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Just a little rant against Doctors (*Edit* And the medical system)


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So I wasn't sure where else to put this, but just wanted to get it off my chest. I went to see my 2nd p-doc within the last month in order to attempt to obtain a legitimate prescription to valium for the purposes of tapering. Also was looking for a script to remeron, since my sleep is still pretty bad even after reinstating. I made the mistake of mentioning tapering down, and switching over from the klonopin that I had previously been on. Big mistake. In the US, doctors just don't get it. He actually said "well if there's an addiction, we need to stop the benzos. You'll feel a little anxiety for a few days, but then you'll be ok" Lol. He then said but if you have GAD, and valium or klonopin seem to work for you, then we can go that route. I immediately said yes, I think I have GAD. You see, docs just don't want to get involved in the whole tapering business. It's messy. I'm not sure if they're completely ignorant to protracted WD, or if they just don't want to get involved in a tapering schedule. With them, everything HAS to have a diagnosis. And if it's benzo dependancy (addiction or not), than they are apparently almost never willing to write a script to taper. Because if it's dependance, the solution is to get off the drug right NOW, find some other diagnosis, and put you on some other med that probably won't help, and will likely make things worse. Long story short.. I get ONE WEEKS supply of valium and remeron, and have to go back in a week (another $150) to re-evaluate. I'm just going to stick to my GAD diagnosis and taper on my own. Hopefully he will trust me enough to change the visits to once a month.

 

Here is the real kicker: In the whole visit, he offered me gabapentin, paxil, effexor, anafranil (which I'd be willing to retry at some point b/c of positive past with it in the past). And the most outrageous of all.. He actually offered me buprenorphine (Suboxone) to help treat DEPRESSION!! Are you kidding me?? I was trying to be as personable and friendly as I could, so I just said "hmmm.. I haven't been on opiates in about 8 months. That might have made a little more sense if I made the transition back then, but at this point, I'm not sure what the benefit would be?". Come to find out, their have actually been clinical trials using buprenophine for depression, and it's soon going to be a new depression treatment! What's next? Oxycodone for depresssion? It makes you feel good, right? Anyway, he just refused to believe or accept that I'm trying to allow my brain to slowly recover from years of addictive psychotropic drugs. And that it takes time. But that's just not how they think. It can't last that long, they say. There must be some underlying condition that needs to be treated with a new drug. That'll fix it. Sigh. Western medicine.. I guess that's how they stay in business.

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Even if the doc would get involved in a taper, s/he would probably not trust you to be able to use a scale to weigh out pill pieces.  S/he would likely write up a taper with cuts done with intact pills or half pills (or quarter pills if you're lucky).  And the notion of making cuts when your body/mind is capable of making cuts (instead of on a certain schedule) would totally go against their nature. 

 

It's hard to blame the doctors.  It's how they were taught to do things.  Deviating from standard operating procedures means that they stick out their neck to some extent.  They're probably more than a little bit concerned that you might weigh something incorrectly and that they would take the heat (since they didn't verify that you were capable of doing this yourself).  So they defer to an approach that works for most people.  However, we're not most people.  We're that 10% (ish) of the population that needs to come off these meds more carefully.

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Of course you can blame them. It's common sense. If they did learn their job the wrong way, the should reeducate themselves or listen to their patients.
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Badsocref, I understand what you're saying. I really do. I blame the system more than the doctors. They're mainly just covering themselves due to the way the system works. As far as the tapering thing, you might be right in many cases. In my case, I'm actually a pharmacist and he acknowledged that I knew as much or more about many of the meds than he did. He should certainly trust me to manage my own liquid titration schedule. There may be some psychiatrists in the US willing to prescribe say '10mg valium daily', and then let the patient work out their own taper schedule (or work one out for them). In this case, it seemed that he wouldn't even consider going from say 10mg, to 7.5mg to 5mg, ect. (not that I would have wanted to have gone that fast anyway). I think part of the problem is that if (God forbid), I had to be admitted to the hospital, and were to tell them that I'm currently on 6.243mg of valium, they'd look at me like I was nuts and the doctor would be questioned. Thinking back on it, maybe if I had found a compounding pharmacy willing to make a solution (I know there is a liquid oral diazepam on the market, but can pretty much guarantee that not a single pharmacy around here would have that in stock), and presented it to him that way, he might have have been more amenable to the idea. But who knows.

