Why is Gout so Often Mismanaged

I often quote the statistic that 78% of doctors do not properly manage gout. This statistic is true (based on the research study that reported it) but the big question is, why? This article with take a look at this question.

First off, let me start by saying that I am not someone that bashes doctors and the medical community or says things like, “all doctors are arrogant, lazy, over-paid idiots.”  Though, as with any profession, there will always be some that fit this description, most doctors are caring, compassionate, highly competent people that do a fantastic job.  The problem however, is that the medical profession is the victim of technology, its own success and its failures…

Victims of Technology and Success

Computers have caused major changes in just about every aspect of human achievement.  Nowhere has this been more pronounced then in areas where lots of data needs to be analyzed.  It has never been more simple, or even possible for that matter, for a single researcher to take the massive amounts of health information that has been accumulated over the decades and using nothing more sophisticated than a $600 desktop computer uncover major patterns that where not previously recognized.  This has certainly been the case with our understanding health, medicine and gout.

Also, the advent of molecular biology has added a whole new level of complexity to the understanding of health and disease.  Molecular biology (basically genetics) has allowed researchers to dig deeper than ever before into the root causes and progression of complex diseases.  These two factors have lead to a tidal wave of treatments, medications and just plain information on disease.  Not only that, these advancements have lead to an explosion in the number of diseases that are now known to medical science. (For an idea of just how many disease there are out there, visit the World Health Organization’s database of known diseases.) This has resulted in information overload for most doctors – and authors.

In researching my book I read over 5000 pages of research studies, medical journal articles and medical texts that I then distilled into the 100 or so pages of Beating Gout. No doctor, in a busy practice would or even could do this to better treat the hand full of their patients that have gout.

Beyond the massive amount of information that exists on all diseases, new and old, gout has historically been seen as a disease that causes painful attacks but a disease that does not cause any long term harm.  This has resulted in most medical schools spend little time teaching about gout and gout treatment. Plus, the research linking gout’s underlying cause, hyperuricemia, with disease is relatively new, not giving it enough time to be fully digested and propagated throughout the medical community. Most doctors still believe that high levels of uric acid are actually beneficial in those that do not have gout since uric acid is an anti-oxidant and is also a neurostimulant. Therefore, because hyperuricemia and gout are not believed to be a big problem by most doctors, it gets little attention.

Unfortunately, new research has shown that hyperuricemia is linked with many of the deadly diseases that are plaguing us today.  Diseases like heart disease, high blood pressure, kidney disease, liver disease, diabetes, stroke and even obesity. Not only that, the strength of the association is startling (see, Is Gout Dangerous).

Victims of Their Failures

Medical science often gets a bad rap.  I often hear people say things like, “one day they say margarine is good for you, the next they say its not.  How are you supposed to know which is right?”  This would be an understandable criticism if you where talking about the kind of gas to put in a car, but people where not engineered by people and we did not come with an instruction manual.  Science is a self correcting mechanism.  If the data shows that “A” is true, that is what is believed until better information shows that “B” is true, but if even better information shows that “A” was the right answer to begin with, then the belief shifts again.  It seems some people are wired for more absolutist thinking and have a hard time with this back and forth, but experience has shown time and again that in the long run, this system works and helps us find the best answers to our problems — even if it causes some short term confusion.  However, because of these past mixed messages that the medical community has given and how much people backlash against these “flop-flops,”the medical community is collectively skittish about making claims until they are pretty darn sure.

It’s important to point out now that even though there is a powerful statistical connection between high levels of uric acid in the body and disease, whether or not there is a direct link between the two is unknown.  In other word, even though having high level of uric acid increases your risk of kidney failure by over 850% and your risk of heart disease by nearly 300%, we do not know why it does and thus cannot say with absolute certainty that having high levels of uric acid will cause heart disease or kidney failure – just that there is a very strong correlation.  It’s possible that uric acid causes these diseases, but its also possible that these diseases cause high levels or uric acid.  It is also possible that this is all just a wild coincidence.

Because of this, few experts are willing to preach the dangers of uric acid and gout.  However, I feel differently.  If uric acid causes disease, then those with high levels are at risk for disease and should be careful.  However, high levels of uric acid are caused by disease, having high levels of uric acid is likely a strong indication that you have one of these diseases or are developing one of these diseases.  This means you are not at risk, but are in danger!  That last possibility, that these two are not at all related and just happens together by chance, I think is extremely unlikely because the correlation between the two is so very strong.  So I have gone out on a limb, although it’s a very thick and sturdy limb because there is a massive amount of data to back this claim up, and am saying that if you have high levels or uric acid, you need to watch out.

The 78%

So to sum up, doctors where taught in medical school that gout is a painful disease but not really dangerous.  Add to that, the massive amount of information out there, the fact that there is a fairly small percentage of people actually suffer from gout and the reluctance of the medical community to call something really dangerous until all the facts are in and you have a formula that add up to 78%. Meaning, 78% of doctors know little about this disease and do not give it the care and attention needed.

One of the most distinguished gout experts said it best:

“Ironically, many doctors in clinical practice know nothing more about gout than that it usually calls for a drug called Allopurinol and another whose principle active ingredient is colchicine.”
— Dr. Daniel J. McCathy

The Solution

The solution is you. Unfortunately, our society has become too much of a throw away society.  If something breaks, we tend to throw it away or have someone else deal with the problem, like taking your car to the shop.  You can’t do that with your body.  When your body breaks down its too late and the best anyone can do is bury it.   It’s your health.  You should take responsibility for it and educate yourself about what ails you as much as you can.  That’s not to say you should become your own doctor, rather, your doctor should be your partner in your health care.  You should work with them, taking their advice but also questioning and challenging them to make sure that you are getting the best care.  If your doctor sees the “doctor patient relationship” differently, then I suggest you find a new doctor.

You only have one chance with this life and with the one body you have been given.  Learn about it, learn how to take care of it and do the right things for your health.  If you do this, then there is a good chance that you will live a healthy, happy and pain free life.

If you liked this post, you will love the book, Beating Gout: A Sufferer’s Guide to Living Pain Free. Get the whole story in one easy-to-understand book, get your copy of Beating Gout: A Sufferer’s Guide to Living Pain Free now. Over 500 research articles and texts where studied and dozens of world class experts on gout were interviews for this book yet it is written for the non-expert. No other book on gout is more up-to-date, comprehensive or easy-to-understand – guaranteed!

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  1. #1 by Burton Abrams on April 15, 2009 - 2:37 pm

    With regard to the association of hyperuricemia with some very serious diseases, there is another possibility besides one causing the other. The other possibility is another cause for both. The cause that I have in mind is sleep apnea, which has been known for a while to cause hyperuricemia and to have all the currently recognized diseases associated with hyperuricemia as some of its consequences. See my article on this website — Gout and the Sleep Apnea Connection.

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