Medical truths: Questioning what is good and what is bad for you
A new Hebrew translation of a book by a Scottish physician tries to turn medical truths upside down.
By JUDY SIEGEL-ITZKOVICHClose up of female doctor holding syringe with injection (iilustrative)(photo credit: ING IMAGE/ASAP)
This book will:a. Save your lifeb. Kill youc. Turn you into an intelligent doubter of a variety of well-known medical assumptions, scientific research and the taking of a variety of drugs, including statins for high cholesterol, avoiding sun exposure, doing hormone-replacement therapy and others.The 304-page softcover Hebrew-language Refuat Yeter: Briut Boharim Bitvuna (Doctoring Data: How to sort out medical advice from medical nonsense) by Dr. Malcolm Kendrick will shake you up. Published in the original English a few years ago, this incredibly iconoclastic NIS 90 translation by Steimatzky has now appeared for the Israeli audience to peruse.Kendrick, who peppers his book with humor and irony, graduated from a medical school in Scotland and specialized in family medicine, dividing his time between treating patients and medical education in Cheshire in northwest England. He was an original member of the Oxford Center for Evidence-Based Medicine and the International Network of Cholesterol Skeptics – a group of scientists, doctors and researchers who think that cholesterol does not cause heart disease. Self-described as “a married man with two children and two cats who likes to ski, play golf, sail, play squash, walk the hills and drink... not necessarily in that order,” Kendrick says he strives to “see more people challenge the medical status quo and ask questions.”He begins the book with an alleged quote from American founding father and third president Thomas Jefferson: “If people let the government decide what foods they eat and what medicines they take, their bodies will soon be in as sorry a state as are the souls of those who live under tyranny.”But in fact, this quote was – disconcertingly – never found in Jefferson’s published papers but apparently a paraphrase of Jefferson’s statement in Notes on the State of Virginia, “Were the government to prescribe to us our medicine and diet, our bodies would be in such keeping as our souls are now.”Now that national leaders in various parts of the world claim everything that makes them look bad is “fake news,” Kendrick has brought this skepticism to the world of medicine.The book begins, of course, with the usual disclaimer that it is “meant to inform, entertain and arouse thoughts. It is not medical advice, and it may cause you to reject acceptable medical and nutritional advice. It’s your life, and your health is in your hands. The author, translator and publisher will not take responsibility for any damage or lawsuit resulting from using or not using the information in this book.”The provocative volume, with 149 footnotes from medical journals and other sources, is unsettling to a medical journalist who believes in the importance evidence-based medicine and accepted ways to prevent illness. Few “medical truths” that escape his skepticism. However, one the most prominent ones is tobacco – which he deems unambiguously deadly in all forms, a view I endorse wholeheartedlyHIS CHAPTER titles and explanations give a taste of his beliefs:Association does not mean causation.Say you’re reading a study titled “Eating Red Meat Increases the Risk of Dying of Heart Disease.” This is usually an observational finding. On one hand, eating red meat, on the other hand heart disease – but it is very rare that this correlation is also causal.So while it is inferred that eating red meat does cause heart disease, the fact that both things happen together does not necessarily mean that one causes another.Lives cannot be saved; we’re all going to die.When we encounter any form of so-called “preventive treatment,” he continues, we must ask ourselves: How much does this intervention really prolong our lives? In fact, there is no such thing as “preventative” therapy, there may be a treatment “inhibitor,” but that rings less dramatic and impressive. They tell you that a certain statin can save the lives of 50,000 people, but those will all die in the end anyway. What about prevention? How long will the lives of statin takers last? You will not get an answer because there is no definitive answer. Most of us take a “preventative” drug to prolong our lives, but they never tell us how much we will prolong them. It is largely a matter of twisting wording in presenting scientific findings.Relative mountains are made out of absolute molehills.Risks are very difficult to assess. When we are afraid of something, we tend to overestimate its risk. For example, in 1995, American women assessed their risk of dying from breast cancer up to 20 times the real risk, recalls the author. At the same time, we tend to overestimate the utility of our defenses against risk. These women estimated the benefits of mammography 100 times more than the real benefit. The term “risk reduction” is highly ambiguous; “relative risk reduction” is even more ambiguous and very different from “absolute risk reduction.”Things that are not true are often held to be true.There are medical stories that are unproven, but we all think they are true – because that’s what everyone says. Why does everyone say that? Perhaps it is from some statement that once someone accidentally threw in some scientific conference and from there it gained momentum, because it’s nice and even cool, so “everyone” is quick to quote it. Perhaps these cases also involve a degree of commercial interest. Reducing numbers is not the same as reducing risk.“Drug companies do not need to prove that their products reduce heart attacks, they only need to prove that the product actually lowers blood cholesterol or blood pressure. The relationship between cholesterol and blood pressure and the rate of heart attacks is so deeply rooted in the public and so obvious that there is no longer any need to prove it. Does the medicine you take on a daily basis really help you? Really prolong your life? The research needed to confirm this assumption is too enormous, expensive and perhaps even impossible, so they simply present facts in a way that there is no need to edit it.”Games are played and the players are…Researchers seek to achieve findings that confirm their assumptions, which are often very conservative and aligned with the professional-medical mainstream, so there is often little connection between the title of the publication and what it contains, he insists.Doctors can seriously damage your health.The medical world is constantly changing; sometimes what was once perceived as truth is now known to be a serious error. You cannot know what will be wrong in the future, but there are warning lights that can be identified.Never believe that something is impossible.It is important to keep an open mind, to listen to ideas that challenge conventional wisdom or to try to keep all ideas in one of three places – reasonable, possible or improbable. There is no such thing as impossible.