Reblogged from ChapmanCentral with full permission.
Evidence-based practice reveals flaws in medicine. Lynne McTaggart believes that this is a great reason for abandoning evidence-based practice. Because reasons.
It’s not a good time to be a drug company employee. Increasingly, those at the top of Establishment medicine are joining the ranks of whistleblowers like us calling for medicine to be decoupled from the pharmaceutical industry.
Have you been living in a hole for the last however many years, Lynne?
This is not whistleblowing. It’s the self-criticism inherent in any scientific endeavour – this always happens and medicine has never been an exception. Self-criticism is how science gets better; using the self-criticism as a way of asserting bullshit instead, has never improved anything except the profits of the SCAM industry.
Whistleblowing is where a senior figure within a company or organisation, produces evidence of malfeasance, usually endemic malfeasance. So Preston H. Long is a whistleblower. I think you may be confusing whistleblowers with whistlebellowers.
One of the biggest canaries at the moment is Peter Gøtzsche, none other than the head of the Nordic Cochrane Centre, the Scandanavian (sic) arm of the Cochrane Collaboration, an independent research and information centre committed to preparing, maintaining, and disseminating reviews of the various treatments of mainstream medicine and examining whether they have adequate evidence of safety and effectiveness. Cochrane was the first group of individuals to champion the notion of‘evidence-based’ medicine – that is, medicine shouldn’t be used unless there’s evidence that the stuff works.
Yes, the Cochrane Collaboration and its various satellites are a perfect example of the self-criticism inherent in medicine. They have been revealing problems in common medical treatments for two decades. Archie Cochrane was pivotal in the development (or more correctly formalisation) of evidence-based medicineW, but it would be grossly misleading to imply that before the foundation of the Journal of Clinical EpidemiologyW in 1988 there was no such thing as evidence-based medicine. Medicine has always been informed by scientific evidence (that’s how ineffective treatments like bloodletting were discarded), the change that Cochrane pioneered was systematic long-term review of treatments not only prior to introduction but post introduction.
In other words, does the clinical outcome match up to the predictions from the clinical trials on which approval was based.
Gøtzsche is a guy after my own heart. When asked to speak at a Danish Society for Rheumatology event, called ‘Collaboration with the drug industry. Is it THAT harmful?’ Peter’s opening gambit was to highlight the fact that Pfizer, one of the meeting’s sponsors, had been fined $2.3 billion in the US for promoting off-label use of four drugs, while Merck, the sponsor the year before, had been responsible for the deaths of thousands due to deceptive information about its arthritis drug.
No, Lynne, I really don’t think he is a “guy after your own heart”, because he doesn’t use problems with medicine to advocate completely abandoning the systematic scientific approach that revealed those problems in favour of a hodge-podge of unproven and disproven bullshit.
Gøtzsche’s latest book, entitled Deadly Medicines and Organised Crime: How Big Pharma has Corrupted Healthcare’ (Radcliffe Publishing Ltd) pulls even fewer punches. The book essentially makes the point that the drugs industry uses virtually every tactic used by the mob to sell its products.
Who knew? Apart from everybody who has ever read a word Ben GoldacreW writes?
Big Pharma are not alone in this. Big Herba is worse – they had stakeholders in the US government push through legislation which means that they can sell product with no demonstration it’s safe, and can even prevent the FDA from investigating whether it is safe!
The problem is in fact endemic to the nature of the corporation. By law, a corporation’s first duty is to its stockholders. Governments compensate for this by regulating. It’s not a coincidence that the industry-driven agenda of deregulation has caused a flood of examples of corporate self-interest, of which EnronW is probably the best known.
He even quotes a former vice-president of Pfizer as saying, ‘It is scary how many similarities there are between his industry and the mob. The mob makes obscene amounts of money, as does this industry. The side effects of organized crime are killings and deaths, and the sides effects are the same in this industry. The mob bribes politicians and others, and so does the drug industry.’
And so does Big Herba, and so do other corporations. This is not unique to the pharmaceutical industry.
Perhaps even more extraordinary than the careful case made by this blunt soothsayer is the fact that Richard Smith, the former editor of the British Medical Journal, agreed to write the book’s foreword. In the book, Smith points out, the characteristics of organized crime include extortion, fraud, federal drug offences, bribery, embezzlement, obstruction of justice obstruction of law enforcement, tampering with witnesses and political corruption.
Sure. So people within the medical establishment criticise the way the establishment works. They always have. This is a good thing.
