"I don't know" is actually a pretty good response when your doctor doesn't know. No human can know all the medicine, that's not what the "talk to your doctor first" advice is supposed to be about. If you want to talk to someone who specifically knows, or get your doctor to specifically learn, that's going to cost you quite a lot more than a normal doctor visit.
In other words: your doctor can try to help keep you from screwing up too badly and obviously. They can tell you if what your doing is far outside the bounds of Normal Standard of Care, or if there are specific things they happen to know that make it a bad idea for you or in general, or if there are specific things you should be looking out for in terms of negative effects. But modern medical care, as normally practiced, is not actually capable of the level of personalized medicine you're asking for.
2"I don't know" is actually a pretty good response when your doctor doesn't know.
That's not what they actually said, they did make the wrong claim that there's no evidence for NAC / glycine helping prevent illnesses.
They can tell you if what your doing is far outside the bounds of Normal Standard of Care
I do like health results that are outside of what you get from Normal Standard of Care, so that's not really very helpful information.
But modern medical care, as normally practiced, is not actually capable of the level of personalized medicine you're asking for.
That basically means that asking doctors for personalized medicine questions doesn't really work. On the other hand, chatbots are able to help with personalized medicine.
That’s not what they actually said, they did make the wrong claim that there’s no evidence
According to your own post:
My doctor just said, she doesn’t know of any evidence
which is not a claim that there is no evidence.
"My doctor just said, she doesn’t know of any evidence" is a summary of a conversation happening in German.
I think the exact wording was something like "Es gibt dafür keine Evidenz. Ist gibt nur etwas für einen schwachen Effekt für Echinacea". I'm less certain for the wording for the second sentence.
Here's my take about docs and specialists based on personal experience:
- Assume that they're 75% wrong about everything, even about common medications that they should know like the back of their hand.
- Yes, print out and highlight the text that shows that they're wrong.
- Usually, they're not trained about nutrition (beyond what you're mother told you to eat) and certainly not about supplements, so don't ask.
- Assume that you're 75% wrong and your doc was right all along.
- Yes, stress-test your doc's opinions and your own research by using LLMs, the opinions of other docs, literature searches, standard-of-care guidelines, and patient forums.
- If they continue to underperform or are assholes, change docs and explain why you switched docs to your new doc in order to avoid repeating the problems you had with your old doc.
Bottom line: they're human; they make mistakes and have many blind spots just like any other professional, and for a sufficiently motivated and informed patient, it's possible to discover at least some of those mistakes and blind spots and avoid them.
If you are doing are thinking about taking any non-standard interventions that are far away from the normal practice of medicine, why would you assume that the average doctor can tell you about the merit of the intervention?
Their "job", if you will, is to (a) talk down people have absolutely zero clue and have bought into total idiotic quackery, and (b) talk down people (and this includes plenty of people on Less Wrong) who overestimate their own cleverness or expertise, think wishfully, and overinterpret inconclusive or downright meaningless research. There is of course a continuum between these. And it turns out that the "talking down" doesn't always require having read the stuff.
The reasons you're "supposed" to talk to them are that (a) telling you to do that covers the teller's ass, and (b) it's a reasonable prior for the teller to expect you to screw up. Random nonspecialists who don't make serious mistakes aren't as rare as Authority Figures think they are, but they're also not at all close to the most common case, and they have to optimize for the common case. And for that matter clueless or nutty doctors aren't as uncommon as Authority Figures would like to pretend... it's just that a random doctor is a far better bet than a random "contrarian".
Speaking of appropriate caution, if you continue the same chat context over multiple days, especially if you're not really careful and disciplined about letting yourself be led into selectively "becoming aware of more symptoms", you're inviting a hallucinatory rathole and/or "AI psychosis". I mean, not to say they can't be useful, but it's pretty tricky to keep them useful if you use them that way.
21I thoght the purpose of talking to you doctor was so they could keep track of interactions, like they may not know if grapefruit extract will help you but will have useful advice on whether you should take it with your schizophrenia medication.
No, you should not expect your doctor to know the details of specific supplements.
A "general practitioner" is a generalist. Their job is to recognize and treat many common things. For uncommon things, their job is to be able to narrow it down enough to find a qualified specialist, and refer you.
Not all general practitioners are created equal! Much like with lawyers and therapists, finding the right professional for your needs makes a huge difference. If you like to read scientific papers, there are GPs out there that will be genuinely interested in what you find.
