Thou Shalt Not Try to Outsmart Me

Medical researchers and their groupies – early adopters, thoughtleaders, those easily influenced or whatever you want to call them – never seem to learn that when you try to outsmart Mother Nature or Our Heavenly Father, whichever appeals more to your world view, you usually get your hand slapped.

When I was a resident (1981-1984), I got penalized if I didn’t offer postmenopausal women estrogen-progesterone replacement therapy because it seemed obvious that if women with endogenous estrogen didn’t get many strokes or heart attacks and women without estrogen did, all we needed to do was make up for God’s or Mother Nature’s oversight in not keeping the estrogen coming after age 50.

Then the Women’s Health Study in 2000, almost 20 years later, showed that women on Prempro had more strokes, blood clots and heart attacks, and more breast cancer on top of that, than women who accepted the natural order of things – menopause with all its symptoms and inconveniences.

The same things has happened with osteoporosis – more subtrochanteric femur fractures after five years of Fosamax than in untreated women.

A simple thing like hypertension has played out similarly: People who take certain third tier blood pressure medicines, like alpha blockers, don’t have the benefit of lowering blood pressure that you might expect; those medications actually increase risk of death from cardiovascular causes.

The typical blood sugar targets that have been drilled into our heads, hemoglobin A-1 C under 7%, have been found to be detrimental to older patients who are more sensitive to low blood sugars than younger patients, so now we have a hemoglobin A-1 C target of 8% for older folks (thank goodness, especially for those with classic late onset diabetes).

And even my own affliction, gastroesophageal reflux, has a downside when you rely entirely on medications instead of lifestyle measures for management; escalating proton pump inhibitor doses are now known to increase the risk of iron and vitamin deficiencies, osteoporosis, pneumonia and C. difficile infections.

Just like prednisone and Humira work brilliantly when you feel like you have do decrease autoimmunity, rather than say “what it is making the immune system overreact” (gluten, artificial food additives and antibiotics in the food chain), reaching for medications instead of asking “what is my body/God/Mother Nature trying to tell me” sooner or later might come back to haunt us.

We must always ask: “Is this a symptom caused by unhealthy lifestyle choices that need to change rather than medicated with more or less risky medications” or “Is this an aging manifestation normal enough to make medications unnecessary” or “Is this premature aging and possibly worthy of intervention?”

Aging phenomena that happen to everybody, such as osteoporosis, are perhaps, just possibly, better left alone, at least as far as drugs go, but certainty a subject for lifestyle exploration and intervention?

Which makes me think of all the hype about “Low T” (testosterone). Isn’t that the estrogen story all over again? I guess time will tell…

14 Responses to “Thou Shalt Not Try to Outsmart Me”


  1. 2 David Welsh December 13, 2019 at 7:23 pm

    Brilliant!!!!

  2. 3 Marguerite joyce December 15, 2019 at 8:29 pm

    I’m old school in 50 had country dr who came to the house i dont trust drs or meds for long time i do home remedies don’t have to go to college or try that to be a professorial i didn’t and in our day’s we took care of family no matter what they had of it weren’t for the Government forces Pharmaceutical. companies to make meds that cause disease and condition we never had back then and they force pharmacies are told not to tell the truth about meds

  3. 4 Brian December 25, 2019 at 10:53 am

    WELL DONE.Similar thoughts offered by Gilbert Welch in Over-diagnosed


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Osler said “Listen to your patient, he is telling you the diagnosis”. Duvefelt says “Listen to your patient, he is telling you what kind of doctor he needs you to be”.

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