I actually had some pretty significant allergies. I went to see this guy who was an allergy specialist. He was well-regarded in the community and all my other doctor friends said, “Yeah,he’s definitely the guy to see”. He’s the best in town, so I went to see him. He has all the right credentials and seemed to be an expert in every possible respect in terms of what we think of as an expert in a field in medicine.
I went to see this guy and I had a specific question. I asked him like, okay, here’s what’s going on. We did a whole bunch of tests and I wanted of course to hear his treatment recommendations but after listening to all of that I had one very specific question for him. I actually wanted to know if these whole-home filtering systems that you can put in that have static electricity that sucks all the pollen and dust and dust mites, all this stuff out of the air.
If that would actually help me, all those things that use static electricity to actually pull allergens out of the air and filter your home, if it would work. The systems are extremely expensive, so obviously I did not really want to spend the money on one unless someone who was clearly an expert in that area could tell me that it made sense. But, I wanted to know.
Before I went in, I actually researched this. I’ve done lots of research. I’ve published medical research. I looked up articles online. I looked up articles specifically online that had been published in medical journals, in peer review journals that seemed to be reputable. Basically, I could find no evidence of this. I went to him, and he’s the expert. Right? I said, “Look, what’s your opinion? Do these things work or not?” He said, “Well, there’s not research to show that they’re effective in the medical literature”. I said, “Right, see I did a Medline search myself and I came up to that same conclusion”.
That’s not my question. My question isn’t, is there any research studies that show that they’re effective. My question is, in your opinion, are they effective? He again paused and he said, “Well, there aren’t any studies that show that one way or another”. I said, “I know”. Sometimes I get a little irritated and I did with this guy. The truth is, look, I’m going to ask you one more time. In your opinion, you as the expert with all of your experience, all of your training, everything that you know about these systems and everything you know about taking care of patients who have allergies, do you believe these things can help or not? He said, “I don’t have an opinion because there hasn’t been any published research”.
When I left there I was astonished. But when I left there, I was like, man, I want my copay back. This is a ripoff. I came in here looking for a very specific opinion and this guy flatly refused to give me one.
Basically, what I learned was when I actually left there, I’m thinking this guy’s not a doctor, he’s a librarian. He’s someone who catalogs information and will only present the information that he can find. He doesn’t have an opinion. He doesn’t have the capacity to form an opinion. He actually doesn’t have the ability to give me the information I need because he’s supposed to be able to as a doctor, in my opinion, he’s supposed to be able to take all the research that has been published and help you understand as a patient what it is that you should do based on all that research. But also in conjunction with all of his training, all of the experience, all of the times that he’s interacted with patients and seen what they’ve done that’s worked and what has not worked.
In an ideal world, we would have research that actually studies everything, every variable, every possible scenario and then helps you know conclusively what will work and what will definitely not work. The problem is that research studies really don’t work out that way. There’s almost never a study that shows that something is 100% effective for everybody, all of the time, given all of the variables that can go into a patient’s given circumstances.
When you’re a runner, that’s even way more complicated because you don’t just get injured and want to heal a specific injury like a metatarsal stress fracture or Achilles’s tendonitis. You want to run. You don’t want to just heal the thing, you want to run. You want to heal it as quickly as possible, so you can keep running. And you want to figure out why the injury happened in the first place so it doesn’t happen again.
Unfortunately, there are many doctors who hide behind their stack of research articles and they don’t really help you understand what the real possibilities are for you. When you’re a runner you have to look at every possibility.
Now, I recently had a webinar about how to reduce stress and keep running when you have a metatarsal stress fracture. I was actually shocked, but there was this flurry of outrage and demands for evidence by doctors, physical therapists, lots of different medical practitioners. They insisted, even though I was going to talk about this and talk about my strategies and talk about what I teach to physicians at medical conferences, people on Twitter were insisting that you have to tell us right now, right here in 120 characters on Twitter, what the evidence is.
I actually wondered about that. What I did was, I of course invited all these doctors to the webinar. Interestingly, a number of them signed up. None of them showed up. They didn’t even come and I actually replied to someone directly and said at least you’re thinking about this but I think you should come on and talk about this. A couple of them, I even invited as a guest on the Doc On The Run Podcast and radio silence as soon as I did that. Apparently they like to talk in 120 characters but don’t want to actually come on the show and give their opinions, but I think their opinions would be valuable. It seems like they’re contributing some valuable things.
