Tuesday, 12 January 2016

Why do endocrinologists prescribe treatment that NEVER works (part 2)

I read a story this morning about a 90 kg triathlete whose endocrinologist advised him never to take more than 25 mg of hydrocortisone on an event day and recorded evidence that he had given this advice to the patient for medicolegal purposes.

Lets assess whether 25 mg HC is a good maximum dose for athletic endeavours of this sort by two different methods.

Firstly medical : The vast majority of Australian endocrinologists have never seen a patient with Addison's disease who does triathlons or similar competitively. They might consult Pubmed or similar, but will find very little. Their advice is mostly derived from extrapolation.

Secondly, internet evidence : There are a lot of Addisonians out there. More than 8000 in the UK alone, mostly adults and most with internet access. While not all of them wish to run marathons / ski race / bike race etc, many will. There would be something seriously wrong if very few of them wanted to.

If 25 mg HC was a good dose, at least some people taking that dose would have posted their success online. I can't find ANY. I do, however, find many Addisonians racing successfully on much higher doses.  Like 15-20 mg Prednisone (approx eq 60-80 mg HC)

You can also look online to see what Addison's athletes take on rest days. It is not what your endocrinologist may have led you to believe.

So many people are now online, that internet evidence gives a much better picture of what is happening in some areas than medical research.

Take home message for the day : Look at what is NOT on the internet. If you can't find any first hand accounts of success with the treatment you are using, start asking questions.