Evaluating Medications and Supplement Products (cont.)
Melissa Conrad Stöppler, MD
Melissa Conrad Stöppler, MD
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
How do doctors recommend treatments for disease prevention?
The decision-making process in disease prevention is necessarily imperfect; it is a combination of judgment, experience, and science. It is a balancing act between being cautious (by doing no harm) versus being proactive.
Preventing disease is different from treating diseases. In treating diseases, doctors and patients are often willing to accept a finite degree of risk of side effects in order to achieve a cure or improvement in symptoms. In preventing diseases, doctors are extremely risk adverse. Remember, the first priority in doctoring is to "do no harm". Thus when prescribing an agent for prolonged periods of time to prevent a disease that may or may not occur, the doctor would not want that agent to cause adverse side effects in a healthy person.
Do not always insist on conclusive proof
Sometimes doctors are willing to recommend a long-term preventive treatment in the absence of any conclusive proof of benefit, provided that we know the treatment is safe. This is especially true if the treatment also has a sound scientific basis and has been found beneficial by observational studies.
Learn from history
Consider blood cholesterol as another example. Thirty years ago, observational studies suggested that high blood cholesterol (like homocysteine) could cause coronary artery disease and heart attacks. Even though there were no double-blind, placebo-controlled trials available, doctors in those days suspected (correctly) that lowering blood cholesterol could reduce heart attacks. They were recommending low fat diet and exercise to lower blood cholesterol, and medications such as statins only when diet and exercise failed. They also did one very important thing-they started numerous, large scale randomized, placebo-controlled trials to determine if lowering cholesterol actually prevents heart attacks.
Today the prospective trials they started have been completed. These trials have conclusively shown that lowering cholesterol (especially the bad LDL cholesterol) reduces heart attack risks and prolongs life. These trials further showed that the benefits of lowering cholesterol outweigh the risks of side effects of the statin medications. Therefore doctors today are much more aggressive than doctors of yesteryears. Doctors are much more willing to use medications such as statins to lower cholesterol, and the "normal cholesterol level" has been rapidly reduced.
Medically reviewed by John A. Daller, MD; American Board of Surgery with subspecialty certification in surgical critical care
Medically Reviewed by a Doctor on 3/20/2017