BPL Membership

I guess I'm a bit of a retro-grouch, but I've never known information (as opposed to opinion) to be free. Back in the day when people used libraries, books could be checked out no charge. But were they free? Heck no! Your taxes paid for them. If you wanted to be up-to-date with current events, you bought a newspaper. The blogs that are so popular only masquerade as journalism, so I still buy the paper. The best things in life are sometimes not free, and that includes paying for a forest pass so I can hike into the areas I enjoy. Happy trails!

I just signed up for membership on here the other day after spending some time reading this site. I think it's the best "advanced" backpacking site I've seen and have learned a lot reading the forums and free articles. Because the level is so high I thought it was worth getting the membership for access to the articles. Once you get interested in lightweight shelters and skills it seems well worth a few bucks to get all the info, which is otherwise hard to find.

WHAT! A fee to hike on a trail?!? Thats ridiculious!!! I will never pay a fee to hike somewhere. If they are charging people to maintain the trail because government taxes arent enough, then Id gladly do volunteer work, but the day will never come where I will pay to walk outside in the nature. That really infuriates me! Seriously, I want to go to wherever this trail is and walk it for free just to say I did so. Really though, if a day like this ever comes where I am confronted by a ranger on matters, then he or she better have a tazor on them and be prepared to convult me to the ground. I know that sounds immature, but what you said really fueled my fire!

"Sorry Evan.
Maybe trolling is too strong. I just find your attitude strange. You post on this forum, yet say it isn't worth a few dollars for membership. That confuses me, as you are basically saying i'm stupid."

Well, the forum is free. Why would I pay for it?

I don't think you are stupid. The membership just doesn't provide value to me so I don't have it.

Glad to see that the advertising link was a relic. Good to know that impartiality is important.

Unfortunately Monty the newspapers that are so popular only masquerade as journalism as well.

"In my experience, your average GP's advice is not worth much unless you know what you need (say you just want a prescription written). Most medical doctors are notorious for basing their advice on anecdotal and pharmaceutically motivated critria rather than evidence based. If I were you, I would read up before you head to your doctor for advice!"

That's a pretty broad brush you're painting the medical profession with, Lynn.

"That's a pretty broad brush you're painting the medical profession with, Lynn."

Probably with good reason. And I'm not painting the whole profession, just GPs who are such generalists by nature that they often aren't very good or don't have time (15 minute time slots!) to put in a lot of 'research' on behalf of an individual patient. Even more than researching UL packing, I would encourage folks to research matters concerning their own health so they at least have some idea of what to ask when they visit their GP.

This thread gave me some pause to consider why I am willing to pay for membership. While there is value-added for me in gaining access to the members-only content, the real value is in providing the BPL powers-that-be with some tangible financial reward to keep doing what they are doing. The presence of a global community sharing information and opinions is not without costs.

I choose to support with my time (and posts) and a bit of money the community of light(er) backpackers without the heavy-handed influence of big-time advertising. By subscribing, I'm taking an extra step to better insure the survival and prosperity of the BPL on-line community. If the owners/managers of this operation can make a profit, then I'm happy for them.

"Probably with good reason. And I'm not painting the whole profession, just GPs who are such generalists by nature that they often aren't very good or don't have time (15 minute time slots!) to put in a lot of 'research' on behalf of an individual patient."

The function of a GP is to be general, Lynn. They aren't called "gate keepers" by accident. 4 years of medical school plus a residency is adequate time and exposure to the real deal to hone their diagnostic skills, prepare them to handle basic health problems, evaluate a person's general health,and recognize when there is something going on that requires a specialist. The 15 minute slot/patient is another question entirely. That's what happens when the "bean counters" and MBA's run medicine. It doesn't allow enough time for even a good physician to catch everything, and mistakes of omission and commission do get made. But to say they are all in the hip pocket of the pharmaceutical industry or rely on "anecdotal" information is, IMO, way over the top. I've known far too many talented, conscientious physicians to buy into that. They take the ancient oath, "primum non nocere" very seriously, and we're darn lucky they do. That said, there turkeys as well, and your point about being informed is well taken. My 2 cents. :)

"The 15 minute slot/patient is another question entirely. That's what happens when the "bean counters" and MBA's run medicine. It doesn't allow enough time for even a good physician to catch everything, and mistakes of omission and commission do get made."

