Lies, Damned Lies, and Medical Science

[Gumby]

Here on the PP forum, we often ridicule financial "experts" and their misleading advice. The following article in The Atlantic may very well change the way you look at medical "experts" and the so-called science that is used to prescribe you medicine and make recommendations about your health...

"Much of what medical researchers conclude in their studies is misleading, exaggerated, or flat-out wrong. So why are doctors—to a striking extent—still drawing upon misinformation in their everyday practice? Dr. John ioannidis has spent his career challenging his peers by exposing their bad science"

http://www.theatlantic.com/magazine/pri ... ence/8269/

By the way.... The article, in no way, attacks doctors. Doctors save lives and no one is saying otherwise. Rather, the article explores why most published studies — that are used to guide doctors — are flawed to begin with.

You may never look at medicine the same way.

[rhymenocerous]

Also see this by the same author:

http://www.time.com/time/health/article ... 44,00.html

I like this paragraph:

"Bad advice tends to be simplistic. It tends to be definite, universal and certain. But, of course, that's the advice we love to hear. The best advice tends to be less certain — those researchers who say, 'I think maybe this is true in certain situations for some people.' We should avoid the kind of advice that tends to resonate the most — it's exciting, it's a breakthrough, it's going to solve your problems — and instead look at the advice that embraces complexity and uncertainty."

[FarmerD]

Here on the PP forum, we often ridicule financial "experts" and their misleading advice. The following article in The Atlantic may very well change the way you look at medical "experts" and the so-called science that is used to prescribe you medicine and make recommendations about your health...

"Much of what medical researchers conclude in their studies is misleading, exaggerated, or flat-out wrong. So why are doctors—to a striking extent—still drawing upon misinformation in their everyday practice? Dr. John ioannidis has spent his career challenging his peers by exposing their bad science"

http://www.theatlantic.com/magazine/pri ... ence/8269/

By the way.... The article, in no way, attacks doctors. Doctors save lives and no one is saying otherwise. Rather, the article explores why most published studies — that are used to guide doctors — are flawed to begin with.

You may never look at medicine the same way.

Just noticed the article was written by David H. Freedman.  I read his Book "Wrong - Why Experts Keep Filing Us"  last year.  In the book he talks about scientists, medical researchers, financial experts, the media, etc.  Highly recommend it. 

[AdamA]

Here on the PP forum, we often ridicule financial "experts" and their misleading advice. The following article in The Atlantic may very well change the way you look at medical "experts" and the so-called science that is used to prescribe you medicine and make recommendations about your health...

"Much of what medical researchers conclude in their studies is misleading, exaggerated, or flat-out wrong. So why are doctors—to a striking extent—still drawing upon misinformation in their everyday practice? Dr. John ioannidis has spent his career challenging his peers by exposing their bad science"

http://www.theatlantic.com/magazine/pri ... ence/8269/

By the way.... The article, in no way, attacks doctors. Doctors save lives and no one is saying otherwise. Rather, the article explores why most published studies — that are used to guide doctors — are flawed to begin with.

You may never look at medicine the same way.

I don't think the world of medicine is that much different from the world of finance when it comes to the professionals positioned to give advice in exchange for money.  If there was a PP-like philosophy for medicine I think it would be:

25%. Think long and hard before taking medication for a condition that is not causing symptoms.

25%. Beware the screening test.

25%. Procedures have complications

25%. Quality of life can be more important than quantity.

[MediumTex]

It doesn't help to have idiots like Dr. Oz on TV spending an hour every day getting people stirred up about half-truths, exaggerations and Nickelodeon-style gross-out medical stuff.

I have watched that guy go from being a mildly interesting Oprah sideshow to a dangerous personal health fortune teller.

Dr. Oz is to physicians what Newt Gingrich is to politicians and what Donald Trump is to rich people--a silly and buffoonish caricature masquerading as a populist bringer-of-truth to the masses.

[Lone Wolf]

25%. Think long and hard before taking medication for a condition that is not causing symptoms.

25%. Beware the screening test.

25%. Procedures have complications

25%. Quality of life can be more important than quantity.

Interesting and enjoyable list.  Would you mind expanding a bit on your thoughts about screening tests?  Is the concern overdiagnosis, cost, or some other factor?

[WildAboutHarry]

They don't call it the "practice" of medicine for nothing...

[Benko]

25%. Think long and hard before taking medication for a condition that is not causing symptoms..

There are a lot of things that need to be said in relation to this thread (and I'm usually the last person to defend conventional medicine) and I'll try to post more later, however while there is a point to this comment, following this advice could be dangerous/fatal depending on the situation e.g. high blood pressure.  Skin rashes, high cholesterol, and lots of other condiitions are a longer answer.  Some conditions which have no symptoms could down the road lead to catastrophic problems, others are minor, others are major and perhaps there are other ways than conventional medicine to deal with them.

