We like to think we practice medicine based on evidence. But, do we? It is not because we choose not to. It is because the evidence is tainted and, like the notorious lemmings, we blindly accept what journals and their editors publish and we incorporate it as gospel.
Unfortunately, the evidence is sometimes corrupt. See: https://trauma01.wordpress.com/2013/02/03/medicines-trick-coin/
It is happening again. I love a good steak, especially one marbled with fat. But, every time I eat one, I think about the so-called evidence that it is not good for me and that I might be shaving days/weeks/years from my longevity. Now there is new data that challenges the evidence that unsaturated fats (like those in the steak that I like so much) may not be as bad as we’ve been told they are. Here is yet another example of evidence based medicine turned on its head:
“For decades, health officials have urged the public to avoid saturated fat as much as possible, saying it should be replaced with the unsaturated fats in foods like nuts, fish, seeds and vegetable oils.
But the new research, published in the journal Annals of Internal Medicine, did not find that people who ate higher levels of saturated fat had more heart disease than those who ate less. Nor did it find less disease in those eating higher amounts of unsaturated fat, including monounsaturated fat like olive oil or polyunsaturated fat like corn oil.”
Just when we thought it was “safe to go back into the water,” we learn that some sacred cows may not be so sacred after all. For example,
- Vitamin D and calcium don’t protect against fractures in the elderly.
- Mammograms may not be what we thought they are in terms of decreasing deaths from breast cancer.
- Screening for prostate cancer once thought to be helpful, may cause more problems than not.
Since this is a blog on trauma anesthesia per se, and non-trauma anesthesia in general, does this post have any bearing on how to do anesthesia?
I believe it does. In a sense, anesthesia is a parallel universe to what happens in medicine in general. I’ve done anesthesia for 35 years. I frequently don’t do things according to the “evidence.” When I don’t, I am well aware that if something should go wrong, I will be taken to task for not doing the evidence based thing. It puts me in a difficult situation, because those anesthesiologist, who can not think for themselves, and do the right thing for their patients, in spite of what might be faulty evidence will quickly say, “I told you so.”
Thirty five years is a long time to ply this trade. Sometimes experience means more than a foolish article published in a journal!
How long will it take before the unsaturated fat controversy is re-upended by another so-called evidence based article?
That fried egg and bacon cheeseburger is making my mouth water.