I stumbled upon 15 examples where evidence-based medicine has shifted its stance over time. Truly intriguing; there was a lot I didn’t know.
1. Cholesterol: “bad vs “good
Originally, total cholesterol was considered the main risk. Nowadays, it’s more important to look at LDL (“bad) and HDL (“good) in the context of inflammation and overall metabolic state. High levels of LDL (“bad)—a confirmed risk factor for cardiovascular diseases, especially when HDL (“good cholesterol) levels are low.
2. Saturated Fats
Long considered a cause of cardiovascular diseases. Modern studies have proven: trans fats are indeed harmful, but natural saturated fats in moderate amounts are permissible. In the USA, as I understand, there has been a complete ban on adding artificial trans fats to food products since 2021, while in Russia, as I found, there is a limit of 2% trans fat content in certain products, but no total ban and less stringent control measures are in place.
3. Hormone Replacement Therapy (HRT)
HRT was long believed to protect against cardiovascular diseases in women. The WHI study (2002) showed an increased risk of heart attacks, strokes, and breast cancer with combined therapy.
4. Vioxx (rofecoxib)
This drug was heavily advertised as safe for joints. In 2004, it was withdrawn from the market due to an increased risk of heart attacks. It was found that the manufacturer had hidden side effects.
5. Antiarrhythmics Post-Heart Attack
Drugs like flecainide were used post-heart attack. The CAST study (1989) showed: such drugs increased mortality.
6. Low-Fat Diets
Fats were once considered the main culprits of obesity. Today, it’s clear that replacing fats with sugar and fast carbohydrates only intensified the epidemic of diabetes and metabolic syndrome.
7. Infant Weaning
Solid foods used to be introduced at 2–3 months. Today, WHO recommends exclusive breastfeeding until 6 months.
8. Stomach Ulcer and Helicobacter pylori
Ulcers were once linked to stress and diet. Now, it’s known that the main cause is H. pylori infection. Treatment involves antibiotics. Upon my arrival in the US, it was immediately detected and treated.
9. Antidepressants and the “Serotonin Theory
Depression was formerly explained by a lack of serotonin. Nowadays, this theory is not supported, and the effectiveness of antidepressants is critically assessed.
10. Omega-3
Omega-3 supplements were once regarded as a panacea for the heart. Major studies (e.g., VITAL, 2018) found no benefits in healthy individuals. Eating fish continues to be considered beneficial.
11. Vitamin D
Its deficiency was associated with many diseases. However, meta-analyses have shown: vitamin D supplements do not prevent cancer, diabetes, and heart attacks unless there is a deficiency.
12. Aspirin for Prevention
Aspirin used to be prescribed to many healthy individuals. Today, its use is limited to high cardiovascular risk due to the risk of bleeding.
13. Statins
Previously prescribed widely, including for moderately elevated cholesterol. Now prescribed selectively, based on overall risk assessment.
14. “Safe Opioids
In the 1990s, it was claimed that OxyContin did not cause addiction. This triggered the opioid crisis in the USA—one of the biggest challenges to the healthcare system.
15. PSA Testing for Prostate Cancer
Mass PSA screening led to overdiagnosis and unnecessary surgeries. Nowadays, its use is individualized, after discussion with the patient.