Why Recommendations for Avoiding Heart Disease fluctuate so much.

Dr. Larry Weinrauch Health Pro
  • Why are there so many changes in the recommendations for avoiding heart disease? I get confused, “take vitamins” one day, “don’t take them” the next, “take aspirin” one day, “aspirin doesn’t help” the next?

     

    Don’t blame doctors or scientists for this one. We have a big conflict between “the public right to know” which is pushed by journalists and advertisers as opposed to scientific need to examine different hypotheses or theories.

     

    In science no single study is able to answer all of our questions about the best treatments. Even something as simple as the study of gravity was not as easy as noting that the apple fell down from the tree, not up. The concept of gravity required many experiments to prove using different objects. In physical sciences we are dealing with objects; in medicine we cannot treat people as things - this makes medical science a bit different and sometimes challenging.

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    With medical science, there is money to be earned if some of the theories are proven correct, or incorrect. If one can convince enough people that something relatively benign but expensive helps health in some way, one can make money. If someone else then demonstrates that it does not help, then it behooves us to demonstrate that they are wrong, so that we can continue to bring in money.

     

    Want some examples of “products” on which people make money, but for which the “science” has not proven a long-term benefit? Try these:

               

    Various weight loss management programs

    Various programs to reduce smoking

    Almost all dietary supplements including soy, kelp, seaweeds, garlic, Vitamins C and E and all antioxidants

    Pilates, exercise tapes, yoga

    Cereals claiming health benefits

    Medications for symptomatic relief of colds, headaches, arthritis

    A huge number of medications that are routinely prescribed by physicians for earaches in children, among other diagnoses, to treat diabetes, and to prevent heart attacks

     

    Why have some of these things not been adequately researched? The answer is usually monetary. It is difficult and expensive to do a long-term study. Therefore medical scientists have to make assumptions to answer questions put to them by the press.

     

    Your physician may be asked today whether suntan lotion is helpful in reducing your chance of skin cancer. On the basis of the information that is available the answer might be that it won’t hurt. But if you ask the tougher question, is there adequate scientific evidence that actually a treatment does work, the answer is unavailable.

     

    We hold medicine to a high standard because it is an honored profession. Most others who call themselves professionals are not held to the same standard of proof that something does or does not help or work. We likewise require of medicine that standards of care be met. This is reasonable. Consider that we spend billions per year on cosmetics, “integrative dermatologics,” massage, chiropractic, nutritional supplements and organic foods, but we have little to no proof that any of these make a long-term difference in your health.

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    Frankly, I think that suntan lotion is about as likely to prevent melanoma, as vodka is to prevent radiation sickness. I had similar opinions about vitamins and antioxidants, and they have already been proven correct.

     

    With regard to vitamins, nutritional supplements and antioxidants and the evidence that they don’t work, there is already dispute in the press. Why?

     

    In the US, 2.5 billion dollars worth of these supplements are bought every year. That will buy a lot of advertising (“spin doctors”) from threatened “industry.” Indeed, the same day that evidence of the non-effectiveness and perhaps harm of using these supplements was published in the Journal of the American Medical Association and picked up by the news agencies, the makers were able to send to every physician in the USA a critique (unsigned) explaining why the conclusions of the study were incorrect.

     

    A new study by some of my colleagues demonstrated that men who take aspirin, acetaminophen (Tylenol) or ibuprofen (Advil) more than 6 times a week have more high blood pressure than those who don’t. This is not really a surprise despite the relative safety of these drugs. But it is a reminder that people who reach into the medicine cabinet more frequently than needed may be doing themselves a disservice even with “minor” over the counter medications.

     

    Let’s look at the battle now over vaccinations for Human Papilloma Virus (HPV). There are currently less than 10,000 cervical cancers in the USA per year, which supposedly “could” be prevented by vaccination. If we vaccinate all girls (and boys) in the US, and such vaccination actually works for a lifetime (not proven), and we assume 10 million doses at $100 per person, the math is easy… one billion dollars to possibly prevent 10,000 cases if the vaccine is 100% effective. Since few vaccines are 100% effective, or prevent disease for a lifetime without a booster, and no vaccine has ever been demonstrated to prevent cancer, what are we really buying for 1 billion dollars?

     

    The theory that raising your HDL or “good” cholesterol with a drug called torcetrapib was in fact tested and results were reported at the Scientific Session of the AmericanCollege of Cardiology. The drug failed to provide the expected benefit. The cost of the trial and the loss to the pharmaceutical company were enormous, but new theories and observations will result that will ultimately advance medical science.

     

    A recent study also demonstrated that “early invasive therapies that open blocked heart arteries does not reduce the number of deaths or heart attacks in patients with acute coronary syndrome” (Lancet, 2007). This new finding will also change the way we practice medicine, perhaps diminishing the rush to do procedures somewhat.

     

    But scientific advancement comes one small step at a time, and while it is happening, it is certainly understandable that people can be confused about changes in what doctors recommend. Indeed, it is as difficult for physician clinicians to keep up with new advances as it is for the general public, but it is our job, and we try to do it diligently.

Published On: June 12, 2007