BY NATAN SCHLEIDER, M.D.
JUNE 24, 2019
As a physician in private practice for 15 years, the specialty I once viewed as rigorous in the scientific method and always backed by strong data in powerful studies has been disappointing me. When paying half a million dollars for medical school, the professors tend to omit the fact that 50 percent of what they are teaching as the latest important clinical findings will be completely wrong.
For example, in medical school I was taught that hormone replacement for women after menopause would reduce risk of heart attack and osteoporosis. Hormone replacement not only helped hot flashes but was good for you, right?
Wrong. In 2002 The Women’s Health Initiative (a large study dwarfing the studies that had provided the info I learned in medical school) found that hormone replacement significantly increased breast and uterine cancer risk. Suddenly, prescriptions for menopausal symptoms went the way of the dodo.
I was also taught that Oxycontin was not addictive, ha!
For years aspirin has been considered an excellent choice for reducing risk of heart attack, stroke, and even colon cancer. Suddenly this month’s editorial in American Family Physician says with need to ‘rethink’ aspirin’s role in primary prevention. Really! Aspirin is the oldest pain medicine around since the mid to late 1800s. And we still are unclear about it’s efficacy?
In medicine’s defense, new large studies are constantly done (as the cornerstone of science is ability to repeat results given the same questions and data but often the second study does not jive with the first. So medical students are left knowing less then when they started [but at least the tuition bills are consistently on the up and up].
Simply put, for patients with risk factors for artery clogging/heart attacks (but with little or no risk for aspirin inducted gastrointestinal bleeding) aspirin 81 mg daily is recommended, especially age 50 to 70.
I am 43, have high cholesterol (addressed with Lipitor) and high blood pressure (addressed with medicines). Rather than perfoming certain convoluted risk calculations to determine my need for aspirin, I just take it daily.
Do I won’t to over-medicate you dear reader? No. But you can take comfort in the fact that if the ‘experts’ praise the results of a study this year, 10 years from now they will likely praise a newer study which discredits the first one.
As objective as medicine presents itself, the good doctor knows the art and science of good medical practice.