What Doctors Don’t Tell You

A spokeswoman from the British Family Planning Association, which has probably handed out its fair share of Pills to teenagers, dismissed any breast cancer risk out of hand, arguing that this theoretical risk had to be weighed against the ‘evidence that the Pill protects against endometrial and ovarian cancer’.

(#litres_trial_promo) This is a typical example of medical reasoning. This drug is beneficial because it may ‘protect’ you against one kind of fatal cancer (a highly questionable conclusion, in any event), even though it may give you another potentially fatal cancer.

And because they live and breathe medicine by numbers, and believe in the infallibility of their tools, doctors are willing to hand out dangerous medication on the confident assumption that new tests will pick up any side-effects that they cause, and yet other drugs will be able to treat these new problems. Hence the reason why family planning enthusiasts will usually patiently explain that, even though the Pill may cause cervical cancer, cervical smears should pick up early changes, at which stage things are mainly treatable. Like many in medicine, they make the fatal error of requiring medicine to be infallible. This reasoning works if a test that can be wrong more than half the time picks up the cancer early, and if medicine can always cure cancer, which thus far it has singularly failed to do.

This kind of tortuous logic was once used to minimize evidence showing a link between vasectomy and the development of prostate cancer. The two studies, which examined over 74,000 men who had had vasectomies, showed that vasectomy increases the prostate cancer risk by 56 to 66 per cent.

(#litres_trial_promo) Those patients who’d had their operation done 20 years ago faced a whopping increase in risk of between 85 and 89 per cent. In other words, having a vasectomy 20 years ago nearly doubles your risk of getting cancer.

Pretty damning evidence, one would have thought. Nevertheless, after it was published, some professional magazines encouraged doctors to tell their patients that the risk of prostate cancer following a vasectomy was minimal. The article attempted to claim that, compared to other methods of birth control (the condom? natural family planning?), vasectomy is ‘still one of the safest’. A Family Planning Association spokesperson concurred: ‘These studies do not tell us that vasectomy causes prostate cancer’ (again, my italics).

A similar situation has occurred with HRT. Although two major studies were stopped when it was found that women on HRT are more likely to have heart attacks, cancer and stroke, the British medical establishment refused to recant or admit that this might not be the treatment of choice for women going through the menopause.

Doctors and medical researchers have been known to hype up the risks of a disease compared with the risks of the drug used to treat it. Dangerous drugs look good if you turn an ordinarily benign problem into a killer disease. In 1992, the UK Department of Health (DoH) announced the hasty withdrawal of two of the three brands of the combined measles, mumps and rubella (MMR) vaccines. The official line circulated to the press about why these drugs were withdrawn, after having been jabbed into millions of 15-month-olds, were allegedly the results of a study showing that the two withdrawn brands had a ‘negligible’ (1 in 11,000) risk of causing a ‘transient’ and ‘mild’ (all DoH words, these) case of meningitis. The third brand, made from a different strain of the mumps virus, supposedly did not pose this risk.

In 1989, when I first interviewed Dr Norman Begg of the UK’s Public Health Laboratory Service, which recommended the vaccine in Britain, he assured me that mumps on its own was a very mild illness in children. Mumps, he said, ‘very rarely’ leads to long-term permanent complications such as orchitis (where the disease hits the testicles of adult males, very occasionally causing sterility). The mumps component had only been added, he said, to give ‘extra value’ to the jab.

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By 1992, however, when the two versions of the MMR were withdrawn, the British government painted a very different picture, announcing that mumps leads to meningitis in 1 in 400 cases. Hence, even though the old vaccine was dangerous (and it must have been pretty dangerous to get hauled off the market virtually overnight), it was not as dangerous as catching mumps.

But of course, two-thirds of medical practices don’t have any proof at all. There is no such regulatory agency like the Food and Drug Administration or the Committee on Safety in Medicines to monitor surgery, screening or diagnostic tests – nothing but peer review through national medical associations. Run by doctors for doctors, these organizations tend to rule by consensus, and by a peculiarly circular logic: if a practice is universally employed, it must be safe, even when many studies point otherwise.

In the case of surgery, most treatments get the nod without any kind of clinical trial (partly because it is very difficult to have either a randomized or double-blind trial or to reverse an operation with an unfavourable result). Consequently, some new techniques get adopted with very little in the way of proof to show they are doing any good or at least not doing drastic harm.

