Medical Flip-Flopping

I don’t know how you all keep from going slightly bonkers over the endless reversal of opinion from “experts” in the world of medicine. In the last few days alone, medical journals/websites (and the newspapers nobody subscribes to anymore) have reported policy changes on issues that I personally was just beginning to wrap my head around.

For the third time in two years, the guidelines on mammogram frequency and Pap smears have changed. The PSA blood test for prostate cancer that was a great breakthrough several years ago, before entering the medical hall of shame for subjecting men to unnecessary surgeries, is now being partially resurrected. Bacon and sirloin strip steaks are apparently more dangerous to the average American than ISIS. And low-fat diets, once the answer to reversing heart disease and promoting weight loss, end up to be pretty useless.

I can only wonder what all this must be doing to your minds.

“Confusing” becomes an understatement
“Oh, screw it!” becomes the most rational thing you can think of as you “reach for a Lucky instead of a sweet.” That quote was actually a piece of medical advice from the 1940s, when doctors fully endorsed smoking not only for relaxation, but as a weight loss aid.

A patient of mine sent me the Ending Medical Reversal New York Times book review, which discusses exactly this flip-flopping and how to protect yourself from it. Prone as I am to impulse book purchases, I promptly downloaded it to my e­reader (after the usual 60 minutes spent struggling with the process) and can now report that thus far it’s been worth the effort.

The authors point out that medical flip-flopping is very common, that roughly half the stuff a doctor learns in medical school turns out to be wrong a few years later, and that, as a result, patients have been subjected to cringingly bad advice, bad drugs, and bad surgeries (prefrontal lobotomy, anyone?).

They lay much of the blame for this on so-called evidence-based medicine, which is supposed to look objectively at data from clinical research, drug studies (the famous double-blind, placebo-controlled approach), surgical outcomes, etc, and reach scientifically based conclusions. What happens after a few years, though, is that someone new re­evaluates the data, undertakes a new study, or uses any of several ways to reconsider a “fact.” And lo, a flip flop. Oops! Changed our minds.

Ending Medical Reversal offers suggestions to avoid being caught in a treatment (medical or surgical) whose veracity may well be reversed in a year or two. Essentially, their ideas boil down to common sense, topics we’ve discussed for years in these Health Tips:

  • Take care of yourself so you can avoid the health care system as much as possible. This is especially important in our current era of for-profit corporate medicine. More and more studies are emerging that show under the direction of non­physician medical executives doctors are being encouraged to order what are turning out to unnecessary diagnostic tests, making referrals to unnecessary specialists, and scheduling unnecessary surgical procedures. I commented on this trend in two recent Health Tips, one on cowboy doctors and another on worrisome mammograms.
  • Do your homework on any new diagnostic test (especially invasive ones) or treatment (medical or surgical) that’s being offered. Get second or even third opinions. Learn to challenge and ask questions like “What can I do to avoid taking this medication?” and “Do I really need this surgery or is there a simpler option?” One key question that should be asked by both doctors and patients about any treatment: “Does the desired end point (the perfect blood pressure, the really low Hemoglobin A1c, the pristine Pap smear, the effect of this gruesomely expensive medication) really matter?”
  • Find a physician you can work with. Again, surveys among physicians show that most newly minted doctors go to work at corporate-owned medical systems and, being obedient wage earners, do too much in terms of tests, drugs, and referrals. You need to find someone who will listen to your concerns and not begin with a treatment that may turn out to be useless or even dangerous in the long run.
  • Don’t be shy about speaking up. Perhaps say to your doc, “I want to make sure I’m going to be comfortable with what I choose. Do you really see a risk in trying lifestyle changes and alternative therapies first, before we move to the Big Guns?”

Appendix of flip-flopping
Ending Medical Reversal concludes with an appendix listing more than a 100 instances in which medicine has changed its mind. For me, it’s really the tip of the iceberg. When I look at the forgotten therapies from old medical journals or long-vanished drugs from previous editions of the Physicians’ Desk Reference, I think “How many people were seriously hurt by this over-reliance on ‘science’”?

Some examples:

  • Tonsillectomy done so routinely it was almost a rite of passage (in my childhood).
  • Removing adenoids from kids with stuffy noses (adenoids are lymphatic tissue at the back of the nasal passages, and they disappear during adolescence).
  • Inserting ear tubes into children with ear infections lasting longer than three months (turned out to cause hearing loss with learning disabilities).
  • Low-calcium diet for preventing kidney stones (actually increased the risk of stones).
  • Arthroscopy for arthritis of the knee (ineffective, no better than placebo).
  • Radical mastectomy–breast, nodes, and chest wall muscles–for breast cancer (this was the major surgical treatment in the 20th century, only recently found to be no better than far less aggressive surgery).
  • Antibiotics for symptom­free bacteria in urine (no benefit).
  • Aggressive treatment for atrial fibrillation (meds plus cardiac electroversion–no benefit).
  • Hormone treatment for menopausal women (this one has been a ping pong ball, currently cited as helpful for symptom relief only).
  • Encasing bedding in plastic covers for people allergic to dust mites (no benefit).
  • Radiation therapy for breast cancer in women over 70 (no benefit).
  • Surgery for torn knee ligaments (most would heal by themselves).
  • Surgery for torn shoulder/rotator cuff (most would heal by themselves).

“Evidence-based” fibro treatment
I have some familiarity with the history of so-called evidence-based treatment for fibromyalgia, the chronic muscle pain condition affecting mainly middle-aged women. Fibromyalgia is a clinical diagnosis, made by listening to the patient and performing a physical exam. There are no positive test results to be had, a fact that to this day many physicians have difficulty grasping.

Initially the rheumatologists to whom fibro patients were referred routinely diagnosed them as neurotic and sent them on for psychiatric evaluation. When psychiatrists reported the fibro patient fine except for pain, the patient would be referred to an orthopedic surgeon in the hope there was something to be fixed.

After xrays and MRIs, especially of the upper (cervical) spine, the radiologist would report some arthritis. Though we all have some spine arthritis in our 50s, surgeons saw this as “evidence” of a pain source and often performed a major back surgery called cervical laminectomy, which turned out to be totally useless. Probably thousands of women underwent this procedure until the fibro flip-flop occurred and doctors realized it wasn’t a surgical problem after all.

(After hearing this, you can likely guess the sad fate of many women whose fibro made its first appearance as chronic pelvic pain.)

And on and on…and on.

Be skeptical, and be well,
David Edelberg, MD

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9 comments on “Medical Flip-Flopping
  1. Angie Heisler says:

    I should probably know this, but where do you stand on statins for women. I’ve read Dr. Sinatras book, The Great Cholesterol Myth, and have stopped taking Crestor. My cholesterol level has been impervious to diet and exercise–I eat right and do exercise. I feel much better mentally off the Crestor. I’m about to have my annual appointment with my internist and would like to ask for the more complicated cholesterol test–good HDL, bad HDL, good LDL, bad LDL. I’m guessing I would have to pay dearly for it so I’m wondering what you think of getting that breakdown.

  2. calle says:

    Oh my oh my!!

    The wonders of misguided research.
    I have belonged to a nutrition journal club for over 20 yrs.
    Some of the garbage research we have read has been amazing.
    The whole publish or perish mentality is sick.. these researchers make money off of research and then newspaper reporters gleen headlines to trap readers based on their limited knowledge, and the misinformation begins.
    And companies pay ghost writers to churn out crap. And the “Abstract or Summary” may not even match what is in the paper. And some doc’s are paid to add their name.
    Or worse yet “Thought Leaders” an MD who is paid to present to other doc’s on a given drug in a hotel with canned slides, gives the impression that this is his/her’s results…
    Big Pharma and Big government pans “Functional” common sense practices, and we have been led to believe everything can be fixed.
    Our microbiome can not keep us well if we abuse it, and foods can not be good if we mess with the microbiome of our soil.
    So many want an Rx to cure them.
    And my biggest beef is this…people want instant and doc’s don’t want their patients to heal in the normal time frame.
    Instant is not possible, we can’t even build a house instantly.
    Making patients be responsible for their own health is not a “Today” kind of attitude.
    It has now taken me almost a year with good professional micro-nutrients to heal my basic body.
    Thanks for your time effort and energy.
    It is time Americans and the world awakened to the fact that science is not exact. And that the “money” equation drives the research.

  3. Teresa Strong says:

    We need to get back to the fact we are social animals who should be taking care of each other and our environment. I doubt we would have half the problems we have if we would just remember who we are and live within the balance of this beautiful planet we live on. At some point we need to say no to these corporate neanderthals who are dragging all of us around. This new emperor has no clothes.

  4. Dr E says:

    Hi Angie
    I make the statin decision on an individual basis. Generally if a woman is healthy, takes care of herself, and has a family history free from early heart disease, then no statins. On the other hand, if there are other risk factors (obesity, smoking, diabetes, etc.) and the women in her family have had heart disease when in middle age, I’ll obviously encourage significant lifestyle changes along with a small dose of a statin combined with CoQ 10

  5. Scott Desgrosseilliers says:

    “Bacon and sirloin strip steaks are apparently more dangerous to the average American than ISIS”. It’s the funniest, saddest, and most true statement I’ll read about the health care system this week..until next week’s newsletter. Thanks for the great article as usual.

  6. Dr E says:

    Hi Scott

    Ready for this? Yesterday the WHO did its own medical flip-flop on what has been dubbed “Bacongate”

  7. David Tenenbaum says:

    We are beyond issues like is rotting animal carcass and dairy infused with pus safe. If you want to live a long quality of life its no secret how to do it. First, stop relying on western medicine to fix your problem. Don’t believe me? Just watch a tv commercial for drugs and see first hand the side effects (effects as bad or worse than the underlying medical problem). Second, adopt a high fiber vegan diet including nuts and seeds and fresh leafy green and root vegetables. When Dick Gregory ran for President in 1968 his health plan was to make vegetable juicers tax deductible. He was spot on. Buy the best juicer you can afford and juice organic vegetables. Third, consume probiotic food like natto and Kombucha. Fourth, exercise. Yoga even better (you will sleep like a baby). And fifth, stay away from sugar. See? Five easy steps. Not so difficult or confusing after all.

  8. Teresa Strong says:

    Watch out for a vegan diet. I know first hand what a b13 deficiency will do to your health. Also, the lack of DHA in the diet can damage the brain. My vegan husband now has tremors in his right arm and leg. Any rigid control of your diet can harmful. Make sure you supplement with active forms of b vitamins if you plan to stay on a vegan diet. Keep tabs on your calcium and iron levels, too.

  9. Carla Steinbuchel says:

    Dr. Edelberg,
    First of all, I would like to thank you for your candid and informative newsletters and references. They are so helpful as I attempt to navigate decisions about my health and wellbeing. This article about medical flip flopping highlights the difficulty of making informed decisions and being cognizant that decisions need periodic review in light of new empirical evidence. As a healthcare professional and a woman living with a C 5-8 spinal cord injury for the past ten years, personal decision making is difficult, but I’m also aware of how overwhelming it is for people with little or no medical background. I wish there was an integrative health center locally, however, your publication helps me fill in the information
    gaps and piece together an approach using the best information available from resources that are available nearby. Again, thank you!

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