The Doctor Is In: Help for the Confused Healthcare Consumer

Dr. Denton Cooley, pioneer of American heart surgery, reportedly had this conversation with his auto mechanic:

Mechanic: “Doc, my job is harder than yours. I have to know how to fix every car, every make and model from every year. You only have to work on two models — male and female.”

Dr. Cooley: “True. But when you do your repairs, you don’t have to leave the engine running.”

Whether or not this exchange occurred, it is a reminder of one of frustrating truths of medicine: there is no standard owner’s manual. Treatment protocols, dosage charts, and behavior recommendations are at best statistical guides — useful for most, but guaranteed to miss some individual needs of the highly complex organism called The Human.

Newspaper articles and broadcasts eagerly announce the latest breakthrough in medical research. Years of research are reduced by the popular press into easily digestible sound bites. Eager for “the answer” to whatever happens to be the question of the moment, the public sometimes creates trends by following medical recommendations offered in 30-second news segments.

Until the next story is filmed, of course. What can you do if you don’t like the conclusions of a study? Just wait a year.

Here are some of the research study conclusions reported by the press over the past ten years:

• Hormone replacement therapy lowers the risk of having a heart attack.
• Hormone replacement therapy increases the risk of having a heart attack.
• Hormone replacement therapy prevents heart attacks, but not in people who take ibuprofen.
• Ibuprofen reduces the risk of breast cancer.
• Ibuprofen increases the risk of breast cancer.
• Ibuprofen’s impact on cancer risk is unknown.
• Low carbohydrate, high protein diets are safe and lead to weight loss.
• Low carbohydrate, high protein diets are unhealthy and ineffective.
• Diabetics benefit from grain-based diets.
• Diabetics should lower carbohydrate intake, including cereal and bread.

So what’s a confused healthcare consumer to do?

1. Listen to your grandmother.

If a study or recommendation contradicts common sense, be careful. Grandma wasn’t on target about every scientific mechanism for disease and healing (e.g., head colds result from exposure to low temperatures without mittens). But she was probably on the right track: viruses are spread easily from the noses of infected children to the uncovered hands of their classmates.

Radical departures from common sense are sometimes correct (yes, surgery may cure diabetes and no, bleeding isn’t a great treatment for depression), but they merit close examination before discarding theories held over time.

2. “One Size Fits All” isn’t the right prescription for every patient.

No matter how effective a treatment is for one person, the identical treatment may be useless — or even dangerous — for another. Even the rare “aha!” discoveries, like the strong link between bacteria and stomach ulcers, have to be tempered by the fact that some ulcers occur in uninfected people. Prescribing a course of antibiotics for a patient with an acid-stimulating pancreas tumor or stomach erosion from overzealous aspirin use is not good medicine.

3. It worked in Sweden; will it work in El Paso?

Even top quality research has limitations. Studies typically include a fairly narrow group of subjects such as adults under 65, men, or non-pregnant women. “Cohorts” (groups of people studied) generally reflect the local mix of races and socioeconomic classes. These results may not translate to a population with very different characteristics because of the effect of genetics, environment, and culture.

As has been shown in studies trying to duplicate results achieved in men, estrogen can have a profound influence on a treatment’s effectiveness. Though these differences may be politicized for other reasons, there are real shortcomings in translating research on limited groups to a wider population.

It is tempting to hope that the key to solving any given human health ailment can be found in a test tube. Surely heart disease, cancer, and obesity must be the result of an untreated vitamin deficiency, missing gene, or other isolated cause. Drug marketing effectively reinforces this: take a pill and enjoy the cure.

But “better living through modern chemistry” works better as a DuPont® slogan than as a panacea for human ills. Some treatments are more promising in news stories than in people.