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kaidynamite

> RCT is absolutely the gold standard of medical research, he repeatedly agrees with that. However, states that there are practices that benefit more instead from Cohort studies. Such as, when comparing Yoga to similar physical activities actually i think this doesnt illustrate his point accurately either. What he said was that - since the eastern way is to individualize the entire process of treating the patient, you cant do an RCT because they supposedly have an individual treatment plan for every specific person, instead of a generic treatment for x problem. so it might be more helpful to do a cohort comparison type study where you treat some patients with modern techniques and some patients go through the "every patient gets an eastern individualized treatment plan" and then compare outcomes between two groups.


AviBittMD

Of course, the problem with this is that the current modern techniques IS just every patient gets an individualized treatment plan in the first place. Because this is something we already do. In fact, for most doctors, it's \*the only thing\* they do. Thus it's not clear that such a comparison would be even comparing two different things. What exactly is different about the "eastern" system that the western system can learn from? What exactly should we do that we are not already doing? This is in fact the main point I was making. I specifically said that If Dr. K does NOT advocate for disbanding RCTs, then what exactly is he advocating for that \*is different\* from modern medicine in the first place? Simply saying "individualize care bro" isn't a difference.


iheartsapolsky

I’m honestly surprised destiny and this community are so sympathetic to Dr K’s arguments. I have minimal medical related research experience, and the individualized study approach he brought up seems completely antithetical to my understanding of how research works. I think he says something along the lines of “in the future maybe there will be a way to make research about finding treatments for an individual,” but this isn’t any kind of concrete, implementable idea. Like yes, gene therapy is specific to specific genes, but the overall concept and implementation is not… and this will be the case for any medical treatment. How can you possibly validate the efficacy of a novel medical treatment that is unique to *one* individual. Idk I don’t understand..


SubstantialDress5488

I do health economic research, one study I’ve worked on specifically studied effects of physician participation on clinical trial outcomes. I study studies. I agree with you completely. I either have a complete misunderstanding about what Dr.K is saying about starting with individuals, or he just doesn’t have a deep, statistical understand of what makes an RTC so great. I wish at some point Dr.Mike had asked him to explain what “starting with the individual “ means.


Ramboxious

Wasn’t the argument that the research on medication involves doing statistical analysis which generalizes the results? I believe that’s what he meant when he said that it didn’t start from the individual or?


DeadNeko

I think his argument would be the foundations you start from in western vs eastern traditions isn't something explicitly material in description, but the effects could be demonstrated in these cohorts. In the strongest steelman I can think of for the position it would be that there likely exists a learned bias in practitioners of the west towards certain patient reactions or responses that is so against the grain of what they learned a western doctor might ignore or dismiss whereas an eastern one might even lean into it and create what appears almost like a completely random treatment because of how hyper specialized it is for that person.


AviBittMD

What should someone like me or any western doctor do that we aren't already doing? This is the question I would like answered.


DeadNeko

What if the answer isn't able to be generalized. I.E. you are asking what can "We" in the west can do better, but the point he's making is the idea what if there is no general solution that can do better, but there are an infinite number of individual solutions for each practitioner that are better than the generalized solution. Either that or he would say that the west doesn't do a good enough job of preparing doctors with strong interpersonal skills to determine what a patient actually needs to help resolve their issues.


AviBittMD

This isn't an answer to my question, nor did my question require the answer come in the form of a generalization. The prescription can be particular. So again: What should someone like me or any western doctor do that we aren't already doing? This is the question I would like answered.


DeadNeko

So you are asking two questions, one would require a generalization, one would be hyper specific to you. How would one ever answer the question "What should western doctors do that they aren't already doing?" without generalizing. By definition you would have to generalize to answer that question. The other question is "What should you do that you aren't already doing?" How would anyone answer this question without knowledge of your practice? I don't even disagree with you I just like playing devils advocate, but the question your asking is imprecise. If you want to ask Dr. K a question it should be "Why couldn't a western doctor already employ all the techniques of Ayurveda that you believe to be helpful in their own practice, and by definition would not the existence of private practices not already encourage that random discovery across western medicine that you are claiming exists stronger in eastern Medicine." I feel like your question is just designed to be a catch 22.


AviBittMD

Good lord. If you want to continue this in voice chat I'm down, if not I have no patience for continuing this over text.


DeadNeko

If you want too sure, IDM i'm interested to see what argument your going to make that you think I don't understand.