This is the main 'problem' with GPs, and I'm not saying it's their fault, just that that's the way it is. Same could be said of many reader reviews (I'm guilty of this too). Because I'm not paid to write gear reviews, I don't put a lot of time and comparative study into my reviews. I have more pressing things to do with my time.

"to say they are all in the hip pocket of the pharmaceutical industry or rely on "anecdotal" information is, IMO, way over the top. I've known far too many talented, conscientious physicians to buy into that."

I've taught too many med students (more to the point I've seen the teaching curriculum that many of my teaching colleaugues put forth as curriculum) to believe otherwise. Again, it's not the student's fault. Most of them are VERY talented and motivated. It's just that a lot of traditional western medical teaching is based on empirical data rather than evidence based. And a lot of the pharmaceutical "evidence based" info is so totally skewed and mis-represented that the poor students don't have a hope of sorting out truth from mis-truth. It's not the doctors that are bad, just the system they are raised in. I think with the information age that this is changing rapidly, and the new crop of med students will hopefully come out more well rounded and with a decent back ground in assessing the merits of information put in front of them as the *gospel* for what it really is. It is only very recently that Evidence Based medicine (EBM) has been formally adopted into most med schools.

Here's an example of what I mean:

To ascertain general practitioners (GPs) views about evidence-based medicine (EBM), perceived barriers and preferred resources to support evidence-based general practice; to assess GPs familiarity with technical terms commonly used in EBM. METHODS: We developed a self-administered questionnaire from an existing instrument. A random sample of GPs completed the questionnaire at the commencement of a trial to improve preventive care. RESULTS: Sixty GPs (100%) participating in our trial returned the questionnaire. The most commonly cited barrier to EBM in general practice was patient demand for treatment despite lack of evidence for effectiveness (45%), followed by lack of time to read and appraise research articles (40%), lack of time to search for evidence (28%) and lack of time to discuss the implications of research findings with patients during routine consultations (25%). Fewer respondents cited insufficient skills in appraising evidence (16%), searching for evidence (12%) or communicating the implications of research to patients (5%). Preferred resources for EBM included clinical practice guidelines (rated as very useful= by 55%) and journals that summarise research evidence, for example Evidence-based Medicine (52%). Systematic reviews were considered very useful by only 15% of respondents however. Unexpectedly, 30% of respondents indicated that they did not understand the term “systematic review” and 43% did not understand “meta-analysis”. Only about one quarter of respondents indicated they fully understood the terms “relative risk” (23%) and “absolute risk” (28%) and could explain these terms to others. In comparison, only 15% of respondents indicated they had the same level of understanding of “number needed to treat”. Even fewer respondents (12%) indicated they fully understood the term “levels of evidence”. CONCLUSIONS: Barriers to EBM in general practice were perceived to be related to time rather than skills. However, GPs lack of familiarity with technical terms commonly used in EBM suggests lack of training. Skills development will be important to strengthen an evidence-based approach in general practice. If methodological research supports the validity of self-assessment of understanding of EBM terms, this measure could be used to evaluate the impact of educational strategies.

A lot of BPL articles lean towards an evidence based approach, especially when compared to other sites and reader reviews. To me, that alone is worth the price of admission.

Oh, and a big hug to all those GPs that do incorporate a good dose of evidenced based medicine into their practice. I know they're out there, they're just not yet the mainstream (and may never become mainstream if HMOs take over the world). It does take extra time and effort, and they should be rewarded (financially) for aquiring and disseminating that knowledge to their patients, just as BPL deserves to be rewarded financially for paying experts in their fields for doing high quality research and publishing it. However, there are always folks like evan who just don't value that info enough to want to contribute to it. And that's what a free-market is all about. Non-members are pretty lucky on this forum. Many exclusive forums don't even allow non-members to read forum posts, much less contribute.

Post deleted.

