Articles

A Foolish Consistency

A foolish consistency is the hobgoblin of little minds, adored by little statesmen and philosophers and divines.
— Ralph Waldo Emerson (1803–1882)

It is odd isn’t it? Large numbers of quality studies published in the best peer review journals consistently showing the same or similar effect and no contradictory studies. Despite the emphasis on evidence-based medicine, the entire literature is dismissed as not relevant because personal experience suggests that the studies are wrong.

Curiouser and Curiouser. Coherent arguments as to the validity and scope of the literature are met with denial but never a critique of the primary literature. The facts of the research are never argued. The only argument is personal experience or blanket denial. Despite the published literature, practice continues the same, untouched by the facts.

How can practitioners routinely deny a preponderance of evidenced-based medicine? What is a doc who believes in the primacy of evidenced-based practice to do but roll their eyes and think, as Bugs Bunny so memorably said, “What a maroon”.

I’m talking about acupuncture? Homeopathy? Therapeutic touch?

Nope.

I’m talking about the interactions of physicians and the pharmaceutical industry.

This is a large literature on the topic. It is collated at www.nofreelunch.org where you find 70, seventy, references to support the following rant.

Good studies. Published in quality journals such as JAMA and The New England Journal of Medicine and the Annals of Internal Medicine. Offering a large, robust, consistent and routinely ignored set of conclusions.

I will summarize key points. Don’t want to trust me? The literature is there.

  • Pharmaceutical companies give misleading and biased information.
  • Physicians prescribing habits are influenced by drug company interactions.
  • Pharmaceutical reps and pharma sponsored lectures are often the number one source of continuing medical education.
  • Small gifts of food, pens, and other paraphernalia create an obligation that alters prescribing behavior.
  • The conclusions in published studies in peer review journals are in part determined by who provided the funding, and the more pharmaceutical funding, the more like the results will be in favor of the pharmaceutical company’s products.
  • Physicians often do not know when they are being manipulated.
  • Physicians deny that these interactions actually alter their practice. To quote one abstract “Although each physician is likely to consider himself or herself immune from being influenced by gift giving, he or she is suspicious that the “next person” is influenced.”

That is, I think, a fair summary of the literature. There are, to my knowledge, no published studies that contradict the above conclusions. It’s not like acupuncture where there are poorly done studies that suggest an effect. The literature on pharma-MD interactions is more akin to the literature on the use of penicillin and syphilis: overwhelming and consistent.

But unlike the penicillin literature, which everyone applies to their practice, there is this ongoing curiosity of a breakdown of critical thinking. Most physicians consistently deny that this literature applies to them.

It is like the issue of a physicist evaluating a psychic: the hubris of the advanced degree prevents the physicist from admitting they can be fooled. A physician can’t be fooled by mere advertising.

It more than branding and name recognition that guides advertising. It is manipulation.

An analysis of 174 advertisements for pharmaceuticals appearing in six Australian medical publications. Fewer than 8% of the advertisements contained quantitative data about the outcomes of therapy, and most of these framed the information in relative rather than absolute terms. Only 28% of the therapeutic claims in the advertisements conveyed clinical outcomes in any specific, substantive and unambiguous way. (5)

It is not what you say, but how you say it that often matters most. Spin, I believe they call it.

Physicians are susceptible to corporate influence because they are overworked, overwhelmed with information and paperwork, and feel underappreciated. Cheerful and charming, bearing food and gifts, drug reps provide respite and sympathy; they appreciate how hard doctor’s lives are, and seem only to want to ease their burdens. But … every word, every courtesy, every gift, and every piece of information provided is carefully crafted, not to assist doctors or patients, but to increase market share for targeted drugs. (6)

The proof of the pudding is probably in the tasting, as the pharmaceutical companies continue to spend billions (paid for, by the way, by our patients in higher drug costs, so don’t complain next time your patient has to pay $1500 dollars for a 10 day course on linazolid). Companies do not spend that kind of money and provide lunch and pen lights because it has no effect. It is estimated that for every dollar spent on drug rep detailing, there is a $10.29 return (2). AARP reports (unreferenced) that one minute with a drug rep increases physician prescribing by 16%; three minutes increases prescribing by 52% (3).

Does this marketing lead to worse outcomes? Or just more expensive treatment. I don’t have data. I will note that one of the driving forces of antibiotic resistance in bacteria is the overuse of broad spectrum antibiotics and choice of antibiotics is more often driven by marketing rather than science. Association or causality? The Xigris marketing lead to the use of the product for patients that, in subsequent clinical trials, had a higher mortality rate (4). How many died or were harmed due aggressive marketing beyond the limitations of the published clinical trials? No one knows. But if that number is greater or equal to one, than it is one too many.

My observation, with all the frailties and biases of the three most dangerous words in medicine (“In my experience”), is that antibiotics are given not because they are the appropriate choice for a given infection, but that somehow the choice is viewed as ‘strong’, ‘powerful’, ‘big gun’, or ‘broad spectrum.” Descriptors that have almost 100% sensitivity and specificity in identifying a physician that knows nothing about the treatment of infectious diseases and everything about their gullibility for marketing ploys.

I have been quoting this literature for years at my hospitals and I am always met with the same argument: I am immune to the wiles of big pharma, I can’t be bought, sold, fooled or manipulated. I’ll eat the food, but I don’t ever remember who is providing it. The literature doesn’t apply to ME. No one has ever argued that the literature is flawed, that the numerous and consistent studies are wrong. They do not point to studies that demonstrate a different outcome.

Nope. Never. Despite the data, there remains an intellectual blind spot in nearly all physicians I know. A complete inability, even after being given the data, to apply it. There is an increasing trend of institutions prohibiting reps at educational events. My institution (Legacy Health System) did it a decade ago, mostly because Housestaff questioned the propriety of mixing medicine and mammon.

I am curious. I assume readers of this blog are interested in applying evidence to the practice of medicine. Read the literature. Get back to me. Why is it wrong? Why am I misreading it? Or if you do find the literature compelling, why do you not apply it?

As an aside, I have not talked to a rep or taken anything from a drug company in at least 23 years. I attempt to apply all evidence to my practice. It is not without its downside. They provide pizza to our local Infectious Disease conference (where the reps can outnumber the medical students) and it is painful to sit there an smell the pizza and not partake. Mmmmmmmm. Pizza.

After one of my intermittent outbursts against the involvement of big pharma in our conferences (I am the lone voice in this argument), the head of my hospital received an anonymous letter complaining about my behavior. The letter was ostensibly from a member of the hospital staff. Accompanying the letter were copies of emails I had sent to the ID docs in the city complaining about the influence of drug reps at our conferences. It turns out when you print a page from Windows sometimes it will also print the path on the hard drive to the file. At the bottom of the page you will see, as an example, C:/folder/folder/bchristi/file. Curiously, and I am sure it was a weird coincidence, the name of the folder was the same as the email address of a local drug rep, bchristi@company.com. Weird, huh, how the folder and the email had the same name? What are the odds of such a serendipitous event? Also of interest was a copy of a private email I had sent to one of our local ID docs. How that personal email ended up in the folder of the writer I still have yet to determine.

