Keep the Scope Out of Your Knees!

40% of patients without pain or a history of significant injury have damaged cartilage on X-rays or MRI.  Studies show that after 5 years, those who had surgery for this problem with an arthroscope do no better than those treated medically.  Nutritional supplements might be better yet, certainly with much less side effects. 

See Overdiagnosed by Dr. H. Gilbert Welch.

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Gallstones That Don’t Hurt

About 10% of people have gallstones found with ultrasound with no symptoms of gall bladder disease.  Surgery is often recommended, even though there is no risk involved.  Most do not require surgery.  Some can be passed by a Gall Bladder flush.  There are many versions described on the internet.

See Overdiagnosed by Dr. H. Gilbert Welch.

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Exercise Can Often Be More Effective Than Taking Another Drug for Cardiovascular Disease or Diabetes.

Exercise Can Often Be More Effective Than Taking Another Drug for Cardiovascular Disease or Diabetes.

A study quoted in JAMA and published online in the British Medical Journal looked at meta-analyses for 4 drug and 12 medication clinical trials.  They concluded that researchers and clinicians concentrated so much on drug therapies that they ignored the great health benefits of exercise.  Regular aerobic activity reduced mortality and the prevention of coronary artery disease and diabetes more effectively than combinations of drugs.

See JAMA 2013;310:2026-2027.

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Evidence-Based Medicine Must Incorporate Patient Preferences

A recent JAMA editorial stressed that scientific evidence is not sufficient for making patient care decisions.  One guideline is that all patients should receive statin drugs.  However, a study showed that 70% of diabetic patients with low cardiac risk who were told about the limited benefit and potential side effects of statins refused to take the drugs.  It is the job of doctors to present the evidence and the options (yes, that should include chelation therapy for patients with vascular disease), but it is the right and responsibility for the patient to make the ultimate decision on what therapies they want to utilize.

See Montori VM, JAMA 2013;310:2503-2504.

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Stents Have No Benefit Over Medical Therapy for Arterial Blockage with Minimal or No Symptoms

Do you have reduced blood flow to your heart but this is not giving you significant symptoms like prominent chest pain and shortness of breath?  The name for reduced blood flow is ischemia, and it is often found incidentally with stress EKG’s, stress echoes, and angiography.  The usual treatment is angioplasty plus stents, but this treatment is no better for reducing future cardiac events than taking standard cardiac meds.  On the other hand, taking chelation therapy does reduce future cardiac events.  Evidence-based medicine shows the difference clearly.  But most cardiologists are not yet abiding by the evidence.

See Dr. Kathleen Stergiopoulus from SUNY—Stoney Brook School of Medicine for a meta-analysis that included the MASS II, COURAGE, BARI 2D, and FAME 2 clinical trials and JAMA 2013;309:1241-1250.

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