By Gus Geraci, MD
I wish medical knowledge was more stagnant. The reality is that what we know as facts changes every year.
So, to my patients who I gave advice to a few years ago, I’m sorry. What I taught you may be wrong.
It was the best we had at the time and based on the best scientific knowledge of the day, but now it has been updated, rewritten, and completely (or partially) changed.
What it means for physicians is we must constantly stay up to date on the latest.
The sad thing is that in the cycle between the writing, editing, approval and publication of a medical textbook, a fact written may be three years old when the book is finally printed. And no longer correct.
The people who wrote those chapters, however, are usually aware of the changes, and so many textbooks are now virtual, with updates published in online versions as scientific knowledge is updated.
It also puts a burden on us physicians to constantly be learning. Things that were once wrong are now right.
Beta blockers and ACE inhibitors for CHF, once contraindicated or used with great caution, are now recommended. Hormonal therapy, screening tests, and hundreds of once established ways to practice are different than what they were a few years ago, and most certainly will be different again in the future.
This adds to the argument for keeping government out of the exam room. It’s easier to legislate today’s medical knowledge than it is to remove it from statute after that knowledge becomes out of date or flat out wrong.
It is estimated that it usually takes three years or more from a solid scientific discovery to common practice. We can blame the late adopters or skeptics for the change, but the majority doesn’t come along very quickly, either.
We are trained to be doubtful, to question data, and get good evidence-based data before changing practice, but it often never comes with that high a level of evidence.
Diet and nutrition are other prime examples.
It never made sense to me that my obese patients were all lying to me about how much they ate and their level of activity. It never made sense to me that, despite all the recommendation for reduction in dietary fat and the reduction in fat in foods, we as a nation kept getting more obese.
The old calories in, activity out theory of caloric balance flew in the face of daily practice. It couldn’t be all fast foods, larger portions as responsible for the obesity epidemic. It didn’t even work for me when I tried it to take those stubborn extra pounds off.
Was I lying to myself?
The evidence now seems to be pointing to the idea that it is NOT all about calories. It is more about how those calories are packaged, processed and delivered to our bodies, and the kinds of fats, carbohydrates and proteins we ingest.
But evidence-based medicine seems to fail us here, leaving us mostly epidemiological evidence for now. Studies are ongoing. Meanwhile, I incorporated some of the newest empiric and somewhat scientific science, and now I am losing weight.
To my patients, to whom I preached for years “calories in, activity out,” I am sorry. I seem to have been wrong. I am living proof.
What are you still teaching that is wrong?