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A very large pinch of salt

Phil feels guilty about spreading disinformation and wonders when patients will catch on

Phil feels guilty about spreading disinformation and wonders when patients will catch on

Well, what do you know? Salt isn't bad for you any more. A recent review of evidence, led by Dr Joel Dunning, consultant in cardiothoracic surgery at James Cook University Hospital in Middlesbrough, has found there is no proof of a link between salt intake and heart disease.

Dr Dunning goes further – he dismisses the theory that salt can cause strokes and heart attacks as ‘an argument of hope over reason'.

I'm going to resist the temptation to dissect that phrase, despite the fact that it opens a whole new can of worms regarding the motivation of those doctors and politicians who have for years promoted the nannying theory that we should be forced to eat less salt in our diets. The obvious lack of a correlation between elevated blood pressure and salt intake should have been good enough for them, just as it was for me.

Public health minister Dawn Primarolo was only recently quoted as saying that a low salt intake was an essential part of a healthy diet. Ms Primarolo's only qualification to spout off on this subject is a six-year pre-MP career as a ‘mature student', so I would always have regarded her pontifications as profoundly suspect, but it's nice to have it confirmed by someone who knows what he is talking about.

However, my remit is a wider one. This is further evidence that it is us, the medical profession, who don't know what we are talking about. I never fell for the bollocks about salt, but I have been as guilty as the rest of spreading disinformation and inaccurate advice about a whole manner of other medical subjects. It is becoming embarrassing.

I'm ashamed of the amount of backtracking I'm doing on HRT. ‘Yes, I know, I might well have told you that HRT protects against heart disease, well that's what we thought last year, but it turns out it doesn't, it makes it worse. However, it still protects you against osteoporosis. At the moment. Possibly. Ask me again next time.'

A few weeks ago a couple of units of alcohol a week were a reasonable indulgence for pregnant women, this week they are a noose round the neck of the fetus. Or possibly not.

How do you explain to a patient that while their cholesterol level of 5.4 was absolutely fine last year, it is dangerously high this year? And how does a patient change from normotensive to hypertensive from one review to the next, just because Liam Donaldson has moved the goalposts in the meantime? Why do punters take this crap from us?

I've given out prescriptions for drugs such as cerivastatin and rofecoxib and then had to shamefacedly explain to returning patients that, no, I wouldn't give them any more of the drug I had earnestly recommended, because now it seemed it might make them drop dead.

I think it was Theodore Dalrymple who told the story of the elderly gent with diverticular disease he saw when he was a neophyte GP. Dr Dalrymple gave him 10 enthusiastic minutes on the newly trendy theory of high-fibre diets, before the chap interrupted him. ‘The doctor who sat in that seat before you has told me, for the last 10 years, to eat a low-fibre diet to "rest my bowel".' ‘Ah yes, but now we know better.' The chap curled his lip, tossed his prescription down on the desk and left, with the immortal (but not original) line: ‘Throw physic to the dogs. I'll none of it.'

I'm still waiting for a patient to quote Macbeth at me, but I'm with this chap all the way.

Take any received medical advice with a very large pinch of salt.

Dr Phil Peverley is a GP in Sunderland

Pev sitting

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