“Tradition-tradition!” sang Tevye in Fiddler on the Roof. That’s to be expected in a backwater Shtetl in the 19th Century, but should it be true of medicine in the 21st? Maybe that’s why some call it “Orthodox Medicine”? Cases in point:
- The recommendation that everyone over 40 take an aspirin-a-day for prevention against heart attack and stroke. It was only after studies showed that this practice caused more harm from gastrointestinal bleeding than the protection it conferred against sticky platelets that it’s been rescinded; aspirin is now reserved only for special high-risk cases.
- Peanut avoidance for babies and toddlers. When peanut allergies started to trend in the 90s, pediatricians urged parents to withhold peanuts until later years. It didn’t help; paradoxically, there was a surge in the incidence of potentially life-threatening peanut reactions. Only when it was demonstrated that early-life exposure to peanut protein accustomed the immune system to its inclusion in the diet that health authorities did a U-turn—and peanut allergies declined accordingly.
2025 has been a banner year for about-faces in medicine. The past few weeks have seen these notions debunked:
Too much protein is bad for the kidneys: This myth has been tough to kill. Intuitively, it makes sense: The kidney acts as a filter for the body’s waste products, including nitrogen which is a hallmark of protein. The BUN that skyrockets in patients with kidney failure is blood urea nitrogen. Is it not reasonable to think that we don’t want to overwork the kidney with excess filtration demands?
Au contraire, according to a meta-analysis comprising 148,051 participants. The authors found:
“The data showed a lower CKD [chronic kidney disease] risk significantly associated with higher-level dietary total, plant or animal protein (especially for fish and seafood) intake”.
The reason may be that diets skimpy in protein don’t deliver enough satiety and sustain cravings for carbohydrates that hike blood sugar; resulting obesity, hypertension, and diabetes become a perfect storm for kidney failure.
Of course, it may be reasonable to moderate protein intake for people who already have ailing kidneys—although not the draconian restrictions that were once in vogue.
Coffee is bad for atrial fibrillation: Caffeine is stimulatory, so how could that not lead to palpitations? Sufferers of atrial fibrillation have studiously avoided regular coffee on advice of their doctors.
A recent study has challenged that notion. Recently diagnosed afib patients who were successfully restored to normal rhythm via electrical shock or medication were advised to either avoid caffeinated drinks or continue with a cup or so of their usual joe.
Remarkably, the caffeinated coffee consumers experienced no heightened likelihood of recurrence of their palpitations. In fact, coffee conferred a 39% lower incidence of renewed atrial fibrillation!
What’s going on? Researchers speculate that caffeine in moderation might actually strengthen the heart, boosting its electrical system and contractility; alternatively, the beneficial dark polyphenols in coffee might help via their antioxidant and anti-inflammatory effects.
Caveat: Results may vary. Genetic variations make people more or less sensitive to caffeine. If you think caffeine makes your heart race, pay attention and hit pause.
“Adjuvant” radiation after breast cancer: In the 1940s, breast oncologists began recommending radiation to the chest wall and underarm in women after surgical removal of breast cancer. It seemed to make sense; even if the cancer were to be completely removed, with clear cancer-free margins, there remained the possibility that errant cancer cells might have escaped detection and migrated via the axillary lymph nodes to take root elsewhere as distant metastases.
Lately, doctors have recommended radiation less routinely, especially with small, localized, non-aggressive cancers. But for cancer that has reached the lymph nodes, or shows more dangerous features, radiation is often recommended “just in case” to increase the likelihood of survival.
A new study has investigated the efficacy of this practice. The trial included over 1600 women with early-stage breast cancer, half of whom had received radiation and half of whom had not. After following them for an average of 9.6 years there was no difference in survival—81.4% for the radiation group, 81.9% for those who skipped it.
Radiation is not inconsequential. It can cause local skin damage and hike the risk of lymphedema in the affected arm. It can harm underlying organs like the heart or lungs, and tissue damage may complicate subsequent breast reconstruction surgery.
Still, select patients in jeopardy of cancer spread may benefit from local radiation, but many women previously thought to be at higher risk may now be able to safely eschew it.
This underutilized cancer spread preventive costs a few cents per vial
What can reduce recurrence is a simple measure that can be undertaken at the time of surgery. Doctors can infiltrate the tissue surrounding the incision with old-fashioned lidocaine, a local anesthetic; it may somehow act to prevent errant cancer cells from spreading. The 5-year survival rate was 90.1% for lidocaine recipients and 86.4% for patients who did not receive lidocaine. It’s a small difference but may ultimately translate to thousands of lives saved.
“Dangerous estrogen”: In the 80s and 90s, there was a hormone therapy bonanza; BigPharma rolled out copycats like Premarin and Prempro and women embraced them in a quest to stay young. Menopause was medicalized, touted as a condition that required a fix.
That all came to a screeching halt with the publication of the results of the Women’s Health Initiative, which was incorrectly interpreted to suggest menopausal hormone therapy increased the risk of breast cancer and cardiovascular disease. Almost overnight prescribers got cold feet, and women went cold turkey, back to enduring the travails of menopause unaided.
Podcaster Peter Attia MD, when interviewed on 60 Minutes, said: “It’s hard not to argue that this is the biggest single failure of the modern medical system.”
Serious flaws in the methodology of the WHI have long come to light, but the stigma endured. Moreover, modern formulations of bio-identical hormones don’t come with the same risks as synthetic concoctions, and in fact stave off osteoporosis and rejuvenate the heart and brain.
Now, newly installed FDA Commissioner Dr. Marty Makary, who has long inveighed against “groupthink” that hinders progress in medicine, has called for the removal of the ominous “black box” warnings on hormone therapies for women, urging wider adoption of HRT in an op-ed in the Wall Street Journal:
“Breaking up groupthink is never easy. But the FDA’s removal of the black box warning against HRT is an important step toward treating menopause with the same scientific rigor we use in other areas of medicine.”
Beta blockers after heart attack: When I did my medical training in the 80s, it was a strict dictum: Ease the workload on the heart after an MI with a lifelong prescription of a medication that puts the brake on heart rate—a beta blocker.
Trouble is, beta blockers can make some people tired and depressed. They can no longer exercise as hard because beta blockers limit cardiac output. Men may experience erectile dysfunction; both sexes can suffer sleep problems. Ultimately, they may gain weight, worsening the metabolic syndrome that originally triggered their heart attacks.
Now, a new study confirms that, for the majority of heart attack survivors, beta blockers have no effect on the risk of subsequent heart attacks, hospitalization for heart failure, or death.
The exception is for the relatively small percentage of heart attack survivors whose cardiac reserve is so impaired that they’re on the threshold of heart failure; beta blockers have a protective role in that cohort.
Try vitamin D instead
Rather than hamstringing heart attack survivors with useless beta-blockers, they should be given vitamin D. Seriously . . .
A new study shows that optimizing MI patients’ vitamin D conferred a whopping 50% protection against a subsequent heart attack.
To get there, many patients required doses of up to 5000 IU of D3 per day, rather than the paltry 600-800 IU customarily offered in multivitamins. Liberally supplemented to a target of 40 ng/ml or above, the chance of having a second heart attack was cut in half among those receiving vitamin D treatment.
A call-to-action: As was once stated by Max Planck, considered the father of modern quantum physics, “Science advances one funeral at a time”. It’s also been said that “sunlight is the best disinfectant”. Why not let the radiance of critical re-evaluation illuminate more of the most cherished beliefs of medicine? The results might be surprising and relieve a lot of unnecessary suffering
