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Back at ya. :)

I also generally tolerate meds well. Amitriptyline (Elavil) had no effect whatsoever. However, I had a terrible reaction to another tricyclic, Protriptyline (Vivactil), that required hospitalization.

Two different studies. The neuroendocrine one requires participants to be female. I didn't pass the test. :(

Also "Participation requires two days, and each day will take about two hours to complete."

Including the oceans...

To be fair, the hyperspatial express route plans were available.

So I can go buy some shark fin and ground tiger penis at the Chinese herb shop 2 blocks away and stop seeing my doctor? What a crazy world we live in. But on the other hand, this will probably help destroy it a bit faster.

UpToDate has informed me "We will pass along your comments to the appropriate physician editor for their review and consideration." So I guess I wait. But I don't see any sense of urgency from UpToDate, nor do I have any way of knowing who the "appropriate physician editor" is or how to contact...

A decade or so ago, I heard a physics professor say that editing the human genome to reduce the human drive to reproduce and consume resources was the only way our species could survive longterm. Perhaps he was right.

New CRISPR article from UCSF. The First Genome Surgeons: Scientists Are Preparing to Bring DNA-Editing Tools to the Clinic https://www.ucsf.edu/news/2018/10/412116/first-genome-surgeons-scientists-preparing-to-bring-gene-editing-tools-clinic Edit: Changed link to point to a more reliable website.

But if I'm reading it correctly, the study finds that the benefits of high cardiorespiratory fitness (CRF) outweigh any previous adverse findings, concluding (bolding mine): This seems a blanket recommendation for doctors to encourage high levels of fitness for all patients.

Kaiser Permanente/University of Illinois study suggesting that "White men who exercise at high levels are 86 percent more likely than people who exercise at low levels to experience a buildup of plaque in the heart arteries by middle age". This is a subgroup of patients who need further study to...

This is all about behavior change. If patient follows healthy behavior A, they get health benefit B. The problem comes in assuming that increased exercise is always the healthy behavior. Doctors may automatically prescribe exercise, thinking it is the healthy behavior for all patients. Patients...

The New Age of Patient Autonomy Implications for the Patient-Physician Relationship https://jamanetwork.com/journals/jama/fullarticle/2707954

One more thing. UpToDate does not mention the AHRQ's findings regarding GET harms. Instead, UpToDate apparently thinks that lack of harms reporting indicates lack of harms.

The AHRQ found that when only stricter case definitions were used, and "fatigue" (Oxford) studies were thrown out, the evidence for GET vanished. UpToDate does acknowledge the AHRQ findings. But UpToDate seems to acknowledge everything... good and bad. UpToDate seems persuaded no one really...

Komaroff is the editor for this UpToDate content, which has pushed GET/CBT and cited PACE as evidence for years. The recommendation for GET has been downgraded, but it’s still there. As is citing PACE as evidence. Gluckman is listed as the actual content author. I don’t know the history as...

I'm learning that Wolters Kluwer is a huge international conglomerate, and each division has its own CEO. They also seem to value their corporate reputation highly. Hopefully all this attention is making it uncomfortable for little UpToDate.

Appreciate the offer, but it's cheap enough with the patient discount that I can easily afford another month if needed. :)

Got a ping back from a higher up in Wolters Kluwer legal. He pulled up my old case # from June, and said he would escalate the issue. Cautiously optimistic. Perhaps a fresh set of eyes looking at this will help.