Medicine based on customs

@varelalaf

The universe of my childhood was full of incontestable rules; most of them had to do with the precepts of religion, although the matter affected all aspects of daily life. I remember that you could not bathe in the sea or in the pool if you had eaten or drank within a minimum period of two hours, a period that the strictest families extended to three. When you were a teenager and you protested, the parents told you all kinds of calamities that could happen to you if you failed to comply with the rule, according to a lot of legends that were passed down from generation to generation.

In this customary culture, modern medicine grew throughout the last century in a climate in which a convincing pathological and physiological theory gave the appropriate scientific patina to create a new recommendation, which soon became an indisputable custom. As an example, in the last few days, three studies have fallen into my hands that question clinical practices that have been taking root in accordance with the precepts of customs-based medicine.

Vitamin D and calcium to prevent fractures in the elderly

If the bones become brittle over the years and lose calcium, it stands to reason that taking vitamin D and calcium supplements may strengthen them and prevent fractures, but now a systematic review of studies done in older people living in a community setting has concluded that these supplements don’t reduce the incidence of fractures (the review has excluded institutionalized individuals with vitamin D deficiencies, osteoporosis, or with previous fractures). What has been discovered, however, is that these supplements are associated with a higher incidence of kidney stones.

Don’t drink liquids two hours before anaesthesia

Preoperative protocols of custom-based medicine recommend not ingesting fluids two hours before an intervention, assuming that a person with fluid in the stomach is more likely to vomit in the postoperative period, but an English retrospective study of 11,500 patients, has discovered that reality contradicts the theory. That is, drinking liquids without restrictions before anaesthetic induction reduces the likelihood of nausea and vomiting upon awakening. This discovery is changing the guidelines, now urgently needed anaesthesia should be able to be dealt with.

Recommending salt-free food to people with heart failure

Salt is a food seasoning that helps to raise blood pressure and, for this reason, abolishing it from the kitchen of older people has a big predicament, but if we focus on people with heart failure, we notice that a systematic review concludes that there isn’t enough evidence to support the removal of salt from the food of these patients in their daily life, nor to prescribe a diet without salt during their hospitalizations. The point is that people with heart failure already have many limitations and must take a lot of medication, so it would be wise not to add more prohibitions, especially if we know that they are useless.

Reviewing practices and routines in light of the evidence is an obligatory strategy, if we want to leave behind medicine based on customs, a culture that has done (and still does) so much unnecessary damage to humanity.

Jordi Varela
Editor