Some patients get upset if I will not accept, on faith, that their latest homeopathic, holistic, ionized, wheat grass remedy (you get the idea) was unlikely to cure their arthritis. Many years ago I accepted the fact that there are many things I do not, and probably never will, know.  But I like to think I know SOMETHING.

I think the perception that we doctors don’t know anything derives from how often patients get told crazy, conflicting health advice. Consider a man who was born in 1949 who would be about 60 now. In his lifetime, he would have seen doctors talk about which brand of cigarettes had the greatest health benefits and that a hearty breakfast of bacon and eggs was healthy. However, he would also remember being told that the cholesterol in eggs and bacon would kill him but then he’d recall being told that maybe it wasn’t as bad as we originally thought. More recently, he has probably heard that there is good and bad cholesterol and he needs to get more of the good and watch out for the bad.

Is it any wonder, after all that, he glumly concludes that we doctors just don’t know what we’re talking about? The problem here is that there’s a vast difference between not knowing everything, and not knowing anything. The few things we know for certain are undeniable facts, as hard and inarguable as a brick. Everything else comes down to playing the percentages.

Why is that? I’m glad you asked. You see, humans are vastly complicated animals, with extremely complex lives. So it can often be very difficult to figure out how best to treat a particular health problem. It could get better because of something you did, something the patient was doing on his own, or some quirk of his DNA that makes him better able to fight it off on his own.

If we want to be sure, we would need to take groups of identical twins, lock them in cages from infancy, feed them identical diets and then infect them with the diseases we want to study and just treat one of them. Of course, that would be nothing short of ridiculous, so in practice we settle for less radical methodologies.  

For example, let’s take the French study on breast cancer risk with different types of estrogen that I mentioned in my last blog. Click here to view the study. They studied 54,000 women over a 10-year period of time, some of whom were on the classic horse-urine hormone cocktail (includes 36 hormones from the urine of a pregnant horse) and some who were on human estrogen. When examining studies like this, we have to take the number of breast cancers that are likely to occur in any random population and measure what the difference is between cancer cases of our test population and the general population.

Hold on… let me explain the math here. If the number of cases of cancer in our test groups corresponds exactly to what you’d expect to find in the general population, we rate this “relative risk factor” as 1. Any number above one means there was more cases than you’d find in the general population and any number less than one means there was fewer than you would expect to find. So, a relative risk factor of 1.4 would mean we had a 40% higher instance of cancer. Or, a relative risk factor of .9 would mean we had 10% few instances of cancer.

Which, incidentally, is just what that French study showed. The horse-estrogen cocktail group had a 40% higher incidence of cancer than the general population and the more human estrogen group had a 10% smaller incidence of cancer than the general population. 

Does that mean that human estrogen will cut your breast cancer risk by 10%? Actually it doesn’t. The intellectually-honest scientist at this point will tell you that the data means just what it says and nothing more. What we can say for certain is that they definitely didn’t have a higher incidence of cancer like the horse-estrogen users did. 

As more studies are conducted and we obtain more data, we may find that there was some other factor that was responsible for that 10% lower incidence. Of course, we could also find that it was actually the human estrogen, with proper diet, exercise, and careful measurement and meditation, that made the difference. Many believe, as I do, that we can most likely increase the number of lower incidences of cancer.

All in all, the results of the study are both scary and encouraging. Scary because the majority of medical doctors are still prescribing the horse urine approach to estrogen. Encouraging because many women are realizing that they now have an option that will accomplish their objective without compromising their general health.

This is the difference between not knowing everything and not knowing anything. Just because you don’t know everything doesn’t mean you can’t (or shouldn’t) play the odds with the data you do have. So, if I were a woman who was understandably worried about the 1 in 8 chance of developing breast cancer in my lifetime, human estrogen would be the way I would bet.

Oh… I’d also point out that while they didn’t have the whole story on cholesterol in the 80’s when they suddenly told people eating bacon and eggs for breakfast every day was bad for them, they weren’t really wrong either. It’s still a bad idea.