The New Revolution in Medical Science

Understanding the Scientific Method has Never Been More Critical

Scientific medicine has never offered more promise. Science has always been my favorite academic subject. In my work as a physician, I have been a practical scientist. I take scientific knowledge and I apply it to patients who have medical problems. For the last 30 years, I have worked to understand the huge volume of peer-reviewed scientific research concerning artery disease and related topics like diabetes. I have translated it for your use while integrating it into best practice approaches to chronic diseases. That has been very productive work, and I am confident that Americans can be much healthier for half the money. This topic has very high stakes.

It is very important to recognize what is medical science and what is not medical science. What are truly reliable sources of information? The scientific method is very well defined and that is the only reliable way to answer scientific questions about your health. The scientific method requires that we ask questions or form hypotheses and perform experiments to prove or disprove these questions in ways that will lead to unbiased answers. The experiments provide the answer to the question. Sometimes the results are completely shocking.

Let me provide an example for you. Sometimes medical ideas make perfect sense, but they turn out to be wrong. There are many examples of this fact, but I will tell you about the most famous one. It makes perfect sense that heart arteries that are chronically narrowed with cholesterol deposits, calcification, and scar tissue cause heart attacks and that opening these arteries will prevent a heart attack. People who had chest pain with exertion (angina) often had heart attacks or died suddenly and on examination they had blocked arteries. Opening those arteries relieved chest pain, so it must protect these people from having a heart attack. There are still people opening and bypassing arteries in stable patients and the clinicians and patients involved still believe that opening arteries saves lives.

The first heart artery bypass surgery was done in 1967 at the Cleveland Clinic. There are still 400,000 of these procedures done each year. The first heart artery stent was done in 1986. There are over 2 million heart artery stents used to open coronary arteries each year in our country despite the fact that this procedure was proven to be useless in stable patients in 2007 in the landmark COURAGE trial. By 2007, we had been opening arteries for 40 years because it seemed like a good idea and we had been putting in stents for 20 years. Many of those procedures provided no benefit.

This is how the scientific method proved that opening arteries in stable patients provides no benefit in the COURAGE trial.

The question or hypothesis: “In patients with stable coronary artery disease, it remains unclear whether an initial management strategy of percutaneous coronary intervention (stents) with intensive pharmacologic therapy and lifestyle intervention (optimal medical therapy) is superior to optimal medical therapy alone in reducing the risk of cardiovascular events.”    Translation: Does a stent added to optimal medical therapy add any additional benefit compared to optimal medical therapy alone?

The experiment: “Between 1999 and 2004, we assigned 1149 patients to undergo PCI (a stent) with optimal medical therapy (PCI group) and 1138 to receive optimal medical therapy alone (medical-therapy group). The primary outcome was death from any cause and nonfatal myocardial infarction (heart attack) during a follow-up period of 2.5 to 7.0 years” 

The Result: “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.”

Now we have answered the question conclusively. Opening arteries in stable patients does not prevent death or heart attack. Now there are a total of 14 studies that have confirmed that finding and you can rely on that information. The most recent study proved opening arteries even in patients with severe blockages does not protect stable patients. It is a fact. It is the truth. Your health is your most precious possession. You can rely on medical information that comes from this kind of experiment. These studies have been done on thousands of medical topics, but here is the most tragic thing. This evidence is not being applied to your care. There are still tens of thousands of stents and bypasses done annually and most of you don’t have access to optimal medical therapy.

There is one other kind of evidence that is reliable, but it is not as reliable as the controlled clinical trial described above. Large population studies in the real world are helpful in informing medical decisions. For example, “According to a 2014 study by Cardiff University scientists published in the Diabetes, Obesity and Metabolism journal, patients with type 2 diabetes who take metformin have a slightly longer survival rate than people without diabetes. The study found that metformin users lived 15% longer, which is about three years, than those in the control group.” People with type 2 diabetes ordinarily lose about 8 years of life compared to individuals who don’t have the disease. In this study of 180,000 people, patients with type 2 diabetes lived 3 years longer than normal people. That is important information, and it is probably valid.

These are the only forms of information that I rely on when I write about healthcare. Other kinds of medical information have little or no value. Testimonials, advertisements, and individual experiences are virtually worthless as a guide to your healthcare choices. They are put before you to increase sales. I never rely on those sources of information. Get your medical information from reliable sources. The stakes are too high to do anything else.