 

Anyway.. buprenorphine for depression? lol

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I think doctors have a lot of blame. After all, they take the Hippocratic oath, and then do not fulfill it. In their fury of seeing as many patients as possible to make money, they do not study or even think about their cases. The oath reads as follows:

 

I will respect the hard-won scientific gains of those physicians in whose steps I walk, and gladly share such knowledge as is mine with those who are to follow.

I will apply, for the benefit of the sick, all measures [that] are required, avoiding those twin traps of overtreatment and therapeutic nihilism :o.

I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon's knife or the chemist's drug :(.

I will not be ashamed to say "I know not," nor will I fail to call in my colleagues when the skills of another are needed for a patient's recovery.

I will respect the privacy of my patients, for their problems are not disclosed to me that the world may know. Most especially must I tread with care in matters of life and death. If it is given me to save a life, all thanks. But it may also be within my power to take a life; this awesome responsibility must be faced with great humbleness and awareness of my own frailty. Above all, I must not play at God.

I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person's family and economic stability. My responsibility includes these related problems, if I am to care adequately for the sick.

I will prevent disease whenever I can, for prevention is preferable to cure  :thumbsup:.

I will remember that I remain a member of society, with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm.

If I do not violate this oath, may I enjoy life and art, respected while I live and remembered with affection thereafter. May I always act so as to preserve the finest traditions of my calling and may I long experience the joy of healing those who seek my help.

 

Look at the meaning of therapeutic nihilism (wikipedia):

In medicine, it was connected to the idea that many "cures" do more harm than good, and that one should instead encourage the body to heal itself. :clap:

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I understand your point, magnesi, but let me give you a scenario and you tell me what you would do...

 

It's a hot day, and you're very thirsty.  I take you to a room containing 1,000 glasses of water, and invite you to pick one to drink.  Only problem is that one of those glasses has gotten contaminated.  It will make you sick if you drink it.  It looks and smells and tastes identical to the other glasses. 

 

The probability is 99.9% that the water will help you.  Do you drink a glass of water?

 

Would you drink the water if the probability was 99.9999% (one in a million)?  How about if it was only 90% (one in ten)?

 

Would you deny a useful treatment to a majority of people because of the harm that occurs to a small number of people?

 

That's the ethical dilemma that physicians face every day when they prescribe meds.  I don't personally blame them for playing the odds.  All of us play the odds (when driving a car, for example).  I do blame physicians for not being more aware of how to treat those who do not respond in a desirable manner.  That training seems to be lacking.

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I worry about the lack of knowledge doctors have ..I recently told a GP in the UK that I am taking DHEA. He flat told me he doesnt know what it is. It is the most abundant adrenal hormone in the human body.

 

The reason I take it is they forced me to cut 7mgs Diazepam a week. ( From 5mg-4 daily) My mind just plain broke.3 months of mental hell followed and I lost my job. The lady Doctor who pit me through all this is now gunning to get me off the pills. I dont think she has a clue

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Doctors are just cogs inside of a broken machine. My theory is that most of them are "book smart" and may lack the ability to think outside the box. They are trained to diagnose and treat according to the book. I doubt that they are encouraged to question their education and the status quo in general.

 

Because if it's dependance, the solution is to get off the drug right NOW, find some other diagnosis, and put you on some other med that probably won't help, and will likely make things worse.

 

When all you have is a hammer, everything looks like a nail.

