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Thursday, January 24, 2019

Once I thought I knew how to advise people how to eat to reduce heart disease risk , Now....

Read this recent brief overview of diet and fats and carbs and and cholesterol levels  and heart disease risk and see if you would presume to advise patients on how to eat. I am glad that I am out of that business.

I have written several times on medical hubris . In light of what we think we "know" now and what I advised ten years ago,I think "who is without sin....." I believed I had the answer while having answers was little more than parroting the recommendations of boards and organizations.

You have to remember the lawyer's classic query "Doctor, where you wrong then or are you wrong now/"

Neither the pre-operative beta blocker debacle nor the post menopausal use of estrogen and progesterone missteps seem to be a teaching moment for the population medicine devotees. The pop med folks , as explicated here would presume to take funds away from the treatment of some to fund preventive program to others which would "after a few generations" bring about a utilitarian gain by some metric even as some might suffer now.

At the time of this writing serious doubt has been cast on the previously widely disseminated advice about how to eat to avoid heart disease and who should take aspirin for primary prevention of coronary artery disease and who , if anyone, shovel be screened to detect low vitamin D levels, just to name a few of the ever changing array of medical recommendation to prevent disease and death. 

The internist who once upon a time was thought to be the physician trained to diagnose and treat complex complicated medical conditions has to extent  that she is now a ambulist ( at least those who are not now hospitalists) sends her time in part giving advice about how to prevent disease. How to eat,how often to get a cervical cancer screening test or a colonoscopy , who should take statins of aspirin or vitamins  and how much to exercise. For this you did not need to study four years in medical school and then three of more years of internal medicine training.You just need to subscribe to a service ( an app on your IPAD) to keep you up to date on the latest, and every changing, recommendation of various panels.

1 comment:

Nicolas Martin said...

We (all people, doctors and not), have to admit just how primitive is the state of human understanding of the most elemental aspects of human health. The “stress ulcer” is a paradigm for much of medical opinion. About 100 percent of physicians were sure that GI ulcers had an emotional basis, and they were all wrong. Such is the case with many things today.

I (not a doctor) was convinced by the vitamin D evidence a decade ago. I see a neurologist currently who has told me that he is “big on” vitamin D for his patients, though I declined to take it and he didn’t contest me. Recently another study confirmed (well, double-hinted) that vitamin D levels in the body are regulated by magnesium, and I sent him a copy. I know it won’t change his mind, but he’ll remember when several professional medical associations issue contradictory advisories on the subject. I’m suspicious of any nutritional recommendation that is impossible to meet without supplements from Costco. At least the amount of magnesium found effective is obtainable in an excellent diet. Many people don’t get that amount, of course. The value of magnesium is a lot better established than that of vitamin D.

We all have to learn to be skeptical of research, and doctors need to accept that humility is a virtue.