An apple a day keeps the doctor away.
One lovely evening while attending a medical conference, I was having dinner with several of my colleagues. These are men and women whom I consider to be among the finest, and wisest, doctors in the world. And like myself and my friend and collaborator, Dr. Alan Lotvin, they are people who love the practice of medicine. It is their passion as well as their profession. And fortunately there are many, many physicians like that. Not surprisingly, that night we were talking about the world of medicine and eventually we began discussing vitamin supplements. I asked each of them what vitamins they were taking. One of them, a man respected nationally as a leader in his specialty, replied, “I used to take several of them, but then all those reports started coming out so now I don’t take any of them.”
I was surprised. “You don’t take vitamin D3?” I asked. The evidence about its benefit is quite clear. It seemed to me that everyone knew about it.
He shook his head. “No. Should I?”
“Yes,” I said, “you should. A thousand international units a day. More if you’re deficient.” I began telling him about all the studies that had shown an association between a vitamin D3 deficiency and several potentially fatal diseases. I literally made him promise me that he would begin taking vitamin D3 the following morning.
Later I realized that I probably shouldn’t have been so surprised. Almost every day in my practice a patient will tell me that he or she is terribly confused about the mountain of medical information that they are barraged with every day. It’s an endless attack: Eat this and it will save your life. Don’t use that because it might cause cancer. Do this, do that, don’t do this, don’t do that. “Dr. Chopra,” I often have patients tell me, “it’s so confusing. What should I be doing?”
Now let me share a secret with you: Most doctors are just as confused about all of this as you are. The pace at which discoveries are being made, the vast number of studies that are being done, and the extraordinary complexity of good science simply makes it impossible for anyone to keep up with all of it. Even your doctor. As my friend Dr. Howard Libman, a professor of medicine at Harvard Medical School reminded me, “Even doctors are not immune from the media hype.
Most doctors are more likely to see something on tele vi sion than they are by opening up the New En gland Journal of Medicine. And often, if it does not directly affect their practice, they don’t have an opportunity to search for the original article. So they remember the headlines.”
We all see those headlines: the pill that can prevent cancer! eat all you want and lose 10 pounds in 10 days! a guaranteed way to avoid Alzheimer’s disease! acupuncture can help you get pregnant! pistachio nuts lower bad cholesterol! breast- feeding prevents cardiovascular disease!
It never ends. How can you possibly know what’s good for you? Once upon a time it was relatively simple. Taking care of ourselves meant eating healthy foods, exercising regularly, cutting out smoking and cutting back drinking, and making sure you got an annual checkup during which your family physician listened to your heart, knocked on your knee with a small rubber mallet, and checked your eyes, ears, nose, and throat.
But clearly that is no longer true. Patients have become “health care consumers,” and we all are barraged every day by a never- ending array of conflicting material designed to grab our attention and convince us that what ever is being promoted is something we cannot live without— literally. It’s all terribly confusing.
The promises made— often in bold headlines— cover an endless spectrum of possible new treatments, cures, medical discoveries, and the occasional miracle. Almost weekly these headlines announce another possible new cure for cancer or a new lotion that will grow hair, nutritional supplements that prevent almost every disease, and an array of products guaranteed to restore your sex life. Or they reveal that scientists are successfully creating individually tailored organs in test tubes and Alzheimer’s patients have regained partial memory by following a specifi =c diet. They explain how to store your child’s embryonic stem cells for that terrible day many years in the future when your child may need them. They even announce the discovery of a pill that can prevent obesity. In many instances these are promoted as “newly discovered secrets,” or more often, miracle cures that doctors or drug companies don’t want you to know about.
And on the other hand, many of the headlines that don’t lure you in with promises are intended to scare you with not- so- subtle warnings that buying this magazine and reading this story might save your life. These are the stories about pills that may prevent strokes, or genetic tests that can predict breast cancer, stories that reveal the terrible side effects of certain common drugs or reveal hidden dangers from abuse of ordinary substances, or supposedly report the discovery of a new AIDS- like disease that threatens civilization or the long-term dangers of the use of cell phones or headphones.
