Change Minds Because Doctors Change Minds

In 2001, when pediatric allergist Gideon Lack asked a group of about 80 parents in Tel Aviv if their children were allergic to peanuts, only two or three hands raised. Lack was perplexing. Back home in the UK, peanut allergy has quickly become one of the most common allergies among children. When comparing peanut allergy rates among Israeli children with the rate among Jewish children in the UK, the UK rate was 10 times higher. Was there anything in the Israeli environment – a healthier diet, more time in the sun – preventing peanut allergies from developing?

He later realized that many Israeli children had started eating Bamba, a peanut-based snack biscuit, as soon as they could handle solid foods. Could the first exposure to peanuts explain it? The idea had never occurred to anyone because it seemed so obviously wrong. For years, pediatricians in the United Kingdom, Canada, Australia and the United States had told parents to avoid giving peanuts to children until they were 1 year old, because they thought an early exposure might grow up the risk of developing an allergy. The American Academy of Pediatrics has also included this advice in its guidelines for feeding children.

Mancanza and his colleagues have begun planning a randomized clinical trial that will take until 2015 to complete. In the study, published in In the New England Journal of Medicine, some children were given peanut protein before childhood while others were expectant after first grade. Children in the first group had an 81 percent risk of peanut allergy at 5 years of age. All past guidelines, developed by expert committees, may have contributed to a slow increase in peanut allergies.

As a doctor, I found the results disturbing. Prior to the release of the findings, she had advised a new parent that their daughter should avoid allergenic foods such as peanut protein. Looking back, I couldn’t help but feel a hint of guilt. What if she had a peanut allergy now?

The fact that medical knowledge is constantly changing is a challenge for doctors and patients. It may seem as if medical knowledge comes with a disclaimer: “True … for now.”

Medical school teachers sometimes he jokes that half of what students learn will be obsolete by the time of their graduation. That half often applies to clinical practice guidelines (CPGs), and has consequences in real life.

A CPG, usually developed by expert committees from specialized organizations, exists for almost any disease with which a patient can be diagnosed. While the guidelines are not rules, are widely reported and can be cited in cases of medical malpractice.

As medical knowledge changes, guidelines change. Hormone replacement therapy, for example, was the standard gold treatment for menopausal women struggling with symptoms such as hot flashes and mood swings. Then, in 2013, a trial by the Women’s Health Initiative showed that therapy may be more risky than previously thought, and several guidelines have been revised.

In addition, for several years, women over the age of 40 were asked to get annual mammograms — until new data in 2009 showed that early routine screening resulted in unnecessary biopsies without reducing mortality from breast cancer. u senu. Regular mammograms are now offered primarily for women over 50, every two years.

Medical reversals usually happen slowly, after several studies changed old recommendations. Covid-19 accelerated them, and made them both more visible and more disturbing. In principle, even some medical professionals have presented the coronavirus as no more severe than the flu, before its true severity was widely described. For a while, people were told not to bother with masks, but then they were advised to try them on. double masking. Some countries are stretches the intervals between the first and second dose of vaccine. Of course the state of the pandemic, and our knowledge of it, is constantly changing. Yet, throughout the past year and a half, we have all experienced medical frustration.

It is too early to say how these changes will influence the way patients perceive the medical profession. On the one hand, seeing the debate among openly conducted medical experts could give people a higher understanding of how medical knowledge evolves. It could also instill lasting skepticism. In 2018, researchers analyzed 50-year-old vote data on confidence in medicine. In 1966, 73 percent of Americans said they trusted “the leaders of the medical profession”. In 2012 that number had dropped to 34 percent – in part, the authors assumed, due to the continuing lack of a universal health care system.

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