Your Health Checkup: Why Is Medical Advice Constantly Changing?

“Your Health Checkup” is our online column by Dr. Douglas Zipes, an internationally acclaimed cardiologist, professor, author, inventor, and authority on pacing and electrophysiology. Dr. Zipes is also a contributor to The Saturday Evening Post print magazine. Subscribe to receive thoughtful articles, new fiction, health and wellness advice, and gems from our archive. 

Order Dr. Zipes’ books, Ari’s Spoon, a new novel, as well as Bear’s Promise and Damn the Naysayers, A Doctor’s Memoir. Check out his website at dougzipes.com.

Friends and family often challenge me with the question, “Why can’t you doctors agree on something and stick to it without constantly changing your minds about what benefits or harms us?”

Their complaint is partially justified. The reality is that our knowledge of medicine is constantly changing; facts we learned today replace concepts we thought were true yesterday, and which will probably change tomorrow. When I was in medical school many years ago, one professor lectured, “Half of what we teach you will be wrong; the problem is we don’t know which half.”

However, ideas and recommendations that are rock solid and have withstood the test of time and the rigors of scientific inquiry remain constant. For example, we know the best way to treat many things, such as infections with certain antibiotics, surgery to cure countless disorders, or vaccines to prevent many illnesses.

But I’m reminded of Winston Churchill’s sage advice: “I’d rather be right than consistent,” a recommendation every competent health care worker follows.

I recently wrote that acetaminophen (e.g., Tylenol), the most widely used over-the- counter and prescription pain medication worldwide, was perceived to be safer than many nonsteroidal anti-inflammatory drugs (NSAIDS, which can elevate the blood pressure) but that high doses could cause liver disease. In the United States it is estimated between three to five percent of the adult population regularly ingest acetaminophen.

Results from a recent study add to concern about risk to the liver. In a carefully controlled investigation, 110 individuals were randomized to receive one gram of acetaminophen four times daily (a recommended dose) or a placebo for two weeks followed by a two-week washout period and then receive the alternate treatment. Acetaminophen compared with a placebo increased systolic (top number) blood pressure by about 4.7 mm Hg and the diastolic pressure by about 1.6 mm Hg in individuals with hypertension. The observation is important because the results raise questions about the safety of regular acetaminophen use since even small elevations in blood pressure increase cardiovascular risk. Another article made the point that effervescent or soluble formulations of acetaminophen contain sodium (salt) and have been associated with a higher risk of cardiovascular disease and mortality compared to non–sodium-containing acetaminophen in a dose-related fashion (i.e., the greater the intake, the greater the risk). Sodium can contribute to elevating the blood pressure.

Blood pressure is a fundamental predictor and determinant of cardiovascular health. It is important to remember that when your doctor checks your blood pressure, be sure the size of the cuff fits your biceps. Think of it as a comfortably snug but not tight shirt sleeve. A cuff too small can give a spuriously elevated blood pressure reading, while a cuff too large can falsely furnish a low reading.

A last detail for Post readers living in rural communities is to be sure you have access to topflight care. A recent study concluded that cardiovascular mortality rates are higher in rural communities, compared with urban areas, due to reduced access to health care and a greater burden of traditional and socioeconomic risk factors. This is especially true for acute cardiovascular conditions such as heart attacks, heart failure, and stroke, for which adults admitted to rural hospitals have higher mortality rates than their urban counterparts. While some rural hospitals undoubtedly provide superb and up-to-date attention, if you become acutely ill consider seeking care at a major urban medical center where the latest in medical advances are likely to be found. They will certainly know which half of medical knowledge is the correct half!

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