A recent article in the British Medical Journal, a news release from the publisher, and news stories published around the world was nothing less than misleading and alarming. The article, based on an analysis of nine previously published studies, reported that vitamin E supplements increased the risk of stroke.
Wait a minute! The study and all the negative publicity were deeply flawed.
First, none of the individual studies had found an increased risk of stroke. Second, the dosages varied from 300 IU to 800 IU of vitamin E daily, some using natural and others using synthetic vitamin E. The studies ranged from about a year and one-half to 10 years, the subjects varied from middle-age to seniors, and some were healthy while others were at high risk of cardiovascular disease (and whom were likely to be taking several medications). With this disparate data, the researchers concluded that one additional person in every 1,250 taking vitamin E would suffer a hemorrhagic (bleeding) stroke, whereas about 2.6 additional people in 1,250 would be less likely to suffer an ischemic (clotting) stroke.
You would think that the significantly greater reduction in ischemic stroke would be the subject of headlines. But it wasn’t. The researchers downplayed the benefits, and headlines warned that vitamin E increased the risk of stroke.
Here’s what else you need to know: you are far more likely to suffer an ischemic stroke. That’s because 90 percent of all strokes are related to blood clots. You are far less likely to suffer a hemorrhagic stroke; they account for only 10 percent of all strokes.
Even though this study was poorly designed, it showed that vitamin E supplements significantly reduced the risk of the most common type of stroke, whereas it slightly increased the risk of the least common stroke. You don’t have to be a rocket scientist – or a statistician – to figure out that the benefits:risk ratio of vitamin E supplements is strongly in your favor.
Sunday, December 19, 2010
Mixed Messages for Health Care
Two recent newswire stories caught my attention. One article noted that there will be a significant shortage of doctors as “baby boomers” hit their 60s and 70s. The other story noted that too much health care is unnecessary and harmful.
Am I the only one who saw a contradiction here?
The second story, sent to newspapers by the Associated Press, noted that “More medical care won’t necessarily make you healthier—it may make you sicker.” The article went on to report that as many as one in three medical tests and treatments aren’t needed.
Fewer medical tests might not be a popular idea among people who keep asking their doctors to identify the cause and then to treat their aches and pains and other health problems. But I would agree, at least to an extent – conventional medical tests and treatments are overused, while nutritional assessments and treatments are sorely underutilized.
In the United States, medicine is a “for profit” business, and most doctors earn a living through some sort of intervention, such as by prescribing a drug or doing surgery. When a patient asks for help, his expectation is that the doctor will do something. Of course, doctors are trained to intervene, and income is related to ordering more tests and doing more interventions. Sometimes the result is iatrogenic disease – physician-caused illness.
Although I believe most doctors are sincere and do want to help their patients, they also know the economic realities of medicine. But not everyone is so sincere. Some years back, I happened to be meeting with a hospital administrator on the morning the government announced that it was reducing Medicare payments to doctors. The administrator was livid. “Do you know what the doctors are going to do?” she asked rhetorically. “They’ve got big mortgages and boats and kids in college. They’re just going to wheel in more patients so they (the docs) don’t have to take a cut in income.”
So, do we really need more doctors? Or unnecessary tests and treatments? Or do we need more doctors who think in terms of more efficient and lower cost nutritional therapies?
Am I the only one who saw a contradiction here?
The second story, sent to newspapers by the Associated Press, noted that “More medical care won’t necessarily make you healthier—it may make you sicker.” The article went on to report that as many as one in three medical tests and treatments aren’t needed.
Fewer medical tests might not be a popular idea among people who keep asking their doctors to identify the cause and then to treat their aches and pains and other health problems. But I would agree, at least to an extent – conventional medical tests and treatments are overused, while nutritional assessments and treatments are sorely underutilized.
In the United States, medicine is a “for profit” business, and most doctors earn a living through some sort of intervention, such as by prescribing a drug or doing surgery. When a patient asks for help, his expectation is that the doctor will do something. Of course, doctors are trained to intervene, and income is related to ordering more tests and doing more interventions. Sometimes the result is iatrogenic disease – physician-caused illness.
Although I believe most doctors are sincere and do want to help their patients, they also know the economic realities of medicine. But not everyone is so sincere. Some years back, I happened to be meeting with a hospital administrator on the morning the government announced that it was reducing Medicare payments to doctors. The administrator was livid. “Do you know what the doctors are going to do?” she asked rhetorically. “They’ve got big mortgages and boats and kids in college. They’re just going to wheel in more patients so they (the docs) don’t have to take a cut in income.”
So, do we really need more doctors? Or unnecessary tests and treatments? Or do we need more doctors who think in terms of more efficient and lower cost nutritional therapies?
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