If you think this kind of behavior is atypical, it is not. I suggest you read Surviving Sepsis — Practice Guidelines, Marketing Campaigns, and Eli Lilly in the NEJM of Oct 19, 2006. If I were prone to conspiracy theories, this would make for good supporting information.

In the interests of patients, physicians must reject the false friendship provided by reps. Physicians must rely on information on drugs from unconflicted sources, and seek friends among those who are not paid to be friends” (6).

References

  1. Halperin EC, Hutchison P, Barrier RC Jr. A population-based study of the prevalence and influence of gifts to radiation oncologists. Int J Radiat Oncol Biol Phys. 2004 Aug 1;59(5):1477-83.
  2. The Drug Pushers. Atlantic Monthly. April 2006. http://www.theatlantic.com/doc/200604/drug-reps.
  3. AARP Bulletin. Jan-Feb 2006. Page 26. http://www.aarp.org/bulletin/yourhealth/drugreptiesthatbind.html
  4. Surviving Sepsis — Practice Guidelines, Marketing Campaigns, and Eli Lilly in the NEJM of Oct 19, 2006.
  5. David A Newby and David A Henry. Drug advertising: truths, half-truths and few statistics. MJA 2002 177 (6): 285-286
  6. Fugh-Berman A, Ahari S (2007) Following the Script: How Drug Reps Make Friends and Influence Doctors. PLoS Med 4(4): e150. doi:10.1371/journal.pmed.0040150

Posted in: Pharmaceuticals, Politics and Regulation

Leave a Comment (141) ↓

141 thoughts on “A Foolish Consistency

  1. phren0logy says:

    Thanks for posting this. My medical center and psychiatry department have a strict policy of accepting nothing from drug reps. I at first thought this was a bit draconian, but as I looked at the same data you presented above I understood the reason.

    Although we have a strict policy at our medical center, some departments continue to accept food, pens, etc. It is my sincere hope that they will come to practice the EBM they preach, as you have so eloquently detailed above.

  2. weing says:

    I think it’s the same reason 80% of Frenchmen think they are better in bed than the average Frenchman and why all the children in Lake Wobegon are above average.

  3. Erica B. says:

    My father-in-law is a pediatrician. For years I listened to him complain about over-marketing of allergy medications, to the point that parents were coming in asking for evidence of allergies so they could get their kid on something. They were sure the seasonal allergies were there, they were sure Whatever Drug would cure it — they only needed a doctor to write a prescription. He hated this.

    A few years after those rants began, my husband and I noticed he was giving some Whatever Drug to his daughter. When asked about this apparent change in attitude towards allergy medications, his answer was rather vague, along the lines of, “well, it seems to work to make her sniffle less.”

    He’s a smart guy. Sure, it’s possible he looked at a large body of evidence, read scientific studies, and came to a logical conclusion. But given the about-face, and the use of language I’ve seen from homeopathy proponents (“seems to work” indeed!), I feel it’s more likely he was gently seduced by Whatever Drug’s marketing. He wouldn’t admit it in a million years, though.

    Oh, and I’m not trying to protect Whatever Drug or anything — I honestly don’t remember which of the many allergy medications it was :-)

  4. Cameron says:

    You forgot to mention that drug companies purchase the prescription histories of doctors so that they can more efficiently target specific doctors with specific drug reps. Washington state has a bill pending that would ban drug companies from doing this. Hopefully, it will pass.

  5. weing says:

    You have to go to the AMA website and specifically not allow your prescription history to be available to drug reps. I did that last fall.

  6. I am familiar with the articles at No Free Lunch. Many physicians I’ve discussed this issue with are aware that they are influenced by pharmaceutical company promotions. There is no reason to think there is massive self deception in the ranks of physicians.

    On the other hand many physicians would dispute any claim that industry promotions impact negatively on patient outcomes. As you acknowledged, there’s not a shred of evidence that they do. It is equally plausible that industry promotions (and their influence on doctors’ prescribing habits) are beneficial to patient outcomes since many promotions are for evidence based therapies known to be underutilized. (Promotion of low molecular weight heparins for VTE prophylaxis is an example).

    In answer to your questions:
    *I am curious. I assume readers of this blog are interested in applying evidence to the practice of medicine. Read the literature. Get back to me. Why is it wrong? Why am I misreading it? Or if you do find the literature compelling, why do you not apply it?*

    I suspect many physicians do apply it. I certainly do. How? By being aware of the bias inherent in industry promotions. By applying appropriate analysis to the claims (e.g. looking not only at relative risk but also absolute risk) and by checking any such claims against primary sources, something much easier to do nowadays than 10 or 20 years ago when many of the No Free Lunch articles were published.

    Concerning the Surviving Sepsis Campaign, I’ve blogged extensively about it. The NEJM perspective piece you cite in reference 4 seemed to me more of an appeal to corporate hatred than to evidence. See:

    http://doctorrw.blogspot.com/2006/10/surviving-sepsis-campaign-guidelines.html

    and

    http://doctorrw.blogspot.com/2006/10/surviving-sepsis-guidelines-guilt-by.html

    At the time the Surviving Sepsis Guidelines came out the evidence was that Xigris, when used as labeled and promoted, was associated with decreased mortality.

    The real test of whether the Surviving Sepsis Guideline authors were promulgating marketing disguised as EBM would come with the publication of the next edition of the guidelines. If the SSG authors were interested in marketing over evidence they would have disregarded negative evidence concerning Xigris which came out after the 2004 guidelines. The 2008 guidelines, published in January, contained a downgraded recommendation for Xigris, evidence that the guideline authors had followed the evidence. That fact should finally put to rest accusations of marketing disguised as EBM on the part of the SSG authors. I covered that in posts linked below:

    http://doctorrw.blogspot.com/2007/12/top-ten-issues-in-hospital-medicine-for_3592.html

    http://doctorrw.blogspot.com/2008/01/surviving-sepsis-2008.html

    http://doctorrw.blogspot.com/2008/02/surviving-sepsis-guidelines-2004-2008.html

  7. phren0logy says:

    weing:

    Last time I checked the AMA web site, it actually was much more wishy-washy. I think it was something to the effect that if you are not already added you do not want to be added.

    And even if you are added, it just asks them nicely not to use your data! It does not stop them from obtaining it.

    It appears to be a total farce.

  8. Calli Arcale says:

    You can have your prescription history hidden from drug reps? That’s awesome! Pity that information isn’t more widely disseminated, like the information about the Do Not Call registry.*

    The main reason this research doesn’t apply to me, personally, at least in the sense that I it affects my professional work, is because I’m a software engineer. Reputed potency of an antibiotic is not significant to a C++ compiler. However, this research does apply to me and every one else in a much more visceral way — if doctors, men and women trained at great expense in science, can be influenced in this manner, how much more are we, the general public, being influenced?