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badsocref, I agree with you. Benzos have helped me at two critical points in life. But doctors are very irresponsible when they don't inform patients of side effects, when they let them stay on these meds for too long, when they prescribe large cuts or CT, when they don't study enough to know how to help patients do a slow taper, when they misinterpret inter-dose withdrawal as a new condition requiring more psychoactive meds, etc. This is what I was talking about. I don't think they are only cogs. They are an active part that chooses money over science and care.

 

All the best  :smitten:

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badsocref, I agree with you. Benzos have helped me at two critical points in life. But doctors are very irresponsible when they don't inform patients of side effects, when they let them stay on these meds for too long, when they prescribe large cuts or CT, when they don't study enough to know how to help patients do a slow taper, when they misinterpret inter-dose withdrawal as a new condition requiring more psychoactive meds, etc. This is what I was talking about. I don't think they are only cogs. They are an active part that chooses money over science and care.

 

All the best  :smitten:

 

I pretty much agree with you on this.  It takes a special physician to continue to study the field in the depth required to deal with those (of us) who need more than the minimum amount of support.  The system works a lot better for 'normal' stuff like broken legs and strep throat than it does for the kind of stuff we're here for.

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I asked my doctor to help me taper Ativan, and he refused to, telling me instead that I needed to be on Paxil and gave me a prescription. That led me on an entirely different path, filled with fear, learning about a whole different language, that of tapering. That was the last time I saw that doctor. I have seen many doctors since and have been given incorrect diagnoses, which I took to heart and thought they were true. I've been told that withdrawal is gone after a month, max. Now I have no faith in doctors at all and realize that they're fault-filled human beings, just like the rest of us. I need to do my own research. I try not to listen to what they're saying because it's almost always negative, but it's very hard to shut their words off because I was brought up to respect authority. I did meet a good doctor but, unfortunately for me, she became a pediatrician. Lucky kids, though!

 

If I had my druthers, I would never see a doctor again. But I realize that testing is important. I just dread every single part of a visit.

 

Unfortunately, there are many more out there who keep trusting doctors unnecessarily, as I did, and don't do research. And the road back up from taking the wrong pill or pills can be very difficult. There might be a lot of former benzo people who have been given multiple drugs, not knowing that they were in withdrawal and the doctors clueless as well. It's sad.

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This makes me angry, sad, and yet, I'm also not surprised.  What do they think an addiction is versus taking it everyday for GAD?  This part I actually find kind of humourous. 
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I worry about the lack of knowledge doctors have ..I recently told a GP in the UK that I am taking DHEA. He flat told me he doesnt know what it is. It is the most abundant adrenal hormone in the human body.

 

The reason I take it is they forced me to cut 7mgs Diazepam a week. ( From 5mg-4 daily) My mind just plain broke.3 months of mental hell followed and I lost my job. The lady Doctor who pit me through all this is now gunning to get me off the pills. I dont think she has a clue

 

I'm sorry to hear you've had this awful experience. And a doctor not knowing what DHEA is?? There's just no excuse..

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I asked my doctor to help me taper Ativan, and he refused to, telling me instead that I needed to be on Paxil and gave me a prescription. That led me on an entirely different path, filled with fear, learning about a whole different language, that of tapering. That was the last time I saw that doctor. I have seen many doctors since and have been given incorrect diagnoses, which I took to heart and thought they were true. I've been told that withdrawal is gone after a month, max. Now I have no faith in doctors at all and realize that they're fault-filled human beings, just like the rest of us. I need to do my own research. I try not to listen to what they're saying because it's almost always negative, but it's very hard to shut their words off because I was brought up to respect authority. I did meet a good doctor but, unfortunately for me, she became a pediatrician. Lucky kids, though!

 

If I had my druthers, I would never see a doctor again. But I realize that testing is important. I just dread every single part of a visit.

 

Unfortunately, there are many more out there who keep trusting doctors unnecessarily, as I did, and don't do research. And the road back up from taking the wrong pill or pills can be very difficult. There might be a lot of former benzo people who have been given multiple drugs, not knowing that they were in withdrawal and the doctors clueless as well. It's sad.

