Tag Archives: Health

So whatever happened with Aduhelm?

Aduhelm and Leqimbi were hot news a few years ago. They are both antibodies that work as anti-Alzheimer’s disease drugs by binding to and hopefully destroying amyloid beta. The hypothesis that amyloid beta is the causative agent of Alzheimer’s, and that reducing amyloid beta will lessen the disease, is known as the Amyloid Hypothesis. And while the Amyloid Hypothesis is still the most widely supported, I wonder if the failures of Aduhelm and Leqimbi to make much of a dent to Alzheimer’s disease has damaged the hypothesis somewhat.

Because think about it, the whole job of an antibody is to help your body clear a foreign object. When antibodies bind to something, they trigger your immune system to destroy it. And this is why you get inflammation whenever you get a cut or scrape, antibodies will bind to whatever microscopic dirt and bacteria that enter your body, and your immune system flooding that area to destroy them is felt by you as inflammation.

And we know that Aduhelm and Leqimbi are working as antibodies against amyloid beta. They bind strongly to amyloid beta, they induce inflammation when given to Alzheimer’s patients (although inflammation in the brain can cause multiple side effects), and tests show that they seem to be reducing the amount of amyloid beta in the patients who take them.

Yet the prognosis for Alzheimer’s is not much better with these drugs than without them. Maybe they just aren’t destroying *enough* amyloid beta, but they are barely reducing the rate at which Alzheimer’s patients decline in mental faculty, and are not at all causing patients to improve and regain their mental state. Maybe the brain just *can’t* be fixed once it’s been damaged by amyloid beta, but you’d hope that there would at least be some improvement for patients if the Amyloid hypothesis is correct.

This has caused the field to seemingly split, with many still supporting the Amyloid hypothesis but saying these drugs don’t target amyloid beta correctly, with others now fractured in trying to study the many, many other possible causes of Alzheimer’s diesease. Tau, ApoE, neurotransmitters, there’s lots of other stuff that might cause this disease, but I want to focus on the final hail mary of the Amyloid hypothesis: that the drugs aren’t targeting amyloid beta correctly.

Because it’s honestly not the stupidest idea. One thing I learned when I researched this topic was the variety of forms and flavors that *any* protein can come in, and amyloid beta is no different.

When it’s normally synthesized, amyloid beta is an unfolded protein, called “intrinsically disordered” because it doesn’t take a defined shape. Through some unknown mechanism, multiple proteins can then cluster together to form aggregates, again of no defined shape. But these aggregates can fold into a very stable structure called a protofilament, and protofilaments can further stabilize into large, long filaments.

Each of these different structures of amyloid beta, from the monomers to the aggregates to the filaments, will have a slightly different overall shape and will bind slightly differently to antibodies. One reason given for why Aduheim causes more brain bleeds than Leqimbi is because Aduheim binds to the large filaments of amyloid beta, which are often found in the blood vessels of the brain. By siccing the body’s immune system on these large filaments, the blood vessels get caught in the crossfire, and bleeding often results.

Meanwhile other antibodies are more prone to target other forms of amyloid beta, such as the protofilaments or the amorphous aggregates.

But what amyloid beta does or what it looks like in its intrinsically disordered state is still unknown, and still very hard to study. All our techniques for studying small proteins like this require them to have a defined shape. Our instruments are like a camera, and amyloid beta is like a hummingbird flapping its wings too fast. We can’t see what those wings look like because they just look like a blur to our cameras.

So maybe we’ve been looking at the wrong forms of amyloid beta, rather than the filaments and protofilaments which are easy to extract, see, and study, maybe we should have been looking at the intrinsically disordered monomers all along, and we only studied the filaments and protofilaments because we were *able* to study them, not because they were actually important.

There’s a parable I heard in philosophy class about a drunk man looking for his keys. He keeps searching under the bright streetlight but can never seem to find them. But he’s only searching under the streetlight because *that’s where he can see*, he isn’t searching because *that’s where his keys are*.

