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See all the Healthcasts at https://www.biobalancehealth.com/healthcast-blog In the history of medicine over the last 2 centuries there have been many changes in the recommendations given to patients by their doctors. In general, to change the way medicine is practiced improving the care of patients, a new treatment had to be opposed by one or two courageous doctors who were willing to put his/her livelihood and status in the society of medical doctors on the line. Any medical practice that was contrary to the dogma that had been taught to doctors in training was looked down upon by medical peers and often the doctors who were trying to improve the life of their patients were ousted from their practices and lost their livelihood. I have been one of those doctors trying to improve the practice of medicine in the face of criticism and “name calling” by other doctors who didn’t want to change any of their practices. In all cases it took a decade or more to regain my status and acceptance by other doctors and in some cases the changes I have made for the sake of my patients are still not accepted, and most likely won’t be for another decade. How and why medicine improves is a painful and complicated process that is always opposed at first. How Progress of Medical Practice Has Been Thwarted by Doctors’ Dogma Example #1 Handwashing between examining patients, When Did That Become a Medical Requirement? Doctors now embrace the practice of washing our hands between examining patients, and the practice of wearing one-use disposable gloves to do a vaginal exam on pregnant patients. However, before 1847 doctors didn’t believe in hand washing between examining patients. There were no sterile procedures or wash basins available in doctors’ suites, and vaginal exams were done on many patients in a maternity ward, one after the other without handwashing. Bacteria had not been discovered in that century and therefore washing away bacteria was unknown, then bacteria were discovered and the presence of dangerous “bugs” that one couldn’t see was questioned by the older doctors and the, but Ignaz Semmelweis proved that ha dogma of the day. With the discovery of bacteria by young doctors and scientists presented a change to the practice of medicine that the older physicians in charge didn’t accept. Then Dr. Semmelweis showed up on the scene, touting the new knowledge, and insisting that he must wash his hands between Obstetric patients in the ward. This set off an explosion and pitted the old guard versus one young, new doctor. His insistence in washing his hands caused the doctors to throw Dr Semmelweis off staff of his hospital and peer pressure caused him to be shunned by all of the physicians on staff. He had a hard time finding a medical practice and ended his life destitute and without anyone recognizing that he was right the whole time. Medical handwashing became mandatory long after Hungarian physician Ignaz Semmelweis discovered its effectiveness (in 1846) in preventing disease in a hospital environment. He was before his time, and if he had been listened to, thousands of laboring women would have survived childbirth, instead of dying from childbed fever! In retrospect we can sympathize with him because we now know he was right, and his refusal to accept a dangerous practice and to help women live through childbirth, was a personally costly stand to make, but was the first step toward an advance in the practice of medicine. Example #2 Is Estrogen Replacement for Menopause: Dangerous or Healthy? Reference--Menopause: The Journal of The North American Menopause Society Vol. 26, No. 12, pp. 1366-1374 DOI: 10.1097/GME.0000000000001405 ß 2019 by The North American Menopause Society Estrogen for menopausal women has always been a hot potato for medicine. Many studies done in the 1950s and 1960s documented the benefit of giving women estrogen after menopause. Medicine embraced this belief, and the majority of women were put on Premarin, the most popular estrogen replacement. All went well until late in the 1960s and early in the 1970s doctors noticed that women with uteruses were getting uterine cancer at a very high number and the majority of women were taking Premarin. Research confirmed that estrogen replacement without progesterone/progestin could cause uterine cancer! This caused two things to happen: Research began within the drug companies to see if giving Provera®, a synthetic progesterone, would protect women from uterine cancer; The second thing that happened was that women immediately stopped their Premarin therapy and were suffering all over the US. “Premarin” and “Estrogen” became bad words in the doctor’s offices, on the front page of papers. This emotional response to a drug name was hard to erase when several years later, when I learned about Premarin replacement through medical school. About that time Premarin + Provera, Prempro® was introduced to the public as the answer to getting uterine cancer in menopausal women. That took over a decade to scientifically establish safety, and menopausal women were without their estrogen to relieve their symptoms. It took that much time to produce enough research to prove that estrogen replacement was not going to cause uterine cancer, but they were right. Estrogen of any type when combined with a progestin protects against uterine cancer, not every case of uterine cancer because there are other factors, but the majority of the time. All was well in regard to E2 during the 1980s-2002 when the next shoe dropped. In 2002 a