Why It's Called the 'Practice of Medicine'

from Bottom Line's Daily Health News,
June 7, 2007

When I was growing up, people drank milk to heal their ulcers, my mother fed me a healthy breakfast of scrambled eggs, and teachers asked me to memorize the nine planets, starting with Mercury and ending with Pluto.
All this was based on what we knew as science -- and the facts were the facts. Or were they? As time went on, scientists learned that ulcers were often caused by helicobacter pylori (H. pylori) bacteria and that dairy could aggravate digestive disorders. Eggs lost favor because they were a source of cholesterol, and now Pluto is not considered an official planet after all. Today, coming full circle, eggs are back on the menu, considered healthy once again.

So-called "facts" change quickly, as science is replaced by newer science. Though we are encouraged to believe that medicine is an exact science, truth be told all medical knowledge -- for that matter, all scientific knowledge -- is only the experts' best "educated guess" based on what they know today and the scientific data they currently have. As we learn more, new questions arise -- and we discover unanticipated new answers, too. Given how much information is directed at us in the area of medical knowledge and practice, how can a health-conscious consumer make the smartest choices?

SHARP ADVICE FROM AN EXPERT
For an insider's view, I turned to Jay S. Cohen, MD, www.medicationsense.com, author of several books for health care consumers, including What You Must Know About Statin Drugs & Their Natural Alternatives (Square One) and Over Dose: The Case Against the Drug Companies (Tarcher). First and foremost, Dr. Cohen said that we should always understand that what we know right now might change. As evidence, Dr. Cohen pointed out the many things we once thought were good for us that turned out to be harmful or unnecessary. Not long ago, it was common for people in the general population to have a chest X-ray to screen for tuberculosis (TB), among other things, and tonsillectomies were practically routine procedures for children prone to sore throats. As for medicines, drugs have been recalled due to their horrifying side effects, including the allergy medication terfenadine (Seldane), which caused cardiac problems... and fen-phen (fenfluramine and phentermine) and rofecoxib (Vioxx), which were responsible for many deaths. And the list goes on and on.

WHAT YOU CAN DO
When it comes to medical drugs and procedures, Dr. Cohen stresses that newer and stronger are not synonymous with better. The media loves "health breakthrough" stories, but the promise of a new treatment doesn't always deliver and the full story is not always apparent from one or two research studies (all too often sponsored by the drug companies that stand to profit by selling the breakthrough drugs and treatments). This is playing out now with regard to recent research on the outcomes of stenting in cardiac patients. (Stay tuned for an in-depth look at stenting in an upcoming issue of Daily Health News.)

Smart consumers can and should take specific precautions to reduce their risk of side effects, says Dr. Cohen. He outlined some strategies to effectively protect yourself and your loved ones in the ever-changing face of modern medicine...

Know your doctor. All too often we choose physicians based on criteria like office hours and location, and what insurance they accept. Your doctor should also be able to explain how he/she stays current on new research, treatments and techniques. You should also feel confident that he/she sees and treats you as an individual with unique needs.
Ask questions. Be sure you understand why a particular drug or procedure is being recommended. If you're facing a serious problem, consider bringing someone you trust to your appointment -- your own emotions can make it difficult to process what you are hearing, and also to identify which points you don't understand or want more information about.
Find out how many times your doctor has performed the particular procedure that has been recommended. You don't want to be at the start of a learning curve -- far better to be one of many success stories.
Get a second opinion. It's worth the peace of mind if the second specialist agrees with the first -- and if not, perhaps you will learn something important, even life-altering. One smart strategy is to seek your second opinion from a non-drug-prescribing doctor, such as a naturopath. Insurance companies often pay for second opinions, and many for naturopathic care as well.
Be skeptical about glitzy advertising. Stay with tried-and-true solutions, rather than being swayed by new drugs hyped by celebrities on commercials and in magazine ads. Medicines that have been around for a longer period of time are often just as effective, less expensive and -- most important -- already have a history of safety, unlike the trendy and pricey new ones.
Be familiar with how drug companies market their products. Not only are they tugging at our individual heartstrings with emotional direct-to-consumer advertising, they regularly visit doctors' offices, delivering lunch and lots of free samples. Many of these so-called new drugs are actually very similar to existing drugs (also called "me too" drugs), which may offer little or no advantage over older versions -- but earn more for the drug company. Also, the harmful effects of new drugs sometimes take years to emerge, and by that time, the damage may already have been done.
For medical problems that are neither acute nor severe, talk to your doctor about starting low and going slow. When beginning a new treatment regimen, Dr. Cohen suggests starting with the lowest effective dose of any drug, and only graduating to higher dosages if necessary. This way, you minimize exposure to dangerous and unnecessary side effects.
Be wary if you are given "free" samples. These generally last for only a short time, and voila -- you've been suckered into an expensive new drug regimen.

Always weigh the benefits versus risks of all medical drugs and procedures -- especially the new ones. It's certainly true that these may be important and lifesaving, and for some people, benefits will outweigh risks. Yet for many others, benefits are minimal, and may be overshadowed by the risk of side effects.
For example, a person who takes a high-dose statin drug to lower slightly elevated cholesterol may develop muscle pain, for which he/she may take an over-the-counter pain reliever, which can lead to a sour stomach (not to mention increased cardiovascular risk), which can lead to popping antacids or acid reducers/suppressants which disturb normal digestive processes, and so on. Don't get on this merry-go-round unless you really need to.
For non-life-threatening problems, consider lifestyle change before taking drugs or undergoing invasive procedures. For example, if you have mildly elevated cholesterol or blood pressure, or have been told you have "prediabetes," you'll benefit enormously from simple measures such as a healthy diet, regular exercise, weight loss and stress management. These efforts often eliminate the need for more aggressive treatment. Dr. Cohen says that ideally, we should first address lifestyle issues, and then if necessary move on to natural interventions -- and only then to pharmaceuticals.

Bottom line: Be careful. Be skeptical. Do your homework, and take charge of protecting yourself, first and foremost. There's a reason why doctors are said to "practice" medicine.

Source(s):

Jay S. Cohen, MD, associate professor (voluntary) of family and preventive medicine, University of California, San Diego. Dr. Cohen is author of What You Must Know About Statin Drugs & Their Natural Alternatives (Square One), and Over Dose: The Case Against the Drug Companies (Tarcher). Visit his Web site at www.medicationsense.com.