I am looking forward to participating in a TEDMED Google+ Hangout, March 25th at noon, on the topic of Health Myths. You should come participate! To quote a blogpost from the TEDMED folks:

You can get the flu – or worse — from a vaccine. Only old folks get strokes and heart attacks. Calories in, calories out. X-rays cause cancer. Sleep eight hours a night and drink eight glasses of water a day. Skip the sunscreen on a cloudy day. Take a multivitamin every day, just to be on the safe side. An apple a day keeps the doctor away. Exercise more to lose weight.

What are the most popular health myths, and how do they spread?  Does social media spread scams faster that it helps dispel them?  How can doctors help patients practice proven steps for prevention – and still keep up on current research themselves?

Great questions all. Leaving aside a quibble about X-rays and cancer (about which the jury seems to be out still, or at least conflicted), the list above points to something important about so-called health myths: they come in many different flavors. Flu is not caused by a vaccine; that's just wrong. But older people are generally speaking indeed at higher risk of strokes and heart attacks (though of course it's not only them). "Exercise more to lose weight" isn't exactly true, but exercising is one way to keep off weight lost through reduced caloric intake (and - can lead to weight loss by itself, actually).

All this is just to say that one myth may be quite unlike another. They are as diverse in their way as any kind of belief. Thinking more about it, I would like to jettison the whole term "myth" altogether. We all have beliefs. Some of them hew fairly closely to the science - others don't.

What the summary above artfully avoids is potentially the most interesting question: who believes most in scientifically unfounded assertions? Is it patients, or doctors (and nurses) themselves? I would wager that we are all in the same boat. Much as doctors don't know statistics, much of us don't practice according to the medical evidence either.

If you push a little bit on many medical assertions once held to be widely agreed-upon truths, you will find yourself coming away with a handful of dust -- and more, if you push harder. Does everyone need screening for prostate cancer? No. What about breast cancer? Unclear. Does vitamin D help much, say, for heart disease (except in older populations at risk of fracture)? Maybe, though the evidence is thin. If we treat mild hypertension, can we expect mortality benefits? Doesn't seem that way. Yet practices based on these suppositions persist.

In other words, doctors are as much myth-makers, and myth-peddlers, as patients. Which means we all need to reevaluate our relationship to science. If doctors can be as uncertain as patients, shouldn't we be skeptical of the hierarchy that still obtains in certain quarters? Shouldn't we come together to discuss our fears, preconceptions, worries, and expectations?

A guest post by a friend who wishes to remain anonymous.

I am an American expat. As a pregnant woman in Israel it is challenging to navigate a new health system when most of my information resources are geared to another system.  This is especially true for pregnancy, where there are many decisions to make regarding symptom management, prenatal testing, and giving birth.  However, on comparing the US and Israeli health care systems from my perspective, I find that the latter has notable advantages.

Unlike the semi-private system in the US, Israel has a nationalized, single-payer health system.  This difference reveals itself in terms of spending priorities.  For example, in the US, obstetricians are responsible for all prenatal care and deliveries, both low- and high-risk.  In Israel, the default is for gynecologists to manage pregnant women’s health and for registered nurse midwives to deliver babies.  Special facilities and obstetricians are available in the event of complications.  This approach is less costly, yet results in similar or better health outcomes.

In a private system, doctors and hospitals may try to attract patients with perks such as more attractive facilities and more attentive staff.  In Israel, the law prohibits private midwives; many hospitals will not accept private OBs or doulas in order to ensure that care is not stratified by economic status.  Furthermore, the women I’ve spoken with report somewhat spartan conditions in the regular birth wards, but are overwhelmingly satisfied with the level of care for women and neonates who experience complications.  In other words, money goes towards medical necessities rather than pleasing the patients.

Another major difference between the US and Israel is the attitude of medical professionals towards the women in their care.  US practitioners are more proactive in providing guidelines to pregnant women regarding food and medication safety and symptom management.  Israeli practitioners rely on women to do their own basic research and to ask specific questions.  Further, in the Israeli system, women have unlimited, no-cost visits to family doctors and gynecologists, whereas cost of prenatal care and testing are greater concerns to women in the US.

Critics of nationalized health care in the US argue that such systems reduce patient choice and reduce quality of care.  In my experience, it is true that patient options are more limited.  However, outcomes are comparable on average.  Furthermore, the limited out-of-pocket expenses and the clear information on costs faced by patients contribute to peace of mind.

I covered one of the chief residents in our hospital for two days this past week, seeing more than 40 patients in total. My off-the-cuff remarks on Facebook still apply:

Twenty-two inpatients later, it is time once again to declare my awe and admiration for all who do this work daily: hospitalists, housestaff, nurses, techs, custodial staff (et al., et al.). And, of course, the patients who are - on the other side of the hospital mirror - working harder, in their way, than all of us.

What's more, I was struck - not for the first time - by the differences between the hospital and clinic, not just in tone, atmosphere, communication, and pace, but in how those things affect medical thinking and decision making.

I am not talking about critical care or emergency medicine, nor about "codes" (cardiac resuscitation) - merely because I do not participate in such care regularly. But I think my observations might still apply.

Simply put, the hospital operates under the assumption that things have to move faster. That tempo, I believe, encourages a certain frame of mind: we should treat, do, test. People are sick, we want to make them better, and lab tests and interventions are an avenue to this.

You already see where I'm going, because - if you know me or my blog - you know my bias. If anything, I think we tend to over-order as a health care system....and the scientific literature bears me out.

What would it mean to apply evidence-based medicine to hospital care, in a thorough-going fashion? I mostly do outpatient medicine, and guarantee you that I assume no superiority for the application of EBM in that realm: no, much of what we do in clinic is still based on intuition, externalities, unsupported lore, personal preference (not the patient's, God forbid, but our own as doctors), or some other blend of bias and conviction.

Would it be harder in the hospital to take stock? Would workflow be disrupted?

Or is it just that I am unaccustomed to the hospital, and things are really changing in that direction? What do you think?