Good and bad medical information
Two themes of frequent mention here are the crucial importance of quality evidence and a laser-like focus on health outcomes. Others use their own issues to raise these points as well, reinforcing the building pressure for action.
An example is the recent column "Medical Information: The Good and the Bad " by Dr.s Michael Arnold Glueck and Robert J. Cihak aka "The Medicine Men."
Dr. Cihak asks:
What should be done, if anything, about the flood of medical information from news stories, popular magazines, TV shows, advertising, and even our own doctors?
Is information overload even a bad thing?
Moreover, are we missing the forest while looking at the trees? Very often, I'd say yes.
It's often best to ask, "What are we really concerned about?" For example, too much cholesterol in the blood can lead to hardening of the arteries, which can lead to plugged-up arteries in the heart or brain, resulting in a heart attack or stroke.
The effect of the abnormally elevated cholesterol level is the concern, not the cholesterol itself, because lowering abnormal cholesterol levels can reduce the likelihood of disability or death from blocked arteries.
So the goal is to prevent illness, not to reduce cholesterol for its own sake. And, there are always tradeoffs. Taking medicine takes time, money, and other resources away from other uses. Plus, the medicine might not work or even cause additional medical problems.
The same dynamic pertains to the health impacts of dietary salt. The public is being fed an alarmist diet of concern about blood pressure when that is but one of several impacts of restricting dietary salt. Others include increasing insulin resistance, skyrocketing plasma renin activity and stimulated sympathetic nervous system activity. So the Salt Institute's been urging HHS to undertake a study of the health outcomes of salt-reduced diets using this same argument. If you read the above quote, substituting "blood pressure" for "cholesterol" and you'll see what I mean: "The effect ... is the concern, not the cholesterol) itself, because lowering abnormal cholesterol levels can reduce the likelihood of disability or death from blocked arteries. So the goal is to prevent illness, not to reduce cholesterol for its own sake. And, there are always tradeoffs. Taking medicine takes time, money, and other resources away from other uses. Plus, the medicine might not work or even cause additional medical problems."
We couldn't say it better -- though we tried . Thanks as well, doc, for your cautionary summary: "Cookie-cutter approaches are dandy for cutting cookies but not for dealing with human beings."