Endlessly searching the only places you *can* search won’t necessarily bring results, you may instead need to alter your methods to search where you currently can’t. And if the Amyloid hypothesis is to be proven true, that will probably be necessary. Because right now I’ve heard nothing to write home about Aduheim and Leqimbi, many doctors won’t even proscribe them because the risk of brain bleeds is greater than the reward of very marginally slowing a patient’s mental decline, not even reversing the decline.

I no longer directly research Alzheimer’s disease, but the field is in a sad place when just 4 years ago it seemed like it was on the cusp of a breakthrough.

Research labs are literally sucking the blood from their graduate students

I’m going for a “clickbait” vibe with this one, is it working?

When I was getting my degree, I heard a story that seemed too creepy to be real. There was a research lab studying the physiology of white blood cells, and as such they always needed new white blood cells to do experiments on. For most lab supplies, you buy from a company. But when you’re doing this many experiments, using this many white blood cells, that kind of purchasing will quickly break the bank. This lab didn’t buy blood, it took it.

The blood drives were done willingly, of course. Each grad student was studying white blood cells in their own way, and each one needed a plethora of cells to do their experiment. Each student was very willing to donate for the cause, if only because their own research would be impossible otherwise.

And it wasn’t even like this was dangerous. The lab was connected to a hospital, the blood draws were done by trained nurses, and charts were maintained so no one gave more blood than they should. Everything was supposedly safe, sound, by the book.

But still it never seemed enough. The story I got told was that *everyone* was being asked to give blood to the lab, pretty much nonstop. Spouses/SOs of the grad students, friends from other labs, undergrads interning over the summer, visiting professors who wanted to collaborate. The first thing this lab would ask when you stepped inside was “would you like to donate some blood?”

This kind of thing quickly can become coercive even if it’s theoretically all voluntary. Are you not a “team player” if you don’t donate as much as everyone else? Are interns warned about this part of the lab “culture” when interviewing? Does the professor donate just like the students?

Still, when this was told to me it seemed too strange to be true. I was certain the storyteller was making it up, or at the very least exaggerating heavily. The feeling was exacerbated since this was told to me at a bar, and it was a “friend of a friend” story, the teller didn’t see it for themself.

But I recently heard of this same kind of thing, in a different context. My co-worker studied convalescent plasma treatments during the COVID pandemic. For those who don’t know, people who recover from a viral infection have lots of antibodies in their blood that fight off the virus. You can take samples of their blood and give those antibodies to other patients, and the antibodies will help fight the infection. Early in the pandemic, this kind of treatment was all we had. But it wasn’t very effective and my co-worker was trying to study why.

When the vaccine came out, all the lab members got the vaccine and then immediately started donating blood. After vaccination, they had plenty of anti-COVID antibodies in their blood, and they could extract all those antibodies to study them. My co-worker said that his name and a few others were attached to a published paper, in part because of their work but also in part as thanks for their generous donations of blood. He pointed to a figure in the paper and named the exact person whose antibodies were used to make it.

I was kind of shocked.

Now, this all seems like it could be a breach of ethics, but I do know that there are some surprisingly lax restrictions on doing research so long as you’re doing research on yourself. There’s a famous story of two scientists drinking water infected with a specific bacteria in order to prove that it was that bacteria which caused ulcers. This would have been illegal had they wanted to infect *other people* for science, but it was legal to infect themselves.

There’s another story of someone who tried to give themselves bone cancer for science. This person also believed that a certain bone cancer was caused by infectious organisms, and he willingly injected himself with a potentially fatal disease to prove it. Fortunately he lived (bone cancer is NOT infectious), but this is again something that was only legal because he experimented on himself.