    Frankly, I find the results of the study obvious. Such studies are the bread and butter of non-medical industries, and it is a problem not limited to medicine. (So I guess this really does apply to me as a software engineer, in that the results most likely apply to marketroids from other fields.) Just look at some of the reports that have come out of the Government Accounting Office. Theoretically, government employees are barred from receiving any gift, no matter how small, from a supplier or potential supplier, and this sort of thing is precisely why. This is also very similar (if not identical) to the sort of work professional lobbyists do. It’s not all big under-the-table scandalous payoffs. Old fashioned marketing works just as well (if not better) and no one’s the wiser — not even the politicians who have been manipulated.

    *Mind you, as a software engineer who has worked particularly in information management and data mining, it may be possible to deduce your prescription history, or at least what sorts of marketing drug companies might like to target your physician with, by other means. All it takes is ingenuity, persistence, and adequate computing power. And computing power is cheap these days. Sure, the results won’t be as clear or reliable as your prescription history, but it would be enough to improve their targeting of marketing. And that’s probably more than enough motivation for them to do it, should prescription data become unavailable.

  9. Apreche says:

    Here’s a complete guess from a layman as to why people think this way.

    When the doctors write prescriptions for these medicines, their conscious minds making the decision are not taking into account any of the influence of the pharmaceutical reps. Only their conscious decision making process is recorded in their memory. When they are asked to remember their decision making process later, they do not remember taking any influence into account. Since people trust their own minds, memory, and senses above and beyond anything else, they will adamantly deny the influence.

    I think it is obvious that the influence, which clearly exists, must not be conscious. If it is conscious, it is not remembered. Because it is not remembered, its “victims” can not be convinced that it exists. If someone’s decision making process were undetectably influenced by an outside force, it would be an affront to free will, freedom, and individuality. People who are so convinced they are in complete control of their lives will not easily accept that they are not.

    I would very much like to see some studies to discover the neurological causes behind this type of thinking.

  10. pec says:

    “The conclusions in published studies in peer review journals are in part determined by who provided the funding, and the more pharmaceutical funding, the more like the results will be in favor of the pharmaceutical company’s products.”

    Yeah it is getting scarier all the time. And I have noticed that some MDs have little or no hesitation about prescribing the latest wonder drugs.

    And a lot of it is subtle and subconscious. MDs are conditioned to be pro-drug. Some drugs are great, for certain specific conditions, but many or most of the new drugs are worthless or harmful, especially after prolonged use. But that doesn’t stop them from looking like in clinical trials, especially when funded by Big Drug.

    And it’s often difficult or impossible for a physician to determine the underlying cause of a patient’s problem. It’s easier, and sometimes possible, to prescribe a pill that lessens the symptoms.

    For example: if a patient complains of being terribly depressed, you can say “Sorry, I can’t help you. I have no idea what is causing your depression. And even if I did know, I probably couldn’t cure it anyway.” You will feel helpless and your patient will feel disappointed and abandonned.

    But you can make yourself and your patient happy by prescribing psychiatric drugs. So which route are you going to take?

  11. weing says:

    Here is the URL: You can opt out of having your prescribing information being shared with drug reps for 3 years, I believe.

    http://www.ama-assn.org/ama/pub/category/12054.html

  12. Good post. A few years ago I submitted a review article to a medical journal. In it I called attention to one of the primary studies having been funded by the maker of the device that was being investigated (I didn’t use the term “prior probability,” but it seemed obvious and uncontroversial that the point was relevant). That brought the following comments from 2 reviewers:

    “The author has objected to subsequent trials that include financial support by the manufacturer of a device that is tested. If this were a standard for rejection, no trial submitted to the FDA for a new drug would be accepted.”

    “…the final point made by the author is that financial support from commercial companies renders the conduct of studies open to criticism. This requires rephrasing to avoid offending authors who may have conducted studies as scrupulously as possible…”

    Those comments were annoying enough to move me to write to the editor:

    “The fact that ‘everyone does it’ in no way excuses financial conflicts of interest, and is irrelevant to the issue. To think otherwise is an example of the logical fallacy known as tu quoque. That doesn’t mean that biased funding necessarily produces a biased study, and I didn’t say that it does. What it does is cast doubt on the validity of the study whether we like it or not. If this was true when the funding source was the Tobacco Institute, it can be no less true now.”

    In other words, “how soon they forget.”

    There is, however, at least some evidence that doctors are not quite as vulnerable to persuasion by drug company reps as your references might suggest:

    Gardner N. 2004. Pharmaceutical marketing tactics hold little sway with prescribing physicians. EurekAlert website. At: http://www.eurekalert.org/pub_releases/2004-12/uow-pmt120604.php

    That press release suggests that most doctors view drug reps kind of the way they view used car salesmen, which I imagine is a familiar feeling to MDs reading this blog. On the other hand, the study did not find that the effect of persistent badgering was nil. Maybe some intrepid reader will dig up the original article in the Dec. ’04 issue of Management Science and tell us what you think.

    The final sentence in the press release is more worrisome than the primary topic:

    “Jacobson added that pharmaceutical marketing aimed directly at consumers might be expected to have greater impact.”

    That’s gotta be true, and you can bet pharm companies believe it is or they wouldn’t be spending a hell of a lot more on TV ads than they do on shilling at hospitals and clinics. The issue of how vulnerable MDs are to simple drug rep approaches may already be one of historical interest only, because the norm now is the poly-whammy of drug reps and anxious, TV-trained patients applying the squeeze, abetted by the stealth bombs of trials, reports, and talks that are funded and sometimes even written by the sponsors.

    At least some in the last category are not apparent to scrupulous practitioners, who may thereby be duped even when trying their best to practice EBM. Plenty of examples can be found over at Health Care Renewal (http://hcrenewal.blogspot.com)

  13. weing says:

    Physicians are human and will be influenced by others whether they be drug reps, insurance executives, or government bureaucrats. If you are influenced by drug reps, the pharm companies will make money, if by insurer, they will make a profit, if by government bureaucrat, the government will save money, and the pharm companies that have made deals with the government or insurer will profit. What is best for the patient?

  14. pmoran says:

    “Despite the emphasis on evidence-based medicine, the entire literature is dismissed as not relevant because personal experience suggests that the studies are wrong.”

    While this matter should be put to bed for the sake of public perceptions, is it a little off-target to be accusing your colleagues of ignoring their own scientific precepts? I don’t think doctors would bother denying that they might prescribe the brand of a common drug that is uppermost in their minds at the time, and that this may well be the one most recently promoted by a drug company.

    What the doctors’ “personal experiences” might actually be telling them, rightly or wrongly, is that the influences you decry have little or no importance for their day-to-day patient care. It is not clear to them how their patients could be coming to harm and you have no evidence to show that they are.

