I kind of regret weighing in on this subject, but since I have, I feel compelled to at least explain some of my position. I will start of by saying I'm sure Dave Lee is very knowledgeable and has helped many people. I value his experience and
I believe anecdotal information is important.
However, my issue was kind of his lack of transparency about his expertise and lack of support for information he was presenting. For example, he demonstrates organic chemistry slides and makes references to complex neurochemical processes, citing GABA receptors, etc. He mixes this scientific information with other information that is pure anecdote. So, he is toeing the line - coming off as an authoritative figure with complex scientific knowledge, yet giving information that is pure anecdote, without distinguishing the two. I think this matters, because he portrays himself as a scientist.
The other thing that troubles me about this conversation is the blind medical establishment bashing, portraying doctors as fuddy-duddy lab-coat wearing absent-minded-professors and scientific research as being driven purely by money. This is not fair and not reflective of reality. I think it can be dangerous to rely solely on anecdotal information for decision making guidance. Now, in the realm of hormone treatment, I think anecdote is VERY important for a variety of reasons, but that does not mean that the scientific method does not matter.
For example, if you walk up to a friend, Bob, who tells you his coin is kinda magic. Despite having both a heads and a tails side, you are highly likely to flip it and end of with heads. You flip the coin behind a curtain, and come out and tell him the result. He thinks almost all of the last ten people flipped heads. Holy cow!
You see another friend, Joe, who tells you: "Actually, that coin is just a coin." What Bob didn't realize is that 20 people flipped the coin. But, one guy had a stroke before coming out from behind the curtain. He flipped tails, but wasn't alive to tell anyone. A family of six flipped the coin, but had to make a plane to Ecuador, so they bailed before anyone could find out what they flipped. Instead of flipping the coin, three teenagers bounced it off the table like they were playing quarters. You start to wonder how magic Bob's coin is.
Joe then proceeds to tell you that he also did a coin flipping experiment. It was weird, because the first ten actually did flip heads. But, he eventually invited 1000 people to flip the coin. Some people cheated. Some people did not report their result. Ultimately, about half the people flipped heads and the other half tails. Joe figured that since he simply had more data, he could account for a few people here and there cheating or leaving before giving their result.
In another example, you have a loved one that just came out of surgery to resect a brain tumor. Although things went well, you are told your loved one will need chemotherapy. Dr. Bob walks in with a IV bag of fluid, telling you we are going to start the chemotherapy right away. You look at him and ask him: Does that stuff work? What are the chances this will save my loved one? Does the potential for a cure outweigh all potential side effects? Dr. Bob says: "That's hard to say. I have seen a bunch of people survive on this chemo drug. I have also seen some people not make it."
Dr. Joe then comes in to give you a second opinion. You ask him the same question. Dr. Joe tells you that the drug was studied in 100,000 people. He just got done conducting a
Level I study designed to answer whether or not the chemo drug was safe and effective. You become a bit worried, wondering - if he was involved in the study, does he benefit financially from giving the drug. You are not shy, so you ask him up front. He goes on to explain that the study was funded by the NIH. He lost his father at a young age to cancer and he knew early in life he was going to pour his heart and soul into trying to find cures to various types of cancers. It was grueling for him. It took him years of punishing pre-med in college, med school, residency and fellowship in surgical oncology for the privilege of calling himself "doctor". But, that was not enough. Dr. Joe really wants to make a difference, so taking care of patients will not be enough. He wants to push the frontier forward. So, in his free time, through all that, he spent long nights in the dark, peering through microscopes and pipetting into test tubes, so he can earn a PHD and become armed to really answer some questions about the human body. Anyway, "I digress" says Dr. Joe. The point I am making is that I went through all this to help people, and I am here to help your loved one.
He assured you that the study he led was had a very low
P-Value and was large enough to give sufficient
statistical power to reasonably estimate whether or not the chemo will help without hurting. He is confident this chemo drug has an excellent chance of helping with manageable potential side effects.
I personally am going with Dr. Joe
Let me reiterate,
I absolutely value anecdotal information. I personally come to this forum for it and strongly consider it in my own decision making. I do believe the medical establishment likely has some blind spots when it comes to understanding things like TRT. But, I think can be a slippery slope and dangerous to whole-sale discount doctors and the
scientific method. I am not necessarily implying anyone here in this thread has done that, but I see a lot of medical establishment bashing on forums like this one. I am in no way suggesting doctors and scientist always get it right (look up
thalidomide) or are always ethical (look up
Tuskeegee Experiment). But to wholesale discount the medical establishment, in my opinion is short sighted and can be dangerous.