But still, those studies were all done half a century ago. In the 21st century, experimenting with your own body seems… unusual at the very least. I know blood can be safely extracted without issue, but like I said above I worry about the incentive structure of a lab where taking students’ blood for science is “normal.” You can quickly create a toxic culture of “give us your blood,” pressuring people to do things that they may not want to do, and perhaps making them give more than they really should.

So I’m quite of two minds about the idea of “research scientists giving blood for the lab’s research projects.” All for the cause of science, yes, but is this really ethical? And how much more work would it really have been to get other people’s blood instead? I just don’t think I could work in a lab like that, I’m not good with giving blood, I get terrible headaches after most blood draws, and I wouldn’t enjoy feeling pressured to give even more.

Is there any industry besides science where near-mandatory blood donations would even happen? MAYBE healthcare? But blood draws can cause lethargy, and we don’t want the EMTs or nurses to be tired on the job. Either way, it’s all a bit creepy, innit?

“I hate them, their antibodies are bull****”

I want to tell two stories today, they may mean nothing individually but I hope they’ll mean something together. Or they’ll mean nothing together, I don’t know. I’ve gotten really into personal fitness and am writing this in between sets of various exercises I can do in my own house.

The first story is from before the pandemic. I used to be a biochemist (still am, but I used to too). During that time I went to a lot of conferences and heard a lot of talks by the Latest and Greatest. One of the most fascinating talks was by a group out of Sweden who were preparing what they called a “cell atlas,” a complete map that could pinpoint the locations of every protein that would be in healthy human cells.

The science behind the cell atlas was pretty sweet. We know that the physical location of proteins in the body really matters, the proteins that transcribe DNA into RNA are only found in the nucleus because DNA itself is only found in the nucleus. Physical location is very important so that every protein in the body is doing only the job it’s assigned, and not either slacking off or accidentally doing something it isn’t supposed to. The first gives you a wasting disease and the latter may cause cancer.

So knowing the location of these proteins on a subcellular level is actually pretty important. But how can we even determine that? We can’t really zoom into a cells and walk around checking off proteins, can we?

The key was that this group was also really into making their own fluorescent antibodies. They could make antibodies for any human protein and then stick on a fluorescent tag that lights up under the right conditions. Then it was just a task of sticking the antibodies into cells and seeing which part lights up, that tells you where the protein is.

There was a bit more to it of course, I should do a post about how all this relates to Eve Online, but that was the gist of it: put antibodies in cells and see where the cell lights up. Use that to build an atlas of the subcellular locations of the human proteome.

It was some cool science and a nice talk. A few months later I was at another conference and the discussion came up of if conferences ever really have “good” talks or if scientists are incapable of anything above “serviceable.” I proffered the cell atlas talk as one I thought was actually “good,” it was good science explained well. The response I got from one professor stunned me: “oh I hate those people, their antibodies are bullshit.”

I don’t know how or why, but somehow this professor had decided that the in-house antibodies which underpinned the cell atlas project were all poorly made and inaccurate. That then undercut the validity of the entire project. I didn’t press further for this professor’s reasoning or evidence, I could tell he was a bit heated (and drunk) and left it at that. But while I never got any evidence against the cell atlas antibodies, I also never heard much in their favor. They seemed like a big project that just never got much recognition in the circles I ran in.

So was the cell atlas project a triumph of niche science, or a big scam? Well I don’t know, but it reminds me of another story.

As I said above, I’m much more into personal fitness these days. The Almighty Algorithm knows this, and so youtube serves me up a steady stream of fitness influencer content. I still stay away from anything that isn’t Mike Israetel or a few other “evidence based” youtubers, but even this small circle has served up its own helping of scientific slapfights.

In this case the slapfight is about “training to failure.” Most fitness influencers agree that you have to train hard if you want results. What exactly counts as “hard” though, that is where the controversy lies.

First of all, what is “training to failure?” Well unfortunately that too is controversial, because everyone has a different definition of what “failure” actually means. But generally, failure is when you are doing some exercise (a pushup, a pullup, a bench press) and you cannot complete the movement. Say you’ve done 5 pullups and you can’t do another, that’s “failure.”

