Today’s state of medicine should make cynics of us all, doctors included. I thought you should realize just how human medicine is and prone to murkiness, mistakes and greed. We should stop treating medicine like it’s the only profession on earth that doesn’t make errors, and as you will read below, sometimes intentionally.
An article was published in Medscape called Five Recent Medical News Stories That Invite Cynicism. It’s by Dr. John Mandrola. Some of Dr. Mandrola’s illustrative examples of why we should all be cynical about what health care is delivering are summarized below. It’s my hope these examples help YOU see the bigger picture for yourself and your family’s health care in today’s crazy world.
Cynicism is when you believe people are motivated more by self-interest than acting for yours or mine. Dr. Mandrola writes it’s becoming more common for experts to lead us astray towards leaner health benefits while their own wallets grow fatter.
Cynical Example # 1. Truth (scientific fact) is often silenced for a long time.
Look at the history of America’s relationship with sugar.
The sinister side of sugar was kept secret for decades. It’s hush, hush began in 1967. A very influential review article got published in a very prestigious journal, the New England Journal of Medicine. This review study, supposedly the definitive scientific analysis of all pertinent research on sugar and it’s effects on health, concluded that refined sugar in the American diet was completely safe. It’s only negative side effect was causing cavities.
This became medical dictum. Based on this review article in this respected journal, doctors and dieticians, for decades, recommended that US citizens should consume all the carbohydrate foods they wanted while minimizing fat. This gave birth to the American dietary fiasco—low fat, high carb foods.
Twenty years later, in the 1980’s, I had a column in the San Francisco Chronicle. I ran my own review of the science on sugar. This reported sound scientific links between refined sugar to increased risks of serious health conditions from heart disease, diabetes, and cancer to obesity even in children. Partly due to the status quo still set in stone by that earlier review article I got sacked. The paper and it’s C & H sugar advertisers did not want to see anything bad in print about negative health consequences from sugar.
Fast forward to September 2016. A group of researchers from the University of California, San Francisco aired the sugar industry’s dirty laundry. They scoured older documents, 15000 pages of them, of the science on sugar back in 1967. They even sleuthed through damning emails between sugar-industry CEOs and scientists from Harvard.
These authors say the negative effects of sugar were known back then. But due to the power of the sugar industry and their influence on the journal, the wrong data got published. If the real evidence had been put forth at the time, if the sugar and journal industry had been honest, dietary recommendations to Americans would have different.
Based on self-interest and greed, the recommendations made to millions of Americans for many decades, have been wrong. How many millions have suffered?
- Americans became low-fat, high-sugar crazy.
- We got fatter
- And sicker.
- Americans and their children crave sugary foods more and more.
- Added sugar is now in so many foods, to sell more product to appease sugary American tongues, it’s almost impossible to avoid. Sugar is in yogurt, chili, salad dressings, processed luncheon meat, ketchup, juices and more. Even at Whole Foods it’s difficult to find items without added sugar.
The American Heart Association has even come out and admitted that salt is not your heart’s enemy. It’s sugar.
How many got this memo?
Just because your doctor or dietician says that something is so, does not mean it is. But then how do we proceed. We must become educated ourselves. We own a body and it is high maintenance. It does not come with a clear set of instructions, darn it.
Cynical Example #2. Bad science sneaks into publications.
Junk science is on the rise.
In the earlier part of this year, 2016, the Journal of the American College of Cardiology (JACC) retracted a scientific paper on a new approach for treating atrial fibrillation (AFIB). JACC is the field of cardiology’s most prestigious journal. Retraction of an article is significant scientific shaming.
Why did that happen? The paper was from the OASIS trial comparing a new procedure to treat AFIB to an industry standard. The outcomes may have affected many of you reading this blog.
Dr. Madrola said this paper got published even with it’s possible serious flaws: it wasn’t randomized as claimed, methodologies were flawed, and scientific and industry misconduct was discovered. Yet it still made it through the peer review process. Got published.
You and your family members could have gotten hurt.
Cynical Example #3. Too many drugs, procedures
and imaging are run, often to the detriment of the patient. Medical overuse.
Daniel Morgan and colleagues identified 821 studies, which warned that medical care, from pediatrics to geriatrics, is rampant with medical OVERUSE.
The over use of drugs, procedures like CT scans and other testing, exposes many (not all) patients to more “harm” than “benefit” while driving health costs higher.
I have written blogs on how the pediatric world is a serious bastion of medical misuse. But when a child gets ill, parents get scared and succumb to the expert’s recommendations. Many young children are on acid blockers, statins, anti-depressants and more without any one professional ever inquiring and addressing diet, digestion or lifestyle.
Does overuse persist because doctors are trained and schools supported by Big Pharma? Is it from parents’ too overwhelmed or unmotivated to change how the family eats? Do doctors run more procedures to make more money or to protect their licenses in this litigious society? Or the clinic they work at wants prefers they order more procedures and not mention other institutions that may have more appropriate ones, or they might loose their jobs?
Cynical Example #4. Is the bar for drugs and devices too low?
Too many drugs so little time.
In many cancer studies remission means one to several months. In some studies all a device has to do is prove non-inferiority rather than statistically significant better acting (beyond chance) than what is now standard-of-care. New drugs and meds are more expensive. Costing you and me more and more.
- Everything in life, medicine to law to love, is prone to human biases, mistakes and issues.
- That’s why knowledge is power.
- But this means you need to roll up your shirt sleeves and take time and diligence to not drown in cynicism but stay-a-float in realism.
- Keep learning. No one will ever care about the health of yourself and your family as much as you do.
1. Five Recent Medical News Stories That Invite Cynicism. Medscape. Sep 23, 2016.
2. Kearns CE, Schmidt LA, Glantz SA. Sugar industry and coronary heart disease research: A historical analysis of internal industry documents. JAMA Intern Med. 2016; DOI:10.1001/jamainternmed.2016.5394.
3. McGandy RB, Hegsted DM, Stare FJ. Dietary fats, carbohydrates, and atherosclerotic vascular disease. N Engl J Med. 1967; 277:186-192.
4. Mohanty S, Gianni C, Mohanty P, et al. Impact of rotor ablation in nonparoxysmal atrial fibrillation patients: Results from the randomized OASIS trial. J Am Coll Cardiol. 2016; 68:274-282.
5. Morgan DJ, Dhruva SS, Wright SM, Korenstein D. 2016 Update on medical overuse. A systematic review. JAMA Intern Med. 2016; DOI:10.1001/jamainternmed.2016.5381.