The fact is that there are plenty of people out there who will happily separate you from your money with promises of better health, longer life, better sex, more hair— the same type of promises that have been made for centuries. The result is a seemingly endless stream of reports competing for your attention with promises that you will be healthier or thinner or smarter or more attractive, claims too often accompanied by the printed wink, “that your doctor doesn’t want you to know about.”
This information comes at you from every conceivable source; it comes in the mail, it comes at the supermarket checkout counter, it comes in a commercial during a favorite TV show, it’s there in brief newspaper stories announcing a new theory, it comes in one of the many health- related subscription newsletters, and it comes mostly uninvited on the Internet. It’s all terribly confusing. And unfortunately many of my patients believe these claims.
We all remember that in 2009 people were genuinely concerned about what was called the swine flu epidemic. Swine fl u was a serious fl u, but it was hardly a plague; yet all the terrifying stories about it resulted in half the population waiting for hours in long lines to get a shot they might not even need, while the other half of the population was convinced the vaccine was going to make them very sick and might even kill them.
While there is a tremendous amount of really interesting and important health- related information readily available, the fact is that knowing what’s good for you has never been more complicated or expensive. Dr. Robert Goode, a Seattle general practitioner, was quite accurate when he told a journalist, “A lot of times, what’s published on the Internet or in the paper is based on one single tiny little study and it doesn’t pan out to be true for the general population. It’s really frustrating for patients if they want to be proactive with their health because there’s so much information out there.” As a result few people really know, or even attempt to learn, the truth.
So how can you separate the valuable information that could change your life from the quackery that could cost you money? How can anyone really know what’s good for them? Dr. Lotvin and I decided together that someone needed to fi nd a way to provide you not just with the real answers to these questions, but also with the information you need to understand it all. We want you to be able to separate those things that might be important for you and your family to know from those claims that are not true or those that will never affect you. As a professor of medicine at Harvard Medical School and the faculty dean for continuing education at Harvard Medical School, it is my job to provide accurate and up- to- date information about medical science to many of America’s physicians. Each year we have about 80,000 physicians from across the country and abroad attend the conferences we offer. These conferences range from two days to a week, and cover a great variety of subjects. In addition to obtaining the necessary credits, we believe that doctors attend our seminars because of a genuine love of learning, and to be inspired and rejuvenated. We hope that they return to their practice with a renewed commitment to appreciate all that is good about our profession— the reasons they became doctors— as well as having the up- to- date information they need to advise their patients and to answer all their questions.
The courses we offer emphasize evidence- based medicine. At one time we had a great variety of speakers, among them legendary physicians, Nobel Laureates, renowned motivational speakers, and basic scientists. But in the last few years the mandate for our continuing education courses has changed. We no longer have speakers presenting their opinions, even the opinions of world famous professors. Our faculty must present rigorously proven, evidence- based medicine: Here is the question to be answered. This is how we performed the study. Here are the results. This is the conclusion published in a respected journal. Let me tell you how I have incorporated it into my practice and what pitfalls to avoid. So our speakers present new information— but also explain how they have integrated it into their practice and how, hopefully, it has enhanced patient outcome. In this book, some of those people who speak at our seminars have graciously offered their time and expertise to help us answer many of medicine’s most controversial and complex questions. What Alan and I have done is eliminated the hype and the promises, and simply reported what the evidence is. Not what people want it to be, or believe it to be. We simply provide the science- based evidence that has been produced by reliable clinical trials to support or debunk the most common medical questions. In other words, when you finish reading this book you’ll know what’s good for you.
We’ve also done more than that. In settling these questions, we’ve made an effort to teach you how you can determine for yourself what’s real and what’s not real in medicine. For example, some of the clinical trials we’ve written about included as many as 100,000 people and lasted decades, while others had 12 people and were six weeks long. But in the media both of them are reported simply as “clinical trials.” After reading this book you’ll know what questions to ask about those headlined claims and you’ll know how to differentiate between fact, hope, and hype. You’ll know what the claims these stories throw at you really mean to you.
In researching the topics in this book we’ve gone to the physicians who deal with them every single day, the doctors on the front lines with patients, to find out what they see in their daily practice of medicine.
In addition, we’ve looked at the clinical studies and tried to sort out those conducted according to acceptable scientific standards from those whose work may be less reliable. We’ve attempted to report both sides of each debate where that seems fair and never rely on only a single study to reach a definitive conclusion.
