WEEKLY HEALTH BULLETIN September 21, 2009
THE EMPEROR HAS NO CLOTHES – THE HYPOCRISY OF MAINSTREAM MEDICINE
We regularly hear from member of the medical establishment and ill-informed media pundits that mainstream medicine is “evidence based” and “scientific”. This is untrue. A great deal of what goes on in doctors’ offices and hospitals is anything but.
There’s nothing inherently wrong with this fact. There simply are not sufficient resources to fund the randomized controlled trials extolled as the “gold standard” measure required to guide medical care. You can’t test everything and you can’t answer every question that needs answering.
COMMON PRACTICES ARE UNPROVEN
What is unacceptable is the apparent willingness to claim that mainstream medicine practice and guidelines are generally supported by this high level of scientific research. This tendency is especially troubling when it comes to widespread, potentially harmful practices that are costing our failing health care system huge amounts of money.
DO STATINS PREVENT HEART ATTACKS AND DEATH?
The first example is whether cholesterol lowering medications (statins) prevent heart attacks and death. According to the best evidence, statins are of proven benefits for adults between the ages of 30 and 80 who already have heart disease. Yet for women of any age and men over 69 who do not already have heart disease, statins are of no proven benefit.1
Even for high risk males between the ages of 30 and 69, you need to treat 50 people for 5 years to prevent one heart attack, hardly an impressive result. At best, this constitutes a statistical crap shoot. Imagine 50 people lined up every morning and receiving a statin drug every day for five years. At the end of five years, only one heart attack will be prevented. 2 Yet up to 15% will experience some sort of undesirable side effect, such as muscle weakness and pain, memory loss, depression, loss of libido or peripheral neuropathy.
Over $20 billion a year are spent on statins for exactly this sort of unproven, questionable care.
HEART SURGERY AND ANGIOPLASTY
The second example: Heart bypass surgery and coronary angioplasty supposedly prevent heart attacks and save lives. According to the American Heart Association, we spend $100 billion a year for these procedures. Yet the recent COURAGE trial showed that angioplasty does not prevent heart attacks or death in most patients (those with stable heart disease).3
Since 1977, heart bypass surgeries jumped from 82, 000 a year to 448,000 at a current cost of nearly $100,000 each. The year I graduated from medical school in Vermont, a doctor who performed these surgeries was reputed to be the highest paid doctor in the state. Yet the available data tells us these surgeries help only a small percentage of patients with especially severe disease (less than 10%).4
BECAUSE THAT’S WHERE THE MONEY IS
What’s going on here? Let’s call it the momentum of money and the fact the medical profession is burdened by an extraordinary degree of conflict of interest. Many of the “thought leader” physicians who make up and pronounce statin guidelines hold medical school faculty posts and highly paid positions at drug companies at the same time. Study results are twisted and massaged then presented to physicians, who as a group mostly lack the analytical skills to
figure out the truth.
This sorry state of affairs goes without mention in the current debate over health care reform, which in my view, is a futile sham.
- Are Lipid Lowering Guidelines Evidence-Based? Lancet 2007; 369
- American Journal of Cardiology 2009; 104
- Evidence-based use of cardiac procedures and devices New England Journal of Medicine 2004; 350
Alan Inglis MD
American Country Doctor