What you can do: Firstly I'd ask your doctor why are you recommending this medicine--what is being treated?  How does the medicine work, and what are the possible side effects and how likely are they?  What is the worst that could happen if I don't take it/do nothing?   How likely is that?  Would you (meaning your doctor) take this medicine if s/he were in your position? (this last is only helpful if your doctor says no as doctors are very invested in the conventional medical model).

[AdamA]

25%. Think long and hard before taking medication for a condition that is not causing symptoms..

There are a lot of things that need to be said in relation to this thread (and I'm usually the last person to defend conventional medicine) and I'll try to post more later, however while there is a point to this comment, following this advice could be dangerous/fatal depending on the situation e.g. high blood pressure.  Skin rashes, high cholesterol, and lots of other condiitions are a longer answer.  Some conditions which have no symptoms could down the road lead to catastrophic problems, others are minor, others are major and perhaps there are other ways than conventional medicine to deal with them.

What you can do: Firstly I'd ask your doctor why are you recommending this medicine--what is being treated?  How does the medicine work, and what are the possible side effects and how likely are they?  What is the worst that could happen if I don't take it/do nothing?   How likely is that?  Would you (meaning your doctor) take this medicine if s/he were in your position? (this last is only helpful if your doctor says no as doctors are very invested in the conventional medical model).

I agree with what you're saying.  I just think that the advertised benefit of many of these tests, medications, procedures and various other treatments is very often overstated, if not misrepresented entirely.  

While I also agree that it is important to have an informed discussion with your physician when making these decisions, I feel like many doctors are slaves to biased ivory tower dogma, and really aren't up to the task.  

[AdamA]

Would you mind expanding a bit on your thoughts about screening tests?  Is the concern overdiagnosis, cost, or some other factor?

All, but mostly over diagnosis because it leads to over treatment.  I'm not saying that there's no place for these tests. It's just very important to understand what their results really mean before you let someone tinker with your prostate, remove part of your colon, operate on your back, crack open your chest, etc.  

[Gumby]

Here's where I see a problem with flawed medical research...

Your test results come back "high" for a certain kind of hormone in your body. Decades of published medical research indicates that people who have elevated levels of this particular hormone in their body tend to die an early death. Drug companies have funded tens of billions of dollars in research to prove that "lowering" the level of this hormone in the body will reduce the incidence of a disease that is related to high levels of this hormone. It turns out the hormone-lowering drug helps lower the incidence of the "related" disease for completely unrelated reasons that have nothing to do with "lowering" the level of this hormone. However, patients who lower this hormone tend to die early anyway, of seemingly unrelated diseases and causes.

If your doctor believes most of the published pharmaceutical-driven medical research, he/she might think that the industry just needs a better drug to lower that hormone — one with fewer side effects. He/she might also believe that — based on medical research — the risks are minimal, when in fact the risks are understated by said research due to highly selective data or participation requirements.

But, what if it turned out that the elevated hormone your body is secreting is a precursor to how your body heals itself and "lowering" that hormone actually causes problems in the body? In other words, what if the hormone is merely a marker and a natural healing response for inflammation or stress in your body? If that's true, then lowering that hormone level in your body is actually a bad idea. In that scenario, the doctors were mislead by the best medical research that money can buy. It's a classic case of treating the symptom and not the underlying problem.

If the money to fund, publish and review studies only comes from those with a vested interest in selling and promoting pharmaceuticals, what are the chances of medical research discovering the truth in the above scenario?

Pretty slim.

The article examines — among other things — how money, the prestige of being published, and errors continually poison science — even if unintentionally. And it doesn't help things when patients are constantly bombarded with advertisements to "ask your doctor if drug X is right for you." ...Not to mention the doctors who are regularly visited by sales-reps with bogus medical research to back their drugs.

[Tortoise]

The article examines — among other things — how money, the prestige of being published, and errors continually poison science — even if unintentionally.

Good ol' "publish or perish." Talk about sacrificing quality at the altar of quantity...

[Reub]

I believe that the push to lower everyone's cholesterol level may be a perfect example of the drug companies creating a hysteria so as to sell more product.

[AdamA]

I believe that the push to lower everyone's cholesterol level may be a perfect example of the drug companies creating a hysteria so as to sell more product.

I suspect you are correct.

http://www.thennt.com/statins-for-heart ... t-disease/

His blog is great too, and speaks to many of the topics we're discussing here.

http://www.thennt.com/blog/

David Newman, the guy who runs the site, is a pretty big name in Emergence Medicine, and lectures on a lot of this stuff (he's a great speaker). 