"Non-members are pretty lucky on this forum. Many exclusive forums don't even allow non-members to read forum posts, much less contribute."

Name 3. I'd question the relevancy of each to the average hobbyist if that is even the target of the forums you name.

I could see this one coming a mile off. :-)

I think in this case Lynn you should do a 'disclosure' so everyone else understands why you can make such a statement and get away with it. Something like "Professor, ? Department, Major Medical School, New Zealand University" would be suitable. You don't have to identify which Uni.
(I think 'Professor' is the rank you would have in an American university?)

Cheers
Roger Caffin

I don't think 'pulling rank' is productive or even meaningful here. I think it would be better to re-state my position on what information wants to be free. My comparison with GPs is this: They are generalists, and that is what they are supposed to be. Many of them are top notch generalists, and very caring and dedicated health professionals. But if you want cutting edge, up to the minute health advise, you don't go to a GP (unless it's to get a referral). You go to a specialist. Specialists cost a lot more than GPs because of the time and experience they dedicate to keeping up to date in their area of expertise. Likewise, if you want cutting edge, up to the minute UL packing advice and info, BPL 'Members Only' articles are a worthwhile investment. Reader gear reviews are the *equivalent* of consulting a GP. Often a good, quick and relatively cheap first stop, but taken with a grain of salt. At the very least you might want to seek a second opinion.

"Specialists cost a lot more than GP's because of the time and experience they dedicate to keeping up to date in their area of expertise."

I'll trust the docs who are members to correct me if I'm off base; All docs, GP's included, are required to take a certain number of hours of continuing education annually to maintain their license in good standing. The GP's area of expertise is the entire human organism. He/she must understand it well enough to spot problems across a wide number of areas and either treat them before they get out of control or know when to refer the patient to a specialist. Not to mention preventive care and nipping emerging problems in the bud. Most docs spend a lot of time keeping up to date, Lynn. They're not perfect, to be sure, and Western medicine is not without its problems, but I think the population explosion and ever increasing life spans in countries that employ Western medicine widely bear testament to its general efficacy.

I would also second Roger's observation that presenting some credentials that establish your qualifications to so roundly criticize GP's might be in order.

There are many who think that medical information should be free as well, and for many people, it is free….lets start a debate on socialism. Its a decent attempt at a metaphor but c'mon. Are you saying that if BLP staff were Ph.Ds in ultralight backpacking, you would consider a membership more valuable? I think we can all agree that they are certifiable. An expert in BPing speaks in footprints, not a piece of paper on the wall. Im sure even those who have earned both can agree with that.

IMO the information on this site is a steal, w/ or w/o a membership. Thanks BPL staff, you have created an online community that is as 'free' as the outdoor activities that inspire us all.

> I don't think 'pulling rank' is productive or even meaningful here.

Sure it is. The PC idea that "everyone's opinions have the same value" is absurd. And especially if you are talking about scientific expertise then, yes, your credentials matter. It doesn't mean that you are automatically correct, but it lets people know that you at least aren't just making stuff up. (Of course, we can make up any credentials we like on a forum like this, huh?)

I remember once reading a science forum where some nutty SciFi fanboy who "had read a lot of textbooks in his spare time, including A Brief History Of Time" was trying to convice a physicist that faster-than-light travel was possible. THAT one was rich!

> Reader gear reviews are the *equivalent* of consulting a GP.

I would have said that it is more like consulting a witch-doctor. :-) All of us "average" readers are essentially self-taught. That doesn't mean that we're invariably wrong, but I'll take a materials engineer's opinion on the strength of carbon-fiber over that of some boob who's just upset that his tent pole snapped. Certainly at some point you do just have to do a field test, but you know what I mean, I hope.

