Continued From Last Post
Unnecessary Treatment is a Massive Problem
According to a report by the Institute of Medicine, an estimated 30 percent of all medical procedures, tests and medications may in fact be unnecessary – at a cost of at least $750 billion a year (plus the cost of emotional suffering and related complications and even death – which are impossible to put numbers on). While overuse and misuse have become a deeply ingrained part of the culture of medicine, there are hopeful signs that things are starting to change. Dr. Makary points out a number of standard blanket recommendations that have been changed in recent years, such as daily aspirin regimen, PSA testing, and annual mammograms.
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“[N]ow people are saying, 'Wait a minute, maybe we’ve gone too far.' ...We told everybody for decades [that] everybody should be on an aspirin once a day. And a lot of people were saying, 'Wait a minute, do I really need to be taking a pill every day, even thought I’m totally healthy?' There were studies, and they looked at certain outcomes but a recent large study has shown that the internal bleeding consequence balances out the benefits to your heart. So we’re now pulling back that recommendation. If you have a healthy heart, if you don’t have a history of heart problems, we’re now pulling that recommendation back.
Same thing with PSA testing. You’re seeing the medical community say, 'Wait a minute, we don’t need to do a PSA test for prostate cancer on every older man in the world.' We’re also seeing the recommendations on breast cancer screening with mammography in that middle-aged group being pulled back.
We’re seeing a lot of research coming out now that’s saying some of these giant recommendations to do more stuff probably were not based on sound science. When we look at the full gamut of consequences of overtesting, we may be creating too many false-positives and hurting more people then we’re helping.”
More Doctors Beginning to Realize What They Were Taught is Wrong
Many doctors are now beginning to accept that some things they were taught in medical school is simply wrong.
“I was taught, for example, that everybody has one million nephrons (the unit in a kidney). We now know that’s not true. We now know that it ranges from 200,000 to two million, and everyone’s different. If you have a lot, you may have more of a reserve. If you have few, you may be more frail in your ability to withstand an insult to your kidney.
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We were taught fat was bad for you. We were taught, 'Don’t eat fat. Fat is bad. Go low-fat everything.' That was probably wrong advice that the medical community gave to the general public. We now know that what’s far more important than avoiding fat is limiting sugar, a highly addictive substance, which a driver of obesity and heart disease and has many detrimental effects, mainly the hormonal effect of changing your fat storage balance. Little did we doctors know that by demonizing fat we were encouraging high-carbohydrate foods because they are notoriously 'low-fat.' Obesity surged parallel to the 'avoid fat' era of medicine. We are now dealing with a generation addicted to sugar and we’re seeing the largest growth in obesity in the history of the country.
In terms of the percent of our population on disability and the average time on disability, we are now the most disabled country in the world. And one leading driver is obesity-related chronic diseases—a problem burdening our healthcare system. These are lifestyle diseases (medical problems that can be avoided with better behavior). We’re now recognizing that some of the emphasis in the direction that we had in medical school was just not based on the solid evidence that we’re now seeing.”
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