Wednesday, November 25, 2015

Wisdom Wednesday: Ending Medical Reversal

This is the title of new book written by Vinayak E Presad, MD and Adam S. Cifu, MD. Medical reversal is the phenomenon of a new superior trial arising that contradicts current clinical practice or the result of many claims that specific treatments have a benefit turned out not to be true.

You’ve all heard the contradictory reports. Coffee is bad for you today, tomorrow it’s good for and by next week it will be bad again.

The medical community is most concerned that these conflicting studies undermine the pubic confidence in medicine and therefore the authority of the doctor. The book claims medical schools spend too much time on the basic sciences and not enough time on practical application.

I believe they need to reverse their concepts of medical reversal. The issue is losing sight of the basic functions and chemistry of the body as it strives to maintain homeostasis. For example, most vitamin B12 injections are cyanocobalamin. This is the inactive form of vitamin B12 found in food. It must be converted to one of the active forms by the cells that line the small intestine upon absorption from the gut. When you inject cyanocobalamin into a muscle, there is no conversion to the active form. The blood levels look great on the lab test, but the patient does not improve. This is biochemistry 101, very basic stuff, that is lost on the doctor that has forgotten much of what they learned early in medical school. They rely of the drug rep to tell them what to use.

The real causes of medical reversal are:
  • Flawed understanding of physiology and pathophysiology
  • Poor quality studies
  • Affected by publication bias and selective reporting
  • Made by dishonest investigators
  • Based on publication subject to the influence of Big Pharma or other conflicts of interest

You are familiar with a few of these – recommending aspirin to prevent heart attacks in patients that have never had a heart attack (primary prevention), the use of cardiac stints in stable heart patients, and the prescribing HRT (hormone replacement therapy) using known carcinogenic compounds.

The issue is not that these therapies were wrong, it is that half the practicing physicians still recommend these treatments despite that overwhelming evidence that they do much more harm than good.

Standards of practice should prevent outdated, dangerous therapies from continuing. However, standards of practice seem to cited to continue a practice that obviously is in need of medical reversal. A physician may “want” to discontinue the use of a dangerous drug but will continue to prescribe it as it is the “standard of practice”.

This is the dogma of modern medicine. The myth that statin drugs reduce the risk of heart attack by reducing cholesterol is the greatest medical concept in need of reversal. It incorporates all the real causes I listed above. I have seen a few chinks in the armor but it will be years before medical reversal of the cholesterol myth occurs.

The Bottom Line:
You must be your own health advocate and stay informed on the latest medical reversals. It is vital to your general health and that of our nation.

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