But some of these doctors and people that were commenting, I actually looked them up. Post after post after post, it’s not actual opinions about anything. It’s just, here’s another article, here’s another article. This article shows this, this article shows that. It’s really reposting of articles. It’s just a cataloging of information but it’s not actually a thing that necessarily helps you because that’s a big problem is that you can take one piece of information and rely heavily on it and it may not actually be accurate for you. That’s what drives me nuts.
Now, I understand a lot about research. I’ve been a peer reviewer. A peer reviewer is basically somebody in the same field who reviews articles before they’re published in a medical journal. I’ve been a peer reviewer for the Journal of the American Podiatric Medical Association. I’ve been a peer reviewer for the Journal of Foot and Ankle Surgery, and I’ve done lots of research. I’ve published research. I’ve won multiple awards for research. I’ve started clinical trials on humans where I got the clinical trial proposal written and submitted and approved through the university institutional review boards. I’ve had a lot of experience in that.
The main thing that I learned through that entire process was something that you may not even realize happens. That’s that all of that stuff can be skewed. I had one study that the company sponsoring the study said that they wanted complete and total control over whether or not the study would be published, at their sole discretion. What that means is that if we did this study and it actually showed that platelet-rich plasma injections were not effective. They wanted to have the right to completely block publication without any sense of appeal or anything on my side. But of course if it showed something favorable for their product, then they would of course want it to be submitted for publication. But, if it was negative, they wanted to be able to bury it. I think that that’s wrong but that happens a lot.
In fact, there was one study, it actually won an award from the American College of Foot and Ankle Surgeons for this study. The editor of one of the premier journals in our field actually sent me a letter that said, we would like to publish this but this one finding is too politically inflammatory and we want you to rework the statistics to obscure the finding.
This guy literally wanted me to deliberately hide a finding and then publish the study which you don’t have to be a doctor to know that’s wrong. Ethically, it’s something that I couldn’t do and I just replied and said no. 10 years later another editor actually sent me a letter that requested I do the same thing. He said, we’d still like to publish it but you’re going to have to hide this. I’m not going to hide anything, so I didn’t publish it.
That’s the thing is, is that you have to understand that just because a study shows something it doesn’t mean it’s the whole story. It’s one piece of evidence. Let’s face it, like the OJ Simpson trial many years ago, everybody remembers this, the glove does not fit. If the glove does not fit, you have to acquit. It’s one piece of information in the whole story, but that’s not the entire story. Some doctors want to take one piece of evidence and say, that’s the entire story and that’s what everybody has to do. It doesn’t make any sense.
One thing you have to remember is that all research studies, they come up with statistics. We show statistical significance. We try to prove with numbers that something is factual. Those things are often very, very persuasive. There’s one guy, Grant Cardone, who always says, I never trust around numbers. So, somebody says, 80% of all people do this, it’s never 80%. If somebody says, 79.2%, well that suddenly seems more believable. When you have big numbers and big statistics, they seem even more believable. But, I’ll never forget, I heard a lecturer say one time, he said, you have to understand, statistics are a lot like swimwear. What they reveal is interesting. What they conceal is essential.
If your doctor’s just telling you about research studies and not really telling you about how that extrapolates to real world experience and what to do with you, and what it is to do with your return to running, then you’re probably not working with a doctor at all. You’re more likely to be working with a librarian.
If you have a question that you would like answered as a future addition of the Doc On The Run Podcast, send it to me PodcastQuestion@docontherun.com. And then make sure you join me for the next edition of the Doc On The Run Podcast!
Dr. Christopher Segler is a podiatrist and ankle surgeon who has won an award for his research on diagnosing subtle fractures involving the ankle that are often initially thought to be only ankle sprains. He believes that it is important to see the very best ankle sprain doctor in San Francisco that you can find. Fortunately, San Francisco has many of the best ankle sprain specialists in the United States practicing right here in the Bay Area. He offers house calls for those with ankle injuries who have a tough time getting to a podiatry office. You can reach him directly at (415) 308-0833.
But if you are still confused and think you need the help of an expert, a “Virtual Doctor Visit” is the solution. He has been “meeting” with runners all over the world and providing just that sort of clarity through online consultations for years. He can discuss your injury, get the answers you need and explain what you REALLY need to do to keep running and heal as fast as possible.
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