Eggs are bad and should be avoided assiduously by those at risk for heart disease. On second consideration, they can be eaten with impunity. But wait, now they’re back on the taboo list. This scenario has been in play dozens of times over the past few decades, as a food, drug or lifestyle choice is touted as the best way to lower the risk of cancer or heart disease, only to be reversed within months or years.
From cholesterol and calories in food to blood pressure management to Vitamin D, research continues to confuse with misleading conclusions resulting from a flawed hypothesis, bad data or the study design itself. Non-medical professionals, no matter how steeped in healthcare information they may be, can’t interpret the studies with any accuracy and most importantly, apply the findings to their own personal health situation.
We all want to eat the right foods, get the right amount of exercise and make the best choices, but determining exactly what those are is more challenging than ever before. In an era of medical information overload, the need for a concierge physician’s highly personalized approach to each patient is not just essential, but potentially life altering.
A research study conclusion that appears sound may provide the wrong answer for patients wrestling with their own set of individual health issues. Dr. Eric Topol, a brilliant proponent of artificial intelligence in medicine, sums up why in a recent article on identifying the best diet.
“Now the central flaw in the whole premise is becoming clear: the idea that there is one optimal diet for all people,” Topol writes..
In nutritional studies especially, trials are rarely randomized and controlled, the gold standard for research, but instead are largely observational and can’t prove associations are causal. Important to note is that even randomized trials cannot control for all potential variables.
As we’ve seen over the years, however, even extensive and well-executed studies like the Women’s Health Initiative can lead to reversals and counter-reversals. The counter-intuitive finding that hormone therapy actually increased the risk of heart disease and breast cancer in post-menopausal women ended the routine prescribing of these drugs to prevent chronic disease, as was entirely appropriate at the time. But numerous follow-up studies that dug deeper into the unexpected results showed that hormone therapy may still be reasonable short-term to manage menopausal symptoms in younger women.
Even more recently, the decades-long prevailing wisdom regarding use of a daily low-dose aspirin to prevent heart attacks and strokes has been revised. New guidelines based on a large, randomized study no longer recommend aspirin prophylactically for healthy older adults because the risk of internal bleeding often outweighs the benefit. However, the study’s lead author cautions, the results reflect the average for a large group, and healthy older people should consult their doctors before eliminating the daily dose of aspirin.
Like so many decisions in medicine, to take or not take aspirin or hormone therapy should be made on an individual basis, with a physician who thoroughly knows your history and personal risk factors.
As Dr. John Levinson, a highly-regarded, Boston-area cardiologist and one of our pioneering Special Docs, says, “In our modern society we are looking for rules to follow. In medicine we call them guidelines and, as guidelines, they are terrific but, as algorithms to follow slavishly for every patient, they are crazy. Organized medicine has come to understand that like everything else in life, it depends.”
This is a real challenge to accomplish in a 10-minute visit at a traditional fee-for-service practice or during a cursory Medicare annual wellness exam.
Returning to the egg question, Dr. Levinson illuminates the dilemma.
“For the vast majority of people, blood cholesterol levels have much more to do with genetic predisposition, exercise habits and body weight than to specific cholesterol consumption. However, there are plenty of exceptions. Patients with severe atherosclerosis, history of heart attack, and lipids inadequately controlled on maximum tolerated medications will need to tighten their diets, sometimes drastically. Care must be individualized. Patient, talk with your doctor. Doctor, talk with your patient,” he says.
At Specialdocs, we believe concierge medicine offers the most viable way to make that happen. Every one of the exceptional physicians in our network is dedicated to making a real difference in their patients’ lives by providing time to listen and advise on new and evolving trends as well as tried and true treatment plans, and being readily available for visits on a same- or next-day basis. If you’re considering a change to this rewarding practice model, we welcome your call.