 

I'm sorry you've had such a difficult experience with doctors. It's unfortunate that we've gotten to the point (especially with psych meds) that we're probably better off doing our own research. It's not fair to have to learn this lesson the hard way. Not that some psych meds aren't beneficial in certain cases or for certain people, but I suppose the lesson is "do your research, and proceed with caution.." And don't be afraid to (respectfully) speak up if you disagree with the doctor. At least your doctor admitted it could be up to a month. My p-doc actually said 'a few days' with a straight face.  :o

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This makes me angry, sad, and yet, I'm also not surprised.  What do they think an addiction is versus taking it everyday for GAD?  This part I actually find kind of humourous.

 

I think it has a lot to do with doctors covering themselves. Every medication is supposed to have an official indication, or at least an accepted 'off label' use. The doc basically told me that if I have an addiction (or physical/psychological dependency in my case), that he couldn't treat the addiction/dependency with the med I was dependent on. There had to be some other mental disorder I had, that needed to be treated with something else. But if I was being treated for GAD, that was acceptable per offical FDA labeled indication. So backwards.. but that's part of their way of keeping you coming back. Hence my having to see him again in a week.

 

 

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I think there have been some good points made in this thread. I don't even blame the problem on doctors prescribing benzos. In certain cases, long term use might even be acceptable. For example GAD that is refractory to other medications, or for certain seizure disorders. The problem is the medical communities unwillingness to accept the damage that can be done to certain people with long term use, and even MORE importantly, the fact that these meds, in most cases, should be tapered very slowly. There is absolutely no system currently in place to do that, the docs only believe what they've read or been taught, and think that everyone experiencing symptoms after a couple of weeks post-discontinuation is either crazy, or has some other psychological issue. The medical community doesn't want to own up to the problems the meds can cause. You see, when benzos first came out, they were the safe alternative to barbiturates. Similar effect, but an overdose on barbiturates could kill you. It's nearly impossible to die of an OD on benzos alone. They were the new 'miracle drug', or at least a major improvement. I think the FDA was happy with that, but never really bothered to look into the potential long term effects/consequences these meds could bring. I am quite sure that if some MAJOR medical journey had the cajones to actually put out an article describing the long term damage that benzodiazapines can cause, and outline a suitable tapering method (not a 1 week detox), than all the doctors would be singing a different tune. Things would change. It would now be 'official', and in the medical journals. TBH, my biggest issue with all of this is simply doctors not actually listening to their patients. Fortunately, there are a few good doctors out there that are willing 'step slightly outside of the boundaries' and work with the patients on a slower, symptom based taper.
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I think part of the problem is that if (God forbid), I had to be admitted to the hospital, and were to tell them that I'm currently on 6.243mg of valium, they'd look at me like I was nuts and the doctor would be questioned.

 

OH man...did that give me a good laugh!!!! ROTFLMAO - thank you!!!! :) :) :)

 

definitely a thread that needed a little levity :)

 

(PharmGuy) I feel for you!!! the system is SOOOO f*d (everywhere...but especially it seems in the US where they just have you coming in like a revolving door - 10 minute visits and a goodie bag of pills on the way out)  - and i still wonder if many aren't getting 'kick-backs' for all their "desires" to be prescribing sooOOO much!!! 

 

 

sigh..just broke my heart listening to your story (too familiar <sigh>)

 

 

(i hope you get the pills you need!!  :hug: )

 

firefly

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I worry about the lack of knowledge doctors have ..I recently told a GP in the UK that I am taking DHEA. He flat told me he doesnt know what it is. It is the most abundant adrenal hormone in the human body.

 

The reason I take it is they forced me to cut 7mgs Diazepam a week. ( From 5mg-4 daily) My mind just plain broke.3 months of mental hell followed and I lost my job. The lady Doctor who pit me through all this is now gunning to get me off the pills. I dont think she has a clue

 

Missanonimity??  How is the DHEA working? or helping you?

