Modern Medicine Critique - Wow! I'm speechless.

[FarmerD]

The Fathead blog had a link to Dr Malcom Kendrick's latest book.  The Amazon description of the book had the following quote:

“It is simply no longer possible to believe much of the clinical research that is published, or to rely on the judgment of trusted physicians or authoritative medical guidelines. I take no pleasure in this conclusion, which I reached slowly and reluctantly over my two decades as an editor of The New England Journal of Medicine.”? Dr. Marcia Angell.

This is a pretty amazing statement for an someone who may be considered part of the "Medical Establishment."  I have Kendrick's book on order and I'll post again if I learn anything new. 

[MachineGhost]

Well, you know talk is cheap, but money is everything.

Which book are you referring to, Doctoring Data?

[FarmerD]

Well, you know talk is cheap, but money is everything.

Which book are you referring to, Doctoring Data?

Yep, Doctoring Data. 

It's seems like the medical field has sort of reached a tipping point where more and more criticism is coming from within.  It used to be only fringe people like Uffe Ravnskov dared raise any criticisms.  As an eternal optimist, I think this may be the start of something good. 

[MachineGhost]

It's seems like the medical field has sort of reached a tipping point where more and more criticism is coming from within.  It used to be only fringe people like Uffe Ravnskov dared raise any criticisms.  As an eternal optimist, I think this may be the start of something good.

And thank gawd!  But, I don't believe they have any answers yet.  They're still recognizing the problem.

[WiseOne]

Wow, thanks for the info!

Let me just say:  there are two types of medical research.  The kind of work I do is heavily focused on mechanisms:  how a particular disease process works and why, and what the implications are for clinical treatments.  There's a lot of crap in the literature in these areas, but it's mainly because people get their logic or facts confused.  There isn't much in the way of industry support typically; it's heavily dependent on NIH or foundation funding.  There are definitely situations where big egos get in the way of good science, but that's probably the case in just about every human endeavor.

The type of medical research that I think this book is critiquing are population studies and clinical trials, which are the main substrate of NEJM articles.  I just hope that in critiquing these studies, the author isn't throwing out the baby with the bathwater:  there have been very good longitudinal/population studies.  But the drug company-funded clinical trials game, which the FDA requires before it will approve any medication, absolutely deserve a hard look.

These trials not only result in specific meds (like statins) being pushed, but they bury other medications that could be useful.  An excellent example is clobazam.  This is a very good and dirt cheap antiepileptic drug that was illegal in the US for many years, simply because no drug company was willing to spend the money it would take to go through the study protocol to get FDA approval.  Clinicians wanting to give this to their patients had to get it ordered from pharmacies in Canada or Bermuda, where it would sometimes be intercepted at customs.  It was kind of comical that technically just about every academic epileptologist in the U.S. was violating US laws on a regular basis, and the only protection was that throwing everyone in jail would not have been a popular move.  Finally, one company did in fact make a version of the medication (now called Onfi) and put it through trials.  The medication is now incredibly expensive, so ironically it's now even more difficult to prescribe because many insurance companies balk at paying for it.

Really looking forward to reading this!!  Just bought the Kindle version.

[MachineGhost]

Let me just say:  there are two types of medical research.  The kind of work I do is heavily focused on mechanisms:  how a particular disease process works and why, and what the implications are for clinical treatments.  There's a lot of crap in the literature in these areas, but it's mainly because people get their logic or facts confused.  There isn't much in the way of industry support typically; it's heavily dependent on NIH or foundation funding.  There are definitely situations where big egos get in the way of good science, but that's probably the case in just about every human endeavor.

WiseOne, thats a really good point!  Off the top of my head, most of the rationale for the supplements I take is based on the mechanism-style kind of medical research, rather than population studies or clinical trials.  I think that maybe reflects more of what a crony political joke the latter two truiy are.  While it would be nice to have proof of efficacy in humans and its always nice when a population study/clinical trial appears to confirm a mechanism, it is just not always practical with supplements where there is just no funding available other than from limited commercial interests in branded/trademarked ingredients.  And there is very little interest in life extension preventive mechanisms compared to lifestyle drug palliatives.  It can take 3.5 years of roadshowmanship just to get funding to investigate a life extension mechanism, then 1.5 years to actually perform it.  So a lot of great science that would actually help humanity is bordering on starvation or takes years to ever see the light of day.  It's just a very sad state of affairs.  It's a big help when rich billionaires like the Google co-founder gets onboard, but it is still a drop in the bucket compared to the gigantic amount of filthy lucre Big Pharma is involved in.

