Change your mind about why the doctor changed his mind


In 2001, when Pediatric allergist Gideon Lack asked a group of about 80 parents in Tel Aviv whether their children were allergic to peanuts, only two or three hands were raised. Luck puzzled. After returning to the UK, peanut allergy quickly became one of the most common allergies among children. When he compared the peanut allergy rate among Israeli children with the peanut allergy rate among Jewish children in the United Kingdom, the allergy rate in the United Kingdom was 10 times higher. Is there something in the Israeli environment — a healthier diet, more sun exposure — that can prevent peanut allergies?

He later realized that many Israeli children started eating Bamba, a peanut-based snack biscuit, after being able to handle solid foods. Can early peanut exposure explain it? No one has thought of this idea, because it is obviously wrong.For many years, pediatricians in the United Kingdom, Canada, Australia, and the United States have been telling parents not to give their children peanuts until they reach the age of 1, because they think early exposure to peanuts may be increase Risk of allergies. The American Academy of Pediatrics even incorporated this recommendation into its infant feeding guidelines.

Laque and his colleagues began planning a randomized clinical trial, which will not be completed until 2015.In the study, published in New England Journal of Medicine, Some children are given peanut protein in early infancy, while others have to wait until after the first year. The first group of children had a 81% reduction in the risk of peanut allergy at 5 years of age. All guidelines developed by expert committees in the past may inadvertently lead to a slow increase in peanut allergies.

As a doctor, I found the results disturbing. Before the results of the survey were released, I advised a new parent that her baby girl should avoid allergic foods such as peanut protein. Looking back, I can’t help but feel a trace of guilt. What if she is allergic to peanuts now?

The fact that medical knowledge is always changing is a challenge for both doctors and patients. Medical knowledge seems to carry a disclaimer: “Yes…for now.”

Faculty of Medicine Professor Sometimes it is joked that half of what students learn will be out of date by the time they graduate. This half usually applies to clinical practice guidelines (CPG), which have real-life consequences.

CPG is usually formulated by an expert committee of a professional organization and is suitable for almost all diseases in which a patient can be diagnosed.Although the guidelines are not rule, They are widely mentioned and can be cited in medical malpractice cases.

When medical knowledge changes, the guidelines will also change. For example, hormone replacement therapy used to be the gold standard treatment for menopausal women who struggled with symptoms such as hot flashes and mood changes. Then, in 2013, a trial of the Women’s Health Initiative showed that this therapy may be more risky than previously thought, and many guidelines have been revised.

In addition, women over the age of 40 have been urged to have a mammogram every year for many years-until 2009, new data showed that early routine screening would lead to unnecessary biopsies without reducing breast cancer mortality. Now it is mainly recommended that women over the age of 50 have regular mammograms every other year.

After multiple studies have changed the old recommendations, medical reversals usually occur slowly. Covid-19 has accelerated them, making them more visible and disturbing.In the early days, even some medical experts described the coronavirus as Not more serious than flu, Before its true severity is widely described.For a while, people were told not to wear masks, but then they were advised to try Double masking. Some countries are Extended interval Between the first and second doses of vaccine. Of course, the state of the pandemic and our understanding of it are constantly changing. Nevertheless, in the past year and a half, we have all experienced medical flogging.

It is too early to say how these reversals will affect patients’ perceptions of the healthcare industry. On the one hand, seeing the open debate among medical experts can make people more aware of how medical knowledge evolves. It may also instill a lasting skepticism. In 2018, researchers analyzed 50 years of poll data on Trust in medicineIn 1966, 73% of Americans expressed confidence in “the leader of the medical profession.” By 2012, this number had dropped to 34%-the author speculates, partly because of the still lack of a universal healthcare system.


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