His reaction is kind of the essence of populist backlash.

People are told that the authorities have it all under control and the experts can be trusted. Then they discover that the experts are human, fallible, and sometimes incompetent or corrupt.

Since the original message was one of unqualified absolute faith in the experts, the backlash is to flip over to believing that the experts are satan incarnate and pure evil and always wrong.

It reminds me psychologically of the arc of an immature relationship. First they’re perfect, everything about them is perfect, they’re going to be your soul mate forever. Then you catch them in a lie or they do something embarrassing. Then you get the screaming breakup. Everything about them is the worst now and you never want to see them again.

Wow, for once Chuck didn't win

I had to have contrast to diagnose a simple cyst, which is entirely asymptomatic and was discovered by accident in the background of a cardiac MRI (family history of SCD, but my own heart is fine).

You're making me feel lucky about what was otherwise a very unpleasant experience!

Maybe donate some plasma afterward. There was a study about firefighters exposed to microplastics that had a statistical reduction after regular donations.

Pretty much just diluting it out of your system.

Nah, they used it on me when I cracked a toe. If I knew that this may be that dangerous I’d go the way without the contrast agent.

> I was kind of annoyed I wasn't offered and MRI, and here we are.

This paper isn’t saying that MRI contrast agent is high risk in general.

There’s a risk in misinterpreting these niche papers to overstate their relative risk. This is a common mistake when people start reading medical papers and begin overweighting the things they’ve read about as the most significant risks.

Really wish more people had that mind set. Practicing medicine isn't easy, especially in the US when you have to battle the insane insurance industry.

> I hold a different opinion to you though, I'm glad doctors are always learning more while generally operating with good /extremely good intentions.

I agree. Expecting perfection from humans, even experts, is not reasonable and is frankly counterproductive.

Willful ignorance is one thing, but people who genuinely attempt to do the right thing at worst just need to be steered slightly differently.

Except that a disturbing number of doctors insist that they are always right and you are always wrong.

A year ago, one insisted vehemently—to the point of yelling—that I shouldn't be supplementing Vitamin K because my potassium levels were fine.

> That's why we don't give MRI's out the wazoo

Why? What are the risks of MRIs without contrast?

Why did you have a brain MRI with contrast?

No one is asking to go back to Ancient Greece.

But given our track record, a little humility would go along way.

When a highly educated doctor tells you that something is safe, a person is going to assume that means that someone somewhere has proven that the substance is safe. If what they really mean is that no one really knows, but so far, no experiments have been able to prove danger, then we should say that instead.

> Does that cause any symptoms?

Tinnitus.

From OpenEvidence.com:

"After ingestion, bismuth is primarily found in trace amounts within organs such as the kidney, liver, spleen, and, in rare cases, the brain, where it accumulates intracellularly—especially in lysosomes and nuclear membranes—and extracellularly in basement membranes of blood vessels.[1-4] In normal therapeutic use, the amount of tissue-bound bismuth is extremely low and is not associated with adverse effects. Potential consequences of tissue-bound bismuth are generally negligible at standard doses, but chronic or excessive exposure can lead to toxicity, most notably neurotoxicity (bismuth encephalopathy).[1][4-6] In cases of bismuth intoxication, histochemical studies have shown accumulation in neurons and glial cells, particularly in the cerebellum, thalamus, and hippocampus, with clinical manifestations including confusion, myoclonus, and encephalopathy.[1][4-6] However, these effects are reversible upon discontinuation of bismuth exposure, and recovery is typically complete within weeks.[5-6] Animal studies confirm that bismuth binds to proteins such as ferritin and metallothionein, and is retained in lysosomes, nuclear membranes, and myelin-associated proteins.[2][4][7] The kidney is the primary site of accumulation and excretion, and tissue levels decline after cessation of exposure, with little evidence of permanent retention at therapeutic doses.[2-3] In summary, permanent tissue binding of bismuth is minimal and clinically insignificant with standard use, but chronic high-dose exposure can result in neurotoxicity and other organ effects, which are reversible after stopping bismuth.[5-6][8-9]"

1. Autometallographic Tracing of Bismuth in Human Brain Autopsies. Stoltenberg M, Hogenhuis JA, Hauw JJ, Danscher G.

Journal of Neuropathology and Experimental Neurology. 2001;60(7):705-10. doi:10.1093/jnen/60.7.705.

2. Metallobiochemistry of Ultratrace Levels of Bismuth in the Rat II. Interaction of Bi With Tissue, Intracellular and Molecular Components. Sabbioni E, Groppi F, Di Gioacchino M, Petrarca C, Manenti S.