Now, there are some claims that you can just go ahead and dismiss as soon as you read them or hear them. For example, as soon as someone tries to convince you that they are giving you information your doctor doesn’t want you to know, run away from this person and keep your hand on your wallet. Here is the absolute truth: There is nothing about your health that your doctor doesn’t want you to know. Your doctor always wants you to know. If your doctor has valid information that is valuable to your health then he or she will tell you about it. The reasons they might not confirm the stories you’ve read are that many of these stories aren’t true, they haven’t been scientifically proven, or in some cases he or she simply isn’t aware of the claims. That does happen.
But believe me, there is no grand conspiracy in medicine to keep people sick to make money and any person or company who makes that claim is trying to con you. There are 750,000 doctors in the United States, and there are more than 5,000 hospitals, which employ millions! As Ben Franklin said: “Three may keep a secret— if two of them are dead.”
In fact, as you’ll discover, the vast majority of health- related products sold in this country are not legally required to be tested or proved to have any value at all before they are put on the market. Prior to 2007 companies didn’t even have to prove these nonprescription products were safe!
Currently, there are more than 30,000 vitamins, minerals, botanicals, sports nutrition supplements, weight management products, and an extraordinary variety of specialty supplements fi ghting for attention from consumers— and not one of them is subject to any tests of their efficacy. Many of them have little or no value, but you couldn’t know that from their advertising claims. The only way they are going to attract buyers is by making big claims. Legally, manufacturers and marketers can say pretty much anything they want to, which is why they often make such dubious statements as “a 14- month informal study of one type of supplement where 51 out of 65 patients with stage 4 cancer became cancer- free when they added it to what ever they were doing.” The only legal right the government has is to determine whether or not they are safe— and even if they are proved to be dangerous it’s difficult to get them off the shelves. This doesn’t mean some of them aren’t valuable and can contribute to your overall health. It simply means there is almost no way a consumer can determine which of the numerous competing claims are true.
Conversely, there is a lot of really valuable information that you probably don’t know about because it hasn’t been definitively proved in tests and so it hasn’t been widely reported— even though the case studies and the statistical data are intriguing. As in almost every other field, the reason for this lack of definitive proof is money. If a company can’t earn a profit from its investment it isn’t going to spend the money.
Aspirin, for example, is truly a miracle drug. Much of what it is capable of doing is already known— it can cure a mild headache or fight a fever, it can cut down the number of heart attacks, and recent studies have shown that at relatively high doses it apparently reduces the incidence of colon cancer. But many additional claims about its value will never be tested— because aspirin is in the public domain. No one owns the patent rights to aspirin, and so, understandably, no company is going to spend the tens of millions of dollars necessary to conduct valid clinical trials. Even if they discover significant information they won’t benefit financially from it. So the primary means to get such studies done would be through a grant from the National Institutes of Health, a university project, or some philanthropic benefactor. That does happen and we have reported on several of those studies in this book. There also is a great amount of intriguing scientific information that could affect your health that has not yet been clinically tested and, in fact, may never be. It’s difficult being a medical consum . . . excuse me, a patient. It’s almost impossible to know what claims to believe, what products to use, which media outlets to listen to. There is a long history of snake oil salesmen in America and they are still out there selling their potions.
It’s possible that some of the subjects we’ve covered may not be of interest to you. Skip those parts if you’d like, but please come back and read them all, because the information in each section will add to the knowledge you need to understand those great claims about medical breakthroughs we hear of almost daily. After you’ve read this book in its entirety, you’ll be equipped to determine for yourself what’s good for you.
We’ve also added a completely cross- referenced index. It’s quite good. We’ve done that because many subjects are mentioned in several different entries and we want to make sure you have access to all the information you might need when you need it. If there is a specific subject in which you are interested, the index will enable you to find each place we’ve written about it.
It is our belief that when you finish reading this book you will feel empowered and want to share this information with others. We are confident you will have a greater understanding of the medical world, you’ll be able to differentiate between respected sources and those people simply trying to sell you their product, and you’ll have the knowledge you need to navigate a path through the complicated world of modern medicine.
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PHOTO (cc): Flickr / apoxapox