[FarmerD]

WiseOne/MG
As a sidenote, there's a really nice long blog post on Vegetablepharm about how the thought on cancer development and treatment has been on a long circular route over the past 30 years or so.  The blogger quotes from several studies including "Coming Full Circle—From Endless Complexity to Simplicity and Back Again."  I'd be interested in your thoughts.

"In the mid-1970s, ...the mechanisms by which cancer started and spread were a total mystery. Half a century of cancer research had generated an enormous body of observations about the behavior of the disease, but there were essentially no insights into how the disease begins and progresses to its life-threatening conclusions. As a result, the field of cancer research was held in ill-disguised contempt by the growing crowd of molecular biologists, geneticists, and biochemists. Even the cancer researchers had become rather disillusioned with the vast body of essentially incoherent phenomena that constituted ‘‘cancer research’’: as one particularly jaundiced cancer researcher told me at the time ‘‘one should never, ever confuse cancer research with science!’’

But maybe the "take-away" of this post should be that no one, from the leading cancer researcher to the latest cancer guru, really understands what causes cancer and how to best treat it! Sure, they can blast it with radiation, flood it with chemicals, or cut it out, but it's all guess-work.
http://www.vegetablepharm.blogspot.com/ ... ircle.html

[MachineGhost]

My thoughts are the complexity of cancer really doesn't matter in-as-far as effective (my definition is cure) treatment goes (which is not the orthodox except in less than a handful of cancers), but some day when the reductionist complexity is all completely understood, we can just order up the necessary epigenetic and genetic changes needed to switch it off with Star Trek technology -- if we even continue to develop cancer in the first place.  The current mentality of non-prevention will likely not change until extended lifespans are much more commonplace.

[WiseOne]

...its always nice when a population study/clinical trial appears to confirm a mechanism, it is just not always practical with supplements where there is just no funding available other than from limited commercial interests in branded/trademarked ingredients.  And there is very little interest in life extension preventive mechanisms compared to lifestyle drug palliatives.  It can take 3.5 years of roadshowmanship just to get funding to investigate a life extension mechanism, then 1.5 years to actually perform it. 

Yup, exactly right:  the correlative studies can help confirm a prediction made on the basis of a known mechanism, but other than that they're not terribly useful. This is why I liked the UCSF/Robert Lustig video lectures so much:  he went straight to mechanism and then applied that to the clinical situations.  Among other things, he points out that obesity does not cause medical problems; the real culprit is metabolic syndrome, which is often associated with obesity.  If you focus on mechanism when selecting/justifying supplements, you'll be way ahead of the pack.

Just one point to disagree with:  you're right about the 3 years to get funding, but the time it takes to perform work is vastly longer than 1.5 years.  The 1.5 years is how long it takes to publish work AFTER you've finished it.

[MilfordTony]

Well, you know talk is cheap, but money is everything.

Which book are you referring to, Doctoring Data?

Yep, Doctoring Data. 

It's seems like the medical field has sort of reached a tipping point where more and more criticism is coming from within.  It used to be only fringe people like Uffe Ravnskov dared raise any criticisms.  As an eternal optimist, I think this may be the start of something good.

We hope so!

[MachineGhost]

Yup, exactly right:  the correlative studies can help confirm a prediction made on the basis of a known mechanism, but other than that they're not terribly useful. This is why I liked the UCSF/Robert Lustig video lectures so much:  he went straight to mechanism and then applied that to the clinical situations.  Among other things, he points out that obesity does not cause medical problems; the real culprit is metabolic syndrome, which is often associated with obesity.  If you focus on mechanism when selecting/justifying supplements, you'll be way ahead of the pack.

So obesity is actually a symptom of metabolic syndrome, but isn't metabolic syndrome actually a symptom of stuffing the piehole with excess calories, but aren't those excess calories actually a symptom of too much fructose & Omega-6?  And to take this further, isn't insulin resistance that is part of metabolic syndrome actually a symptom of carbohydrate post-prandial spiking that is too high?

I'm not real confident focusing on mechanisms worked in the case of the dietarylipidcholesterolwhatchamacallit hypothesis.  At least, not politically.

[WiseOne]

Check out the Fructose 2.0 video...it's more complicated than that (of course).  Among other things, whether obesity is harmful depends on where the weight is and what it's made of.  Examples: the typical NFL player is classed as obese, and obesity due to subcutaneous fat has a positive effect on health.

BTW everyone, the Doctoring Data book is a fun read.  Seriously.