Outdated medical practices, before they’re outdated
Been a while! Busy summer, making progress on my PhD, playing soccer, living life, etc. Some little ideas have been on my mind, which warrant a quick post. These are some embedded practices that most people take for granted, which I’d guess will eventually be thrown out. Into the dustbin of history, and medical professionals who advocated them pretending they never did.
Fluoride in the water:
Oh boy, has Olek finally gone off the rails?
I came across this Nature article about fluoride in the water supply. This seemed to be one of those things that I had passively accepted as helping teeth without any real downsides. It seems that was naiive.
In order for fluoride in the water to be a net benefit, it first has to have virtually no side effects, and second has to have a benefit for teeth.
The data basically boils down to:
1. Fluoride in the water doesn’t help prevent cavities since the advent of fluoride in toothpaste. Most countries do not fluoridate their water.
2. Fluoride is a pediatric neurotoxin and causes decrease in IQ of children when their mothers drink fluorinated water.
The effect size seems to be small, but significant. At relevant concentrations in the US, fluoride looks to cause about a 3 IQ point drop. Doesn’t sound like much, but an IQ of 100 is average, and 97 is 8% below average.
Public health decisions like this carry immense weight. If you add a mineral to the water supply where everyone is exposed to it, and can’t easily avoid it, you better be damn sure it’s perfectly safe (and effective). 😉
On wisdom teeth:
Wisdom teeth are removed by 90% of Americans, if you trust the Chapel Hill dentistry office. It’s a fairly common experience (I think) that people are shamed by their dentists into eventually removing their wisdom teeth.
Every time you go in they show you an x-ray, and tell you: “Oh this is looking pretty bad, wouldn’t want anything to happen to those pretty little teeth now, would we?”
Funnily, every time I broach the subject to someone (which I do regularly) they say “Oh, hmm, maybe but mine really had to come out.” Well, how true is that, really? No one who gets their wisdom teeth out can evaluate the counter-factual of “what if I had left them in?”
People other than dentists and maxofacial surgeons are asking some questions. The NYT:
This review states:
Third-molar surgery is a multibillion-dollar industry that generates significant income for the dental profession, particularly oral and maxillofacial surgeons. It is driven by misinformation and myths that have been exposed before but that continue to be promulgated by the profession.
I like people who write like me. But, it boils down to
1. Only 12% of people who don’t have their wisdom teeth removed will have an issue with them later in life (88% will be fine).
2. Molars can’t actually crowd your teeth, because they don’t have firm backing to push in
3. Getting wisdom teeth out is not more dangerous when delayed.
On wisdom teeth alone, dentists make $500k a year. Gotta guess that they’re not gonna be the ones to pull the emergency brake on that gravy train.
“There can be no excuse for tolerating so many unnecessary extractions on millions of unsuspecting and misled people and putting them at risk of so much iatrogenic nerve injury. This is a public health hazard.”
Appendix removal:
The humble appendix. It hangs off the colon, and an infected appendix has made an appearance in movies, books etc. In the US, virtually all infected appendices are removed.
This ignores the fact that there are multiple levels of danger for an appendix infection. An infected appendix that is “perforated” aka torn is dangerous, and a medical emergency.
However, ultrasounds can now tell without fail whether an appendix is burst. A large, randomized trial has also found that about 2/3 of infected appendixes can be treated with a course of antibiotics. That means a huge amount of people are getting their appendix cut out for no reason.
It seems that we’re also realizing that the appendix is not simply a vestigial organ, and might have useful functions. It might be a home for healthy bacteria which repopulate the gut when you get sickStill not certain though.
Colonoscopies starting at age 40:
This was the subject of a recent and high profile randomized trial, I’m gonna push Professor Vinay Prasad because I find him to be the most compelling assessor of medical evidence.
This NordICC trial says that colonscopies don’t have a benefit in overall survival. There are other cancer screenings he fires at in this take, but it seems like men have largely been drinking a bucket of laxatives, getting put into a “twilight” state of sedation, and having a big camera shoved all the way up your colon, with pincers that can take samples, for no reason. Oopsie.
There is some incidence of perforation, and side effects. There are other, less invasive treatments with more data. I’m gonna have to pass on this one, doc.
That’s all for now folks, hope everyone is doing well.