Monday, November 1, 2010

Changing medicine

Doctors who practice medicine for many years are struck between now and then by changes that turn their previous beliefs upside down. I say this with two examples in mind:
  1. The use of antibiotics in the treatment of peptic ulcer: Before the discovery of Helicobacter pylori and then establishing its relationship to the development of peptic ulcer no one would have been stupid enough to consider antibiotics when confronted with a patient with peptic ulcer. In fact mentioning it in an examination would have been a sufficient reason to fail the candidate in the opinion of many examiners.
  2. The use of beta blockers in the treatment of heart failure: Not many years ago we considered these drugs contraindicated in the presence of heart failure because they depress myocardial contractility. Now they are considered an essential part of the treatment of heart failure due to systolic dysfunction except when there is some strong contraindication like bronchial asthma.
 It makes one wonder which of the ideas that we consider now established facts will turn to be fallacies in the future and which of the forbidden practices nowadays will become established practices tomorrow. As they say, change is the only constant in medicine!

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