Mike Israetel shows off example workouts of himself training hard, and he claims he’s training with “0 to 1 reps in reserve,” that’s a fancy way of saying he is training very near failure. If he does 5 pullups and claims he has 0 to 1 RIR (reps in reserve), then he is saying he could do AT MOST 1 more pullup, but he might actually fail if he even tried. He does this for almost every movement: bench presses, leg presses, squats, deadlifts, his claim of 0 to 1 RIR means he is doing the exercise until he can either no longer do it, or do it at most 1 more time before failure.

Failure itself is hard to measure, and sometimes you don’t know you’ll fail a move until you try. I once was doing pushups and just suddenly collapsed on my chest, not even knowing what happened. A quick assessment showed my shoulders gave out, and since pushups are supposed to be a chest exercise this implies I was doing them wrong, but that was a case where I clearly trained to failure since I tried to do the motion and failed.

But other fitness influencers have called Mike out on his 0 to 1 RIR claim, they think he isn’t training anywhere close to failure. The claims and counterclaims go back and forth, and unfortunately the namecalling does as well. I’ve kinda lost respect for the youtubers on all sides of this argument because of it.

But it gets back to the same point as the antibody story up above: a scientist is making a claim that they think is well-founded and backed by evidence, other scientists claim it’s all bullshit.

We think of science as very high minded and such, that science is conducted through solemn papers submitted to austere journals. I don’t think that’s ever been the case, science is conducted as much through catty bickering and backbiting as it is in the peer-reviewed literature. Scientists are still people, I’m sure a lot of us will be happy to take our cues from people we respect without spending the time to go diving into the literature. The literature is long and dense, and you may not even be the right kind of expert to evaluate it. So when someone you respect says a claim is bullshit, I’m sure a lot of people accept that and don’t pay the claim any additional mind.

So is the cell atlas actually good? Is Mike Israetel actually training to failure? I don’t know. I’m not the right kind of scientist to evaluate those claims. The catty backbiting has reduced my opinion of all the scientists involved in these controversies, although I understand that drunk scientists are only human and youtubers need to make a living through drama, so I try not to be too unkind to them.

Still, it’s a reminder that “the science” isn’t a thing that’s set in stone, and “scientists” are not all steely-eyed savants searching dispassionately for Truth. I don’t have any good recommendations from this unfortunately, the only thing I can think of is the bland “don’t believe scientists unquestioningly,” but that’s hardly novel. I guess just realize that scientists can disagree as childishly and churlishly as anyone else.

“I go with the athletes, not the science”

Sorry I haven’t written about finance in a while, I know science+finance (SciFi, if you will) was kinda my niche, but since I got serious about my fitness I’ve been recommended a lot of fitness content by the Almighty Algorithm, and it’s gotten me thinking.

Today’s topic requires just a tiny bit of background. As I wrote about, I’ve been following the advice of Dr Mike Israetel in part because he says all the right science-y shibboleths to make me believe he knows what he’s talking about. But I’ve also gotten recommended content from many other lifters who push back against some of his claims.

To an extent their pushbacks pass the smell test as well, they reference the same concepts that Dr Mike (and others) discuss, but they interpret those concepts differently. So the disagreement between Dr Mike’s “science-based” advice and other people’s advice seems to be a legitimate disagreement over the science, rather than a denial of science and the substitution of personal preference in its stead.

But other parts of this disagreement strike me as more… thoughtless. I watched a video critiquing some of the science-based conclusions, and it stated (paraphrased) “people say this move is terrible, but then you see world record power lifters doing it and you think hmmm, maybe it’s not so terrible after all.”

I think this appeal to authority has no place in a science-based discussion. Now yes, every scientific theory on exercise must be tested and proven *outside* the lab as well as in the lab. If a conclusion only works in a controlled lab environment then it isn’t necessarily best in the “real world.” But saying “well the best power lifters do this so the science must be wrong” is kind of absurd, because maybe they could be *better* if they actually listened to the science.

