Wednesday, September 28, 2005

Stumbling over the truth

My solo practice has been busy lately, despite "closing" to new patients about a month ago. More of a filter than a barrier, I am still agreeing to see relatives of pre-existing patients. This has resulted in 16 new patient this past month, or about half of the number of new patients I was getting before.

This week has been especially busy. On Monday (2 days ago), I saw 9 patients in the office, the most I've seen in my practice in one day. In addition, I had 2 in-patients to see, too. I'm thinking it's a good thing I closed to new patients when I did otherwise I don't think I could have handled it.

Plus, it was an abbreviated work week for me. I am currently in San Francisco attending the American Academy of Family Physician's Annual Scientific Assembly. It will be the longest time I've spent away from the office since going to Canada last summer. Fortunately, a couple of local family physicians agreed to cover for me while I am away. Nevertheless, I am still checking my answering machine every few hours and getting back to people. Since I carry my EMR with me in my PowerBook, I can look up anyone's chart just about anywhere.

Today I attended a lecture, "Cardiovascular Disease Treatment with Evidence-Based Nutritional and Lifestyle Changes". The lecturer, a family physician and certified nutritionist, went through the current thinking about CAD (coronary artery disease) and plaque formation. A couple of telling statistics:
  • 500,000 new cases of CAD diagnosed annually in the US
  • In 2000, we spent about $200 billion of CAD therapy but only 6% on medical treatment and prevention.

*Gets on soapbox*
This seems to be the American way of thinking with a lot of issues. We'd rather spend money jailing criminals and drug abusers than on dealing with the social causes of crime and drug abuse. We'd rather spend billions of dollars and the lives of our soldiers fighting terrorists than try to figure out political solutions to stop terrorism in the first place. We'd rather spend billions of dollars rebuilding New Orleans than on developing an adequate flood control infrastructure.
*Gets off soapbox*

Anyways, the lecturer goes on to describe how to fight CAD. As he's going along explaining the lifestyle changes, I'm thinking, even I don't follow most of the dietary recommendations he's talking about. I've always figured that as long as I exercise regularly (1 hr of basketball twice a week), keep my weight normal and have a normal cholesterol level (total <200 with an HDL > 60), I figured I'm okay and can continue to eat junk food. But as a doctor, I know that people can have coronary artery disease even with no risk factors. It's tough to think that I have to go on a "diet" when I'm not having any health problems. It's also an admission that I might be getting old.

Anyways, the lecturer talked about fish oil supplements, folic acid, Co-enzyme Q-10, flaxseed, garlic, hawthorn, magnesium as having some benefits for heart disease prevention. Some had better evidence than others. He talked about the recent studies which showed that vitamin E could be HARMFUL to those with low HDL levels who are also taking a statin and niacin.

He gave a quote by Winston Churchill: "Everyone stumbles over the truth from time to time, but most people pick themselves up and hurry off as though nothing ever happened."

My take is that with science and medicine, there have been many truths presented through the years that upon closer scrutiny have turned out to be something less. The formerly widely held belief that vitamin E could help reduce the risk of CAD is just one example.

So I hope that if I stumble over something, I'll check it carefully for some truth before I hurry off to see my next patient. Before I go recommending supplements to all my patients, I'm going to have to do some more reading and examine the evidence myself. I may even find something that convinces me to take fish oil supplements. At any rate, I will try harder to discuss with patients the many ways they can prevent heart disease through nutrition and lifestyle changes.

Intellectually, I know that I should eat healthier. Besides, I know if I don't then I am practicing what I just preached against: waiting to deal with the problem after it happens instead of doing something beforehand to prevent it from happening. I guess I'm as American as the next guy. *sheepish grin*