Dr. Eric Topol: ‘Population medicine — Let’s get over it’

Dr. Topol devastates one-size-fits-all health/lifestyle advice.

Topol says:

Eric Topol MD: The topic is population medicine and why we can’t get over this. It’s befuddling to me. Let me go back for a few examples so you can understand what I’m really getting at:

– The New York Times, June 9, 2013—”This is your brain on coffee”; why drinking three cups a day may be good for us. Well, does that take into account that at least 20% of people carry an allele where the metabolism of caffeine is markedly reduced, and that risk allele has indeed been linked to a higher risk of heart attack? Why should there be a recommendation now that all of us should be drinking three cups of coffee a day?

– Then in May of this year there was a big Institute of Medicine report regarding what should be the salt guidelines. And this got all sorts of organizations rankled—the American Heart Association [for instance], about what should be the salt recommendations for everyone. This is crazy stuff, because we know there are some people who are remarkably salt-sensitive and will have a blood-pressure response to a salt load, and then there are many others who are what essentially appears to be salt-resistant, as they can have as much salt in their diet as possible and it’s not going to have an effect on their blood pressure.

– Currently we have this European Society of Cardiology/European Society of Hypertension guidelines that blood pressure should be less than 140 mm/Hg for all. Now if you go through the guidelines it talks about [how] those over 80 years . . . are exempt, but why do we have to have this “for-all” approach? That is just not working, it’s not right, it’s basically the structure of guidelines that doesn’t respect the individuality of what’s unique about us biologically, physiologically, and anatomically—our environment, everything.

It’s frustrating to me just because I’ve been watching this for so many years, and we still have this fixation about having some guidelines or recommendations for all people. It just doesn’t stop. When are we going to get this straight?

I’ll be really interested in your comments. It’s been a pet peeve of mine for a long time, and unfortunately I’m not seeing any progress. Maybe you know how we can not try to simplify things so much and move forward.

Thanks a lot for your attention.

Watch the Topol video.

4 thoughts on “Dr. Eric Topol: ‘Population medicine — Let’s get over it’”

  1. is the poster THE ERIC TOPOL, THE EDITOR OF ONE OF THE WEB’s BEST MEDICAL PRACTITIONER WEB SITE MedScape–MY GOODNESS, AND TALKING SENSE. This post or essay or whatever is like the Shaw discussion of last week on obesity diabetes thing–common sense talk about medical junky stuff..

    Ok Topol, you asked for it. Multiple inquiry produces some of what Stan Young talks about–the kind of crap that comes out of the Nurses Heatlh study group that dredges for associations that don’t end up being important or even verifiable. They can’t be duplicated because people like Ascherio and Willett and the army of epidemiologists just find asslciations in the small ranges that are the product of tunnel vision and confirmation bias and CHEATING by using small associations that come nowhere close to meetin ghte requirements for magnitude of effect.

    Stan Young is an old ally on this stuff and works at the National Institute for Statistical Science (NISS) and one little project he did was ask many Medical and EPI Journal Editors if they required a multiple inquiry adjustment (the Bonferroni claw) and the answer back was no. They also don’t do an adequate job of weeding out the small association studies that have confidence intervals that include 1.0..

    I could go on, but its important to know what is said in the Epidemiology Chapter of the Reference Manual on Scientific Evidence, now in its 3rd edition. The Chapter was written by three prominent people, the lead author was Leon Gordis, the doyen of public health epidemiology.

    May i remind you one of the myths proven wrong was the type a personality/heart disease thing, but the boys at Harvard are always coming up with some new thing that is the product of dredging in the low rates of events, producing “statistically and the work of the Ascherio and Willett group.

    they want to nanny around and medical people have been obsessed by the idea of risk profiling.

    One last thing–i disagree with the great Topol, the salt thing developed, not around hypertension but around heart and kidness disesae–salt restricted diets were considered good to reduce congestive heart failure and salt sensitive kidney disease and so it became a kind of myth that restricting your salt was going to save you from edema and fluid overload. Sure, some made a case on the idea that salt excess would cause hypertension, but that was i the context of people know all kinds of people who were on salt restricted diets and “public health advocates” just got sloppy and started trying to get people salt conscious.

    today I got a great link to an interview with Sebelius on the bamstercare
    and Topol asked good questions of the idiot lawyer from kansas.

    I would say the simple analysis is centrally planned utopian projects don’t work and the one that gonna kill the structure of the current bamstercare is the phenemenon called the death spiral–a dramattic phrase that describes adverse selection, which happens in the setting of what economists call the tragedy of the commons–community rating and elimination of underwriting to deal with preexisting conditions always produces a negative price trend that keeps people on the sidelines.

    The only solution would be a penalty that exceeds the cost of the insurance in the age groups of the invincibles and a Medicare B like retrograde premium.

    Right now the left is not interested i makin Bamster care work–they budget for bamstercare is just another slush fund, and teh exchanges are jobs programs for ACORN people between election campaign and political gigs.

    john dale dunn MD JD

  2. One size does not fit all. In fact, observational studies replicate so poorly that claims from observational studies may not fit anyone. In 2005 Ioannidis JAMA examined highly cited studies where he could find a replication study. 5/6 the claims coming from observational studies failed to replicate or the claimed effect was much smaller.

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