It reminds me of a story about Pliny the Elder. Pliny was a wealth Roman politician, whose wealth was derived mainly from vast agricultural estates. Not only that, he had extensive sources of the best knowledge available in the Roman world. So in his book Natural History, he draws upon his knowledge and experience to categorically state that *if you do not honor the gods, you will not be successful in agriculture*. And if you asked any of the Roman agriculturalists of his era, they’d probably give you the same answer.

Is the science on agriculture wrong? If all the best farmers honor the Gods, is that the only way to succeed?

No.

So if the best power lifters in the world are doing a certain move that science says is terrible, maybe the science is actually right and the power lifters are succeeding due to their own innate abilities combined with all their other training. I’d hazard a guess that a single move isn’t make or break to their training at all, and defending a move with this appeal to authority doesn’t really seem logical. It seems more like casting about for evidence to support an idea that you’d like to be true.

Science must be refuted with science. You have to be able to use real-world data and say “lab results say this move is bad but here’s all the evidence showing that people who eschew the move generally fail and people who use the move generally succeed.” You can’t point to a single piece of anecdote and say “well some people who use it succeed,” because then you’d be pointing to Pliny the Elder and saying “well I guess honoring the gods does improve your farm, because this guy was a really successful farmer and that’s what he did.”

Anyway, exercise science still seems to be in its infancy. I hope it gets more rigorous and comprehensive in the future, but it still seems to need some time before we can believe its claims as much as we can believe virology or chemistry.

Cope, or good sense?

As I wrote last time, I’ve been following Dr Mike Isratael’s youtube channel in my own quest to lose weight and (maybe) gain muscle. And as I said last time, Dr Mike says all the right words to make me think he knows what he’s talking about, but I’m afraid I only believe him because he knows the shibboleths, not because he’s actually right. What if he’s a charlatan like the rest, but his shibboleths are “basic biochemistry” instead of “pseudo-right wing culture,” and that’s why I believe him? What if what he’s saying isn’t correct, will I have the sense to know?

Well I’ve started… not disbelieving, but rather not following all the advice he gives. On the one hand, this could be proof that I’m a free-thinker, who takes all advice to heart and executes it not based on its source or shibboleths, but on its factual content. On the other hand, maybe that’s all cope and I’m not following it because I don’t want to.

The basic idea comes down to 1 thing: dieting. As I said, my primary goal is to lose weight, but I’m hitting the gym and I’d sure like to gain muscle on the way. Well Dr Mike has a video out about how that entire idea is a myth, and that the most productive way to do things is to eat a calorie surplus to gain weight (and go to the gym to make sure that’s muscle weight), while eating a calorie deficit in order to lose weight (and go to the gym to make sure that’s only fat weight). Trying to gain muscle on a calorie deficit, or lose fat on a surplus, is inefficient and possibly impossible.

Now Mike does caveat this with a few exceptions. If an exceptionally jacked individual was gravely injured and has lost muscle and gained fat while laid up in the hospital, then it’s much easier for them to gain back that fat and lose back that muscle once they get out of the hospital. It’s always easier to get *back* in shape than to get in shape *for the first time*.

Another caveat he talks about is “newbie gains,” where someone who is young and never went to the gym can start gaining muscle/losing fat together. But the caveat to the caveat is that this isn’t sustainable, eventually it will be one or the other.

So I’ve decided to believe that I’m in the “newbie gains” stage, the caveat to my own claim being that I did used to go to the gym a bit and I’m not actually that young. Regardless, I’m choosing to believe that Dr Mike is giving this advice to aspiring bodybuilders, people who are already fairly muscular and with a health amount of bodyfat, and therefore his advice doesn’t apply to me who is very unmuscular and with an unhealthy amount of bodyfat.