    After all, the doctors of most countries would be entitled to assume that any drug allowed onto the medical market has already been well vetted for safety and efficacy (if not, the solution lies elsewhere). In reality, the vast majority of the marketing is directed at promoting brand names of drugs that are identical or almost identical to each other. It scarcely matters which is chosen. If doctors are tempted towards off-label use it will be for conditions where there are usually no other entirely satisfactory treatments and where there will be at least some suggestive evidence to warrant giving the treatment a trial.

    But I am a surgeon — there may be aspects to this I am not aware of. .

  15. pec says:

    Drugs do not have to be tested for long-term effects, or for interactions with other drugs they are likely to be taken with. Drugs are given to children, without any information about how they may interfere with brain development, for example.

    HRT for women was tested and approved, and prescribed to millions for decades. However it turned out to be harmful.

    Cancer drugs only have to show they prolong life a little more than a drug already in use, in order to be approved. If the research leading to the approval of the earlier drug was unreliable or biased, the later research that builds on it will be also.

    In many cases it is not possible to know if a cancer drug is effective, since you cannot deprive a group of cancer patients of standard treatment. All you can do is compare one drug to another that is similar, or a new drug in addition to an earlier drug.

    The situation with AIDS drugs is also confusing. It’s biased because the drug companies fund the research and they stand to make billions from favorable results. HIV positive patients may never get AIDS, or not until decades later. It is very hard to know exactly how effective a given drug might be. And, of course, all HIV patients must be treated with one or another drug. If the earlier drugs were not very safe or effective, if the research was biased or flawed, they are still the gold standard for judging later drugs.

    If drug research were impartial, it would still be extremely difficult and confusing. But we all know that it is biased, possibly crooked in some cases. So add that on top of the basic foundation of confusion.

    I am NOT an advocate for CAM treatments. I am just extremely skeptical about mainstream treatments, and I think we can all agree I have good reasons for this skepticism.

  16. PalMD says:

    Bravo! A post worthy of wide dissemination!

  17. PalMD says:

    And BTW, the opt-out page has worse wording than do-it-yourself furniture kits.

    “If you don’t wish to not opt-out, then fail to not click on the link below, to be enrolled in the program to opt-out of the restricted list.”

  18. qetzal says:

    I know it’s probably a waste of time, but I can’t resist responding to some of pec’s whoppers:

    Drugs do not have to be tested for long-term effects, or for interactions with other drugs they are likely to be taken with.

    Neither of these is true as blanket, unqualified statements. Testing for long term effects in humans generally depends on expected duration of use in humans. For drugs that will be taken chronically, it’s common to have large trial populations that have used the drug for several years, with subpopulations that may have used it even longer. Of course, if pec considers “long-term” to be 10+ years or something, that’s different. Also, most drugs are tested in rodents continuously at high doses for 2 years, which equates to most of their life.

    Interactions with other drugs must also be tested in many cases. Maybe not as often as pec thinks is appropriate, but far from never, as he impies.

    Drugs are given to children, without any information about how they may interfere with brain development, for example.

    This is an issue, but mainly because many drugs that are only labeled for adult use are prescribed off-label for children. If drugs are labeled for use in children, they have to be tested in children. Where the main use of a drug will be in adults, pharma is understandably reluctant to also test in children. However, there is more effort these days to encourage them to do so.

    HRT for women was tested and approved, and prescribed to millions for decades. However it turned out to be harmful.

    No argument there.

    Cancer drugs only have to show they prolong life a little more than a drug already in use, in order to be approved. If the research leading to the approval of the earlier drug was unreliable or biased, the later research that builds on it will be also.

    Non sequitur. The first sentence is true, but the second sentence doesn’t follow. If Drug A is the current standard, and Drug B is shown to be superior to Drug A, then Drug B is superior. Even if Drug A actually provides no benefit, Drug B still provides some.

    In many cases it is not possible to know if a cancer drug is effective, since you cannot deprive a group of cancer patients of standard treatment. All you can do is compare one drug to another that is similar, or a new drug in addition to an earlier drug.

    More fallacious logic. If A + B is better than A, or if A + B is better than A + C, then B is effective, and can be approved for use in combination with A.

    The situation with AIDS drugs is also confusing. It’s biased because the drug companies fund the research and they stand to make billions from favorable results. HIV positive patients may never get AIDS, or not until decades later. It is very hard to know exactly how effective a given drug might be.

    Agreed. There are indeed real issues.

    And, of course, all HIV patients must be treated with one or another drug.If the earlier drugs were not very safe or effective, if the research was biased or flawed, they are still the gold standard for judging later drugs.

    There’s that fallacy again. And it’s still wrong, no matter how many times you say it.

    I am NOT an advocate for CAM treatments. I am just extremely skeptical about mainstream treatments…

    Funny how you’re sooo skeptical of mainstream treatments, backed as they are by years of animal and human testing, double-blind RCTs, and FDA review. Yet elsewhere you’ve argued that homeopathy might work, and we should at least give CAM some consideration. Maybe you’re not an outright advocate for CAM, but your double standards are obvious to all.

    I think we can all agree I have good reasons for this skepticism.

    No, we can’t agree on that at all. Some of your concerns are valid, but most of them are just wrong.

  19. Ted Powell says:

    “Despite the emphasis on evidence-based medicine, the entire literature is dismissed as not relevant because personal experience suggests that the studies are wrong.”
    See:
    On Being Certain : Believing You Are Right Even When You’re Not
    Robert A. Burton, M.D.
    http://www.rburton.com/
    Disclaimer: I’m only 2/3 of the way through the book, but he seems to be making sense so far.

  20. delaneypa says:

    You are right on Mark. I get strange glances as I eat my peanut butter on wheat sandwiches for lunch (…mmmm peanut butter). Unfortunately in my office setting, which has 30 examining rooms for 10 MDs, mine are the closest to the break room where the drug whores peddle their wares.

    More than one patient has stated, smelling the pizza from a few feet away, “I hope you enjoy that lunch I’m paying for.”

    My concerns are brushed off. I honestly think physicians think that drug lunches are a right to which they are entitled.

  21. delaneypa says:

    “You forgot to mention that drug companies purchase the prescription histories of doctors so that they can more efficiently target specific doctors with specific drug reps. Washington state has a bill pending that would ban drug companies from doing this. Hopefully, it will pass.”

    AMA has a program letting you opt out…they do not advertise it, though, since the AMA gets millions of dollars selling physician data

  22. farmgal says:

    Mark Crislip:

    THANK YOU for the refreshing article. It is just amazing to read the truth for a change.

    delaneypa:

    Your reference to “drug whores” is exactly what I call the reps. I have many, many times been disgusted by the presence of those whores sharing the waiting room with patients AND hearing them called back to see the doctor during MY appointment time, causing me to have to wait.

