Skepticism about science and medicine

In search of disinterested science

Archive for June, 2013

Why NOT to “Ask your doctor”

Posted by Henry Bauer on 2013/06/22

Doctors take their knowledge at second-hand (or perhaps third-hand).
Doctors are not scientists, and medicine isn’t science,   though the distinction is often overlooked. (Most scientists also take much of their knowledge at second hand, of course: anything outside their own specialty. Only people with time on their hands — amateurs or retired scientists or doctors — have the opportunity to make sufficiently comprehensive and in-depth surveys on a given topic of any complexity.)

Doctors are trained to apply pre-existing conventional, mainstream knowledge, not to question or modify or extend it. Therefore it is of literally vital importance, what the sources of doctors’ knowledge are.

Nowadays, unfortunately, much of what doctors “learn” comes from the drug industry, directly from traveling drug-salespeople and indirectly from advertisements that patients are urged to parrot by asking their doctor whether the product may be right for them.

Doctors can also resort to official guidelines from such agencies as the Food and Drug Administration, the Centers for Disease Control & Prevention, the National Institutes of Health, and from patients’ groups and charities like the American Heart Association.

All those sources of information are seriously biased.

Those official guidelines and the views of patients’ groups and charities are biased by pervasive conflicts of interest: Medical researchers almost universally receive research funding and consultantships and a variety of other perks from drug companies, and patient groups and charities are also supported (and sometimes even founded as well as funded) by the pharmaceutical industry.

Jeanne Lenzer, in “Why we can’t trust clinical guidelines” (British Medical Journal 346 [2013] f3830; doi: 10.1136/bmj.f3830), illustrates the dreadful consequences of biased guidelines with examples from treating spinal-cord injury with high-dose steroids and stroke with the thrombolytic drug alteplase. In the former case, “One expert estimated that more patients had been killed by the treatment in the past decade than died in the 9/11 World Trade Center attacks”; in the latter, “a Cochrane review of pooled effects . . . showed alteplase increased fatal intracerebral haemorrhage nearly fourfold, and . . . thrombolytics overall were associated with a significant increase in mortality by the end of follow-up, representing an extra 30 deaths per 1000 treated patients.”

Also mentioned are cholesterol guidelines, where “all but one of the guideline authors had ties to the manufacturers of cholesterol lowering drugs.”

A devastating and thoroughly documented account of the influence of the drug industry is in Ben Goldacre’s Bad Pharma: How Drug Companies Mislead Doctors and Harm Patients.

How science overall, not just medical science, has been corrupted by outside influences is documented in my Dogmatism  in Science and Medicine: How Dominant Theories Monopolize Research and Stifle the Search for Truth.

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