“Peter produces evidence, most of it detailed, to support his case that pharmaceutical companies are guilty of most of these offenses,” says Smith. Indeed, most of the billions paid out as fines by the drugs industry for flouting the law as thought of as ‘the cost of doing business.’
“As an epidemiologist with very high numerical literacy and a passion for details, so that he is a world leader in critiquing clinical studies, Peter is here on very solid ground,” says Smith. “He shows too how the industry has bought doctors, academics, journals, professional and patient organizations, university departments, journalists, regulators and politicians. These are the methods of the mob.”
Correct. So, here’s the elephant in the room:
Of the various abuses uncovered within the pharmaceutical industry, how many have been uncovered by people within the medical and regulatory establishment, and how many have been uncovered by people within the SCAM establishment?
How many of them have been addressed or fixed by people within the medical establishment, and how many by people within the SCAM establishment?
We know the answer.
SCAM is a consumer of medical science’s self-criticism. In fact it’s an exploiter of medical science. When scientists find that cancer cells are often fuelled by glucose, SCAM sets up a cottage industry in promoting glucose starvation as a “miracle cure”, while medicine sets about testing this and finding that glucose starvation actually makes the cancers grow more aggressively.
SCAM exploits every flaw and weakness in medicine, as exposed or explored by medical science, in order to assert bullshit that is almost universally totally contradicted by exactly the same scientific processes that revealed the flaws in their claims.
As Mencken pointed out, for every complex problem there is an answer that is clear, simple, and wrong. Gøtzsche is documenting the complex problem, you’re providing the answer that is clear, simple and wrong.
This is only the latest canary from among Establishment medicine to blow the whistle on Big Pharma. Marcia Ancell, the editor for two decades at the new England Journal of Medicine, recently published her own book: The Truth About the Drug Companies: How They Deceive Us and What to Do About It.
Indeed. Skeptics love these books. And Ben Goldacre’s Bad PharmaW (why do you not mention that?, and Margaret McCartney’s The Patient Paradox, and of course Phil Hammond’s “Trust Me, I’m A Doctor”.
All of the major medical journals, from the BMJ and the Lancet, to the Journal of the American Medical Association and the New Eng Journal, have revealed the scale of the problem – that correctly prescribed drugs are the fourth leading cause of death, that drug companies massage and make up data.
Whoa, bait and switch time. Yes, drug companies massage the data (you badly need to support All Trials but probably can’t because that would make your head asplode, what with Simon Singh being involved and all). No, it is not meaningful to say that correctly prescribed drugs are the fourth leading cause of death, because there is a lot of nuance buried in that statement – for example, a significant cause of death in the US is people taking their correctly prescribed medication, incorrectly.
But even if this were true – and if it isn’t now it’s likely to become so as the population ages and more and more people push the boundary of what medicine can do to keep them alive – it absolutely does not justify abandoning the process of evidence-based medicine.
The fact that medical science reveals flaws in practice is expected, normal and entirely healthy. Engineers call this a “negative feedback loop” – compare what you get with what you expect, and correct accordingly. WDDTY and the many SCAMmers it promotes adopt a dangerously different system: they compare what they see with what they want to see, and weight it accordingly, so that confirming results are believed and disconfirming results discarded. This is not only incapable of self-correction, it is guaranteed to be wrong, stay wrong, and get more wrong over time.
Medicine should be a gift to us all rather than a money-making scheme for the pharmaceutical industry, as it now largely is.
This embodies so much Wrong it’s hard to know where to start.
The pharmaceutical companies are without question problematic. Within them, however, are many people working hard to produce genuine cures for genuine diseases. In doing this, a vast amount of money is spent on science, some of it bad, but much of it good. Big Herba basically does not do research, it’s all down to Big Pharma, universities and charitable foundations.
If you want Big Pharma to be run as a not-for-profit enterprise, which Big Herba isn’t, and to stop lobbying politicians in the way Big Herba do, and to stop trying to manipulate the laws to be favourable to them, as Big Herba do (and rather better!), then who do you think is going to pay for the research, development and manufacture of new treatments?
Or do you want us to stop medical science in its tracks, discard evidence and science in the practice of medicine, and go back to the days when nobody had any idea whether the latest snake oil huckster was selling a genuine cure or just bleach?
With that in mind, we suggest that the following be implemented.
An independent funding body should be created to finance all medical trials, whether of drugs, other forms of therapy or alternatives
Doctors should be required to spend one year of their five-year training learning about nutrition, alternative modalities and new possibilities
Drug-company influence should be entirely excluded from medicine, from training colleges and from trips abroad
Doctors should be rewarded for adopting non-drug therapies, thus saving the nation at least one small part of the £160 billion spent every year on drugs by the NHS.
