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Tuesday, October 26, 2010

Does My Medication Really Work?

I am always interested in how science and medicine are used for financial and/or intellectual leverage over folks who are neither scientific or intellectual.

If you're not scientifically minded then you really have to rely on what other people are telling you - about your health, about medicine, about the environment, about many things in the world that you don't direct understanding of.  So if you're at the "end of the tail", so to speak, you'll often hear those who present themselves as knowledgeable (and farther up the tail) quoting various scientific studies about a given subject.

Often these quotes directly reflect the belief system of those doing the quoting.  About climate, about medicine, about many things that affect your life.  Many people find this troubling, and lacking a scientific background, are more or less put in a position of helplessness.

For example, we all know that cholesterol is bad and will make us die from a heart attack unless we take medicine to control it.  But stop for a minute.  Where does this information come from?  Usually the television or ads in magazine and web sites.  We've all seen the ads for Crestor and Lipitor with happy, smiling doctors telling patients about all the of nasty side effects they cause.  The assumption is that these medications are so vital to our survival that "liver problems, even death" should be waived in favor of these miraculous cures.

So is this really the case?

Are these medications so important to our very survival that we must take them regardless of the dire consequences?

Well, the first question we must ask ourselves is do these medications actually work.  Let's forget for a moment about whether reducing cholesterol is actually a good thing and just focus on the medications.

From the perspective of logic it would seem that the entire premise of these ads and all the pressure doctors put patients under assumes that they in fact do work as advertised.  If the medications work, we can think about whether they are good for us to take.  If the medications don't work, then we need to reassess their value.

You say "But of course they work" and "there are many scientific studies that show they work."

I propose that this in fact may not be the case.  I came across this article today by Dr. Mark Hyman.  The article begins "A recent study in the Journal of the American Medical Association found over 40 percent of the best designed, peer-reviewed scientific papers published in the world’s top medical journals misrepresented the actual findings of the research. The “spin doctors” writing the papers found a way to show treatments worked, when, in fact, they didn’t."

That's right - forty percent (40%) of the best studies misrepresent their results.  Not only did the studies misrepresented the data in the abstract or in the main text of the study, but it was discovered that in cases where studies had negative outcomes—in other words, the treatment studied DID NOT work—the scientists authoring the studies created a “spin” on the data that showed the treatments DID work. Here is their conclusion:

“In this representative sample of RCT’s (randomized controlled trials) published in 2006 with statistically non-significant primary outcomes, the reporting and interpretation of findings was frequently inconsistent with the results.”

In plain language, Dr. Hyman writes 40 percent of the studies we count on to make medical decisions are authored by scientists who act as “spin doctors” distorting medical research to suit personal needs or corporate economic interests.

He continues: Consider the example of the recent large and widely quoted JUPITER trial “proving” that Crestor (a statin or cholesterol-lowering drug) could prevent heart attacks in people with normal or low cholesterol. In this trial researchers twisted the data to suit the commercial sponsor of the study. An independent review of the JUPITER trial published in the Archives of Internal Medicine showed that it was deeply flawed and the actual data did NOT show any benefit for the prevention of heart disease.

If this were an isolated incident, we could overlook it. Unfortunately, it’s a consistent pattern.

The article goes on to discuss specific drugs and the results of their uses (specifically Avandia and an estimated 50,000 unnecessary deaths).  At the end it describes some ways to protect yourself.  I think they are incomplete so I have taken Dr. Hyman's list and augmented it:

  1. Follow the money: Be a detective and look up the articles mentioned in the news. Find the study, see who wrote it, and determine what financial conflicts of interest they have. Also check who funded the research.  Fortunately with the internet this is not as hard as it looks.  Start out by simply typing the name of the drug into Google.
  2. Do your homework: Be suspicious of media reports of scientific findings. Be even more suspicious of advertising.  Does it sound too good to be true?  Do the finding miraculously exactly match what is being sold?
  3. Does it pass the “sniff test”: Is the treatment suggested just a “me-too” drug that has not been proven to be any better than existing treatments? Does it make sense to you or does something smell rotten? Trust your intuition.
  4. Can you accomplish the same results by changing your behavior: For example, getting more exercise, abstaining from problematic behavior that makes the problem worse, improving your nutrition.
  5. Don't go to the doctor without your homework:  The doctor is bombarded with marketing and "skirts" pushing drugs from big Pharma.   Many times he has not does his homework and merely prescribes what makes sense based on what he's told.  Be prepared to argue.
  6. Don't expect instantaneous results: Health problems take time to develop, e.g., obesity.  Expect to invest at least as much time in getting them fixed.  Be wary of "instant cures".

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