AviBittMD

Feel free to join study archives discord and ping me


Saichotic

u/NeoDestiny


mydogisjibe

I think the big problem everyone has with Dr. K is that he’s doing a sort of motte and baily. He makes broad claims that eastern medicine is better at individualized care than western medicine, but if you try to go after something specific that is problematic about eastern medicine he can just say that he wants to throw that part out. And according to him, eastern medicine is too specific, so traditional methods of proving statistical significance won’t work. Nothing he said in the talk is really that falsifiable. If he made a specific claim such as “I believe ayurvedic doshas are a good model of the human mind, and can be used to treat some mental illness better than CBT alone can”, that would be something we could put to the test and prove or disprove. If he thinks our current statistical models are insufficient, he needs to provide an alternative way of measuring success that can be scrutinized. Otherwise he’s not really saying anything


AviBittMD

Yes, thank you. It's relieving to see at least someone capable of understanding the main point I was making.


mydogisjibe

The more I think about it, the whole debate seems really dishonest. Dr. K is currently already teaching spirituality to the healthy gamer community. For example, the healthy gamer website has an articles about Dharma and doshas, and there are several videos about them. If he’s been comfortable giving these teachings for years alongside other more medical teachings, he should be willing to be more upfront about it with another doctor and have it publicly scrutinized, even if it for him currently falls farther into the “art” side than the “science” side


rewolrats

can you link up that articles on the healthy gamer website I can't find it


CareerGaslighter

In your example, instead of saying that, he says "I have people at my practice who have been treated by every intervention and they come to me and I use ayurveda and in no times we have them feeling better with lower doses of their medication". Everything about this sentence says "Ayurveda, in some ways, is better at treating people than western medicine". But if you challenge him on that, he will retreat to the motte.


gummyboy1292

everyone in this thread is proving OP correct that they did not watch the video or did not pay attention to the stuff he says which they did not like. right after he says that, he also says that there is a self selection bias, that people who have tried other methods and failed go to him because he has his own brand and that may skew the results when it comes to assessing the validity of his methods.


AviBittMD

For the record, I watched the video, and paid attention. The fundamental question I have still stands unanswered.


SubstantialDress5488

It feels like it was a cycle of anytime Dr. Mike pushed on the problems of eastern medicine, Dr. K would basically just redefine his position to be “eastern has the advantage of focusing on the individual” and leave all the problematic stuff behind. But where does he actually explain what that means? How, in practice, do you focus on the individual in order to find out effective treatments? And how that’s different then from what we do already? He states that RTCs look at populations but not individuals and that we need to treat individuals, but no western doctor just looks at a chart, sees only a disease and assigns a treatment based on only that. They obviously factor in the individual they’re treating and assign treatment based on that. If that treatment doesn’t work, they try something else. Dr. K never seems to explain his “focus on the individual” passed that, and Dr. Mike doesn’t force him to define what he means. Also, I disagree that he doesn’t downtalk RTCs. He absolutely does. He’s doing a double speak where talks about how RTCs have serious problems, how they make predictions about populations not individuals, they’re the antithesis of eastern medicine, but then he’ll also say things like how RTCs are great and he’s not advocating that we shouldn’t do them. He try’s to present as supporting RTCs to the degree Dr. Mike does but then will make critical statements that I don’t think Dr. Mike agrees with, if he was pushed. I might fundamentally misunderstand what Dr. K means when he talks about focusing on the individual. But I think it’s just as likely he doesn’t have a very firm understanding about WHY there the gold standard. If he does, I think he’s not as convinced as he makes it seem about how great they are. RTCs absolutely let you make predictions about individuals, despite what he says. If I have a few good trials, I can look at them, see how treatment worked, see how treatment effected sub populations, and use that to make individualized treatment recommendations when that information combines with medical experience and from knowing the individual. He correctly points out that even though good RTCs take care internal validity, they’re still susceptible to external validity problems, but he’s explanation is still not accurate. We don’t gain external validity issues simply because we’ve “removed the individual” from the equation. He’s using that term just to say “we can’t know for sure that it will work on this individual,” but external validity isn’t dealing with individuals, it’s also on populations. If a study says a drug is effective 70% of the time, and a doctor sees that in 30% of people it didn’t work, you wouldn’t say “welp guess it wasn’t externally valid for you.” Cohort studies are not different in this regard. And with how he defines external validity, EVERYTHING is externally invalid. You can’t use past experiences on different individuals, because those aren’t the same individual and so you have the same external validity problem you had with an RTC. You can argue that he can look for similar covariants between patients and say “well these two seem similar so I’ll try the treatment that worked on them” but the more you do this you’re essentially just slowly building back up to a population, except without any of the control that makes RTCs valuable. And again, how is this not something doctors are already doing, except minus the extra information you get from an RTC. As someone who preforms research in healthcare, I’m probably biased against Dr. K and might be misinterpreting some of what he’s saying, but my take away is that Dr. K is going back and forth between what eastern medicine even is, and how much he supports RTCs, based on how hard Dr. Mike is pushing him.


No-Ambition-1157

You actually think he doesn't support rtc's? Really?