And there is a difference between "anecdotal" evidence and "empirical" evidence, Lynn. Sometimes you simply can't do the gold standard (a randomized controlled trial) to answer a question. For instance no one has ever PROVEN the efficacy of a lot of the interventions for the more severe congenital cardiac deformities because no one is willing to randomize neonatal patients into the placebo group. It would be immoral. Thus the best we can do is a retrospective analysis. The reason that a paper studying Evidence Based Medicine even exists is because that is a VERY hot topic in modern medical education. I had it pounded into me. Most likely, many of the GPs from that study are old coots who need to retire, frankly. I not infrequently encounter fellow surgeons that I could describe like that, too. At least with a surgeon you can shuffle him off to the ambulatory surgery center where he can't do much harm…

BTW, in the US a GP is someone who graduated from medical school and did only 1 year of internship, then went and hung a shingle. If you do a full residency we usually call primary-care providers Family Practice or Internal Medicine. Is it the same in Oz, or are we using different definitions, here?

OTOH, the influence of pharmaceutical companies IS pervasive. Luckily I do not work in an environment where I would have to deal with the reps very much. Usually, though, there are several options among effective medications. For instance, I don't care which statin someone is on, as long as he is on one if he needs it. If my hospital only stocks simvastatin because we have a contract with the drug company then that's what the patients get.

Anyway, I guess I'm just trying to say that the medical establishment is growing VERY persnickety about the pharmaceutical companies and in particular the studies that they sponsor. Those studies get read with a very critical eye, and the data is verified.

And personally I LOVE it when a new patient reads up before coming to my clinic. It lets me save some time on educaion. The flipside of that is that there is a lot of REALLY BAD information available and occasionally I have to convince patients that they were given horrible advice.

I once had a patient decide not to take her medication because the clerk at CVS had told her that a certain nutritional suppliment would cure her. Think about that for a second- I have spent 25 years of my life in school, and I'm probably in the top 1% of educated people on this planet, and she stopped taking her synthroid because the GED-equivalent kid at CVS told her to.

Arrgh.

Monty,

> I guess I'm a bit of a retro-grouch, but I've never known information (as opposed to opinion) to be free. Back in the day when people used libraries, books could be checked out no charge. But were they free? Heck no!

No, books aren't free. But we aren't talking about books, we're talking about information. The whole "information should be free" thing is meant more like in the X-Files's "The Truth Is Out There." Or for an even better example, more like the Open Source Software movement: I.e. not like "free beer", more like "free press" or "free speech."

Dean F > For the record, it is the ONLY website that I pay to access. For whatever that's worth.

Me too. BPL is a great site, and the member only articles are written by people who not only know what they are talking about, but who have spent many hours doing the practical hands on research they pass on to us. This needs to be paid for.

I would like it if da management would earmark some cash to improve the site's infrastructure and organisation. It cries out for a competent inhouse web admin / code jockey. Having said that, it's generally a good thing that followup posts don't autoquote the previous poster in full. So many people just add a 'me too' to a long post without trimming it to the salient point. I would like some easy to use tags though.

Anyway, one good deal on gear swap easily covers a years subscription, so pay up and smile.

Hi Rog

Well, I am far enough away from 'management of BPL' that I can comment without committing BPL to anything.

I think BPL would LOVE to spend a whole LOT of $$$ on upgrading the web site. We do have one person working a lot of time on it already, but he does not have infinite available time because BPL does not have an infinite amount of $$. However, small improvements are being made regularly.

Actually, times are pretty tough in USA right now, and my understanding is that BPL is being very carefully to not get into any financial difficulties. Some very tough measures have been taken to restrict cash outflow. Sigh!

When the economy recovers … :-)

Cheers

Roger C

Oh no, their not going to make you pay for your own 'stove testing' alcohol are they? :o)

> Oh no, their not going to make you pay for your own 'stove testing' alcohol are they? :o)

I don't think Tony claimed for the cost of his alcohol in the 2-part series.

Cheers

Let me be even more clear on this: I am NOT criticising GPs. I am merely pointing out that GPs are generalists, and their opinions and diagnoses should be accepted with this knowledge. It was merely meant as a metaphor for BPL membership, and only becaue someone else mentioned that you pay for the info from a GP (implying this was a specialist opinion worth paying for), so why shouldn't you pay for BPL members articles which are likewise specialist. I agree, but only to the point that I don't consider a GP to be a specialist opinion, and they often get it wrong.