[FarmerD]

I believe that the push to lower everyone's cholesterol level may be a perfect example of the drug companies creating a hysteria so as to sell more product.

I suspect you are correct.

http://www.thennt.com/statins-for-heart ... t-disease/

His blog is great too, and speaks to many of the topics we're discussing here.

http://www.thennt.com/blog/

David Newman, the guy who runs the site, is a pretty big name in Emergence Medicine, and lectures on a lot of this stuff (he's a great speaker). 

Thanks for the link.  It's refreshing to have thoughtful doctors like you, Benko, etc on this site. The majority of doctors I've seen simply regurgitate what they memorized in medical school years ago, get all their information from drug representative, or practice cookbook medicine.  Doctors like you who take the time to keep current on medical issues ensure their patients receive the best medical care. 

Now if I could only convince my 85 year old mom (been trying for years) her doctor should never have put her on a statin.....

[Gumby]

Now if I could only convince my 85 year old mom (been trying for years) her doctor should never have put her on a statin....

I'm in a similar situation. My 93 year old grandma was put on a low dose of statins 20 years ago — for "preventative" purposes. Her doctor was convinced it was very safe and good for her. She was very healthy at the time. She recently showed me a local newspaper clipping extolling the virtues of Zocor (her statin) and how it's a wonder drug that supposedly prevents Alzheimers and Parkinsons. Never mind that the study was only three years long, never conclusively proved those claims, and nobody ever understood why it supposedly prevented those diseases (they likely lowered one's inflammation).

Over the past few years — and culminating over the past few months — she started to show visible and physical signs of Congestive Heart Failure (CHF). Eventually her edema got so bad, she had to be rushed to the hospital. Her doctor has since put her on Hydralazine, to lower her blood pressure. So, now she's on a statin and blood pressure-lowering medication.

In the past few months she started having tingling in her extremities, fatigue, loss of balance, pain in her legs, and sores on her legs that don't heal. She blames it on "getting old". It would seem her medications are causing some of these problems. And perhaps her statin may have brought on CHF to begin with. This is a woman who has no history of heart disease in her family and her cholesterol has always been "good". She's still fairly convinced that Zocor is good for her. "It's a very low dose," she says.

It clearly comforts her to take a statin. And I do recognize that statins reduce inflammation. But, from what I can tell, some doctors believe that CHF has increased dramatically from statin use. Apparently CHF has risen dramatically in the United States as statins have been prescribed more and more...

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...Of course, the increase in CHF could be due to any number of factors. But, it is an interesting correlation.

I told my grandmother to ask her (new) doctor if it's possible that her symptoms are caused by statin use or her blood pressure medication (or a combination of the two). I doubt she'll get anywhere with having this conversation with her doctor. She's an old lady that easily gets confused by complex scientific rhetoric and ultimately does whatever her doctor tells her to do.

[Benko]

Gumby,

It is not that well publicized, but statins can CAUSE memory problems.

Also anyone taking statins should be taking 200 mg coenzyme q-10.

[FarmerD]

Gumby,
I feel for you - Many older people tend to be very trusting of doctors (like my mom) and explicitly trust any advice given them. I've tried over and over to convince my mom to toss the statins but she resists.  I figure if taking the statin gives her peace of mind, maybe I should just shut up.  I haven't noticed any side effects so far so I don't push the issue. 

On the other hand, my mom's doctor recently thinks she's diabetic (her normal blood sugar is 110) and told her to take a glipizide pill every morning when she wakes up.  (Why any doctor would be worried about an 85 year old woman developing diabetes is beyond me.  Perhaps he thinks she may develop complications in 10-15 years?)  Since my mom sometimes skips breakfast, this is extremely dangerous advice. No one should ever take glypizide without testing their blood first (my mom doesn't even have a blood sugar meter) otherwise you'll wind up in a coma.  I put my foot down and made her toss those pills and ignore her doctors concerns.  Obviously I'm not very happy with the medical care she's been given.       

[Gumby]

Gumby,

It is not that well publicized, but statins can CAUSE memory problems.

Also anyone taking statins should be taking 200 mg coenzyme q-10.

Thanks, Benko. I was aware of that and had mentioned it to my grandmother. Luckily she's a big fan of coq-10. From what I can tell, that's a big problem with statins. She had stopped taking coq-10 for a few months after entering the hospital (can't remember if her doctor ordered her off of it or not), but she asked her doctor if she could resume and the doctor allowed it (thankfully).

[MachineGhost]

Now if I could only convince my 85 year old mom (been trying for years) her doctor should never have put her on a statin.....

It does reduce the incidence of some cancers.