‘Facts’ can be, and often are, plucked from thin air.As difficult as it may seem to believe, there are medical “facts” that do not work at all, but are simply invented. Medical evidence is sometimes simply derived from expert opinion or evidence from the lowest level. Instead of calling it evidence, it is often better to say “celebrity-based medicine” and to treat the “fact” with the required skepticism, Kendrick writes.The guidelines recommended by doctors for considering yourself healthy are constantly changing, he argues. The “permissible levels” for low-density lipoprotein (LDL cholesterol), body mass index, glucose in the blood and safe blood pressure levels have been reduced many times. They have fallen so much that almost nobody in middle age or even younger can be normal, he argues.“In fact, a study done in Norway a few years ago looked at the issue of cholesterol and blood pressure targets in more detail.Using guidelines developed by the European Society of Cardiology, they established that, by the age of 50, over 95% of people there would have a cholesterol level and/or blood pressure level considered high enough to require drug treatment. This is despite the fact that the Norwegians are among the healthiest and longest-lived people on the planet, so God knows where that leaves the rest of us.”KENDRICK DOES not hand out instructions to his readers; instead, he entreats them to have an open mind and think – and consult people you trust – before doing something, taking a drug or undergoing a medical test that may be harmful.For example, if you want to drink coffee, go ahead, Kendrick suggests. In fact, coffee drinking has found by medical researchers to have potential benefit, including reducing the risk of colon cancer, type-2 diabetes, liver disease and cancer, heart disease and Parkinson’s disease.But the author does not state that doctors have warned against overdoing caffeine consumption, because it can also be deleterious: The Mayo Clinic has reported that consuming more than 500 mg. to 600 mg. of caffeine a day may lead to insomnia, nervousness, restlessness, irritability, an upset stomach, a fast heartbeat and even muscle tremors. So, the layman public can neither believe or ignore everything they hear. Instead, advises Kendrick, they should deal with medical “truths” – drug company claims and even doctors’ statements – with “naive skepticism.”Statins to reduce cholesterol are among the mostly widely taken prescription drugs in the world, but Kendrick pooh-poohs the evidence.“This has become so completely ridiculous that, according to the latest American guidelines, if you are a man, by the time you are 63 and you have no risk factors whatsoever for cardiovascular disease – perfect weight; no diabetes; cholesterol optimal; blood pressure super-optimal – you still need to go onto a statin.”Patients, he continues, “are being cajoled to undergo ever more screening tests to pick up the early stages of cancer and numerous other diseases. As if this were not enough, your GP will be haranguing you to have endless measurements of blood pressure, cholesterol, and blood sugar levels, to name but three. As if good health is only really possible through constant monitoring by the medical profession.”As for the elderly, it has become virtually impossible to find anyone taking fewer than four or five separate medications.“One of my jobs is working in intermediate care where I help to look after elderly people, many of whom have suffered an injury or fracture of some sort. When patients enter this unit, the average number of medications taken is 10. That is 10 different drugs, to be taken each and every day, some of them three or four times a day. I suppose it saves on buying food.”THE AUTHOR two prominent medical editors.“It is simply no longer possible to believe much of the clinical research that is published, or to rely on the judgment of trusted physicians or authoritative medical guidelines,” said Dr. Marcia Angell author of The Truth About the Drug Companies: How They Deceive Us and What to Do About It. “I take no pleasure in this conclusion, which I reached slowly and reluctantly over my two decades as an editor of The New England Journal of Medicine.”Dr. Richard Horton, editor of The Lancet, is quoted as saying: “The mistake, of course, is to have thought that peer review was any more than a crude means of discovering the acceptability – not the validity – of a new finding. Editors and scientists alike insist on the pivotal importance of peer review. We portray peer review to the public as a quasi-sacred process that helps to make science our most objective truth teller. But we know that the system of peer review is biased, unjust, unaccountable, incomplete, easily fixed, often insulting, usually ignorant, occasionally foolish and frequently wrong.”The book comes with endorsements from various Israeli as well as foreign doctors. Dr. Ofer Shahar, a family physician who works in the Galilee, says, “Medical research is not pure. There is always somebody who will say there is a big study that proves... but that does not make it true.” This book, Shahar continues, “is one of the volumes that will change your thinking from one edge to another on what is good and what is bad in the medical world, what and to whom to believe. This is not a book with a happy ending, but it will open your eyes to the medical world of our time, with all its colors.”The world of medicine, Shahar concludes, has lost the intimacy between the doctor and patient, so in many cases, it has lost the trust of the patient. I invite you to start thinking for yourself, to develop your skeptical gene. Discuss with your family doctor your hesitations, fears and worries, and believe that your body knows what is good for you.”Surely it is good advice to consult with a doctor you trust, but too much skepticism can make you throw out the baby with the bathwater. The best course might be to heed the advice of the great sage and physician Maimonides, who counselled “moderation in all things.”