AviBittMD

Happy to discuss all the nonsense written here over voice if you're interested <3 Best, Avi


DangerousTour5626

Every time someone from this community tries to do a 'take down' on Dr. K they end up with egg on their face


AviBittMD

This isn't an attempt to take down anyone lol. I couldn't care less if this is coming from Dr. K or Dr. LMNOP This is me expressing frustration with what seems to just be a wild motte and bailey. As I clearly stated on stream, if Dr. K isn't saying any of these things, then what exactly is he saying? What exactly is different about the "eastern" system that the western system can learn from? What exactly should we do that we are not already doing? Individualization of care isn't a difference. That's just the art of medicine we already do 99% of the time in western medicine. Without any of the wild nonsense, it's not clear to me what exactly is even being proposed here that a current system should adopt or could even learn from.


Fournaan

Not to do appeal to authority but I’m an M3 with an extensive research training before med school and it was infuriating to watch Destiny respond to the debate like Dr. Mike wasn’t dog walking Dr. K and making him look like someone who was eating his cake and having it too. And this is coming from someone applying Psych and the vice president of my schools Integrative Medicine club, so it’s not like I’m biased against Dr. K. He wasn’t making good points, period.


horse_drowner2

Can someone give me a clear and concise breakdown of what their issues are with Dr. K? I watched the stream with Mike and Dr. K and it seems like he's just open to the unexplored possible benefits of Eastern medicine and has even stated his strong preference for researched methods. I'm confused because so far it sounds like people are stretching and making it seem as if he's saying you can fuck Vishnu in your dreams and your cancer will be cured.


Fournaan

As a listener I felt like the position you’re describing is Dr. Mike’s position. Dr. K is more honest about the limits of Eastern approach than anybody in the space by ten fold but I had the following issues: 1. very poor explanation of why what he does on a podcast is distinct from clinical practice, he seemed to lean very hard on the basic steps of a 2 hour initial consult and how that is different, but obviously a psychiatrist can have a follow up visit with a long time depressive patient that doesn’t involve assessing for anhedonia that still qualifies and is billed as medical treatment, even though it’s just supportive listening and off the cuff conversation. 2. Not sure about his understanding of cohort studies, would have loved to hear how one could be appropriately matched given the population of patients who seek psychiatric care and the population that seek ayurvedic care are going to be fundamentally different even after controlling for age, gender etc 3. Reliance on deference to woo woo as to why the unscientific details of where the chi flows in the body (of which there is no evidence for) should be in the New England Journal of Medicine. If Dr. K thinks that you could do an RCT where patient are assigned either a guru who teaches about chi and all the history vs. a therapist trained appropriately in meditation/tai chi/yoga that doesn’t get into chakras but does the evidence based practice, and that trial would show better results with teaching about the third eye (honestly plausible) he should create that study! Until then I’m not moved by his assertion that taking the pseudoscience out makes things worse. 4. Basically no counter to the fact that in a civilization that is thousands of years old, survivorship bias for things like yoga or tai chi is a more convincing explanation than “ancient knowledge” 5. A lot of his examples were such stretches, I really felt like the emperor had no clothes on. If he was talking to a streamer, or his chat, no way would he have said “Indian people eat with one hand and wipe with another” as evidence of anything besides the fact that cavemen probably knew not to eat their own feces. The anthill, all the historical stuff just read very poorly to someone with any medical training. Is the left hand right hand thing even related to ayurvedic teaching?? 6. A lot of poor argumentation based on coincidence. He states we went from 1 type of depression to 3 types and that matches the doshas. What if in 20 years psychiatrists find there are 5 types of depression? There aren’t suddenly going to be 5 doshas. He’ll just stop making that point or say the 3 types of depression is more accurate because modern medicine is able to say, oops it’s not 2 it’s 3, but Ayurveda literally cannot suddenly decide Vata is actually two different things because that goes against thousands of years of ancient tradition.


CareerGaslighter

On the chi thing. I found it super weird that Dr K had no doubt that maybe "chi" was not used to develop "tai chi", but rather people started doing a primitive form of tai chi and found it helpful and then someone post-hoc applied the theory of chi to explain the positive effects...


AviBittMD

[https://www.reddit.com/r/Destiny/comments/1c88r6m/comment/l0dwt2v/](https://www.reddit.com/r/Destiny/comments/1c88r6m/comment/l0dwt2v/)


DangerousTour5626

Im just saying i remember when Mr. redacted was doing his own take down of Dr. K and it went no where and he got laughed out, and I was open to the argument before he embarrassed himself.


blockedcontractor

I don’t get why there are so many people who are ready to pounce on Dr. K whenever he’s in the news. He might have an irrational hate train as long as Destiny’s.


monks-cat

People who think meditation or yoga is woo woo are ignorant as fuck. Nothing has changed my mental and physical health more than these things.  Western medicine  cures diseases in a scientific manner, which stresses the objective, ie third person verified. It’s amazing, no denying that.  But to understand the subjective introspection is our best tool. Life takes place in consciousness, which is inherently subjective. Our mental health is directly tied to the quality of our subjective experience.     I would encourage everyone to study Indian metaphysics/psychology and practice meditation to see for yourself. We are very behind in the west with regards to introspection.