To reiterate, my goal is to lose weight and gain muscle. Dr Mike says that’s not usually possible and that I have to pick one and only one goal if I’m going to succeed, and I’ve decided to ignore that advice and believe that his advice is aimed at an audience that I’m not really a part of.

But maybe this is all wrong. Maybe for an obese person to become healthy, they need to lose a lot of weight, and during that time they simply won’t gain much of any muscle no matter how they try. And maybe that obese person is me.

If I were to take Dr Mike’s advice to heart, I would probably restructure my training with the understanding that I need to focus solely on the weight loss, probably by entering a more severe calorie deficit than I’m at now, in order to more quickly lose weight so I can then put on muscle. I’d probably spend a lot less time thinking about my gym technique and a lot more time working on my diet.

Am I ignoring Dr Mike’s advice because I’m a free-thinker making a rational conclusion about whether his advice is right for me? Or am I doing it because this is the first piece of advice I just don’t like?

I don’t know.

Exercise and shibboleths

I’ve been trying to lose weight and gain muscle for years. But despite being in the target Young Male demographic, I never listened to Joe Rogan, or Logan Paul, or any of the exercise/fitness influences. Part of that was that they just didn’t interest me. Part of that was that fitness is filled with a lot of pseudoscience, and as a scientist myself I could see that almost everything said online was tinged with nonsense and falsehood. Everyone is looking for “one weird trick” to get abs of steel and 4% body fat, which leads to a proliferation of voodoo practitioners giving terrible advice and selling you supplements.

I stayed away from online exercise discussions.

But while idly scrolling one day, I found a video by Dr Mike Israetel of Renaissance Periodization. And for the first time in my life, I’m hooked. I’m watching his videos, I’m trying to learn his techniques, I’m putting into practice what he say I should be doing.

I think a large part of this sudden switch is that Dr Mike seems to have legit credentials. A teaching record at Lehman College, a genuine publication history, this guy is clearly doing science, not voodoo. But I think even more than his credentials are his shibboleths.

Put simply, Mike Israetel says all the right words as a scientist to make me (a fellow scientist) believe he knows what he’s saying. There are certain words that started out in science but have reached the mainstream: anyone can talk about carbohydrates and calories. But few people know what a motor unit is, or can accurately talk about the immune system. Dr Mike is saying things that pass the smell test to me (I am a fellow biology but not an exercise scientist specifically), and that helps me believe him when he says things I might otherwise be skeptical of.

And those shibboleths… make me nervous. Because I know I’m not actually doing research, I’m not actually seeking out all sides of the debate and forming my own rational conclusions. There’s hundreds of hucksters selling you on “the best way” to do exercise, so am I trusting Dr Mike for all the wrong reasons? Maybe he knows his biochemistry, but his exercise science is dogshit. I’d never know.

And even if Dr Mike is truly giving me the most accurate, up-to-date information in the scientific literature, that information could be wrong, and I could spend my time following baseless advice and getting less fit than if I’d just trusted the gymbro with a 6-pack and pecs.

I haven’t looked for any advice outside of Dr Mike, because to be honest I don’t have the time or the background necessary to know if he’s *really* got the goods or is a huckster like all the others. I have the background to know he knows his biochemistry, but beyond that I’m lost. But as someone without much time to exercise anyway, I feel like latching on to a charismatic Youtube professor is at least better than latching on to any other charismatic Youtuber, and is hopefully better than flying blind like how I used to exercise.

Time will tell.

Healthcare needs to stop infantilizing its patients

I was once told a family story about one of my great-great aunts, let’s call her Clara. As a young adult, Clara was diagnosed with Lou Gehrig’s disease, or as it was known in those days “turning to stone.” Before Lou Gehrig made it noteworthy, the disease that bears his name was named after its most noticeable symptoms, a progressive atrophy of motor neurons until a person can’t even move at all. They feel like they’ve “turned to stone,” and death follows when the neurons controlling the heart or lungs also atrophy away.