Medicine as it is currently practised is a private conversation by doctors, for doctors. There’s no doubt that medicine maintains a double standard. Doctors often privately voice their doubts, disappointments and fears about particular treatments in their own literature, yet fail to disclose this in any discussion with patients or the press. For instance, some years ago an especially alarming piece of information came to light about vaccines. The US Centers for Disease Control and Prevention in Atlanta, Georgia, discovered that children receiving the triple jabs for diphtheria/tetanus/whooping cough or for measles/mumps/rubella were three times more likely to suffer seizures. Nevertheless, this information was only announced to nine scientists and was never otherwise publicized.

Another prime example of this double standard surrounded the issue of treatment for breast cancer. An editorial in The Lancet published a scathing attack on the failure of mammography as a technology to halt the rising breast cancer death rates, and organized a conference to talk over new solutions

(#litres_trial_promo) – at the same time that various government bodies were calling for increasing the frequency of mammograms.

The greatest reason that medical research is tainted is that the majority of it is funded by the very companies who stand to gain by certain results. These drug companies not only pay the salaries of researchers, but they can often decide where – indeed, whether – they get published. It’s wise to keep in mind that this industry, in a sense, has a vested interest in ill health: if drug companies found cures, rather than lifelong ‘maintenance’ therapies, they’d soon be out of business.

The constant exposure of medicine to the pharmaceutical industry, and the reliance of future medical research on these companies, has bred a climate in which much of mainstream medicine refuses to consider any other treatment options besides drugs and surgery, even when copious scientific evidence exists to support those options. Many conventional doctors are especially vituperative in their dismissal of important work by innovators, while uncritically embracing many surgical or drug-based solutions that are little more than modern-day snake oil. This has bred a climate into which healers are polarized into ‘alternative’ and ‘orthodox’ camps, rather than into one common group approving of anything that has a solid basis in science or clinical practice. Dr Peter Duesberg, a leading University of California professor in molecular biology, was one of many publicly vilified for suggesting, with a well-reasoned argument backed up by a 75-page published paper, that HIV is not the cause of AIDS.

To give you some idea how medicine handles heretics, witness how it still reacts to scientific evidence supporting alternative medicine. A study conducted scientifically, with all the usual gold-standard double-blind, placebo-controlled checks and balances that medicine prides itself on, showed that homoeopathy for asthma actually works. Scientists now had some proof: homoeopathy works. In fact it was the third study carried out by the same man since 1985 to show exactly the same result.

Nevertheless, in his published report the leader of the trial distanced himself from his results, pointing out in his conclusion that tests such as these just might end up producing false-positive, or wrong, results.

(#litres_trial_promo) Despite the scientific design of the trial, an editorial in The Lancet flatly refused to accept the results: ‘What could be more absurd than the notion that a substance is therapeutically active in dilutions so great that the patient is unlikely to receive a single molecule of it?…Yes, the dilution principle of homeopathy is absurd; so the reason for any therapeutic effect presumably lies elsewhere.’

(#litres_trial_promo) In other words, the scientific method works only when it applies to things we have faith in, but not, it seems, with anything we don’t understand or agree with.

The problem with this dogmatic adherence to preconception and dismissal of dissension or doubt, as far as you and I are concerned, is that it covers up the fact that much of standard medical practice may not work very well. It makes dangerous drugs look safe and effective. It makes it seem like people who don’t need drugs should take them. It justifies a lot of useless surgery that may very well kill you, and certainly isn’t going to make you better. It explains away many promising treatments that don’t require dangerous drugs or surgery. Despite the very best of intentions, it sometimes causes untold pain and suffering, rather than contributing to your health. In fact, you are in grave danger from the moment you walk into your doctor’s surgery, particularly at the point when he tells you he’d like to take a few tests.

PART II DIAGNOSIS (#ulink_3eb81d4d-1087-526c-911c-fad4a5013915)

2 Diagnostic Excess (#ulink_f371b84f-106c-51df-bc54-50e8b8104864)

Your modern-day doctor has at his disposal an array of high-tech gadgetry that allows him to monitor and measure virtually every nook and cranny of your body. He and his fellow doctors are now completely reliant upon these tests to diagnose disease. As patients, we trust tests so implicitly to provide us with a definitive view of our state of health, even to predict when we’re going to get ill at some distant point in the future, that most of our children begin having tests as soon as they’ve been conceived.

At last count, there were more than 1,400 of these, ranging from the simple blood-pressure cuff to the most sophisticated computerized nuclear magnetic imaging devices. Back in the relatively dark ages of 1987, some 19 billion tests were performed on Americans that year alone, which works out to be 80 tests for each man, woman and child.

