When doctors disagree in public, it drive patients crazy. Most people assume that their health professionals know what the best treatment is for any given ailment. But on some matters there is surprising conflict.
Doctors Fight Over Statins:
Many cardiologists believe that the best way to prevent or treat heart disease is with a statin prescription. Others, however, question whether statins make much difference for people who don’t have heart disease.
Some cardiologists point out that a Mediterranean diet is more effective than statins in preventing death from cardiovascular disease (World Journal of Cardiology, July 26, 2015).
Statins and Longevity?
Researchers have estimated that taking a statin conscientiously for several years results in a “surprisingly small average gain in overall survival” (BMJ Open, Sept. 24, 2015). They estimate that death is postponed by a median of three to four days.
Cardiologists vs Cardiologists Equals Confusion:
Many cardiologists find such analyses heretical. They fear that studies like this might encourage people to stop taking statin medication.
Dr. Steve Nissen, Chair of Cardiovascular Medicine at the Cleveland Clinic, worries that “discontinuing statin treatment may be a life-threatening mistake” (Annals of Internal Medicine, July 25, 2017). He argues that dietary approaches are not an acceptable alternative to statin treatment.
In contrast, other prominent cardiologists argue that:
“It is time to shift the public health message in the prevention and treatment of coronary artery disease away from measuring serum lipids and reducing dietary saturated fat. Coronary artery disease is a chronic inflammatory disease and it can be reduced effectively by walking 22 min a day and eating real food” (British Journal of Sports Medicine, Aug. 2017).
Doctors Fight about HRT:
Statins and diet are not the only contentious topics in healthcare. Others have included hormone replacement therapy for menopausal women.
Years ago, many physicians believed such drugs could prevent cardiovascular disease with few, if any, side effects. Now most doctors accept that HRT is linked to an increased risk of breast cancer and blood clots. Heart attacks and strokes may also be elevated.
Doctors Fight about Blood Glucose:
Aggressive treatment of blood sugar was long considered beneficial for people with type 2 diabetes. A large trial called ACCORD was designed to test that belief. The results shocked the medical community.
Patients who received the most intensive blood glucose treatment died earlier and fared worse than those getting more moderate treatment (New England Journal of Medicine, June 12, 2008). It turns out that low blood sugar may be almost as bad as high blood sugar. Aggressive treatment can sometimes lead to dangerous dips in blood glucose levels.
When Paradigms Shift, Confusion Reigns:
Not surprisingly, patients find themselves caught in a terrible double bind when physicians don’t agree on optimal treatment programs. This is especially true when there is a paradigm shift in thinking.
Some health professionals may find it difficult to abandon traditional or outdated therapies. That is why it is so important for doctors to tell patients plainly when there is no consensus on the best approach. Shared decision-making takes patient perspectives into account, especially when doctors don’t agree.
Patient Stories:
Gary in Oregon responds to Dr. Nissen:
“Sorry, Dr. Nissen, but Internet fear mongering had nothing to do with my stopping simvastatin. I did do some Internet research and the common thread on several medical sites was that statins can cause severe muscle pain.
“The pain in my legs and other muscles was so bad I had to stop taking it. I had a difficult time even falling asleep. Within a year after starting simvastatin, I was diagnosed with Type 2 diabetes. There is no history of diabetes in my family. Perhaps this is a coincidence, but I don’t think so.
“With more and more evidence through legitimate studies showing little benefit for many people, I question its value except to the drug companies. I am now taking red yeast rice and have slightly modified my diet. My cholesterol is not where they say it should be but it is much lower and just above the upper normal limit.
“The ‘test’ to see if you need a statin or not sounds way too swayed to age. One size doesn’t fit all. But like many things my experience is just that – my experience.”
Lorraine in Atlanta had success with diet:
“I am 64 and used the Cardiovascular Risk calculator and got a risk of 2.8% so age doesn’t automatically cause the calculator to say you need a statin.
“My blood pressure is 110/68. What really helped me was my cholesterol at 162 and my HDL at 79. My cholesterol used to be 220.
“How did I achieve 162? A whole foods plant-based diet. I am a vegan. My husband had high cholesterol and LDL and was on a statin for several years. He also became a vegan and has cholesterol levels like mine. He was able to go off the statin. Don’t want to be on statins? Change your diet to plant-based.”
Joseph in Houston, Texas, also changed his diet:
“I tried several statins; they ALL caused muscle aches, muscle weakness and irreversible (to date) muscle damage to my quadriceps.
“I’ve had medical professionals (note plural) tell me privately that although statins can reduce cholesterol, overall their recommended use is a dirty little secret within the medical community, and that anyone who exhibits negative side effects should run from statins.
“I cleaned up my diet and I exercised with dedication. My cholesterol numbers are just over the borderline range. That does NOT mean I’m going to have a heart attack.
“By going strictly vegan, my cardiologist told me that I passed my nuclear stress test with ‘normal’ results and that he discharged me from care…with the recommendation that I follow my exercise routine and a move from strictly vegan to more Mediterranean Diet. He did NOT see any further need for statins. Not that I’d have taken them anymore anyway. To each his/her own, but there is NO way I’m going to sacrifice my quality of life to Big Pharma.”
What Do You Do When Doctors Fight?
Have you ever been in a situation where you have received conflicting information from different doctors? How did you deal with the confusion? We would love to hear your story. Please share your experience in the comment section below.
