Part of a series on WDDTY’s “free” advertorial report “100 ways to live to 100“
10 bits of medical advice you should question
In general, it’s always fair to ask for the evidence supporting any proposed medical intervention.
In general, WDDTY does this for you by quote-mining and cherry-picking to suit its anti-medicine agenda.
What WDDTY does not do is to provide any actual evidence that this information is anything other than a routine part of the normal process of informed consent, especially in the UK. For example, discussion of radical prostatectomy is dominated by a test that has been deprecated in the UK for over twenty years and an operation that never reached a quarter of its peak level in the USA.
81 Lower your blood cholesterol levels
The theory that high-fat foods—like meat and dairy—build up fat in our arteries has never actually been proven. After people eating high-fat diets were followed for 10 years and not one suffered a heart attack, researchers concluded that “the evidence is not there” to support a high fats–heart disease connection.48 In fact, high levels of the ‘bad’ LDL cholesterol may actually be good for us, especially as we get older.49
Reference 48: Nutr Metab Cardiovasc Dis, 2012; 22: 1039–45 Biomarkers of dairy intake and the risk of heart disease. Aslibekyan S, Campos H, Baylin A.
Reference 49: J Gerontol A Biol Sci Med Sci; 2007; 62: 1164–71 Statins and dietary and serum cholesterol are associated with increased lean mass following resistance training. Riechman SE, Andrews RD, Maclean DA, Sheather S.
The first reference is specific to dairy, noting:
Dairy product intake as assessed by adipose tissue 15:0, 17:0, and by FFQ is not associated with a linear increase in the risk of MI in the study population. It is possible that the adverse effect of saturated fat in dairy products on cardiovascular health is offset by presence of beneficial nutrients.
This is a great point against WDDTY’s anti-dairy agenda, but not really a point for the argument that cholesterolW is good for you. The second source finds:
These data suggest that dietary and serum cholesterol contribute to the skeletal muscles’ response to RET in this generally healthy older population and that some statins may improve this response.
A great point against WDDTY’s anti-statin agenda, but not much of a hit for the promotion of cholesterol either since this applies to people undergoing “12 weeks of high intensity resistance exercise training (RET) with post-exercise protein supplementation”. Few 60-69-year-olds do this, and the overall evidence is taken from the largely sedentary general population not from atypical sub-populations like this.
WDDTY seems to be disputing the lipid hypothesisW but without actually tackling it head on, still less addressing the evidence base behind it. In fact both the lipid and the chronic endothelial injury hypothesisW are converging over time to a single hypothesis which puts LDL front and centre in the mechanism of hypertension.
The Centers for Disease ControlW are blunt: “Having high cholesterol puts you at risk of developing heart disease, the leading cause of death in the United States”.
82 The mercury in your fillings is permanently locked in and harmless
Dentists have been saying this for years, but the European Commission’s BIO Intelligence Service (BIS) begs to disagree. The group recommends that a total ban on amalgam fillings be fully implemented in five years’ time, and the use of mercury fillings virtually eliminated throughout the EU.
No, the EU does not say that your fillings are a problem. It has a rather technical document detailing measures to reduce usage and pollution from mercury in the environment. It puts the report by Bio Intelligence Service S.A. (which is,a s the name suggests, a commercial entity and not an EU body) into context. Its principal argument is that dental use of mercury represents an environmental, not a toxicological, problem.
The report does not say that amalgam fillings in-place are a significant source of concern, instead it discusses the pollution caused by the mixing and installation of amalgam, and the disposal of amalgam after teeth are extracted or the patient dies.
Overall, you’re probably fine as long as you don’t heavily chew nicotine chewing gum. A controversy that has raged for a century without any consensus forming or any concrete and damning evidence of significant biological effect – a “smoking gun” – is evidence of philosophical differences, not provable harm.
83 Go for angioplasty
Balloon angioplasty and stents were to be medicine’s ‘miracle’ treatments for blocked arteries, but around one in 10 heart patients returns to hospital for emergency treatment following the procedures, and nearly a third of non-emergency ‘drug-eluting’ stents are also likely to cause potentially fatal harm.50 Patients given a cocktail of generic heart drugs instead do just as well .51
Reference 50: Arch Intern Med, 2012; 172: 112–7 Factors associated with 30-day readmission rates after percutaneous coronary intervention. Khawaja FJ et. al.
Reference 50b: N Engl J Med, 2007; 356: 1009–19 Long-Term Outcomes with Drug-Eluting Stents versus Bare-Metal Stents in Sweden Bo Lagerqvist et. al.
Reference 51: N Engl J Med, 2007; 356: 1503–16 Optimal Medical Therapy with or without PCI for Stable Coronary Disease William E. Boden et. al.
This is a particularly pernicious piece of misinformation. It is very easy to find cases where people are readmitted not long after surgery for coronary heart disease: the reason they have had the surgery is often because they are very sick. Unsurprisingly, they are a poor surgical risk and a high risk for post-surgical complications. In other words, even with surgery, doctors may not be able to save them. That’s a great reason for keeping your heart in good shape and a truly terrible reason for refusing heart surgery if it’s indicated.
WDDTY say that nearly a third of drug eluting stents are likely to cause potentially fatal harm. The source absolutely does not support this.
Drug-eluting stents were associated with an increased rate of death, as compared with bare-metal stents. This trend appeared after 6 months, when the risk of death was 0.5 percentage point higher and a composite of death or myocardial infarction was 0.5 to 1.0 percentage point higher per year. The long-term safety of drug-eluting stents needs to be ascertained in large, randomized trials. (emphasis added)
WDDTY have been caught before confusing relative and absolute risks, but rarely this blatantly.
The final study also doesn’t support WDDTY’s statement:
As an initial management strategy in patients with stable coronary artery disease, PCI did not reduce the risk of death, myocardial infarction, or other major cardiovascular events when added to optimal medical therapy.
WDDTY recommending intensive pharmacologic therapy. That’s a turn-up for the books.
84 You don’t need your womb anymore
A University of California committee of gynaecologists once concluded that three-quarters of all hysterectomies done are not necessary.52 Except for genuine indications like uterine cancer and life-threatening bleeding during childbirth, some 90 per cent of referrals for hysterectomies can be treated with conservative surgery, medication, alternative medicine, nutritional supplementation or just waiting until menopause.
Reference 52: Obstet Gynecol, 2000; 95: 199–205 The Appropriateness of Recommendations for Hysterectomy, Michael S Broder et. al.
This is an US study. One in three US women will undergo hysterectomy, compared with one in five in the UK. The US removes ovaries in 73% of cases, the UK in 20%.
WDDTY editor Lynne McTaggart is American. Sometimes she forgets which side of the pond she’s living.
Sometimes she also forgets that the anecdotal claims of quacks to “cure” endometriosis, fibroids and the like are a long way short of being evidence that they actually can do this.
85 Have ‘catch it early’ surgery for prostate cancer
Men in the early stages of the disease are often offered radical prostatectomy, where the entire gland is removed. At best, it’s a trade-off, mostly because of the high risk of permanent impotence and incontinence. Unless you’re under 55, you’re more likely to die with the disease than from it.
That’s why the standard of care for indolent prostate cancer is “watchful waiting”. Who are these doctors who supposedly “don’t tell you” this? I suspect they may be American again, though even there it’s been in decline since the early 1990s. The UK has deprecated screening since the 1990s and the UK’s rate of radical prostatectomy never reached 10 per 100,000, a quarter of the peak rate in the US.
Bottom line: if your doctor recommends radical prostatectomy, it’s probably the conservative option.
86 Have a radical mastectomy to ‘catch it all’
This mutilating operation involves removing the breast, the chest wall, the lymph nodes and much of the skin, but it confers no advantage over other, less aggressive forms of mastectomy, including the simple removal of the lump with radiotherapy.53 Also, some 70 per cent of double mastectomies—where both breasts are removed following a diagnosis of breast cancer—are unnecessary as the cancer was never likely to have spread, say researchers.54
Reference 53: Ann Surg, 1986; 204: 136–47 Treatment of primary breast cancer without mastectomy. The Los Angeles community experience and review of the literature.