    Office staff that can barely manage a smile for a patient checking in will make complete asses out of themselves falling all over the drug whores, giggling and carrying on like darn fools. Too disgusting for words.

  23. pec says:

    qetzal,

    ” If Drug A is the current standard, and Drug B is shown to be superior to Drug A, then Drug B is superior.”

    “Superior,” for cancer drugs, is often defined as prolonging life by several months, or decreasing tumor size. Neither of those measurements is meaningful for patients’ health. And if the earlier drug has serious harmful side-effects, the later drug can have the same side-effects and still be considered “superior” and “safe.” If you are comparing bad to worse, bad will be superior.

    The earliest AIDS drug, AZT, is very toxic. Later drugs may be just as toxic, but this will not show up in the clinical trials. Why? Because the newer drug just has to prolong life a little, compared to AZT or other older drugs.

    There is never an untreated control group. Of course there are good ethical reasons for that, but it’s also immensely beneficial for the drug companies.

  24. David Gorski says:

    “Superior,” for cancer drugs, is often defined as prolonging life by several months, or decreasing tumor size. Neither of those measurements is meaningful for patients’ health

    Bullshit.

    Steve Novella may slap me down for breaking the decorum that he normally expects of the bloggers at SBM, but there’s no better way to describe my reaction to what you just wrote.

    Let’s look at a specific example: Colorectal cancer metastatic to the liver. The median expected survival after such a diagnosis used to be around six months. Now, with a combination of newer chemotherapeutic agents and antiangiogenic therapies like Avastin, the median has increased to as high as 18-20 months, more than a tripling. Are you honestly arguing that such an improvement is insignificant and “meaningless”? Sure, it’s not a cure and five year survivors are still quite uncommon (although they do exist), but I assure you that patients certainly don’t find the improvement meaningless. It’s an increase that means the difference for patients between seeing the marriages of children or births of grandchildren and not. It can mean over a year or more of good quality of life that patients of a couple of decades ago (or even as recently as a decade ago) couldn’t expect. Indeed, in the case of the father of a good friend of mine, it looks like it’s going to mean the difference between his being able to attend his granddaughter’s high school graduation or not.

    I will concede that most examples are not that dramatic. However, if you ask many patients whether they’d be willing to undergo chemotherapy, even after potential side effects are graphically described, if it “only” meant the difference between surviving 12 months and 16 months (a more typical example), a significant proportion, if not the majority even, would answer with a resounding yes.

    As for shrinking tumor size, again, in many cases shrinking tumors can be excellent palliation. Indeed, oncologists will sometimes give chemotherapy (or radiation oncologists will give radiation therapy) to do just that even in the case where a survival benefit can’t be reasonably expected because the patient’s tumors are causing pain, obstructing bowel, or causing other problems.

    Are there problems with overuse of chemotherapy when it’s unlikely to benefit the patient? Probably. There is a basis for the old joke that goes:

    Why do they nail the coffin of deceased cancer patients shut?

    To keep the oncologist from giving them more chemo.

    However, when rationally used, the benefits of drugs that “only” extend a patient’s life a few months are not “meaningless” and it can in some clinical circumstances be entirely rational to give a treatment designed to shrink a tumor in order to relieve symptoms, even when no benefit in terms of increased survival is to be expected.

    At least you understand why ethics prevents us in most cases from using placebo controls in trials of new cancer chemotherapies.

  25. pec says:

    “The median expected survival after such a diagnosis used to be around six months. Now, with a combination of newer chemotherapeutic agents and antiangiogenic therapies like Avastin, the median has increased to as high as 18-20 months, more than a tripling.”

    You have basically agreed with my statement, depending of course on the definition of “several.” So what if 18-20 is a tripling? Three days is a tripling compared to one day.

    You found an example where the increase in average survival time is actually a year or more, but you know you could have easily found examples where it’s well under a year. And in those cases “several months” would be a fair description.

    Your angry language results more from your need to defend your profession than from any inaccuracies on my part.

    The question of whether several months, or a year or so, matters to patients and their families is a different matter. I think different people would respond differently. Most of us are afraid of death and anxious to put it off. I don’t know how doctors generally frame the situation to patients. Would you say “This drug will make you feel lousy and will not cure your cancer. At best it will extend your life for several months or a year or so.” Framed that way, some patients might refuse. I know I would.

    It’s harder if we are deciding for a loved one, and our nature dictates that we cannot stand to see our loved ones die. So we make desperate decisions and hope the doctor and his drugs can perform a miracle. You never know.

    But the hard facts remain. The real benefits of these drugs go to the drug companies. And maybe to doctors who can feel they have something to offer desperate patients. And maybe you believe the incremental improvements in the drugs are leading us slowly towards a cure. But you have absolutely no scientific reason for believing that.

  26. David Gorski says:

    You have basically agreed with my statement, depending of course on the definition of “several.” So what if 18-20 is a tripling? Three days is a tripling compared to one day.

    And three years would be a tripling of a year and three decades would be the tripling of a decade. What’s your point?

    What I disagreed with was your blanket statement that an increase of a few months’s survival is “meaningless” to a patient’s health. In fact, I could say that you just conceded point when you admitted that different people would respond differently when asked whether they’d want to take a drug that would prolong their lives a few months. In such instances, the patients and their doctors don’t find that drug “meaningless” to health.

  27. pec says:

    “And three years would be a tripling of a year and three decades would be the tripling of a decade. What’s your point?”

    It was a typical example of how to mislead with statistics. A patient lives 18-20 months longer, instead of 6 months longer. So you have tripled their survival time, but not by a whole lot. “Tripled” sounds better than it really is.

    And I do think, from a medical perspective, that increasing survival time from 6 to 18-20 months (and drugs are approved that do much less) is not terribly meaningful. The patient’s health status, subjective and objective, does not improve. The patient’s future is still dismal. You can tell all the anecdotes you like about people seeing their children married or grandchildren born. It is still an extremely gloomy outlook. And of course you don’t bother telling, or remembering, the anecdotes about patients whose extreme suffering was prolonged.

    You can argue that these treatments are better than nothing, at least in some cases. Ok. But better than nothing can still be very bad, can still be deserving of criticism and skepticism.

    The cancer PR says the war is being won, and most people, including MDs, believe it. Skepticism should be encouraged, not called “bullshit.”

  28. qetzal says:

    Prolonging life by several months is meaningless for patients’ health?

    Really, pec?

    Who are you to decide how much extra life is meaningful to a cancer patient! That’s the most arrogant statement I’ve seen in quite a while.

    Just when I think you’ve reached the bottom, you start digging again.

  29. BlazingDragon says:

    The current bout of flu (with all its nasty secondary infections) has given me a good education on this topic.

