Tuesday, December 21, 2010

Physicians who cannot heal, themselves or anyone

kw: book reviews, nonfiction, alternative medicine, scientific method, humor

For about seven years physician Ben Goldacre has written the column "Bad Science" for The Guardian. While one might expect his new book to be composed of past columns, it is not so. Bad Science: Quacks, Hacks, and Big Pharma Flacks draws upon his journalism but is fresh from the top down. It requires a light touch to review this book. Dr. Goldacre is a good fellow, but some of the people about whom he writes are decidedly not, and at least one has sued him, an event that cost The Guardian some $350,000, even though Goldacre won! (The litigant was required to pay legal expenses for both parties, but paid only half.)

I could take the garden path through the book's dozen chapters but that would be a distraction from the real issue at hand. The root problem of the misunderstood, mismanaged, mis-labeled, mis-reported, inept and frankly fraudulent attempts at science by various medical and "alternative medical" or "complementary medical" practitioners is the business of medicine. Medicine ought not be a business in the first place.

I remember when very few doctors were members of "clinics" or "group practices," when many made house calls, and were well enough paid to become quite well-to-do, but none became filthy rich. Our doctor employed an office manager who also answered phones and did most of the filing, and things rocked along very well for decades. Having an appendix removed used to cost about a month's pay for a tradesman. Now, if you had to pay for it yourself, it'd be a year's pay. Same appendix, same skill, but three times as many people around the operating table, and all of them being paid more, proportionately, than the 1960s doctor.

A cute side note: My oncologist, about ten years older than I, knew a few diagnostic tricks that have been forgotten. Once, checking my abdomen, he put a stethoscope over the spot where my bowels had been stitched back together and scratched nearby with a fingernail, here and there. I held my giggle as long as I could. He explained, "Poor man's ultrasound. I can hear echoes from the scar tissue." A younger doctor would use a CT scan to observe the same scar. That kind of big medicine generates big money. Just the technician's fee for running the CT machine is more than the oncologist charged to scratch my belly.

To pick a target: the pharmaceutical business grosses nearly $230 billion in the United States and $800 billion worldwide. And when you hear how drug prices need to be set high to repay the costs of research, consider this: The total amount spent on drug research in the U.S. is about $32 billion, or 14% of the whole, while advertising and administration (management "overhead") is more than twice that at 31% or more than $70 billion. This makes me wonder where the other $128 billion goes; it is not all reported as profit, and manufacturing costs are certainly only a fraction of that. Yikes!

Then there is the "CAM" or Complementary and Alternative Medicine business. This is everything from both well- and poorly-founded nutrition "therapies" to homeopathy to kinesiology to "crystal therapy". It is worth some $50 billion yearly in the U.S. With that much at stake, science really doesn't matter. These folks can afford a phalanx of well-paid lawyers who make damn certain that science doesn't matter.

This is why, in the closing chapter of Bad Science, Dr. Goldacre writes to his opponents, "You win." Quacks know what your pet dog knows: any attention is better than no attention. Simply engaging them, even when you prove them wrong, is good for business. Throughout the book, knowing we can't do much about the rampant quackery in CAM and the surprising amount of poor practice in allopathic medicine, if he can't beat them, he can at least laugh at them. Maybe there is no force that can oppose them, but perhaps we can laugh them out of town. The book gives a reader many of the mental tools needed to see just how laughably poor the "science" is in CAM and in the underbelly of the medical business.

Now, I just have to pass on this one item from the book. It was something I hadn't known. Do you take big doses of antioxidant vitamins to counteract free radicals in your body? Have you been told that those free radicals cause cancer? It occurred to some researchers to study the matter, to see if the "free radical theory" worked in practice. Using a proper double-blind, placebo-controlled study protocol, they found, firstly, that antioxidants didn't affect cancer rates, but secondly, they sure affected death rates, and in the wrong direction! More of the people who were taking the antioxidants died during the study, significantly more than those who were not taking them. They just didn't die of cancer.

Now, vitamin A is known to be toxic in large amounts. It turns out that all the antioxidants, and all vitamins, are toxic in large amounts. That goes for vitamins C and E, and for all those various "phytochemicals" with antioxidant properties. So, take your vitamins in the recommended amounts, but don't overdo it. There is a "sweet spot" if dosage, which is around 80-100 mg/day for vitamin C, for example. Troubling side effects show up at five times that amount, after which the more you take the more likely you are to shorten your life.

We need doctors. We need doctors who are knowledgeable. Some are not, not enough. We also need patients who are knowledgeable. We do not need a clamoring horde of ignorant "alternatives." A few alternative medical methods are helpful. Most are not. Some are harmful or even deadly. Read this book for some solid nuggets of knowledge that just might save your life and health.

No comments: