Who To Believe in Health Care

Last week an article was published in the Journal of the American Medical Association (JAMA), which concluded that the evidence in this study did not support the commonly held opinion that a high fiber diet is protective against color cancer. What? How often over the past several years have we read in the press or heard in a 15-second newscast that a health care issue that most take for granted has been questioned by the "latest study." This is a confusing dilemma for millions of Americans who are increasingly health conscious and eager for the latest medical advances. It is also frustrating for health care providers who are daily asked their opinions on an increasingly long list of health care issues that are quite controversial. Prostate screening, hormone replacement therapy, immunization schedules, antibiotic use, dietary supplements and diets, I could go on and on. A word of caution, beware of the practitioner who tells you they have the definitive answer.

1. Medicine is not math. Measurement of what we do in medicine is often difficult. Bias and confounding variables are statistician terms for part of what may lead to a conclusion that is not necessarily the truth.
   
2. Interpretation of a study is often highly variable. Most medical studies are fairly careful about interpreting results. However, by the time the results are filtered through the media or a drug company, the information may not necessarily reflect the study’s findings.

How do we sort out the results of confusing or contradictory medical studies? We need to be patient, I think, with many of the new findings. Often restudy and investigation is necessary before a new treatment or test finds its correct place in everyday medicine. People are often concerned about the length of time it takes for a new medical advance to be approved for the general public. But it is a laborious process and I think safety and effectiveness need to be well established before recommending drugs or tests to our patients.

I encourage patients to be careful about self-treating with unproved or poorly studied supplements or medications. Our store shelves are packed with pills and concoctions that make unrealistic claims and can be potentially dangerous. Very few of these have undergone clinical trial and there is very little proof of their efficacy.

Too many, I am afraid, expect that the miracles of modern medicine will bail them out if the above are ignored. If we could just pay more attention to these simple guidelines, the general health in our country would improve dramatically and we may be able to cut considerably the overwhelming cost of health care. For the time being, I encourage people to stop worrying so much about whether to cook with corn oil or canola oil, whether selenium will forestall Alzheimer’s disease, or whether ginkgo will help us pass calculus.

Medical advances in the past fifty years have indeed been incredible. Antibiotics, vaccines, cancer care, surgical and public health breakthroughs have greatly improved the general health of advanced countries and we hope this will, in the future, have as great an impact in the third world. But I fear, sometimes, we are a society becoming consumed by our emphasis on medical technology to the point we are not seeing the forest through the trees. Human physiology is a wondrous and finely balanced thing. Don’t mess with Mother Nature.