Reference 54: J Clin Oncol 30, 2012; suppl 34: abstr 26 [Medline does not find this reference]
This advice is literally decades out of date. Radical mastectomy no longer involves routine axillary clearance, instead the lymph nodes are staged, often in real time. Prophylactic mastectomies will only be advised for women who already have cancer, or who, like Angelina Jolie, have both genetic and family history indications.
WDDTY were among the strident chorus of natural-woo promoters who denounced Jolie for her decision. Jolie showed grace and fortitude in the face of this torrent of bullshit, pointing out that the risk for her was in excess of 80% given family history and evidence of specific expressed genetic mutations.
Lumpectomy is the standard of care for small, well-defined tumours; radical mastectomy is not recommended lightly.
The moral of this story is, listen to oncologists, not cranks who hate the entire world of medicine on reflex.
87 Let’s fix your inguinal hernia
The wise doctor will delay surgery until the patient is in pain or discomfort—partly because he knows that surgical repair carries a long-term risk of recurrence and can itself cause more groin pain than the hernia, as it does in a quarter of patients.55 When more than 700 men with hernias underwent watchful waiting instead, the vast majority carried on with their everyday lives without a moment of pain and without the need for surgery.56
Reference 55: Ann Surg, 2001; 233: 8 Groin Pain After Hernia Repair, Robert E. Condon.
Reference 56: JAMA, 2006; 295: 285–92 Watchful waiting vs repair of inguinal hernia in minimally symptomatic men: a randomized clinical trial. Fitzgibbons RJ Jr, et. al.
Once again, WDDTY recommends the standard of care. Well done for telling your readers what doctors already do tell them.
The only problem with WDDTY’s commentary is that it seems designed to deter anyone from undergoing repair, based on a speculative finding from 2001 (“Could it be that the major change in the technique of hernia repair that has evolved over the most recent two decades—the widespread use of implanted prosthetic mesh, whether needed or not—is a cause?”) and a report based on minimally symptomatic patients.
The 2001 paper refers to what is now termed post herniorraphy pain syndromeW, a recognised complication that leads to – guess what? – the standard of care being “watchful waiting” for minimally symptomatic patients. The problem does not seem to be caused by mesh itself, but by damage to the nerves, which may be consequent from the original injury
So as usual it’s safe to follow WDDTY’s advice as long as you’re not actually ill…
88 Let’s cut out your gall bladder
This procedure (cholecystectomy) may increase the risk of colon cancer, according to a review of 33 studies.57 Surgery can often make matters worse by injuring the bile duct, releasing gallstones and causing more digestive issues. Stones can usually be sorted out by avoiding processed food and sugar, eating less red meat and eschewing HRT, which doubles the risk.
Reference 57: Gastroenterology, 1993; 105: 130–41 A meta-analysis of cholecystectomy and risk of colorectal cancer. Giovannucci E, Colditz GA, Stampfer MJ.
CONCLUSIONS: Because the risks varied substantially by study design and because time since cholecystectomy or potentially confounding factors were often not considered, we could not firmly quantitate this risk. However, the findings are consistent with other evidence that suggests some characteristic of bile acid metabolism increases the risk of cancer of the proximal colon.
CholecystectomyW became much more common in the 1990s after laparoscopic techniques were devised which made the surgery effectively a day-case. Yes, like any surgical procedure, it has potential complications, and those should be (and are) taken into account when considering surgery.
The accuracy of WDDTY’s commentary can be demonstrated pretty simply:
WDDTY: Surgery can often make matters worse by injuring the bile duct, releasing gallstones and causing more digestive issues
Goldman’s Cecil Medicine (24th ed.): The most serious complication of cholecystectomy is damage to the common bile duct. This occurs in about 0.25% of cases.
Often… 0.25%. I think this might be a problem of perspective.
