We all (inaudibly🤞) sigh when patients utter this & adopt the brace position for whatever mis- or dis-information may follow.
So how would you feel, if instead, these were the words of the health professional you’re seeing?
We could debate forever the pros and cons of FB and its forums – & indeed it offers both – but one thing we must never lose sight of is what it has in common with the ‘wild west’: unregulated, unvetted, and with plenty of cowboys – often sadly, masquerading as experts, or just ‘very “generous” very very active group members’, with hidden agendas. I don’t generally engage with the naturopathic forums but occasionally I catch sight of things that I can’t look away from, and I can’t not speak up. Recently, someone (with a not-so-hidden-at-least-to-me-agenda) was raving about the dangers of N-acetylcysteine as a supplement & the way it was spoken about made it seem like it would be *poison* at any dose. Wha? As you may have learned from me it is definitely potent and in turn, demands our respect as a powerful therapeutic agent – directing our decisions about timing and reminding us, yet again, that least dose is best dose. But what this individual was purporting were adverse effects I’d never heard of in relation to this nutraceutical. So I simply asked, ‘Can you please share your reference(s)?’
Prior to me inserting myself into the comments – there had been enormous engagement specifically with this individual’s claims- which mostly went like this:
‘Oh wow! I didn’t know this!!’
‘Thank you – that’s so interesting!’
“Oh that explains why Tom doesn’t like it, and Dick won’t take it and Harry says it’s horrible!”
🤦♀️
FB forums – seeking out the support & opinions of our peers can be truly wonderful but it can totally derail our knowledge too if we don’t keep checking the quality of that information. A simple: Can you share your references, or, where did you learn this? Should be part of the respectful and expected scientific discourse in our profession. I’ve asked that before when I’ve found myself yet again in a forum thread and had a truly fabulous response – with the practitioner generously sharing a number of high quality published articles that would have taken me ages to find myself! 💪Not the case in this recent episode. The 3 distinct claims, which all centred on NAC being bad for high histamine individuals, were ‘substantiated’ by just 1 primary reference & that was a Poster Presentation: “Human placental tissue was minced and subjected to a fractionated ammonium sulphate precipitation (35% / 65%). A fraction high in DAO activity was purified using hydrophobic interaction chromatography (HIC), and incubated with the drugs in prescribed concentration” . The full research has never actually been published in its entirety and the brevity of detail on a poster means you know barely any of the important details regarding the methodology. I also looked for any other research that emulated these methods or findings or even cited this paper – nada. And if you lead with your best – this was appalling low level evidence that is really unlikely to be relevant. But hey – here’s the 1 provided reference – make your own mind up! (see how easy that is?!)
I asked for clarification and for papers to support the other 2 claims.
Silence.
But actually before silence a bit of
‘How dare you ask!’
That’s when I got a different insight into this forum & arguably a culture that doesn’t foster curiosity & questioning, if that risks challenging the ‘poster’s’ position. And when several incredibly intelligent, kick-arse clinicians quietly contacted me on the side to say, ‘THANK YOU!~ This person posts comments like this all the time & it’s so misleading & someone needed to say something, but it probably had to be you.’ Well that really made me 😥 because it didn’t, you know – any one of us can ask, “Can you share the reference(s) for that?” and clearly we need to more often 🤓
Why are we afraid to question information or ask for references and why are people afraid of the question? This should not be a competition or hierarchy of who can ask or not ask questions. And if the forum that you’re a member of makes it seem that way – then ask yourself, if its doing you more harm than good.
Aren’t we on the same team here? We all have a professional duty of care to our patients to ensure that in looking for quick answers we don’t get incorrect ones that misinform us, our patients and our treatment decisions.