I did a short ~ 4 week stint on 2 mg ativan last year and tapered relatively fast and painlessly - though i did go back to zopiclone.

i think i was on DHEA back then (trying to find the records) and wondered if it helped. Reading online here it sounded like it was not a good idea but i still wonder...

 

is it helping you? and how? :)

thanks - and feel free to PM me if you want

 

firefly

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when they don't study enough to know how to help patients do a slow taper, when they misinterpret inter-dose withdrawal as a new condition requiring more psychoactive meds, etc.

 

 

 

<nod>!!!!!!  that's all i have to say..('cause i don't feel like typing the rant going on in my head lol) ...therefore..<nod> :)

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This makes me angry, sad, and yet, I'm also not surprised.  What do they think an addiction is versus taking it everyday for GAD?  This part I actually find kind of humourous.

 

I think it has a lot to do with doctors covering themselves. Every medication is supposed to have an official indication, or at least an accepted 'off label' use. The doc basically told me that if I have an addiction (or physical/psychological dependency in my case), that he couldn't treat the addiction/dependency with the med I was dependent on. There had to be some other mental disorder I had, that needed to be treated with something else. But if I was being treated for GAD, that was acceptable per offical FDA labeled indication. So backwards.. but that's part of their way of keeping you coming back. Hence my having to see him again in a week.

 

Pharmguy - is there any chance he was doing that in the same way a lawyer would say "hypothetically" <insert scenario> (you know what i mean?)

or was he believing what he was saying?

 

firefly

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Fortunately, there are a few good doctors out there that are willing 'step slightly outside of the boundaries' and work with the patients on a slower, symptom based taper.

 

but what kills me and angers me is it is NOT outside of the boundaries...

 

let me find this one major medical school guideline for benzo withdrawals....tell me if it's not something "reasonable" by this boards standards!!!

 

hold on...(not that you're going anywhere lol)....http://nationalpaincentre.mcmaster.ca/opioid/cgop_b_app_b06.html

 

here's the beginning - just for a taste:

 

McMaster University

Michael G. DeGroote

National Pain Centre

Canadian Guideline for Safe and Effective Use of Opioids for Chronic Non-Cancer Pain

Site Map [sITE MAP]TOC [TOC]Back [bACK]

Appendix B-6: Benzodiazepine Tapering

Benefits of Benzodiazepine Tapering

Lower the risk of future adverse drug-related risks such as falls.

Increased alertness and energy.

Approach to Tapering

Taper slowly: slow tapers are more likely to be successful than fast tapers.

Use scheduled rather than p.r.n. doses.

Halt or reverse taper if severe anxiety or depression occurs.

Schedule follow-up visits q. 1–4 weeks depending on the patient’s response to taper.

At each visit, ask patient about the benefits of tapering (e.g., increased energy, increased alertness).

Protocol for Outpatient Benzodiazepine Tapering

Initiation

May taper with a longer-acting agent such as diazepam or clonazepam, or taper with the agent that the patient is taking. (Diazepam can cause prolonged sedation in the elderly and those with liver impairment.)

 

tell me what you think?  Doesn't this seem reasonable...it's but one that i found - what are the students not learning ....maybe not this..???

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Terry...sorry...my brain isn't exactly "on" right now...i was replying to PharmGuy's comments but my heart goes out to you as well - all of this blended together - i could rant with you all the live long day!!!! (didn't want you to think i was responding without recognizing you as OP)...i heard it all...it all breaks my heart and angers me to no end.

not the least of which i just went through recently but i want to relax before bed and i'm feeling riled up! lol ;)

 

you're not alone and rant away..we're all with you!! :)

 

:hug:

 

firefly :)

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This makes me angry, sad, and yet, I'm also not surprised.  What do they think an addiction is versus taking it everyday for GAD?  This part I actually find kind of humourous.

