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Comment by ralusek | Hacker News Reader

You are severely underestimating how much of being a doctor is having to defend the route of standard care against what is actual nonsense. For every path outside standard care which might actually amount to something useful, there are a hundred totally useless, potentially harmful alternative paths. I'm sure in the modern era, when they are just trying what they know is the best researched, best chance they know for a successful path for you or your loved ones, they are beyond sick of hearing your alternative theses assembled from mommy blogs and witch doctors.

In other words, I suspect the emotions you're detecting are probably exhaustion and annoyance, and any genuine fear is most likely going to be that they fear for your outcome should you deviate from what they believe to be the best course of action.

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This. My wife is a doctor and she cares and tries hard to keep her patients healthy, only to have them oftentimes undo all the work she does by ignoring her advice and doing some other nonsense. This is true even when they are completely insured, the real medicine is free and it would require very little efforts. She seems exhausted by it especially since she's the one who then has to deal with the subsequent unraveling of their health and sometimes the emotional spiral of their early death.

Sounds like trying to convince a friend to do the right thing.

>You are severely underestimating how much of being a doctor is having to defend the route of standard care against what is actual nonsense.

I can assure you that my wife and I received orders of magnitude more nonsense from friends, family, colleagues and random assholes in the mall that saw her headscarf. The amount of unsolicited packages and potions we received at our doorstep from anonymous people over the course of her treatment puts anything that I brought to her doctor to shame.

>I'm sure in the modern era, when they are just trying what they know is the best researched, best chance they know for a successful path for you or your loved ones, they are beyond sick of hearing your alternative theses assembled from mommy blogs and witch doctors.

I get it. I really do as I personally was asked repeatedly to 'just try this' random bullshit for my wife all the time. There's a huge gap between sprinkling lion's mane mushroom on your eggs and seeking treatment for my wife's hyperglycemia that put her solidly in the diabetic category. Endocrinology wouldn't treat it because she didn't show elevated A1C, but I had nobody in my wife's corner to explain why A1C isn't a good signal when you're severely anemic and getting transfusions every other week. Google 'hyperglycemia cancer progression' with a 'site:gov' to keep it from NIH and other government agencies. There's a GIANT FUCKING SIGNAL that elevated blood glucose increases cancer progression, but I couldn't find a single doctor to even listen. To them it's all equivalent bullshit.

Maybe it's not fear then. Maybe it's apathy. I'm not sure that's better.

Yes, I think that's much more likely. It's unfortunate, because the reality is that the internet is a wealth of knowledge that in its entirety does trump their own. I just think if you assume that all of the people that gave you and your wife unsolicited advice, and more, are in there day in and day out, barraging that physician, they're probably apathetic. They are probably not equipped to recognize that your particular article might actually be relevant.

Why would you assume that a physician is unable to recognize the relevance of a study in their field?

I should have clarified that I meant that they're not equipped to consistently discern based off of patient interactions alone, which of the things their patients are telling them things that they read from credible journals vs which of the things they read from Elsweyr.

Years ago one doctor (IIRC a general practioner) noticed that all his diabetes patients taking metformin never got cancer. So he wrote a letter about it. I've lost the cite.

Today everyone, even doctors, knows that high blood sugar levels increase the odds of cancer AND diabetes. That's why everyone and his dog is taking metformin and why that drug is almost always the first ingredient included in "life extension" cocktail drug tests.

High glucose creates all kinds of stresses on the body (as a diabetic I get more easily ill when glucose levels are high) but I would not be surprised if cancer has some kind of operational working like pregnancy related diabetes which then causes the high glucose levels and accelerates everything even more.

But: High glucose levels do not cause diabetes. Diabetes causes high glucose levels. Once they go up you need treatment as you either have no insulin or are producing not enough and need to mediate that. Both are diabetes.

>I would not be surprised if cancer has some kind of operational working like pregnancy related diabetes which then causes the high glucose levels and accelerates everything even more.

Ding ding ding. My wife's blood glucose levels went from normal 90's range to averaging around 120 over the summer to averaging close to 200 last December. Her liver had a heavy disease burden, and my understanding based on my own research (because none of her doctors would address it) is that this can affect insulin sensitivity, which in turn can cause elevated blood sugar. This does not seem to be a dominant effect, however, and can go the other way as well.

When it does create hyperglycemia though, it also creates an unfortunate feedback loop in that the elevated blood sugar levels can increase the cancer progression, compounding the effect.

The anti-cancer protective effects of metformin would appear to be due to some other mechanism than reducing blood sugar levels.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6497052/

Indeed, an additional benefit of specifically using metformin to help address both.

But guess what, nobody will bite. I had to go to some weird third party service to get a prescription and spend weeks going back and forth with oncology and endocrinology to get anyone to comment on it. Oncology said NFW with zero rationale and endo said a small starter dose with regular monitoring for lactic acidosis due to compromised liver function.

There is no real proof that elevated blood glucose increases cancer progression. The Warburg effect (cancer cell aerobic glycolysis) has been extensively studied and reducing blood glucose levels isn't an effective cancer treatment. Don't believe the hype.

https://www.nature.com/articles/s41467-018-07857-9

Reducing blood glucose and A1c levels may be a good idea for other reasons, but it won't cure cancer.

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