What I Learned

About Medical Advice

Doctors and medical researchers are people. They are not perfect. They can make mistakes or be wrong.

This has to be balanced by the fact that they have spent many years absorbing very specific knowledge and engaged in rigorous training. The knowledge of a lay person with an internet connection cannot be compared with that of a medical professional.

Add to these two points the fact that the body of medical and scientific knowledge is constantly evolving. Why does it evolve? It does so because technology improves. New methods for research and clinical practice are developed. Experience is gained. Research studies are expanded to include larger and larger populations over longer periods of time. It is natural, expected, and beneficial that what medical professionals know (and tell us) changes over time.

Change is not monolithic. New knowledge gained through research eventually leads to changes in medical practice which eventually leads to changes in medical education. Change radiates out from centers of research to the far reaches of medical practice over time. It can take a while for clinical procedures and medical textbooks and the education of doctors and nurses to catch up to the state of the art.

I am thinking about this for two specific reasons.

The first is obviously the SARS-CoV-2 pandemic. People have complained that the medical advice we receive is confusing. That what we were told at the start of the pandemic no longer seems true. That every day someone seems to claim something different from the day before. This is understandable. Medical science around the pandemic has been influenced by a number of factors including previous knowledge about viruses, empirical results from the treatment of COVID-19 patients, and the explosion of medical research spurred on by the desire to end the pandemic as soon as possible so lives can be saved. Knowledge is evolving rapidly and the timeline of change becomes compressed. There is also so much effort being expended, so many different avenues of investigation. Some will bear fruit and some won’t. It can be hard for the lay person to understand which is which. And it can be frustrating to deal with the lack of certainty. But scientists and researchers know that knowledge changes. There is always more that needs to be done in order to achieve a level of confidence in what they know. And that confidence, while eventually high, might never reach 100%.

The second reason is I will have a medical procedure done soon. There are a number of restrictions I must abide by prior to the procedure. One of them is to avoid a number of vitamins and supplements. I was curious about this so I did a little bit of online research. The basic reason is because these substances are believed (and in some cases known or intended) to cause thinning of the blood. This can increase the potential for bleeding/decrease the blood’s clotting ability. So as a precautionary measure, people who are planning to have a procedure done are told to avoid taking these substances. One of them is fish oil. I thought that was odd so I looked it up. Fish oil – specifically omega-3 supplements – is lumped in with these other vitamins and supplements that can cause blood thinning. So many doctors tell patients not to take them before a procedure. However, I was able to find two articles (one from 2014 and one from 2018) suggesting that there is no significant difference in bleeding for patients who take omega-3 supplements vs. those who don’t prior to an operation.

So why am I still told not to take it? Well, there are two reasons. One may be for CYA reasons. The risk might be low but doctors like to minimize risk. They want to eliminate any possible complicating variables. That’s perfectly understandable. Don’t we all? The second might have to do with the state of the research. Perhaps the research is new and not yet established. Perhaps the research has not yet led to changes in clinical practice that may later be incorporated. In the meanwhile, doctors continue to employ practices that they trust. Asking someone not to take fish oil for a few days before their procedure probably isn’t a really big issue.

The medical advice we receive is influenced in a number of ways. But I believe that, for the most part, it is based on the best information that a doctor or medical professional has at their disposal at that time. That doesn’t make it perfect or always correct, but it is most reasonable and least risky as determined by a person or people who have more experience and training than I will ever have.

I can respect that.