 

I think it has a lot to do with doctors covering themselves. Every medication is supposed to have an official indication, or at least an accepted 'off label' use. The doc basically told me that if I have an addiction (or physical/psychological dependency in my case), that he couldn't treat the addiction/dependency with the med I was dependent on. There had to be some other mental disorder I had, that needed to be treated with something else. But if I was being treated for GAD, that was acceptable per offical FDA labeled indication. So backwards.. but that's part of their way of keeping you coming back. Hence my having to see him again in a week.

 

Pharmguy - is there any chance he was doing that in the same way a lawyer would say "hypothetically" <insert scenario> (you know what i mean?)

or was he believing what he was saying?

 

firefly

 

Yes, absolutely. Well.. a little bit of both. When he mentioned that I would need to have GAD, I immediately took the bait and played long. That pretty much solved the problem. But the fact that he waid WD would be over in a "few days" also makes me seriously question his knowledge on the matter.

 

And yes, I wouldn't be surprised if there were some illegal kickbacks going on. Pharmaceutical reps are allowed to give certain gifts, or take clients out to dinner or some other form of entertainment. There are monetary restrictions on the expenses that the reps are allowed to use. But still, you get the picture. Nice trusted, friendly pharm rep comes in. Takes up busy doctors time, highlighting all of the wonderful benefits of this new 'miracle drug', while any potential adverse effects are not mentioned, or only in the fine print. Pharm rep gives doc a bunch of free samples. Now MD, who does no research of his own begins prescribing the drug to everyone. That's pretty much how it works a lot of the time..

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Fortunately, there are a few good doctors out there that are willing 'step slightly outside of the boundaries' and work with the patients on a slower, symptom based taper.

 

but what kills me and angers me is it is NOT outside of the boundaries...

 

let me find this one major medical school guideline for benzo withdrawals....tell me if it's not something "reasonable" by this boards standards!!!

 

hold on...(not that you're going anywhere lol)....http://nationalpaincentre.mcmaster.ca/opioid/cgop_b_app_b06.html

 

here's the beginning - just for a taste:

 

McMaster University

Michael G. DeGroote

National Pain Centre

Canadian Guideline for Safe and Effective Use of Opioids for Chronic Non-Cancer Pain

Site Map [sITE MAP]TOC [TOC]Back [bACK]

Appendix B-6: Benzodiazepine Tapering

Benefits of Benzodiazepine Tapering

Lower the risk of future adverse drug-related risks such as falls.

Increased alertness and energy.

Approach to Tapering

Taper slowly: slow tapers are more likely to be successful than fast tapers.

Use scheduled rather than p.r.n. doses.

Halt or reverse taper if severe anxiety or depression occurs.

Schedule follow-up visits q. 1–4 weeks depending on the patient’s response to taper.

At each visit, ask patient about the benefits of tapering (e.g., increased energy, increased alertness).

Protocol for Outpatient Benzodiazepine Tapering

Initiation

May taper with a longer-acting agent such as diazepam or clonazepam, or taper with the agent that the patient is taking. (Diazepam can cause prolonged sedation in the elderly and those with liver impairment.)

 

tell me what you think?  Doesn't this seem reasonable...it's but one that i found - what are the students not learning ....maybe not this..???

 

 

Yeah, I think that looks like another good resource that you could add to your arsenal or 'evidence pile' when talking to your doctor. That, along with the Ashton manual. N.I.C.E apparently also has some guidelines on tapering benzos. N.I.C.E is actually a well respected organization, but that's UK stuff so it likely gets ignored or probably never even seen by most US docs, unfortunately. I think that all of the other stuff would, at least in their mind, fall under the category of a protocol that some particular clinic was using, and they would not give much credence to it. But I suppose that if you went in armed with enough info, you might be able to persuade any good doctor who is willing to listen. Either way, I don't believe that anything will change drastically until something is published by a MAJOR medical journal and grabs everyones attention. 

 

But yeah, the guidelines you posted from that clinic certainly seem pretty reasonable, and certainly when compared to the norm of a 3-7 day detox.

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