    I went into the doc with a secondary infection, was given Avelox (10 days worth, I have a lot of trouble fighting off bacterial infections), and slowly got better over 3-4 days, then was fine for about two weeks (I finished the antibiotic like I was supposed to). Then a week after I was off it, I got sick again (even worse sinus infection, with creeping bronchitis). This time I was given Levaquin, which was actually pretty worthless (went from sinus infection with the beginnings of bronchitis to horrible sinus infection, sinus pain, with full-blown bronchitis in 3 days while on Levaquin). When I called my doctor back to tell him I had gotten worse and I would like a different antibiotic, his response was quite telling.

    I asked him “You must have seen a lot of these patients recently, which antibiotic is working best?” His response “Levaquin is a good broad spectrum antibiotic I give to most of my patients (unless they cannot tolerate it), so it should be working for you.” A total non-sequitur and one that told me he had been prescribing Levaquin for almost all of his patients who needed it, without trying to determine susceptibility. To his credit, he was following guidelines and giving most patients antibiotics only when they did not improve after a week of being sick. But it was still kind of shocking to realize he had made no effort (yet) to determine if an older antibiotic would be effective for the ugly infections going around.

    I have no way to know for sure, but I’m guessing free samples, marketing hype, and/or a drug rep had a lot of influence in making his first-choice antibiotic be Levaquin.

    I switched back to Avelox and began to get better in a little over 24 hours. But illuminating nonetheless.

    My feeling is that reality is somewhere between the doom-sayers who think pharma reps influence doctors a LOT and the doctors who deny they are influenced at all.

    But food items (down to pieces of candy) should be absolutely banned (even sponsoring meals should be outlawed). Human beings are way too influenced by food for this to be a good idea (the old saying goes, “The way to a man’s heart is through his stomach,” which has a LOT of truth to it). Trinkets and gizmos won’t be as effective as even a simple candy bar in subconsciously influencing doctors.

  30. qetzal says:

    P.S. You don’t know what skepticism is. You haven’t the first clue, despite repeated attempts to educate you.

    And guess what? Your future is dismal, too. No matter how much you may want to see your children married or your grandchildren born, the ultimate outlook is extremely gloomy.

    Now, you can argue that a few more decades is better than nothing. But I’ve decided that in your case, those decades are not terribly meaningful.

  31. pec says:

    When you can’t think of anything logical to say, resort to nasty insults qetzal. I’m sorry you feel so threatened by my skepticism.

  32. pec says:

    “Prolonging life by several months is meaningless for patients’ health?”

    This is where most of the cancer research money and effort is going. Prolong life a little bit more. I think it’s a farce.

  33. David Gorski says:

    And I do think, from a medical perspective, that increasing survival time from 6 to 18-20 months (and drugs are approved that do much less) is not terribly meaningful. The patient’s health status, subjective and objective, does not improve. The patient’s future is still dismal. You can tell all the anecdotes you like about people seeing their children married or grandchildren born. It is still an extremely gloomy outlook. And of course you don’t bother telling, or remembering, the anecdotes about patients whose extreme suffering was prolonged.

    If it’s your attitude that anything short of a cure is “meaningless” (and that really does seem to me to be your attitude when you dismiss an increase in median survival time for colon cancer metastatic to the liver from 6 months to 20 months), then I’m very, very glad that you are not a physician. For you it seems to be all or nothing, cure or don’t bother.

    Unfortunately, medicine doesn’t usually work like that. Improvements in therapies are incremental, particularly in cancer.

  34. daedalus2u says:

    “For you it seems to be all or nothing, cure or don’t bother.”

    I wonder if that is an attitude based on a belief in life after death. With an eternity of infinite bliss awaiting someone, anything that delayed that would be pretty gloomy and dismal.

  35. pec says:

    “Improvements in therapies are incremental, particularly in cancer.”

    You don’t get it — you are not approaching your goal. You are not moving toward your goal. You are on the wrong track.

    I am not saying anyone knows what direction to take regarding cancer. I think some of the holistic theories are more promising than your non-holistic approach. But obviously no one has much of a clue.

    You should be thinking about changing direction, looking around, doing some hard thinking and re-analysis, but instead you plug ever onward. And you are proud of prolonging a suffering patient’s life a few months, or a year or so.

    The approach is wrong and it will not become right.

  36. pec says:

    And furthermore, you’re forgetting what this post was all about — that we have no good reason to trust drug research funded by the companies that make the drug. How do we know the cancer drugs are doing the very small amount of good the research claims?

  37. David Gorski says:

    I am not saying anyone knows what direction to take regarding cancer. I think some of the holistic theories are more promising than your non-holistic approach. But obviously no one has much of a clue

    Really? What specific “holistic” therapies and what is the evidence that they are more “promising” than present scientific approaches. (I reject your characterization of “non-holistic.”)

  38. pec—

    You said “And furthermore, you’re forgetting what this post was all about — that we have no good reason to trust drug research funded by the companies that make the drug.”

    I don’t know if that’s what Mark means. I hope not, although a surprising number of people feel that way. It seems a little simplistic to me to judge evidence solely by the company it keeps. Why not examine the evidence on its own merits?

  39. David Gorski says:

    Actually, to people like pec, funding sources trump everything, including study quality. To me, funding sources should increase the level of skepticism shown towards an article’s finding, but good science is good science, whether it’s funded by the NIH, big pharma, a rich donor, or an independently wealthy scientist (the last of which is, sadly, very rare).

  40. pec says:

    “What specific “holistic” therapies ”

    I had a feeling you would change “theories” to “therapies!!”

    After I repeatedly said I have no opinion on CAM therapies for cancer.

  41. pec says:

    Another thing you never consider — new drugs are compared to older drugs (since, of course, patients cannot be deprived of treatment). Now suppose an older drug was accepted even though it was harmful and shortened life in some patients. The new drug only has to be a little less harmful than the older one.

    So we really don’t if cancer drugs do more good than harm, overall.

  42. daedalus2u says:

    As they say, TSIB. pec, you have “no opinion on CAM therapies for cancer”, but your opinion of the science based therapies that Dr Gorski (as one of many thousands of EBM based MDs and researchers) uses and are working on is that they are all wrong? That the direction that each and every one of those science based researchers is wrong?

    pec says “You don’t get it — you are not approaching your goal. You are not moving toward your goal. You are on the wrong track.”

    And you know this how? Do you know what those different tracts actually are? “Cancer research” is a big field. 592,304 citations in PubMed. How many of those research tracks do you know and understand well enough to be able to evaluate them. I think we all know the answer to that question, that number is zero.

    Let me try and understand how pec’s “reasoning” works. pec knows nothing about how CAM works because even the practitioners of CAM have no coherent idea of how CAM works because there is no coherent idea of how CAM works (or actually doesn’t work). But CAM is a better approach than EBM where the researchers do have coherent ideas of what they are doing (and which ideas fit together with all other coherent ideas in science). Because EBM promises small incremental improvements, and then delivers them, EBM is the wrong approach, but because CAM promises gigantic improvements (i.e. “cures”) but never delivers them, CAM is the right approach?

