Medical science goes topsyturvy

Medicine has this funny habit of challenging its own wisdom from time to time and swinging to the opposite direction. Unlike physics for instance where the proverbial apple always continued to fall to the ground from the tree due to gravity, medical science has proved to be somewhat fickle, changing its rules every few years.

A string of recent research findings have started questioning what we all knew, held and preached for the last few decades.

Cholesterol, the greasy stuff that circulates in our blood and has long been incriminated to be the villain that clogs arteries and causes heart attacks, has suddenly been partially exonerated. All the time and money that was spent over the last few decades researching, promoting and marketing cholesterol reducing foods and medicines, is being turned upside down.

Modern scientists have started wondering whether insisting on lowering blood cholesterol and triglyceride levels to basal levels indeed translates into better and longer lives. Medical associations in USA are now arguing to relax their guidelines in a spirit of reluctant admission that we were perhaps chasing the wrong thief all these years.

A similar story is unfolding in the field of sugars. Undoubtedly diabetes is a major health problem especially in India, and if uncontrolled leads to several nasty complications that claim several lives. But what has upset the ‘lower-sugars-are-better’ apple cart and set the cat among the pigeons is a set of recent guidelines published by an American diabetes association that seems to find no proof of over-tight controls of HbA1C (measure of average blood sugar control of previous 3 months, where 7 is the ‘Lakshman rekha’) and suggest relaxing it to 8 (hurrah!).

This has come as a jolt to Indian diabetologists who have scurried to refute the wisdom of the American guidelines and their application to Indian patients, worried that their grip on patients (I mean their sugars!) might have to loosen up.

Another major shake up seems to be in the utility of a blood test called PSA (Prostate Specific Antigen) that has been in use over decades as a screening tool for prostate cancer in men above 40, a rising or high value suggesting that a cancer could be developing. Recent studies suggest that this test may not be reliable, missing many with cancers and causing anxiety in many without cancer due to falsely high values, and could be a waste of money. It has been dropped from the panel of “health check up tests” in men in few countries.

I wonder if such things happen in physics and whether the apple will climb up one day from the ground to the branch or the value of pi would change! As for us doctors, we need to be humble when we preach and practice, never knowing when we may be proved wrong.