Also, it never ever hurts to take notes. Particularly when dealing with emergency medicine or multiple specialists, it's easy for stuff to slip through the cracks. I know of one case where having relatives who took notes saved someone from a dangerous and inadvisable procedure. I know of another case where someone was on horribly inadequate pain medication, and the doctor explained why things had to be that way for several days, and the doctor turned out to be 100% correct. But you don't know unless you ask.
Patient participation in care is vitally important. But at the same time, no, your GP isn't going to be aware of the details of supplement research. Not unless you pick your GP carefully, at least, or get referred to an appropriate specialist.
Maybe this is a swedish thing only but we're able to book times with specialist doctors using online services like the following: https://medicheck.se/about-medicheck/
I found it quite helpful for some in-depth endocrinology questions that I had that I didn't trust an AI for nor a doctor who wasn't a specialist in endocrinology. Maybe there's something like this where you live (I completely agree with your assessment and this is what I've also heard from a friend of mine who is a doctor.)
This is probably not the main point that you're making but I was thinking it might be a partial solution to it?
No, you should not fault them for any of it. If you are healthy and not taking regular medicine, the initial assumption — that you have to talk to your doctor about supplements — is wrong.
Yes, doctors should follow up on current research but also prioritize what is most relevant. How to have a slight effect on common infections and influenza is definitely not top of mind. Cross-medication effects for the elderly are just one example of much more relevant research to stay on top of, amid a myriad of topics.
You are definitely not supposed to have papers printed out for them. You might refer to a study you read, yes, but bringing print-outs is over the top even if you are a colleague of some sort. If you feel confident in a chatbot's advice for something not remotely life-threatening — go ahead! And during your next regular visit inform your doctor of your decisions and any supplements you take (just as you would with OTC medicine) — but don't expect a professional discussion. Also: doctors have the same range as any other profession, so the chance of having a mediocre one follows the bell curve.
Sidenote: your cited study is rather old. Has there been no new research since 1997? This would indicate it is not something the medical community feels is worth following up on.
Sidenote: your cited study is rather old. Has there been no new research since 1997? This would indicate it is not something the medical community feels is worth following up on.
Yes, that says quite bad things about the medical community that they are only focused on things that can be patented to make money. It's another reason to be distrustful of doctors.
How to have a slight effect on common infections and influenza is definitely not top of mind.
We are not talking about slight effects. We are talking about an extremely huge effect that unfortunately didn't get studied more to be well validated because it's not in the financial interest of the system to do so.
The effect for chicken bone broth on reducing length of acute respiratory tract infections according to the literature review is 1-2.5 days reduction which is more than tamiflu's 0.5-1.5 days while it's a more general treatment that doesn't require you to test for the specific virus than you can give it.
The N-acetylcysteine effect is comparable to influenza vaccines but more general "only 25% of virus-infected subjects under NAC treatment developed a symptomatic form, versus 79% in the placebo group".
The reason why it's okay for a primary care doctor to be unaware is that primary care doctors are supposed to practice medicine based by relying on the general treatment guidelines being good and not supposed to practice based on what individual studies that haven't been replicated say.
On the other hand, NIAID and it's equivalents all around the world not wanting to study whether those huge effects hold up is not okay.
Let me start by saying my question was genuine. 30 year old research in medicine triggers scepticism in me.
"Yes, that says quite bad things about the medical community that they are only focused on things that can be patented to make money. It's another reason to be distrustful of doctors."
Sorry, I don't subscribe to this. "The medical community" is vastly diverse and merit is not only gained through patentable research.
Which is proven by the point there actually has been ongoing research into the effect of chicken soup on influenza as well as the effect of supplements. The latest study I could find was a 2025 meta-study. One of the underlying studies supports the claim of a 1-2.5 reduction. All support "modest benefits". All in all I would say the result is not as "extremely huge" as you portray but I do agree further research is warranted to verify and explore the exact mechanisms at play.
All support "modest benefits".
Tamiflu also only provides modest benefits and doctors still give it to patients. The benefits are larger than the benefits of standard of care. If those benefits generalize, Galen with his theory of the four humors, Traditional Chinese Medicine and a lot of other traditional systems of medicine outperform the standard of care.
I do think that's extremely huge. If you would approach this from a modern medicine perspective you can also simply attempt to increase the dose to get a bigger effect.
