April 8, 2014

the altar upon which we worship


     "What happened to evidence based medicine?  I thought we were supposed to be a school that teaches that, not hocus pocus stuff like acupuncture," I overheard a student say at the end of a workshop dealing with integrative medicine.  I will be the first to admit that there is much woo in alternative therapies.  I approach ALL therapies with a skeptical eye.  But how many doctors are willing to admit, hell are even aware that there is quite a bit of our guidelines that have just as much woo and hand waving?  I told the student, "I've gone to acupuncture.  It helped somewhat but just wasn't cost effective," as I gave him a brief rundown of what life is like with chronic pain. 
      "It sounds like you need a good orthopedist," he replied.  Did he think me stupid?  Of course, that's the first person I went to after my family doc.  Surgery couldn't help me so he wished me luck and ominously told me to come back when I "get worse".
     But what I really wanted to tell the student was to be careful at which altar you worship.  Our precious medicine is not always as hard and fast as we've been taught.  For instance, cardiovascular disease is the number one killer in the western world.  You'd think we'd have a very firm grasp on that with it being the number one killer and all.  And yet, when somebody decided to ask the question, how many of the things we preach to patients about avoiding heart disease are really based on solid evidence, the answer was less than awe inspiring.  About 300 recommendations.  Out of 2,700.  About 1 in 10.  What's worse is that more and more recommendations are being added and, "The proportion of recommendations for which there is no conclusive evidence is also growing."  So when my dad got a lecture from the cardiologist about changing his diet, I told my dad that statistically speaking, 9/10 were based on weak data or worse, "expert opinion."  (Actually, it was all nonsense.)

5 comments:

Cary Reams said...

While trying to get my own diet under control, read Gary Taubes' 'Good Calories, Bad Calories.' It skewers the medical community (here and abroad) for the process that led us to a low-fat crazed society.

Isaac van Sligtenhorst said...

Taubes is great but he's not the last word either. There's been only one study that looked at several diets long term, including the lower carb Taubes approach. None of them proved superior or inferior. In fact, the best diet was the one they stuck to. In the end, there's more than one way to skin a cat.
He may be dead on, though, in predicting who gets fat. Getting fat and losing weight, alas, are not mere opposites.

Cary Reams said...

The rebound effects of any diet are potentially catastrophic. My doc keeps referring to it as a lifestyle - not a diet. Mine particular cross is Metabolic Syndrome. So. Carbs. Extreme (not clinically extreme, but still) sensitivity to the slightest carb intake. Like falling off a wagon and down the side of the canyon. Two weeks to lose 10 pounds can evaporate after two days of USDA-recommended doses of starches.

Isaac van Sligtenhorst said...

It sounds like you've got a good doc. And you're right. Everybody's individual so lumping everyone's fat loss in the same boat probably isn't the most ideal approach.

If you haven't been told this by your doc, the latest (and best) research shows that strength training and/or HIIT does FAR better than your long and slow cardio at controlling glucose and metabolic syndrome. Trade the elliptical trainer for weights and/ or short sprints on the rowing machine (30 seconds all out followed by 1:30-2 minutes rest repeated for 5-10 bouts. That's the beauty of it being far shorter, too). Much better at controlling diabetes and preventing it in those close to diabetes.

Cary Reams said...

Thanks. I'll give that a try at the six week mark when I change things up.