flawed study was released from the NIH called the WHI or Women’s Healthcare Initiative, which was published with a headline that startled doctors and women patients alike “Post-Menopausal Hormones Cause Breast Cancer and Heart Disease”. This Press Release Title was a misinterpretation of the data in the NIH Research article that claimed that Estrogen plus Progestin caused heart attacks and strokes! The truth has been excavated from the huge report describing the study, in the 20 years since the WHI article was published, but the original misinformation won’t go away! The study scared millions of women off hormone replacement and caused doctors to stop prescribing them. The outcome of the WHI study is that one brand of estrogen, Premarin(estrogens) PLUS Provera a synthetic Progestin, together do cause heart attacks and strokes. However, estrogen (Premarin or estradiol) alone, does not cause either of these diseases and were proven to protect women from getting heart disease and breast cancer! The original press release of the WHI study should have been titled, Provera, a Progestin, Increases the Risk of Heart Disease and Breast Cancer, and the FDA should have pulled Provera from the market. If it had been properly titled and interpreted by the publisher, doctors would have just changed the Provera® prescription to a natural progesterone (bio-identical progesterone or Prometrium®, progesterone in oil) to take with estrogen, and women would not have had their quality of life changed for 2 decades without estrogen for their menopausal symptoms. I am shocked that Provera® is still on the market with this kind of study showing the damage it can do! I believe the FDA is protecting the pharmaceutical company that makes this substance. I, personally, have not prescribed Provera® since before the WHI when I tested blood levels of my patients and found very high levels of estrone. As is typical, a fearful headline always stays in people’s minds even when it is proven to be a lie, so for 20 years, most women have not been able to treat their menopausal symptoms. Since 2002 a multitude of studies have been published (usually by women) stating the real benefits of estradiol replacement to prevent: Heart Disease, diabetes, obesity, dementia, arthritis, hot flashes, insomnia, longer life, and many more symptoms of aging. You might guess, I never stopped giving estrogen to my post hysterectomy patients, and bioidentical progesterone plus estradiol to my patients with a uterus, to protect their uterus from cancer, yet to allow them to have the benefits of estradiol after menopause. Because I read the whole WHI study, I realized that it was not estrogen, but progestin that caused the problem in the WHI study. However One very old doctor told one of my patients that I was going to “kill” her….he was just ignorant of the study. This seems to be how doctors react when they hear part of the information published about one of the medical treatments in question. Interestingly it is an emotional response that causes them to react negatively to new information instead of investigating it like scientists, which is what we are supposed to be! They have now been proven wrong and I look pretty good to the patients who remember. You can see why it is both difficult to trust the information given us as doctors, and why even if we know the truth, it is difficult to treat patients in the negative environment that is caused by careless journalists. This makes it difficult to make changes in medicine for fear someday, a researcher will find fault with it. Example #3: Medical Advice about Drinking Water with Your Meals 100 years ago the JAMA Journal printed an editorial that said no one should drink water with their meal because it isn’t healthy. There was no scientific research to back up that medical advice and they didn’t say what would happen to you if you did drink water with your meals, but they were adamant that it was dangerous. In the following century doctors have discovered and presented scientific proof that drinking water with your food helps your food digest, makes you feel full now doctors recommend that everyone drinks water with their food! This is proven with scientific research and finally replaced the previous dogma that restricted patients from the simple habit of drinking water with their meals. It took a long time to reverse the beliefs of people, and I remember that in the 1970s my parents believed that no one should drink water with food. The outcome of that habit was that they both had kidney damage as they grew older! They maintained an environment of dehydration in their bodies which is physiologically dangerous to kidney function. Conclusion: So why should we listen to these medical “experts” when they are not advising us in a healthful lifestyle?? Well, about half the time they are right, and half the time they are wrong---it’s a toss-up! How does one tell the difference between bad and good advice from their doctor? You have to ask your doctor and trust her advice. As a doctor I read research that tests a given medical practice then I compare the outcomes of the research with the outcomes of my patients, and if their findings agree with my patients’ experiences, then I embrace the research and include it in my medical advice. If not, I don’t use that information and wait for a better study to parallel what I see every day. You can do the same thing. If you think that the advice a doctor gives you is not consistent with your own experience, then you have to decide whether you take the medical advice and use it or not.