Dean, your post was one of the more cogent, educated and thoughtful ones I've read on this site, and if you are a GP then we need more like you. I don't believe the old fuddy-duddies should be pushed out of the profession however, as they bring a wisdom and empirical knowledge to the profession that is priceless. But caveat emptor (young or old physician).

And of course double blind RCTs can't be done on every condition, either for ethical reasons or the rarity of the condition. But where there IS a plethora of sound clinical data showing something really does or does not work, and GPs are not aware, or are swayed by other considerations against implementing this EBM, then there is a social and educational problem that needs to be dealt with. A classic example of this is the extreme over-prescribing of SSRIs, despite any evidence of benefit to all but the most severly depressed folks. I am heartened that Dean is open to patients researching their own health concerns before coming to him. This means they are taking an active role in their health care, and it pushes GPs to pull up their pants (if their pants are down). However, a lot of GPs dread the thought of their patients playing GoogleDoc, and to the extent that the internet can be a wallow of mis-information if you don't know how to sift through it, and also to the extent that many docs feel it undermines their traditional role as an elite health care professional, I understand this. But the internet is not going away, so it's better to try and teach (docs and public) how to use this info rather than pretend it doesn't exist.

Anyway, as I mentioned earlier, times are changing, and I think new medical graduates have a better handle on this side of doctoring than their older counterparts. It doesn't mean I would discourage someone from consulting an older GP, just to consult all GPs with their eyes wide open. As for socialised medicine…I'm all for it. But that doesn't mean the info and skills are free, merely that you pay for them through taxes instead of at the door. Kinda like a BPL membership ;) I consider my BPL membership to be a voluntary tax to keep a worthwhile resource avaialable.

I have zero medical credentials but I know you have to do you're own research and that you are responsible for your own health.
The GP's I know actually still believe in the "Lipid hypothesis" and recommend diets and dangerous drugs based on this old fraud. Plus I have a hard time convincing family members who have diabetes to stop eating sugar and refined carbs because the GP keeps telling them them its OK to eat "in moderation" and one was sent home with a pamphlet (writen by drug companies) with a diabetics recipe for brownies that called for 1 1/2 cup of sugar. what? I don't need to be a doctor to know thats insane!
Im sure there are good GP'S out there but as always your on your own.

Jason,

>> I remember once hearing about this Patents Office guy who came up with some crazy ideas about space and time :).

That just implies that you might not know the patent clerk's full history. :o)

Einstein was quite well educated. He was publishing papers while still in gymnasium. He studied mathematics and physics at the Polytechnic in Zurich. His earlier performance on the math and physics portion of a university entrance exam was described as exceptional. He was a patent clerk not because he wasn't educated or accomplished- it was because he had problems with authority and was living in a society that had a stifling academic bureaucracy, and thus he couldn't find a teaching job at the time. Even at the patent office he specialized in issues with complex basis in physics, mostly electricity.

And I'm not saying that savants aren't out there. Obviously they are, but they are VANISHINGLY RARE. And if you count on every idiot you listen to on the internet being a misunderstood savant then you are going to have a very hard, brief life. :o)

I'll also point out that I am talking about scientific and technical subjects. I'll gladly accept the refined opinion of an experienced farmer on aspects of farm management. (But even then most farmers in the western world have degrees, nowadays.) I guess a better example would be a subject that you CAN master by reading a few books. For instance, I guess a rabid collector of Garand rifles who has read every book ever written on the subject would be a good authority on identifying a World War II manufactured weapon versus a postwar model.

So I guess I'm saying "lets not compare apples and oranges."

Brian,

I never said that there aren't bad doctors out there. Obviously there are- just as you will find bad apples in any other profession. And you will always be able to find some old coot who refuses to change the way he does things. But…

Lynn,

I came across as more harsh that I meant to towards older doctors. Heck, all of my attendings during residency were "older doctors" after all. I'm not trying to come across as anti-elderly. Obviously most doctors do keep up with current best practice, and obviously there is something to be said for experience. But it just takes one interaction with one "coot" to spoil a layman's opinion of the medical profession in general.
Also, the paternalist model of medicine is on the way out. A partnership approach is taught in most (U.S.) schools nowadays. But you'll still find "coots" who just want their patients to do as they are told and not give them any lip. And I have to admit that sometimes I get upset when I know an OBVIOUS and EASY solution to a patient's problem- and they won't comply. To cite an over-used example it is impossible to convince some people to stop smoking even when they are 40-year-old diabetics with two heart attacks, one foot with three toes, a bilateral fem-pop bypass, emphysema, and carotid stenosis. That's just the way it is.

Back to Jason,

Your statement about observer bias is nothing new. Again, it is something that has been pounded into students in ALL science fields for some time. And, again, every so often you find someone who forgets… But that is what peer review is for. And THAT is why sensationalist science reporting in the media is annoying. The media has a tendency to go wild over some result before other scientists have a chance to confirm it- which is a very BASIC tenet of science: "If it ain't reproduceable, it ain't science…" (Pardon my vernacular.) This is what happened with Hwang Woo-Suk, for example, though he was Very Good at faking data and it took a while to catch him. And he is an extreme example- he was knowingly falsifying data as opposed to just reading into the data what he wants to find, which is far more common and much more easily forgiven.

Another tenet is "extraordinary claims require extraordinary proof." A good example is those Australian guys, Warren and Marshall, who tried to convince other doctors that most ulcers are caused by a bacterial infection. Before that almost all ulcers were blamed on some sort of pathologic acid production. The medical community laughed at them. So, Marshall infected himself with Helicobacter pylori and gave himself ulcers. (Ya gotta love Australians!) Then he cured himself with an antibiotic regimen, and the ulcers resolved. He repeated this several times. Then they did it on volunteers. THAT was extraordinary proof. AND it was reproduceable by others. AND it won the Nobel for Medicine.

That story was a total non sequitur, but I'm fond of it. :o)

Maybe the use of GPs verus "specialsists" was too controversial. I might have got my point across just as well by comparing the advice you get on re-wiring your home from some kid down at Home Depot (free), versus advice from a licenced electrician (costs $$$). Some folks would be just fine with the Home Depot advice, but most people would be better off paying more money for a professional electrician. BPL is like that professional. If all you want to do is make a cat stove, there is plenty of free advice out there to guide you, and BPL subscrition may not be for you. However, if you want to make a top of the line MYOG down sleeping bag or quilt, then you might find it's worth the $25 to read Roger's thorough expose on it. There are plenty of other examples where mebership is of value to a lot of UL folks, just like there's a lot of other examples from the other professional versus amatuers (not saying GPs are amatuers).

Sigh. I've just had (yet another) dis-appointing encounter with a GP. In this case my son's GP, chosen by his father (my ex), and a real automaton IMHO. His father took my son to the GP 5 weeks ago with severely swollen neck glands, killer swollen and painful sore throat and tonsils, and moderate fever. The docotr gave him 7 days of penicillin and said it was strep throat. Naturally I asked (his father who will not take any advice from his ex-wife) if a swab was taken to confirm this diagnosis. He said no, but the GP said if it wasn't better in 3 days to come back. 5 weeks later (my ex is not the brightest tool in the shed either), he took him back again, this time symptoms were the same but much worse. The GP sent him away with 12 days worth of penicillin this time. When I found out, I was livid. To give someone two courses of antibiotics for the same symptoms, without even verifying the antibiotics were appropriate, was unbelieveable to me in this day and age. So naturally I dragged my son back (to a different GP) and told the GP the situation. Of course he did a swab on the spot, and took a blood test for mono, both at my request. He phoned the next day to tell my son to stop the antibiotics as there was no culturable pathogens. It was mono. Now I don't need a medical qualification to know that this incident (and many other previous that I as a consumer have had) shows that the consumer, of primary medical care or any other goods and services, needs to be as informed as possible to not get "ripped" off by shoddy practitioners and salesmen. This includes specialists and 'experts'. But this is more a topic for chaff than general UL backapcking…and yes, you can even get 'poor' advice on BPL 'members only' articles. But in general the standards are very high.