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December 13, 2018

BehindTheMedspeak: Trust, but verify


Long story short: about twenty years ago I developed runner's anemia, a condition in which silent gastric bleeding associated with extreme distance training results in iron deficiency anemia.

Oddly, my running regimen wasn't in the least exceptional, perhaps 20 miles per week.

I diagnosed myself by looking at my fingernails, one of the nice things about having gone to med school.

I had koilonychia ("spoon nails"; below).


But I digress.

I drilled down and found a doctor whom I believed to be the best hematologist in central Virginia, and self-referred myself.

He worked me up and sure enough, my blood iron stores were lower than the normal range.

He put me on a regimen of daily Feosol (oral iron tablets); after a month there'd been no change in my level.

He said to give it another month.

At that point I invoked "verify," and began a systematic search of the medical literature.

I consider myself a world-class expert in such investigations, having honed my chops in the early 1980s when I single-handedly researched and wrote a fifteen-page-long review article on aminophylline

It had over 400 references going back to the 19th century, each and every one of which I read.

I knew each and every — and I mean every — paper and study involving aminophylline ever published, in any language.

A number written in languages other than English I had to get translated by the Library of Congress so I could understand them.

In fact, I can safely say that by the time my review was published in 1981,

Screen Shot 2018-12-11 at 8.45.06 AM

no one in the world knew more about aminophylline than me (Stuart Sullivan was my supervising professor; he reluctantly let me add his name to the paper).

But I digressed yet again.

I discovered that the most recent literature concluded that the foods and supplements my doctor had advised against taking with Feosol in fact enhanced iron absorption, while those he said to take with my iron tablets reduced iron absorption.

How could this be?

Easy peasy: my hematologist/internist ran a busy one-man private practice which allowed little time to keep up with the literature.

What he'd learned during his residency (in England, for what that's worth) twenty years ago about iron absorption was long since out of date, but it's unlikely he'd ever opened the journals that reported the latest findings.

Rather than get into it with him, I simply modified my iron intake regimen to that advocated by the latest research, and in fact my iron levels quickly responded, increasing to normal levels within months.

So what's the lesson here?

I guess, for civilians, it's to stick to scheduled major airlines, and hope your pilots are rested and alert.

Beyond that, it's in the hands of the gods.

December 13, 2018 at 10:01 AM | Permalink


Trust everyone, but cut the cards.

Posted by: antares | Dec 13, 2018 1:30:24 PM

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