We do that people with genetic defects that produce glutathione deficiency suffer from recurrent infections. While that does not prove that the average person has a clinical problem where glutathione would reduce infections, it makes it pretty clear that at least some people do and from a mainstream medicine perspective you would want to target them to fix their glutathione deficiency. There seem to be some practical issues where glutathione in different tissues might have different levels and thus testing for glutathione deficiency isn't straightforward, but this should provide motivation for the research agenda.
Sorry, I don't subscribe to this. "The medical community" is vastly diverse and merit is not only gained through patentable research.
You need more than the desire to have your merit recognized to raise millions of dollars for a clinical trial.
This is the same dynamic that lead to the medical community getting the simple question of COVID19 being airborne wrong at the beginning of the pandemic that I had no problem getting right. A lot of the research is centered around the needs of big pharma.
If you have another answer why nobody tried to repeat the trial or do another trial to give glycine + NAC vs. NAC vs. Placebo to maybe build glutathione even better, I'm happy to hear that answer. The chatbots that I asked didn't really come up with another answer.
You are definitely not supposed to have papers printed out for them. You might refer to a study you read, yes, but bringing print-outs is over the top even if you are a colleague of some sort.
This is the right advise for more unproven or controversial stuff like supplements or certain diets, but it's the wrong advice for other stuff like medications. For instance, if your doc says that one med (which doesn't work for you) is just as effective another med that you want to try but that he's unwilling to prescribe, the only way to change your doc's mind is to print out and highlight the exact text where his colleagues (especially if they know more about this med than he does) disagree with his opinion.
I agree with your premise but would expect any decent doctor to actually enter a serious discussion with you to find the best med when you say one doesn't work for you. You are proving from your own experience, and the vast variability in reactions is something well documented in the medical field.
You should not need to bring studies for this and not have to prove via academia. I will maintain that bringing print-outs shifts the interaction from patient-doctor to adversarial peer-review. Many doctors will dig in, not concede.
I don't think my doctor was bad. I think she was doing her job the way she's supposed to and that's kind of the reason why asking her about this issue wasn't useful and it's better to discuss these kind of questions with chatbots.
Going in I had a some hope given that NAC, glycine and glutathione are are all textbook substances. Genetic glutathione-synthesis disorders causing recurrent infections is something that mainstream medicine does recognize. Glutathione being important and not some weird body work intervention (of the kind that I think increased my collagen turnover and created the increased glycine usage that left less for glutathione) that interacts with pathways that aren't in the textbooks.
Many docs might dig in, and if they don't change their attitude and opinion when they should, you'll just need to switch docs until you find a decent one. The doc I brought the print out to didn't dig in and prescribed the med I requested after he read it. This had nothing to do with any study; it seemed that it was widely known among experts (the print out quoted expert opinion), but this doc just had the wrong opinion about it. I asked another doc about a combination of meds that's usually not prescribed often (but probably should be) to younger age groups and the reasoning behind it without showing a print out (but I had one just in case) and he agreed even though it wasn't standard of care. Sure, advocating for yourself could lead to an adversarial situation, but if you want to avoid mistakes and blind spots that can lead to your condition not improving or even worsening, I don't see any other alternative.
As you are supposed to ask your doctor about supplements, I just asked my primary care doctor about taking glycine and N-acetylcysteine.
I had a lot more infections in the last two years and I'm doing some fascia work that could increase collagen turnover, so there's reasoning in that time frame that would be a causal explanation for increased glycine usage for collagen generation and less leftover for glutathione production.
My doctor just said, she doesn't know of any evidence for either supplement helping with immune function.
Should I fault her for not knowing about De Flora et al 1997 finding that N-acetylcysteine helps prophylactically to prevent influenza from becoming symptomatic? Should I fault her for not knowing that chicken bone broth soup has been shown in the last evidence review to be helpful for reducing the length of acute respiratory tract infections, and its glycine content being a prime causal explanation?
Should I fault her for not knowing that much about glutathione, as it doesn't come up that much in her daily practice?
Are you supposed to have the papers printed out to hand them to your doctor, or what are you supposed to do in a situation like that?
If you are doing are thinking about taking any non-standard interventions that are far away from the normal practice of medicine, why would you assume that the average doctor can tell you about the merit of the intervention?
Chatbots aren't perfect but they have access to a lot more information and if you talk to them about specific studies they can easily engage with you. You can push back. You can continue a conversation over multiple days when you first conversation made you more aware of other symptoms. You can ask another chatbot to check the work of the first one.