WDDTY: “Stones can usually be sorted out by avoiding processed food and sugar, eating less red meat and eschewing HRT, which doubles the risk”
NHS: “There are several non-surgical ways to break down gallstones, but they are only effective in around less than 1 in 10 cases and are rarely a viable option.”
Perhaps WDDTY has been mistaking the claims of its advertisers for fact.
89 Sort your overactive thyroid with surgery
Nearly a third of all cases will resolve on their own. Even when just part of the thyroid is removed, only 30 per cent will have normal thyroid levels after eight years, a whopping 41 per cent will have a permanently underactive thyroid and 12 per cent will still be hyperthyroid.58
Reference 58: J Endocrinol Invest, 1993; 16: 195–9 Follow-up evaluation of patients with Graves’ disease treated by subtotal thyroidectomy and risk factor analysis for post-operative thyroid dysfunction. Sugino K, Mimura T, Toshima K, Iwabuchi H, Kitamura Y, Kawano M, Ozaki O, Ito K.
Grave’s diseaseW is the commonest but not the sole cause of hyperthyroidismW, and it’s not the sole indication for thyroidectomy. In fact, it’s been considered debatable for some time:
Operation is indicated mainly when the disease is severe with a larger goitre or in younger age groups (below 40 years) where radioiodine may not be advisable. For preoperative treatment the use of antithyroid drugs in preferred, although iodine perhaps in combination with beta blockers may be used safely as well at least for moderate cases. In the presence of alternative means of treatment surgery should not exceed an operative risk of 0.5-1.5% with virtually no mortality
It’s unlikely that any patient will be offered surgery for management of hyperthyroidism without first excluding non-surgical approaches. WDDTY seems to think partial thyroidectomy is common, in the UK at least this is not the case. As the NHS says:
Surgery to remove all or part of the thyroid gland is known as a total or partial thyroidectomy. It is a permanent cure for recurrent overactive thyroid.
Your specialist may recommend surgery if your thyroid gland is severely swollen (a large goitre) and is causing problems in your neck.
Other reasons for surgery include:
- a person is unable to be treated with radioiodine treatment as they are pregnant and they are unable or unwilling to take thionamides
- a person has a severe form of Graves’ ophthalmopathy
- the symptoms return (relapse) after a previous successful course of treatment with thionamides
It is normally recommended that the entire thyroid gland is removed as this means there will be no chance of a relapse.
See that word “specialist”? In the UK you will not get anywhere near thyroidectomy for Grave’s disease without seeing a specialist endocrinologist and exhausting the alternatives.
It’s almost as if doctors know what they are talking about and WDDTY don’t.
90 You need a blood transfusion
This routine medical practice suppresses the immune system, increasing the chances of infection, pneumonia—and cancer. Patients who received a transfusion during cancer surgery are 42 per cent more likely to develop cancer again, say Johns Hopkins University researchers.Transfusions should be reserved for emergencies like trauma or haemorrhage, when they can be a lifesaver.59
Reference 59: Anesthesiology, 2012; 117: 99–106 Variability in blood and blood component utilization as assessed by an anesthesia information management system. Frank SM, Savage WJ, Rothschild JA, Rivers RJ, Ness PM, Paul SL, Ulatowski JA.
CONCLUSIONS: The use of data acquired from an anesthesia information management system allowed a detailed analysis of blood component utilization, which revealed significant variation among surgical services and surgical procedures, and among individual anesthesiologists and surgeons compared with their peers. Incorporating these methods of data acquisition and analysis into a blood management program could reduce unnecessary transfusions, an outcome that may increase patient safety and reduce costs.
Needless to say, this does not support WDDTY’s statement. The article proposes spreading of best practice in the context of the US health system (where interventions may risk being profit-driven).
Yes, transfusions might indeed have negative effects, especially in the US where payment for blood donors has led in the past to contaminated supplies. However, cancer surgery tends to be at the upper end of things that are not considered “emergencies” even by WDDTY’s rather arbitrary standards, and some people might consider that the chances of being offered a transfusion just on the off chance when you’re not in mortal danger is probably pretty low. Especially in the NHS.