Selected Passages
Selected passages
On one occasion, a week after a lady was admitted to the hospital with an infection, my attending physician asked me why she was deteriorating despite her infection improving. I gave my honest assessment: “Sir, the patient came in with one medical illness and then we hit her with two more - sleep deprivation and malnutrition.”
I reached out to the AAP committee that had recommended peanut avoidance back in 2000. By their credentials, many appeared to be in the field of nutrition. None appeared to be experts in immunology. The committee was comprised of a small core group of seven physicians and nine representatives from the Centers for Disease Control (CDC), the Food and Drug Administration (FDA), the NIH, the U.S. Department of Agriculture, the American Dietetic Association, and others. Since the publication of their recommendations, none have expressed regret or apologized. Most went on to receive national awards and academic promotions. I contacted all of them for a comment. Two of the seven committee members got back to me. One acknowledged to me that the recommendation in the year 2000 came from a previous AAP handbook on nutrition. “There was an internal policy that all AAP recommendations had to be consistent. It was old dogma, perpetuated.” In other words, protecting the institution was more important than letting the public see alternative viewpoints.
In 2009, Dr. Langer received an email informing him that he was being removed as chair of a WHI committee and banned from involvement in any future WHI publications on HRT. When he asked why, he received the following email response from a WHI leader: The PIs have reached a consensus on interpretation of our data and prefer that our publications not be contradictory.
No randomized trial or credible study has ever shown that HRT increases a woman’s risk of dying of breast cancer. Yet to this day, the dogma lives on. ... In many of my discussions about the data, it struck me that the fear of HRT-induced breast cancer was not a scientific discussion. It’s become a belief system.
One of the most humbling cases I saw as a student was that of a 52-year-old woman that came to the surgery clinic with a three-year history of new-onset abdominal discomfort, palpitations, depression, and numbness and tingling. We doctors huddled to try to crack the case. One doctor rattled off the need for a CT scan, a cardiac stress test, and a litany of blood tests. Another doctor wanted to do nothing because the patient had dismissed her symptoms as mild. A third doctor, always worried about malpractice liability, insisted that we get a consultation from a cardiologist, psychiatrist, neurologist, and sleep medicine specialist. He enthusiastically offered to make the referrals himself because he knew good people in each field. Incidentally, all three doctors were male. Then, finally, a female medical student cut through the chatter and solved the enigma by interjecting two words: “It’s menopause.” What? I thought. Really? We had spent fewer than 15 minutes talking about menopause in medical school. I know because a female classmate, Jennifer Rosen, had complained about how the curriculum virtually skipped over the topic, as most of the rest of the class (mostly male) rolled their eyes. Could it really account for all these symptoms, some of which were severe? Menopausal symptoms, we were told - by male professors - were merely mild hot flashes and night sweats, affecting just some women, and lasted about two years. But in fact menopausal symptoms affect 80% of women, can be severe, and last an average of 7.5 years. The patient was sent back to her primary care doctor, who cured all her symptoms with estrogen and progestin. She came back to the clinic just to tell us how much better she felt and to thank us. She had been relieved of her debilitating medical problems.
Many believe that telemedicine is all good. But a Johns Hopkins study my colleagues and I recently conducted found that a doctor is far more likely to prescribe an antibiotic in a telemedicine visit than in person. Many of those prescriptions are unnecessary - and the overprescribing of antibiotics is causing more harm than we may realize.
It’s amazing that we can spend billions treating conditions with no benefit while spending pennies to learn what causes the conditions. I sometimes wonder if the culture of medicine plays a part. Our high-volume, memorize-and-regurgitate culture of medical education seems to be stifling our intellectual curiosity.
I asked Dr. Nestle to reconcile her view with the above three large studies, none of which found a connection between fat intake and heart disease. Here’s how she responded: “If you think that everybody was wrong . . . then you’re looking at an awful lot of people who were delusional, all those people in the American Heart Association, all those people in the National Academy, all those people in the Surgeon General’s report. Really? Everybody was crazy? I don’t think so.” In other words, everyone believes it so it must be true.
Medical paternalism still looms large. In recent years, the American Medical Association has been lobbying against patients having full access to all their test results in real time, despite this being a right granted every American in the 21st Century Cures Act enacted by Congress in 2016. On September 30, 2020, California signed into law a provision blocking real-time patient access to test results until a doctor reviews the results first. ... I get the motivation behind such bills. We doctors don’t want to be bothered with patient calls about tests we haven’t looked at yet. But blocking patients’ access to their own health information is not the answer.
Every medical intervention has risks. The question is: What are the trade-offs?
Most peer reviewers are anonymous. Medical journals have an odd tradition of keeping the names of reviewers secret from the authors of a study. If they were truly dedicated to addressing cronyism, they would flip it. Reviewers should review studies while blinded to who authored them.
Most research today is concentrated in the pharmaceutical space because that’s where funding is abundant. Studies that lead to a drug’s approval are rarely repeated - for fear they might not yield the same favorable results. And studies on food and lifestyle changes are rarely supported by industry or government agencies. As a result, we spend billions on new drugs and blood tests, but very little to study how food affects body inflammation, nutrition, and the microbiome.
In 2023, the U.S. Preventive Services Task Force lowered the recommended age for low-risk women to start getting mammograms from 50 to 40 years of age. You would think that recommending that millions of healthy, low-risk women in their 40s should receive an uncomfortable medical procedure with radiation exposure would be supported by clinical trials showing that it saves lives. But that wasn’t the case. There was not a single clinical trial demonstrating that mammograms in low-risk women in their forties saves lives. ... And false positives are common. About half of women who get an annual mammogram will experience a false positive over a ten-year period, according to the American Cancer Society. That may lead to unnecessary surgical procedures and additional radiation exposures - not to mention the stress of being told you might have cancer