Clara’s doctor told her sister about the diagnosis, but the sister was *adamant* that Clara not be told. “Turning to stone” was a horrific way to go, and conjured ideas of a person being trapped in their own body unable to move or call for help until at last they slowly, agonizingly, died. Clara was never told her diagnosis, and continued to see her doctor while being told lies that she was “improving” and “getting better.” Until at last she died.

And with the fullness of time, I guess she really will “turn to stone,” as will we all.

I don’t know what Clara thought as she was dying. Maybe she never really knew what was happening to her, or maybe she figured it out. Either way, her family probably thought they were doing her a favor by not telling her, and saving her the pain of knowing her inescapable fate.

But were they really saving her? Or did she pass away sad and frustrated that despite her efforts and all the encouragement, she only ever got worse and worse? Maybe knowing would have given her peace of mind, and made it easier for her to understand her condition.

Stories like Clara were common a century ago. It was not uncommon for doctors to hide a diagnosis from a patient, on the assumption that it was better they simply not know. Fortunately now we’re past that, and doctors are willing to treat patients with a lot more respect. Sometimes.

Recently I switched doctors and have been trying to continue taking the medicine I had been prescribed by my old doctor. My condition isn’t immediately life-threatening, but my live is much improved with the medicine. However I have had an absolutely terrible time of it, and have seen first hand how stupid the medical system can be when doctors get it into their heads that the patient is best kept in the dark.

The first thing that happened was that the doctors, with too little information in hand, misdiagnosed me and tried to brush brush off my condition. The medicine I’m taking has some slight psychoactive properties for some (although not for me) and is occasionally used to treat depression or insomnia. I have neither, and I wasn’t taking it for either.

I listed both my condition and the medicine I had been prescribed, and the doctor agreed to set up an appointment with me. But when I arrived for the appointment, the nurse did nothing more than take my weight before telling me that I was in the wrong place, *that* medicine is proscribed by psychiatric care, and I needed to get an appointment with an entirely different department. I made the appointment, but had no idea why I was even doing so.

The medicine isn’t psychiatric, nor is the condition. But because it has alternative affects, someone got it in their stupid thick skull that this was *only* a psychiatric medicine and that I couldn’t possibly be taking it for the *non-psychiatric* reason that I had put in the mandatory intake form. It’s clear neither doctors nor nurses ever read a damn word of the forms they ask you to fill out, because even glancing at mine would have told them what my condition *really* is. And if they *did* think I needed to visit psychiatric, then *they should have told me so before the damn appointment*. They should have realized “oh, this person is in the wrong place” and told me before they wasted my time!

As I said I scheduled the appointment with psychiatric, but after an angry phone call with the original doctor’s office, someone actually realized their mistake and got me a new appointment with someone who could treat my condition.

*Could* though, not *will*. Because see, my condition can also sometimes be treated with lifestyle changes, but I’ve worked on it for years with no luck before I got the medicine, and the medicine is the *only* thing that helped me. But the doctor I spoke to decided to treat me like someone who had never heard of their own condition, the condition *I had to tell these people about*, and started off with the whole lifestyle spiel before I had to cut them off and list off everything I’ve tried before medicine actually getting some help with medicine.

The doctor also decided that I had so *little* understanding of my condition that she had to list all the signs and symptoms, all the ways it will affect my health, even though *I already know all this, which is why I’m here for some god damned treatment*. These people were too stupid to read a form, and now are too stupid to listen to me and understand that I have had this for a while, I know what it’s all about, and I know I both need and want medicine to contain it.

They treated my like a child, quite frankly. They assumed that I was completely lacking in knowledge, that I didn’t know what I needed or wanted, and that I had zero understanding of my own health. I got a prescription but I’ve decided after filling it that I’m unlikely to ever visit this practice again, because for all the horrors of the healthcare system, infantalization of the patient is one thing that should have stayed in the 19th century.