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Despite the kind of gadgetry that would put NASA to shame, the problem is that the technology doesn’t really work very well. Most tests are grossly unreliable, giving wrong readings a good deal of the time. A false-positive test sets in motion the juggernaut of aggressive treatments at your doctor’s disposal, with all their attendant risks. But the tests themselves can be as risky as some of the most dangerous drugs and surgery, risks that are magnified because so many of these tests are patently unnecessary. In many cases (more so in the United States), doctors protect themselves against potential lawsuits by ordering every test they can. In fact, in the US, many orders for tests are motivated by a doctor’s own self-interest, since so many physicians either own or have substantial shareholdings in the facilities to which they refer their own patients.

Another problem is that, these days, technology has replaced the fine art of diagnostics – of examining a patient’s clinical history and having a good look at his eyes and the state of his tongue. The problem often comes down to trainee doctors, who often order tests under the mistaken notion that their consultant superiors desire such ‘just-in-case’ medicine. But in many cases senior doctors do flog their juniors if they fail to request particular tests, engendering the view that more is better and that massive test-taking is what constitutes good doctoring.

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Tests also make the fundamental error of assuming not only that all people are alike, but that people (and their measurements) always stay the same.

The other problem is that, unless your doctor has a particular feeling for taking apart computers in his spare time, he can get a bit muddled by this gee-whizz technology. One study found that virtually all doctors and nurses don’t know how to work a pulse oximeter, a monitoring system which is vital for monitoring patients recovering from anaesthesia and recording potential life-threatening situations.

(#litres_trial_promo) Consequently, they make serious errors in evaluating readings. The medics reported not being ‘particularly worried’ when patients had levels indicating that they were seriously deprived of oxygen and needed immediate attention if they were to live.

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BLOOD-PRESSURE READINGS

Your problems can start even when your doctor brandishes his blood-pressure cuff to record your blood pressure. Professor William White, chief of Hypertension and Vascular Diseases at the University of Connecticut, refers to this gizmo, known in medicalese as the ‘sphygmomanometer’, as ‘medicine’s crudest investigation’. Blood pressure, he says, can vary tremendously – as much as 30 mm Hg over the course of any day.

(#litres_trial_promo) In fact, the time it’s most likely to rise is in your doctor’s surgery, when you’re waiting to have the test – a phenomenon known as ‘white-coat hypertension’. A recent study comparing blood-pressure readings taken at home, at work and at the doctor’s surgery found that the most inaccurate were those performed in the doctor’s surgery.

(#litres_trial_promo) Such an artificially high test reading at the doctor’s surgery can launch a patient onto a lifetime of blood-pressure medication.

(#litres_trial_promo) The latest studies into blood pressure and hypertension have concluded that true high blood pressure is more related to average levels over 24 hours and also the degree of fluctuation between day and night than any particular or casually-made blood-pressure readings.

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These days, your doctor is more likely to give you a home-monitoring device or even to strap you up with a portable electronic device, which will measure your blood pressure at pre-set intervals over 24 hours. This is now thought to be the more accurate way of assessing your average blood pressure, although there is still a great deal of evidence that this system, called ‘ambulatory monitoring’, likewise doesn’t provide accurate enough information for doctors to decide whether a patient needs treatment for high blood pressure.

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Even the World Health Organization recommends that ambulatory monitoring is best conducted with multiple readings over six months. But because no one has yet bothered to do proper large-scale scientific studies, no one can agree over how long you should go on doing the ambulatory monitoring before making a diagnosis, or what actually constitutes high blood pressure over this period, or even how much blood pressure should be lowered by to make it ‘normal’.

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The values used today are still hypothetical, gleaned from studies of populations with normal blood pressure.

(#litres_trial_promo) With home-monitoring systems, accuracy also remains a large problem. Only about a fifth of self-recording devices evaluated in recent studies have met acceptable criteria.

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In the US, the Food and Drug Administration mandates that any hypertension medication must be shown to lower blood pressure over 24 hours through ambulatory monitoring. Nevertheless, neither doctors nor drug companies really understand which reading – morning average, evening average, ambulatory reading, difference between day and night, degree of variation – shows that things are finally under control. Furthermore, many patients have different degrees of variability, depending on the nature of the stress they confront on the job.

(#litres_trial_promo) Older patients also have more exaggerated differences in day and night readings – the significance of which is anyone’s guess.