Journal of Trace Elements in Medicine and Biology : Organ of the Society for Minerals and Trace Elements (GMS). 2021;68:126752. doi:10.1016/j.jtemb.2021.126752.

3. Distribution of Bismuth in the Rat After Oral Dosing With Ranitidine Bismuth Citrate and Bismuth Subcitrate. Canena J, Reis J, Pinto AS, et al.

The Journal of Pharmacy and Pharmacology. 1998;50(3):279-83. doi:10.1111/j.2042-7158.1998.tb06861.x.

4. In Vivo Distribution of Bismuth in the Mouse Brain: Influence of Long-Term Survival and Intracranial Placement on the Uptake and Transport of Bismuth in Neuronal Tissue. Larsen A, Stoltenberg M, Søndergaard C, Bruhn M, Danscher G.

Basic & Clinical Pharmacology & Toxicology. 2005;97(3):188-96. doi:10.1111/j.1742-7843.2005.pto_973132.x.

5. Bismuth Encephalopathy- A Rare Complication of Long-Standing Use of Bismuth Subsalicylate. Borbinha C, Serrazina F, Salavisa M, Viana-Baptista M.

BMC Neurology. 2019;19(1):212. doi:10.1186/s12883-019-1437-9.

6. Bismuth Subgallate Toxicity in the Age of Online Supplement Use. Sampognaro P, Vo KT, Richie M, Blanc PD, Keenan K.

The Neurologist. 2017;22(6):237-240. doi:10.1097/NRL.0000000000000144.

7. Bismuth Tracing in Organotypic Cultures of Rat Hippocampus. Locht LJ, Munkøe L, Stoltenberg M.

Journal of Neuroscience Methods. 2002;115(1):77-83. doi:10.1016/s0165-0270(02)00004-3.

8. Bioactive Bismuth Compounds: Is Their Toxicity a Barrier to Therapeutic Use?. Gonçalves Â, Matias M, Salvador JAR, Silvestre S.

International Journal of Molecular Sciences. 2024;25(3):1600. doi:10.3390/ijms25031600.

9. Review Article: Safety of Bismuth in the Treatment of Gastrointestinal Diseases. Tillman LA, Drake FM, Dixon JS, Wood JR.

Alimentary Pharmacology & Therapeutics. 1996;10(4):459-67. doi:10.1046/j.1365-2036.1996.22163000.x.

It is underpinning, as it is the most frequently cited in the entire paper.

It is underpinning, as the claims in both introduction and conclusion are precipitate to it.

The correction:

> After personal communication with the radiologists the administered Gd-contained contrast agent was documented in the MR examination reports of the mentioned nine patients incompletely and inexactly as Gd–DTPA by themselves. There is solely one MR contrast agent used in the described observation period: Gd–DTPA–BMA. Therefore, all mentioned nine patients received Gd–DTPA–BMA and not Gd–DTPA.

Means that Gd-DTPA is irrelevant. Guess which is analysed here?

Yep.

https://my.clevelandclinic.org/health/diseases/17783-nephrog...

What are you proposing instead? Should patients just die of their illness instead?

Medical procedures have risk, some are small risk some are higher risk. There are none that are 100% safe. Doctors are supposed to evaluate if the risk is worth the value the procedure would supply.

What is the alternative to the status quo that you would propose?

When I had mine I got the form with warnings about side effects. When I saw the allergic reaction I was a bit concerned, I asked the tech and was told it wasn't a big deal. Since I was in the basement I didn't have service and I decided to trust them given the large number of my friends who've had MRIs. It was fine, but it seemed like a major thing to toss in the patients lap right before they get strapped down in a tube.

There have been no cases of NSF in over ten years after newer gadolinium contrast agents have displaced the problematic ones.

People getting MRIs frequently have bigger fish to fry.

When my wife was under cancer treatment she had them frequently. Risking some minor reaction, which in her case was disclosed many times, was well worth the value in managing the acute and long term treatment plan.

> Undereducated, worrying about their likely life threatening potential illness or injury. That's basically under duress

I was never communicated about gadolinium pollution. Not once.

And yes, on my recent MRI, I explicitly asked why there was metal particulate in my joint. "I dont know, sometimes it happens'... No you fucking tool of a doctor. Its gadolinium.

And I finally find out here.

That's somewhere between a Hobson's choice and Russian roulette.

> I am positive that you were not told that '[gadolinium] is perfectly safe' because there is a well-known complication of gadolinium administration. It's rare, but it's mentioned in every consent form.

Consent is not "Sign this cause its the only course of treatment". And thats what happens almost every time.

And yes, I too have gadolinium retention in my joint. 3 MRIs. And no, was not told this was a complication... But I'm sure the papers I signed included weasel words to that effect.