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A woman waits outside the mammogram and women's health services area on the first day of the fourth annual free Care Harbor clinic in South L.A. in 2012. Dr. Felix Aguilar, the president and CEO of UMMA Community Clinic, said he's seen the recommendations regarding mammogram frequency change during his time working on the southside.
Over the past decade, medical experts have reversed course on certain practices and procedures – like hormone therapy for menopausal women, which is no longer a widely recommended treatment.
A new report appearing in Mayo Clinic Proceedings counted how many times this occurred over the past 10 years, and found that doctors reversed course on 146 previously established practices, treatments and procedures.
"That's just the nature of medical knowledge," said Dr. Felix Aguilar, the president and CEO of UMMA Community Clinic in South Los Angeles. "We learn new things, we learn that things do not work, or that things we were doing were actually causing harm. Things get reversed – that's what happens. We move forward with new knowledge."
Aguilar pointed to hormone therapy as an example. He said patients will often come into UMMA with questions about menopause.
"When I was in training, we were told that hormones were good for women who were on menopause," he explained. "And so we would recommend that to everybody. And then it was found that no, that causes harm."
That revelation came after large clinical trials analyzed the benefits of the therapy, which was found to be worse for menopausal women than no medical intervention at all. At the time, said Aguilar, the common knowledge about hormone therapy came from smaller, less reliable studies.
Evolving medical practices
The Mayo Clinic study highlighted a few key medical reversals – that is, according to the authors, "when an existing practice is found to be no better than a lesser therapy:"
- Stenting for stable coronary artery disease.
- Routinely installing a pulmonary artery catheter for patients in shock.
- Using the drug aprotinin during heart surgery.
- Using COX-2 inhibitors, a type of drug which targets certain enzymes responsible for causing inflammation and pain.
- Applying particularly stringent blood sugar targets for diabetic patients.
Dr. Vinay Presad, the study's lead researcher, said in a statement that the 146 reversals identified by his team "by no means represent the final word for any of these practices."
"But, the reversals we have identified, at the very least, call these practices into question," he said.
Aguilar, who's worked in South L.A. for around six years, said he's seen other medical practices evolve in recent years:
Diabetes treatment. Aguilar says when he was in medical school, insulin "was not the first-line treatment for diabetes." That sort of regimen was reserved for people who had advanced forms of the condition. That led a lot of folks to believe that insulin "was bad for you," he said – which can present a problem, since insulin has since "become the first-line treatment for people whose diabetes is out of control."
Pap smears. "The recommendation was to get Pap smears every year," said Aguilar. And then it wasn't – once a woman has two normal Pap smears, he explained, they only need to get the screening every three years. "When I tell a woman, 'OK, you don't need this,' a lot of patients look at me like, 'Are you sure?'" said Aguilar. "Some women have been getting Pap smears for decades."
Mammograms. "We used to do yearly mammograms for women 40 and above, and then the data showed that was probably causing more harm than good in most women," said Aguilar. "So we moved to 50 and above."
Digital rectal exams. "Those were a pretty standard part of the male exam," said Aguilar. "Then, a couple years ago, data started showing they were probably unnecessary because they were not as diagnostic as we thought they were." Now, he added, those sort of exams are only used in "very specific situations" where certain symptoms are present – not as screenings.
Although it's medicine's nature to be constantly evolving, said Aguilar, he acknowledged that patients may not always realize that.
"It does create confusion when the medical knowledge changes," he said. "It does also create misunderstandings, because now we're telling people they don't need [certain tests] any longer."