    It sounds a lot like Pascal’s wager. Reject the EBM approach which will only deliver a modest life extension, but embrace the CAM approach which promises complete cure.

  43. weing says:

    I thought the reason for this post was to point out that we are all susceptible to sales pitches and that pharmaceutical companies spend money to influence physicians prescribing behavior. The question that I have is “Is this necessarily bad or just a fact of life that has to be factored in?”. We are all influenced by the hand that feeds us. The research needs to be evaluated on its own merits. I do not see independently wealthy physicians and scientists developing new drugs and advances on their own. Are NIH grants given out objectively? Am I making sense?

  44. pec says:

    weing,

    This is a fact of life and of human nature. Medical research is expensive and the money has to come from somewhere. Government-run, publicly-funded research would not be better. But maybe it would provide some balance and perspective.

  45. pec says:

    “It sounds a lot like Pascal’s wager. Reject the EBM approach which will only deliver a modest life extension, but embrace the CAM approach which promises complete cure.”

    No.

    The non-holistic, mainstream approach is great for some problems. If you fall off the roof, you need surgery. For some infections, antibiotics are life-saving.

    The great successes, in limited areas, of non-holistic medicine have won the public’s trust. As a result, it’s great failures have been ignored and minimalized for decades.

    Cancer, AIDS, many chronic diseases, have been great failures. When lifestyle is known to be the main cause, as in heart disease or type 2 diabetes, the solution is obviously holistic — lifestyle improvements.

    But we don’t have proven holistic solutions for most diseases, and that’s why CAM research is needed.

  46. pec says:

    Why do I think a holistic approach is better, for certain kinds of problems? I will use the analogy of economics — most economists recognize that economies are complex systems. They know that changing one variable can have unpredictable, often damaging, results. It’s called the “law of unintended consequences.”

    For historical reasons, probably, medical scientists and biologists do not see living organisms the way economists see economies. Even though organisms are far more complex.

    Maybe, since biological systems result from evolution and economies are created by humans, you fail to appreciate how amazingly complex living systems really are. You are taught that DNA is full of useless junk, for example.

    Holistic scientists are unlikely to perceive nature this way. They are more likely to understand that changing one variable in a living system will probably have unpredictable and unintended consequences.

    Non-holistic medical researchers are more likely to focus in on one variable — cholesterol level, for example — and try to change it. There is not enough effort to look at the whole system, not enough wondering about what has caused a particular variable to get out of range.

  47. daedalus2u says:

    Huh? AIDS is a lifestyle disease? Cancer is a lifestyle disease? Calling these things lifestyle diseases is just another way of blaming the victims (who you obviously don’t want to help) and justifying flushing research money down the toilet of CAM.

    You have a fantasy of what “success” would be; a complete cure. Anything short of that is “failure”. What basis do you have for believing that there is a path that would lead to what you call “success”, and that path is the one that CAM is on?

    You don’t know enough about EBM to know what actually is taught. You base your beliefs on myths. Maybe some people believe some DNA is junk. Certainly the people who are actually working to understand it don’t. There is some error in the EBM literature. The CAM literature is nothing but error.

  48. weing says:

    I disagree with your division of medicine into holistic and non-holistic. I don’t know of any physician who does not also prescribe lifestyle changes. The division is into medicine and quackery.

  49. qetzal says:

    When you can’t think of anything logical to say, resort to nasty insults qetzal. I’m sorry you feel so threatened by my skepticism.

    LOL! That’s rich, pec.

    If I call the length of your life meaningless, it’s a nasty insult.

    But when you call the length of a cancer patient’s life meaningless, that’s skepticism?

    More proof that you haven’t a clue what skepticism is.

  50. qetzal says:

    Non-holistic medical researchers are more likely to focus in on one variable — cholesterol level, for example — and try to change it. There is not enough effort to look at the whole system, not enough wondering about what has caused a particular variable to get out of range.

    Yeah, medical researchers never take into account confounding factors like age, weight, smoking history, medical history, concurrent illnesses, etc., when they’re testing their simplistic interventions.

    With pec, the comedy just never stops.

    P.S. pec, eukaryotic genomes are full of junk. And organisms are complex. The two are not mutually exclusive. Biologists understand that far better than you.

  51. pec says:

    “When lifestyle is known to be the main cause, as in heart disease or type 2 diabetes,”

    THAT IS WHAT I SAID. AS IN HEART DISEASE OR TYPE 2 DIABETES.

    “Huh? AIDS is a lifestyle disease? Cancer is a lifestyle disease?”

    ARE YOU INSANE?

  52. pec says:

    “Maybe some people believe some DNA is junk. Certainly the people who are actually working to understand it don’t.”

    You are absolutely wrong. Geneticists assume any DNA they don’t understand is “junk” with no function.

  53. pec says:

    “I don’t know of any physician who does not also prescribe lifestyle changes.”

    The idea that lifestyle matters has become accepted, very gradually, into mainstream medicine. It took a very long time.

  54. pec says:

    “eukaryotic genomes are full of junk.”

    Yeah, if you don’t understand it, it must be junk.

  55. pec says:

    “when you call the length of a cancer patient’s life meaningless,”

    I never said anyone’s length of life is meaningless. I said that as a medical treatment, extending life several months is not very meaningful. Have you ever heard a patient, or patient’s relative, praise their doctor for extending life several months? Probably not very often.

    And, as I said, we don’t even know if the new drugs are doing any good. Maybe they just cause a little less harm than the older drugs. You are comparing newer drug to older drugs. You don’t really know how the patients would have done with no treatment at all.

    I am NOT saying they would live longer with no treatment. Just that you don’t know. You think it’s just wonderful that toxic artificial substances supposedly can extend life a short while. Well I don’t think that is such exciting news. You’re expecting the life-prolonging effect will continue indefinitely, but you have no rational basis for that expectation. None. You simply do not know.

  56. trrll says:

    “Superior,” for cancer drugs, is often defined as prolonging life by several months, or decreasing tumor size. Neither of those measurements is meaningful for patients’ health.

    I must say that I find this an astonishingly arrogant and insensitive statement statement. Who the hell are you to judge how meaningful several months of life might be to somebody else? It would be unfortunate indeed if the FDA or another government agency were to adopt this sort of dictatorial attitude over the lives of others.

    The oncologists I’ve had cause to interact with have generally been very knowledgeable about what level of benefit the average patient can expect from the chemotherapeutic drugs, and very direct about communicating the hard facts of limited benefit and potentially serious side effects to patients and their families.

    Cancer, AIDS, many chronic diseases, have been great failures. When lifestyle is known to be the main cause, as in heart disease or type 2 diabetes, the solution is obviously holistic — lifestyle improvements.

    Here you are preaching to the choir, with the exception of labeling well-established evidence-based preventative strategies as somehow “holistic.” But this begs the question of what to do when a patient shows up with one of these diseases. As the saying goes, “it’s too late to talk about how you should have drained the swamp when you are up to your neck in alligators.

