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As I start my 18th year of practicing as a physician and surgeon (after 7 years of training to become an ENT surgeon just for kids), it is clear to me that the number of shades of grey increases in direct proportion with my age! How interesting that when I was a young medical student and resident, I eagerly embraced textbooks, what my attendings told me, and the research papers I read as the whole truth and nothing but the truth.
As it turns out, I have realized over the course of my career that science, medicine, and knowledge, just as life itself, is not black and white, and rarely is a “fact” today definitive until the end of time. Frankly, scientific and medical “facts” are about as true until the next larger, better study, or perhaps new knowledge points out flaws in the prior accepted “truths”.
Here are my comments about the 10 medical findings listed in this NY Times article:
Peanut allergies occur whether or not a child is exposed to peanuts before age 3.
NYT: Pediatricians have counseled parents to keep babies away from peanuts for the first three years of life. As it turns out, children exposed to peanuts before they were even 1 year old have no greater risk of peanut allergies.
Me: Allergies aside, nuts for toddlers who do not yet have molars pose significant choking and aspiration risks! See my blog on choking hazards for children.
Before 12 months of age, and likely even those younger than 2, kids at these ages will likely have difficulty and lack oromotor skills to get peanut butter off of the roof of their mouth! To me, risks outweigh benefits in exposing infants and toddlers directly to peanut butter and/or nuts so early in life, even if there is not a greater risk of allergies.
Fish oil does not reduce the risk of heart disease.
NYT: At one point, the notion that fish fats prevented heart trouble did seem logical. People whose diets contain a lot of fatty fish seem to have a lower incidence of heart disease. Fatty fish contains omega-3 fatty acids. Omega-3 supplements lower levels of triglycerides, and high levels of triglycerides are linked to an increased risk of heart disease. Not to mention that omega-3 fatty acids seem to reduce inflammation, a key feature of heart attacks.
But in a trial involving 12,500 people at risk for heart trouble, daily omega-3 supplements did not protect against heart disease.
Me: Be careful! It's really easy to interpret the sentence above to mean the study proves omega-3 fatty acids/fish oil is not beneficial...
The public needs to understand that the study used adult subjects who already received care and who had multiple cardiovascular risk factors or atherosclerotic disease but no previous myocardial infarction (heart attacks). The study concluded no evidence of the usefulness of n−3 fatty acids for preventing cardiovascular death or disease in this population. (Not the same as in the ENTIRE human population.)
Being of Asian descent, fish is almost a daily part of our diet, and even my Slovak grandmother-in-law, who is now 105 and a half, spent years taking fish oil! Of course it’s impossible to say that a fish oil supplement, by itself, without accounting for other factors, is or is not beneficial. For me, my message is that if children or adults who are not exposed to fish and/or other seafood or these foods are not an option in their diet, any potential benefits may be missed.
A lifelike doll carried around by teenage girls will not deter pregnancies.
NYT: These dolls wail and need to be “changed” and “cuddled”. The idea was that girls would learn how much work was involved in caring for an infant. But a randomized study found that girls who were told to carry around “infant simulators” actually were slightly more likely to become pregnant than girls who did not get the dolls.
Me: The focus probably really needs to be honest and gentle conversation about risks and consequences, both emotional and physical, for teenage girls to engage prematurely in any sexual activity. Having an unplanned pregnancy in teenage years has implications and negative consequences far beyond the role of a “doll” and learning to mimic domestic responsibilities and motherhood. The medical and health risks to the teenager, worse, the risk of premature birth to the baby, and finally, immense life changes that may or may not result in a positive and healthy lifestyles deserve to be the focus of conversation and our goals as parents, not whether a doll may decrease premature sexual activities in young people.
My daughter will not be getting a doll, but she has been “brainwashed” since age 8, about all details on the medical (including STDs, pregnancy, etc.), scientific, and most importantly emotional and human implications of “sex” and sex during teenage years and how unplanned pregnancy may impact educational opportunities and change the course of any life.
Ginkgo biloba does not protect against memory loss and dementia.
NYT: The supplement, made from the leaves of ginkgo trees, was widely used in ancient Chinese medicine and still is promoted as a way to preserve memory. A large federal study, published in 2008, definitively showed the supplement is useless for this purpose. Yet ginkgo still pulls in $249 million in sales. Did people just not get the message?
