The Banality of Evil — and modern medical practices

”The banality of evil” is a phrase famously used by Hannah Arendt in her description of the trial  of Adolf Eichmann. There has been much argument about what exactly she meant. For me, the insight is that evil is so often unintended, that it can result from perfectly well-intentioned actions.

The root of all evil is wrong belief.

If one believes that the most important thing about a human being is the immortal soul, and that the soul will burn in hell for eternity unless it has accepted what the Holy Roman Catholic Church believes, then obviously one should leave nothing undone in the effort to bring that soul to proper belief, even if that amounts to torturing the immortal soul’s body, even to death.

If one believes that one’s country was defeated and devastated by sabotage perpetrated by Jews, communists, homosexuals, gypsies, and the like, then obviously one should do whatever is necessary to rid the country of those perpetraitors.

 And so on

The human tragedy is that we acquire beliefs according to the environment into which we are born and in which we are raised; and once belief has been acquired, it tends to become increasingly entrenched and increasingly difficult to modify.

The problem for society is how best to ensure that collective public actions are based on correct rather than on wrong beliefs.

Nowadays that is taken to mean that public actions should be based on science.

Unfortunately, the nature of scientific activity is widely and thoroughly misunderstood [1], in particular its fallibility, which results inevitably from the fact that science is carried out by fallible human beings.

That fallibility is well illustrated by the history of medicine, where many past practices are now recognized as having been harmful rather than helpful — drawing out blood in sizable amounts, for example. Nowadays, the excellent intention to base medical practices on sound scientific knowledge has sadly gone wrong in several ways, as a result of beliefs that turn out to be wrong.  One pervasive reason is that statistical associations are taken as indicating cause and effect — an error that is warned against in even the most elementary introductions to statistical analysis.

Several pertinent stories are analyzed in Jeremy Greene’s magisterial Prescribing by Numbers [2].

One story has to do with blood pressure. Life insurance companies required physical examinations. Their accumulated data revealed that on average mortality increased with increasing blood pressure. Now, mortality increases with age; and it happens also that every relevant study has shown that blood pressure too increases naturally with age in otherwise healthy people. The association of blood pressure with mortality is an artefact illustrating the common principle in statistics that when two things, A and B, are each correlated with a third factor, C, then A and B will also show a correlation with one another; even though neither causes the other [3].

The misinterpretation of life-insurance statistics has resulted in contemporary medical practice based on a wrong belief, namely, that it is beneficial is to bring everyone’s blood pressure to a level that is normal only for people in their twenties.

This mistake becomes particularly harmful since the means used to lower blood pressure almost invariably involve administering drugs, though lip service is always paid to advising appropriate diet and exercise as the first resort.

That drug companies are permitted to advertise direct to consumers (among developed countries, only in the USA and New Zealand) means that such practices become so taken-for-granted as to be virtually unquestionable.

Another mistaken belief is that high levels of cholesterol in the blood constitute cardiovascular disease and increased risk of stroke and heart-attack. The corollary misguided belief is that bringing cholesterol levels down by administering statin drugs is beneficial; even though statins hinder the body’s production of coenzyme Q10, which is a necessary component of the energy-producing mechanisms of all cells. Inevitably, therefore, statins induce in muscular weakness, which is officially but quite mistakenly described as a “side” effect; it is a direct effect.

Many well documented books and articles have debunked the cholesterol theory (for example, Kendrick (2007) and Ravnskov (2000) in [4]), without effecting any change in standard practice — although many individuals ignore or defy their doctor’s prescribing of statins.

Not only do modern American medical practices rely on misleading, incompetent statistical analyses, they are based fundamentally on the wrong belief that preventive medicine can be successfully practiced by administering of drugs. This becomes increasingly harmful when those drugs continue to be prescribed as people get older and the steadily cumulating danger from drug “side” effects outweigh any possible benefit from “reducing risk” of one or another ailment [5].

Drug-based treatments are particularly well entrenched because the pharmaceutical industry is hugely profitable in large part because of the profligate prescribing of drugs stimulated by pervasive advertising.

The greatest immediate improvement in prescribing practices would result if the Food and Drug Administration and other regulatory authorities would demand statistically competent and honest protocols for clinical trials, including that outcomes not be assessed as “significant at p ≤ 0.05” but in terms of NNT and NNH: numbers of patients needed to be treated for 1 successful outcome compared to numbers of patients needed to be treated to observe 1 undesired adverse event [6].

That would prevent much harm, for example that now perpetrated by HPV vaccines, which are responsible for the greatest number of officially reported averse events as well as many horrifying anecdotes [7]; while there is no actual proof that HPV causes any cancer at all, HPV having been found guilty only because a few strains (out of many dozens) are often statistically associated with some cancers.

Well intentioned physicians are doing harm because of wrong beliefs, even as dozens of books [4] have exposed the misdeeds and their causes.

Is it not an evil,
 to persuade people to ingest things that do harm
 without any compensating good?

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[1]    Science Is Not What You Think: How It Has Changed, Why We Can’t Trust It, How It Can Be Fixed, McFarland, 2017
[2]    Jeremy Greene, Prescribing by Numbers, Johns Hopkins University Press, 2007
[3]    “Seeking Immortality? Challenging the drug-based medical paradigm”, Journal of Scientific Exploration, 26 (2012) 867-80
[4]    What’s Wrong with Present-Day Medicine
[5]    “When is enough, enough? Stopping medicines in older people”, Best Practices Journal, #27 (April 2010) 6-9; Rushabh J. Dagli & Akanksha Sharma, “Polypharmacy: A global risk factor for elderly people”, Journal of International Oral Health,  6 (#6, 2014) i–ii
[6]    How (not) to measure the efficacy of drugs
[7]    Mary Holland, Kim Mack Rosenberg & Eileen Iorio,  The HPV Vaccine On Trial: Seeking Justice For A Generation Betrayed, Skyhorse, 2018
Documentary: Sacrificial Virgins

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