Tuesday, June 30, 2009

Medical Biases

I recently attended a review course to prepare for the Boards. For 4 straight days we started at 7 AM and finished at 9:30 PM. This intellectual boot-camp took place in Vegas, but the only fun thing I got to do was eat dinner by myself at the Paris buffet; a Japanese tourist and I were the only ones loading up on the veggies and sushi.

The course itself was brutal, but a great way to prepare. Interestingly, a couple of presenters epitomized the state of affairs in non-pharmaceutical medicine; one continually railed against the misguided over-reliance on many virtually ineffective pharmaceutical treatments, while the other reluctantly discussed some herbs and nutrients that have significant evidence and efficacy.

The latter doc warned that the evidence was thin and that there were significant side effects with those natural items. Yet, this presenter did not do likewise when it came to drugs. For example, black cohosh, approved for use in menopausal problems by the American Academy of Ob-Gyn, was said to be worthless and potentially dangerous. Yet, nothing was said about hormonal replacement with estrogen, which has been shown to increase the risk of cancer by the NIH since 2002.

Amazing: estrogen is OK, yet poor little black cohosh, which has never been associated with any cancers, is not.

What is really going on? It is simple; let me illustrate with another example:

Initially it was reported that hip padding/protectors did not reduce the risk of hip fractures in falls sustained by the elderly. Later, it was shown that they DO INDEED reduce the risk of hip fractures by a whopping 50%. It turned out that one of the authors of the negative study had not disclosed his financial ties with hip replacement surgeries.

“Follow the money.”

It is extremely naïve to deny the fact that our beliefs do not influence our intellect.

PS, I do not sell non-pharmaceutical products. Occasionally, I speak for companies that do.


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