One of the reasons that being a doctor is hard is that patients want to feel better RIGHT NOW. There is a natural temptation toward intervention vs conservative treatment, more medication vs less.
But there is a problem with this. Every time a doctor makes a health intervention, there can be a potential downside. Sometimes, the downside is immediate and obvious (think major surgery). Other times, the risks may come much later, and may not even be known.
Every once in a while, we see a research study that highlights this uncertainty. This week, I came across a new meta-analysis showing a very small, but statistically significant, increase in breast and ovarian cancer risk in women who use SSRI-type antidepressants. The study compiled data from 61 different clinical trials, and found an 11% higher risk of cancers of the breast and ovary in women taking this popular class of medication.
I think some advocates of natural health interventions are going to look at this and say “I told you so” or “this is why you should use natural products instead of drugs.” I saw a lot of this behavior when hormone replacement therapy was linked to heart disease (note: link is not presented because I agree with the content, only to demonstrate the point). But I think interpreting these results as evidence that natural products are better than drugs misses a key point.
Here’s my preferred take-away message: the SSRI class of medications became popular initially not because they were more efficacious, but because they were safer than existing antidepressant medications. The older class of antidepressants, however, had no association with cancer risk at all. So, after looking backwards at data covering hundreds of thousands of women, we find out that what we thought was the safest choice may not have been at all.
I find myself concerned from time-to-time that doctors/health-food store employees/multi-level marketers/etc who recommend natural products can be a little cavalier in the way they equate lack of immediate adverse effect with evidence of safety. Even though this new meta-analysis is a drug study, it should remind us that any time you use an intervention to change human biochemistry, there are a set of risks and benefits, and these need to be weighed soberly before deciding to intervene.
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