In 2013, some common therapies were shown to be less effective than we thought
Aaron Carroll: Some examples -- exercise is better than pills, vitamins don't work
Carroll: Therapies that work for severe cases (statins, antibiotics) are over used
Carroll: We spend billions on these when we could spend it on better measures
Editor’s Note: Aaron E. Carroll is a professor of pediatrics at the Indiana University School of Medicine and the director of its Center for Health Policy and Professionalism Research. He has supported a single-payer health system during the reform debate. He blogs about health policy at The Incidental Economist and tweets at @aaronecarroll.
It’s hard to be too curmudgeonly about the state of medicine right now. After all, you’re much less likely to die of almost any disease today than at any other time in human history. Infant and maternal mortality are at an all-time low. Life expectancy is on the rise. And yet, 2013 feels like it was a bit of a disappointment in terms of medical advances.
Part of that is because some commonly used therapies were shown to be less effective than we thought. A few weeks ago, I wrote here that lifestyle changes are just as effective for reducing your chances of dying from heart disease, stroke and diabetes as drugs were. Yet we spend billions of dollars on such drugs.
Multivitamins have been the subject of many studies. Some have shown them to be of limited benefit; a few showed vitamins caused some minor improvements in the risk of certain diseases like cancer.
More adults in the United States take vitamins than don’t, and on these, too, we spend billions of dollars per year. But three studies published in the Annals of Internal Medicine this year laid waste to these claims. One of them was a huge meta-analysis that found vitamins didn’t prevent heart disease or cancer after all. Another showed that vitamins did nothing to improve cognitive functioning in men over the age of 65.
The studies were accompanied by an editorial titled: “Enough is Enough: Stop Wasting Money on Vitamin and Mineral Supplements.”
The FDA has also made news this year by banning things we once thought were good for us. First it went after trans fats. It’s hard to believe, but these additives became popular, in part, because the medical community believed they were safer than animal fats. Turned out we were wrong.
Because of a growing body of evidence, it’s hard to ignore that trans fats are, in reality, more dangerous, and worsen cholesterol levels in people who eat them. Unless the FDA alters course, which seems unlikely, they will be all but eradicated from our foods in the near future.
The FDA also went after antibacterial soaps. For decades these have been touted as a way to prevent disease by making hand washing more effective. Of course, for decades the FDA knew there was no proof that they worked any better than plain old soap, but until now it didn’t do anything about it. That changed just a few weeks ago. Companies will have to start producing evidence of their effectiveness, or remove the antibacterial components from their products.
One of the reasons for our concern, by the way, is the growing evidence that our overuse of products to fight bacteria could lead to a future where they don’t work at all. In addition to the antibacterial chemicals in soaps, antibiotic drugs are used quite a bit in raising livestock. Earlier this year, a person died in New Zealand from an infection that was resistant to every single antibiotic they could find. This led many to worry about a not-too-distant future where many of our medical gains would be reversed.
At some point, we must accept that if something works for the very ill, it does not mean that it works for everyone. Vitamins have a place in the treatment of people who are truly clinically malnourished. Providing them to people who already get more than enough does no good.
Statins were studied, and worked, in people at high risk for heart disease; but we’re seeing guidelines that push them on huge numbers of Americans. Antibiotics have their place in fighting real bacterial infections, but we often use them when they’re not needed.
At the same time, we don’t spend nearly enough on public health measures that could make much more of a difference. We have no problem subsidizing the cost of drugs, but we’d hardly consider subsidizing exercise or dieting at the same levels. When we look back on 2013, it feels like we’re relying too much on medical fixes for problems that have other solutions, and, perhaps, beginning to see their limitations.
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The opinions expressed in this commentary are solely those of Aaron Carroll.