[MachineGhost]

On the other hand, my mom's doctor recently thinks she's diabetic (her normal blood sugar is 110) and told her to take a glipizide pill every morning when she wakes up.  (Why any doctor would be worried about an 85 year old woman developing diabetes is beyond me.  Perhaps he thinks she may develop complications in 10-15 years?)  Since my mom sometimes skips breakfast, this is extremely dangerous advice. No one should ever take glypizide without testing their blood first (my mom doesn't even have a blood sugar meter) otherwise you'll wind up in a coma.  I put my foot down and made her toss those pills and ignore her doctors concerns.  Obviously I'm not very happy with the medical care she's been given.

As a compromise, put her on metformin.  She'll be happy that "something is being done", it won't burn her pancreas out like all the other anti-diabetic drugs and has life-extending benefits to boot.

[MachineGhost]

Benko. I was aware of that and had mentioned it to my grandmother. Luckily she's a big fan of coq-10. From what I can tell, that's a big problem with statins. She had stopped taking coq-10 for a few months after entering the hospital (can't remember if her doctor ordered her off of it or not), but she asked her doctor if she could resume and the doctor allowed it (thankfully).

I'd recommend switching her to Ubiquinol, the bioavailable form of CoQ10.  CoQ10 is outdated and it is unethical that it still being sold.  200mg of ubiquinol is equivalent to 1600mg of CoQ10.

[MediumTex]

Benko. I was aware of that and had mentioned it to my grandmother. Luckily she's a big fan of coq-10. From what I can tell, that's a big problem with statins. She had stopped taking coq-10 for a few months after entering the hospital (can't remember if her doctor ordered her off of it or not), but she asked her doctor if she could resume and the doctor allowed it (thankfully).

I'd recommend switching her to Ubiquinol, the bioavailable form of CoQ10.  CoQ10 is outdated and it is unethical that it still being sold.  200mg of ubiquinol is equivalent to 1600mg of CoQ10.

MG,

Can you provide a little more detailed information about how CoQ10 is outdated?

What does that mean?  Did it used to be a good supplement, but now isn't?  Why is it unethical that it is still being sold?

[Benko]

Even assuming impeccable research studies, doctors always making the best decisions (within the context of conventional western medicine), etc. there is still the basic problem that the paradigm of conventional western medicine is grossly deficient in many areas and often misguided.  

Severe motor vehicle accident, or  pneumonia: western medicine does really good job.  Other cases e.g. chronic illnesses  not so much.  

Significant soft tissue injuries e.g. ankle sprain These are not an ibuprofen deficiency.  COnventional medicine is useless for soft tissue injuries (unless you tear or break something) and hands on manual therapy of some sort is often what is needed.  That sort tissue work can be done by physical therapist (if you can find old school PT), a chiropracter WHO DOES ART (active release technique), or a highly skilled massage therapist.

Diet is a complex issue, but suffice to say that if you are diabetic the advice conventional medicine gives you i.e. a diet high in carbs, often carbs which will raise your blood sugar, is spectacularly bad.  

Many illnesses from the majority of back problems to cancer to RHEUMATOID arthtritis to many stomach/intestinal issues have a WHOPPING emotional component  Traditional western medicine virtually ignores this, but traditional chinese medicine does not (it is part of the system, not that TCM is a panacea). For example I woman who I "met" on another board years ago had "intestinal issues".  I did a brief consult for year and after questioning her I told her that I could only help her minimally as her main problem was her job and until she changed that, there was not much I could do.  She e-mailed me about a year later after changing jobs, and her intestinal issues went away.  Emotional issues are part of many illnesses and there is no simple remedy for this (psychiatry is useless) and most emotional issues are far more difficult to treat than simply changing jobs.

Someday I want a job directing people to the appropriate alternative or conventional practitioner.

[Gumby]

Benko. I was aware of that and had mentioned it to my grandmother. Luckily she's a big fan of coq-10. From what I can tell, that's a big problem with statins. She had stopped taking coq-10 for a few months after entering the hospital (can't remember if her doctor ordered her off of it or not), but she asked her doctor if she could resume and the doctor allowed it (thankfully).

I'd recommend switching her to Ubiquinol, the bioavailable form of CoQ10.  CoQ10 is outdated and it is unethical that it still being sold.  200mg of ubiquinol is equivalent to 1600mg of CoQ10.

Thanks, MG. I appreciate it. I'll check it out. Are there any particular brands or qualities of Ubiquinol worth looking into? My initial research suggests that some Ubiquinols contain soy!

MG,

Can you provide a little more detailed information about how CoQ10 is outdated?

What does that mean?  Did it used to be a good supplement, but now isn't?  Why is it unethical that it is still being sold?

It seems that Ubiquinol is just the natural form of CoQ10. Sounds like "generic" CoQ10 is synthetic.