Sorry, but what we told you is wrong


Winston Churchill, Britain’s wartime Prime Minister, once remarked, “To every question there is a clear, concise, coherent answer that is wrong.”

In medicine there are also many questions, and all too often the answers from experts are found years later to be wrong, sometimes with devastating consequences.

A report in the Archives of Internal Medicine found that 13% of research articles published in the prestigious New England Journal of Medicine in 2009 reported reversals in medical findings involving drugs, screening tests and invasive procedures!

For example, for years we’ve been told that increasing good cholesterol is a prudent move. But new research shows it does nothing to protect against heart attack, strokes and early death.

Here’s another hummer. Doctors have urged men to have regular PSA testing. Now, it’s reported that routine prostate-cancer screening is less likely to save lives and more likely to cause substantial harm from the treatment.

Do you ever cringe when you’re with a friend who has a knuckle-cracking habit? Since we’ve been told this leads to arthritis, why not bite the bullet and bluntly tell them to stop it. But in a research study that reviewed hand X-rays of 215 people aged 50 to 59 the incidence of arthritis was about the same in those who did or did not crack their knuckles.

We’ve also been warned by health nuts, and everyone else, that for good health we must drink at least eight glasses of water a day. This feeling persists in spite of the fact that there’s never been any scientific evidence of its benefit. The Institute of Medicine reports that most people get the water they need by letting thirst guide them.

No doubt many of those reading this column will be heading for the gym this week. There’s little doubt that they will stretch before and after exercising. After all, this prevents injury. But does it? A study presented at the American Academy of Orthopedic Surgeons found that stretching before running had no effect in preventing injuries. However, they did conclude that doing an easy five minute warm-up to increase range of motion makes exercise easier.

Here’s the most recent example of reversal. Today millions of North Americans are taking bisphosonates, such as Fosamax and Aclasta, drugs designed to decrease the risk of developing brittle bones. Consumers have been told by doctors that this medication is effective and safe. But now the U.S. Food and Drug Administration reports that these drugs may not be of much advantage for many women.

This is followed by a report in the Archives of Internal Medicine that women taking bisphosonates are more likely to develop serious and unusual fractures of the femoral bone. This is admittedly a rare occurrence, but if it happens to you it’s a 100% hit. What is more worrying is that these fractures are not the result of a fall or accident. Rather, the thighbone snaps for no apparent reason. In addition, it is not known why these drugs are linked on rare occasions to degeneration of jawbone.

A professor once started his lecture by saying, “All this has been said before, but must be said again because no one listened.”

I’ve often stressed in this column that there is no free lunch when taking prescription drugs. But not enough people listen, so I too have to say it again.

So how many more medical reversals will hit the headlines in the years to come? I have no crystal ball to know the exact number, but history shows there will be many more.

I will make one prediction, that sooner or later there will be convincing evidence that cholesterol-lowering drugs do more harm than good and may be one of the greatest medical errors of modern times. I realize it’s close to heresy to make this remark, like damning Motherhood and apple pie. And I’m wise enough to know that in making such a rash statement, I too may be 100% wrong. Time will tell.

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