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PREVENTION – Are You Sure?

Dr. Levi

Prevention is an interesting term. Most people would agree it’s a good thing.  If someone says, “take an asprin a day to prevent  heart attacks by 50%,” that sounds good.

“Get a mammogram to prevent dying from breast cancer”.  People do it.  Besides, who wants to die from something that’s preventable? No one!

But, how do you prove you prevented a disease? Ah, there’s the rub. It turns out that its not a very scientific process.

Say someone gets the flu shot for 20 years and never gets the flu. They may say “the flu shot prevented it”. Take another person who, for 20 years never got a flu shot, but also didn’t get the flu. Surely they came into contact with a flu virus several times over 20 years. Their body’s systems were strong enough to deal with a little flu virus. Back to the other person. How do they know that their body, not the vaccine,  didn’t fight off the virus? They don’t. They can only have faith.  There is no feasible way to prove it. What if the person who gets the shot, gets the flu also? They are told that it wasn’t the flu because the vaccine can’t cause the flu. It must be influenza-like illness. What if the same scenario happens in the person who doesn’t get the flu shot? They are told they should have gotten the flu shot.

Take heart attacks for example: 2 million Americans lay down on the catheterization table every year.  About 800,000 are in the throes of a heart attack, which would be the ones to generally benefit the most from bypass or stent. But, Dr. Richard Lange, chief of clinical cardiology at Johns Hopkins Medicine says, “Angioplasty and stenting have never been shown to improve survival. You can stent until the cows come home and not prevent a heart attack.” Veterans Affairs study released in the New England journal of Medicine backed him up. Angioplasties and stents have skyrocketed over the past 10 to 15 years yet there has been no change in the rate of heart attacks.

Dr. Nortin Hadler, professor of Medicine at UNC at Chapel Hill, put it this way “There are only two reasons you’d ever want to do it (bypass surgery): one, to save lives, the other to improve symptoms. But there’s only one subset of the population that’s been proved to derive a meaningful benefit from the surgery, and that’s people with a critical defect of the left main coronary artery who also have angina.(chest pain) If you take 100 60-year-old men with angina, only 3 of them will have that defect, and there’s no way to know without a coronary arteriogram. So you give that test to 100 people to find 3 solid candidates—but that procedure is not without complications. Chances are you’re going to do harm to at least one in that sample of 100. So you have to say, “I’m going to do this procedure with a 1 percent risk of catastrophe to find the 3 percent I know I can help a little.” That’s a very interesting trade-off.” And this is for Angina, not heart attack prevention which hasn’t been proven.

In a controlled trial of cardiac surgery for angina, half of the patients received bypass surgery while the other half only received a skin incision and stitches. The number of people in each group who had significant symptom relief was the same for each group.

So why do so many people submit to these procedures and why do so many doctors do them in spite of the lack of scientific evidence that it saves lives? Believers? Ideology? Faith?

There a lot of people walking around having survived these types of surgeries. The cardiac doctors have gotten better at rerouting blood flow in the heart without killing as many people on the table. But the assumed result, less deadly heart attacks, hasn’t happened. There isn’t 2 million less heart attacks per year.

An aspirin a day? Do you know the evidence? If you have already had your first heart attack your 5-year survival rate is 96%. If you take an aspirin a day the average survival rate goes to 98%. 2%  increase doesn’t sound impressive. But if you reverse the numbers and use mortality rates of 4% and 2%  then the American Heart Association can say there is a 50% reduction in deaths by taking an aspirin a day. That’s equivalent to proudly proclaiming that you have doubled your chances of winning the lottery because you bought 2 tickets instead of one. Not too many people I know would be excited about their chances. How many side effects would you expect for taking an aspirin a day for 5 years. Stroke anyone? There is zero evidence that shows taking an aspirin a day will prevent a first heart attack.

Cholesterol medicine. All I have to say is:  read the package insert. It says “has not been proven to prevent heart attack or death.” Lipitor claims they are the only FDA approved cholesterol lowering drug proven to prevent heart attacks. If you keep reading it tells you “in men who currently have heart disease” which means men who have already had a heart attack. Even in this group the benefits are marginal. 25 men will have to take the medication to prevent 1 heart attack. The 24 others receive no benefit. For the ones who haven’t had a heart attack, these odds are even more slim, over 500 to 1.

The mind game that is being played is that every single person actively taking the medication believes the “1” is THEM.  But the science says this can’t be so. It actually says it’s most likely not so.

“I take my medicine to prevent XYX”

Really? Is that science or is that belief?

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