Me: So many supplements, so little science as defined by the accepted medical academic community. Everyone is entitled to believe and embrace supplements as they wish, as based on their cultural background, cultural dietary habits, etc. However, more broadly known and accepted science shows that movement, exercise, sleep, active engagement of the mind and body, along with a healthier diet, support health, life, memory, mood, and frankly no amount of ginkgo or any other supplement can substitute all that I have listed to magically give you incredible health! No short cuts is the bottom line!
To treat emergency room patients in acute pain, a single dose of oral opioids is no better than drugs like aspirin and ibuprofen.
NYT: Yes, opioids are powerful drugs. But a clinical trial showed that much safer alternatives relieve pain just as well among emergency room patients.
Me: This is often where I am disheartened that despite published research and studies that show risk of respiratory depression in young or obese children, if given narcotics, many Emergency Rooms and doctors still prescribe Tylenol with codeine for children, even when the FDA has published a black box warning! Clinical practice always lags research findings, and frankly, so many doctors either don’t believe it matters, or they believe they are too busy to make or find the time to read published and accepted standards of care, and instead may unintentionally increase harm to a patient by doing what they were taught decade(s) ago.
In my subspecialty, we accepted new information and science that shows not every child metabolizes codeine the same and those who metabolize it too fast will have a higher level of morphine in their blood! When data shows that head-to-head, Tylenol and ibuprofen work just as well as Tylenol and codeine after tonsillectomy surgery in preschool aged children, many of us stopped using codeine all together.
Testosterone treatment does not help older men retain their memory.
NYT: Some men have low levels of testosterone and memory problems, and early studies had hinted that middle-aged men with higher testosterone levels seemed to have better preserved tissue in some parts of their brains. Older men with higher testosterone levels also seemed to do better on tests of mental functioning.
But a rigorous clinical trial showed that testosterone was no better than a sugar pill in helping older men avoid memory loss.
Me: As a Pediatric ENT, this is not my area of expertise. I do think about my grandparents and my husband's grandparents, and senior friends, neighbors, and colleagues I respect. Memory is dependent on many factors, in my opinion, but aside from genetic, anatomical, medical factors, I am a firm believer that “if you don’t use it, you lose it”. Much like muscle mass as we age, if we want to avoid memory loss, activity, conversation, reading, mental challenges like crossword puzzles, visually and through our hearing, we make the brain pay attention to something different and it will be stimulated.
To protect against asthma attacks, it won’t help to keep your house free of dust mites, mice and cockroaches.
NYT: The advice from leading medical groups has been to rid your home of these pests if you or your child has asthma. The theory was that allergic reactions to them can trigger asthma attacks. But intensive pest management in homes with children sensitized to mouse allergens did nothing to reduce the frequency of their asthma attacks, researchers reported in 2017.
Me: My curiosity for this study and conclusion is whether all these patients in the study were ONLY allergic to mice, and nothing else. People who suffer from environmental allergies, like me, generally are allergic to more than one allergen. No matter what we do, we can’t really ever eliminate dust and dust mites completely, that’s why I always advocate a holistic approach to managing the nose!
Here is a recent blog I wrote on how to know whether your child has allergies.
Step counters and calorie trackers do not help you lose weight.
NYT: In fact, dieters may be better off without digital assistance. Among 470 dieters followed for two years, those who wore devices tracking the steps they took and calories they burned actually lost less weight than those who just followed standard advice.
Me: 470 people in a study does not lead to a generalization for our entire population, furthermore, there are many reasons the above statement may be true. I suppose those who wear the tracker because it was their Christmas or birthday gift but were not motivated to do so or to exercise, they might have less weight loss. Again, multifactorial; don’t read once sentence and decide it’s the “truth”.
Torn knee meniscus? Try physical therapy first, surgery later.
NYT: An estimated 460,000 patients in the United States get surgery each year to fix knee cartilage that tears, often because of osteoarthritis. The tear is painful, and many patients fear that if it is not surgically treated, the pain will linger.
But when patients with a torn meniscus and moderate arthritis were randomized to six months of physical therapy or surgery, both groups improved, and to the same extent.
Me: I believe in this study because Americans get more surgeries than they need, take more medications than they need, and go to the doctors and even emergency rooms more often than they need because they can…because we simply do not emphasize education about how to maintain optimal health and avoid the health care system. Johnson and Johnson has a great program to optimize patient outcomes after joint replacement all based on what patients do before surgery, and I definitely accept that by not trying non-surgical options first, one may miss out on a chance NOT to need surgery and get better.
If a pregnant woman’s water breaks prematurely, the baby does not have to be delivered immediately.
Me: That depends on the clinical situation—is the baby in distress? Is the mother? There are so many factors to consider...