But most of all, we need to open up the entire field of cancer—our understanding of what it is, what causes it and how it could be treated—while taking on board new understandings of the body and the impact upon it of the environment, stress and emotions. As a researcher once commented when asked whether research into alternative healing should continue, “We can’t find the answers if we don’t keep asking the questions.”
OK so here are the issues with that.
- The real problem is not that Big Pharma makes a profit, but that it places profit too high on its priorities. You can’t fix that by withdrawing its ability to make profit.An independent body that breaks the relationship between development of a treatment and profit from manufacturing and selling that treatment, will result in a situation where drug companies cannot make a profit, and they will shut down. This already nearly happened with vaccines (which is no doubt why you love the idea, as you hate vaccines); the costs of making vaccines had become prohibitive due to perverse decisions by the courts so the US Government had to set up a special system to manage the generally vexatious claims of vaccine injury, otherwise there would be no company prepared to sell them in the US.
- Two parts:
- Doctors already learn about nutrition as part of their training. They can also draw on the expertise of qualified dieticians when in practice.
- What “alternatives” do you want them to learn? Alternatives-to-medicine encompasses a wide range of often mutually contradictory disciplines, many of which are long since proven to be nonsense. Would you include “Miracle Mineral”? Escharotics? Of course not, because these are not just delusional nonsense, but actively dangerous. So then you have a problem: what objective system can you come up wth to decide which alternatives should be taught and which not? And how do you protect any such objective system against the obvious problem: Minchin’s Law, which states that a treatment is only alternative because it either hasn’t been shown to work, or has been shown not to work.
- Your comments on “drug company influence” are founded in an outdated view of how drug companies work. A few jollies do still persist, but not many, and public officials cannot be included. Many GP practices won’t see drug reps. Medicine is awae of the pernicious influence of the marketing dollar and is actively addressing it, and has been for a long time.
- Doctors already have a financial incentive to use the best value treatment for any patient, why would you want to skew that by introducing a system that is wide open to abuse by those promoting quack therapies? Oh, wait, I think I might have answered my own question there…
When should doctors be rewarded for using “non-drug therapies”? When they would have used them anyway, as they currently do when referring to a dietician or physiotherapist? Or when they substitute a drug with a “supplement” that is actually a drug in all but name? Or do you subscribe to the fallacious view that things are only “chemicals” if they have been through the hands of an Evil Corporate?
- Where is your evidence that investigation of cancer is closed in the way you suggest? The only “problem” (and it’s a problem only in the minds of nutters) is that once a treatment has been shown not to work, it’s no longer investigated.
And we also have, again, the problem of how you decide what to investigate. You can’t do clinical trials on things that are dangerous, provably ineffective, or utterly implausible, because that violates basic ethical principles. Consider laetrile. Cochrane (your new best friends, remember?) show that there is no evidence for any beneficial effect from laetrile – only cyanide poisoning. So you cannot, ethically, investigate it. What system do you use to decide what should be investigated and what should not, and how would that be different for the existing system, that uses medical science and epidemiology to inform practice?
Do you believe that Cancer Research UK are an honest broker? Or the American Cancer Society? Or the National Cancer Institute? Or does your definition of acceptability hinge on advocacy of “alternative” treatments? If so, that is probably the single worst criterion available.
So, you want the conclusions of evidence based medicine to be used to enforce the use of treatments that evidence-based medicine says do not work. That way lies cranioproctosis.
We will shortly announce our campaign for freeing medicine from the pharmaceutical industry, so that doctors and patients alike are free to use an entire toolkit of modalities to get and stay well.
You really don’t understand, do you?
What you are advocating is as follows:
- Medical science is self-critical.
- The conclusions of medical science and evidence-based practice, show problems in the pharmaceutical industry.
- Based on these problems, you advocate
- abandoning the conclusions of medical science and evidence practice where these conflict with your religious beliefs.
- going well beyond the limits of applicability of these conclusions to place the pharmaceutical industry at a massive disadvantage compared with your religious beliefs
- enforcing the teaching of your religion in medical schools, to reduce the influence of evidence-based practice and medical science
Yes, that genuinely is what you are saying. You can’t perceive your own biases so you’ll probably never realise it.
The bathwater is dirty so you want to throw it and the baby down the drain. And then fill the bath with mud. And then shit in it.