If I need medical care, I would be wary of seeking it from an ‘expert’. Their notoriety is often from research, publications, medical conference speaking gigs and a tincture of self-promotion. These guys are often clinically clumsy, as they simply don’t do much medical trench work. They often champion a medical intervention or diagnostic test that may have achieved the requisite statistical significance, but has no real meaning for individual live human beings. Another fallacy, often promulgated by experts, is to rely upon surrogate markers as a clinical objective. Not long ago, cardiologists were going gaga over the CRP blood test as a marker for cardiac disease. This was great news – for the statin manufacturers, but did it really prevent disease? I wonder. Surrogates often take on a life of their own, far removed from the actual disease at hand. Patients shouldn’t care if their ‘surrogates’ are improving; their objective should be to prevent disease, feel better and live longer. Yet, physicians have often convinced our patients that surrogate improvement means better health. Monitoring tumor markers in cancer patients illustrates this point well.
“Great news Mrs. Bedridden. Your cancer blood test dropped 10 points!”
“Thank you doctor, but I still can’t walk.”
Those of us who have been reading journals for some time are skeptical before we jump on the medical breakthrough of the day or week. What is sound medical dogma today may very well fade over time and become junk medicine. When I was a medical resident, we were taught that every post-menopausal woman should receive hormone replacement, unless there was a contraindication to this treatment. That’s what the experts taught us. We now know otherwise. It is reminiscent of the margarine-butter debate, which went on for a few years. I’m still not sure which is the preferred choice, but I’m sure it will change again soon.
As for aspirin, I view this issue through the prejudiced prism of a gastroenterologist. My gut is an aspirin-free zone. But, don’t take my advice. Ask a real ‘expert’.
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