    But we don’t have proven holistic solutions for most diseases, and that’s why CAM research is needed.

    That seems a curious argument. None of the “holistic” therapeutics show any benefit whatsoever in treating these diseases, so we need to spend less money on the approaches that do show proven, albeit small, benefits, and spend more on the ones that have never been shown to work at all.

  57. trrll says:

    You are absolutely wrong. Geneticists assume any DNA they don’t understand is “junk” with no function

    This is a myth. As somebody who interacts with molecular geneticists on a daily basis, I can tell you with absolute certainty that this is completely false. In my experience, molecular geneticists are highly prone to suspect that DNA that they don’t understand has some sort of as-yet unrecognized regulatory function. Certainly there is a strong theoretical basis to expect some amount of “junk” to exist, and experimental evidence to support this. But this certainly provides no basis for assuming that a given sequence is junk, and in my experience molecular geneticists consider the junk hypothesis only reluctantly, when all efforts to find evidence of function have failed.

  58. pec says:

    “I can tell you with absolute certainty that this is completely false.”

    Well trrll, not everyone shares your absolute certainty.

    http://en.wikipedia.org/wiki/Junk_DNA

    “About 80-90% of the human genome has been designated as “junk”

    “While much of this sequence may be an evolutionary artifact that serves no present-day purpose, some is believed to function in ways that are not currently understood. ”

    See — “much” of the “junk” is thought to have no purpose.

    And if you don’t trust wikipedia, there are plenty of other sources. I guess the geneticists you happen to know are different from most of the others.

  59. qetzal says:

    pec on 01 Mar 2008 at 6:36 pm:

    I never said anyone’s length of life is meaningless. I said that as a medical treatment, extending life several months is not very meaningful.

    pec on 29 Feb 2008 at 9:50 am:

    “Superior,” for cancer drugs, is often defined as prolonging life by several months, or decreasing tumor size. Neither of those measurements is meaningful for patients’ health.

    Don’t take my word for it, pec. The posts are right upthread.

  60. skidoo says:

    So the majority of physicians are idiots who can’t think for themselves, and are easily seduced by ball point pens and cheap plastic wall clocks? Interesting.

  61. Michael X says:

    Wow, Skidoo.

    That is not only a specious rewriting of the post, it is also a complete strawman. The point is that people who can think for themselves are still effected by such methods of influence, not that they can’t think for themselves at all. Reciprocity is a much stronger force in our social interactions than most people realize. It is no surprise that drug companies might use such knowledge to their benefit. The point is though that our rational physicians are not infallible, and still suffer from all the negatives of our shared humanity, and thus should be even more on guard. And let us remember, that knowledge of the anatomy is not knowledge of psychology. Even the greatest minds of our time can be manipulated by simple emotional triggers.

  62. pec says:

    “Even the greatest minds of our time can be manipulated by simple emotional triggers.”

    There is a myth in our society that people with a science education are way above the rest. That there is a tremendous gulf between the educated and the uneducated. I think this is just part of our cultural mythology without any basis in reality.

    Yes, the average uneducated American does seem very irrational, biased and downright stupid at times. But I think this is true of every single one of us, except in areas where we happen to have some expertise. The car mechanic may be rational when he talks about cars, the brain surgeon may be rational when he talks about brain surgery.

    Outside of our areas of experience — and these must be narrow because a lifetime isn’t long enough to become an expert in many different things — we are all pretty idiotic.

    And even in our areas of expertise, it’s impossible to keep up with constantly changing information.

    Because of the myth that there are smart people who are different and above the rest, we have tended to trust physicians like gods. I think it’s human nature to look up to the elders of the tribe, to trust the priests and the witch doctors. We have the same nature as our primitive ancestors and the same need to trust and worship.

    MDs have taken on the role of priests in our secular society. We expect them to be more than human, and they expect the same from themselves. They try to live up to our expectations, to provide the “magic” we demand.

    And the new drugs are that magic. Everything gets a pill.

    You can’t blame it all on the drug companies — they are just making the best of a really great opportunity. They probably think they are keeping us all alive and happy. Doctors don’t need bribes to be won over, because they deeply believe in the magic.

    As I said before, some of the standard medical treatments and technologies are great and really do save lives and allow patients to recover their health. But medical treatments have extended way beyond the narrow range of things that actually do save lives and permit real recovery.

  63. pec says:

    Chemicals that interfere with natural processes are used to treat everything from terminal diseases to minor annoyances. The chemicals focus on changing a specific variable or symptom, without regard for how the rest of the system may be effected.

    That is why the new drugs almost always have side effects. Watch the TV ads — a drug that promises to cure insomnia may cause diarrhea; a drug for diarrhea may cause nausea; the drug for nausea may cause insomnia, etc., etc.

    You could easily wind up taking a dozen different drugs, just to treat side effects.

    I saw real examples of this recently when investigating my mother’s medication. What a tangled mess. The hypertension drug can cause depression, the depression drug can cause hypertension and nausea, the nausea drug caused something else … Her MDs have had her on all these for decades.

    Lifestyle changes were NOT recommended when my mother was diagnosed with hypertension. She was not told to stop smoking and start exercising — they just didn’t think that way. Instead she was started on a vicious cycle of poor mental and physical health and dependence on drugs.

    Did you know that people cannot stop anti-depression drugs after being on them for years? Do you realize the medical industry is creating drug addicts who can never stop buying their drugs?

    Even now, lifestyle is not emphasized. It’s much easier to prescribe a drug. Americans won’t exercise or eat vegetables anyway.

  64. Fifi says:

    Ah yes, the “cure” for cancer. Isn’t that what every quack is selling and anti-science based medicine people always tout as some kind of golden proof that conventional medicine sucks because it doesn’t promise to cure cancer? Unlike “alternative medicine” which never ceases to claim their methods have cured cancer?

    The latest and most pernicious version of this I’ve run across is http://www.beatcancer.org (though it really should be a “.com”). On the surface the “Centre for the Advancement of Cancer Education” (CACE) seems pretty on the level – “clinical” studies are mentioned, no one can argue that eating well and exercising can both help prevent cancer and aid in keeping cancer in remission, it even says that they work with oncologists and that “Dr.” Susan Silberstein is associated with established medical centres. A little bit of digging soon turns up the fact that “Dr.” Silberstein’s “Dr” comes from a non-medical degree (though it’s never clear just what kind of PhD she holds), that she’s in the employ of Juice+ (who trot out all kinds of shaky studies published outside of the mainstream as “science” and are actually on the “beware” lists of some major cancer organizations). It also becomes clear that Silberstein is making plenty of money peddling products and pseudoscience – and that some oncology clinics are even in bed with her.

    It’s obvious why shysters and frauds (or even well meaning but ignorant/scientifically illiterate people) are drawn to incurable diseases like cancer and AIDS – it’s simply because where science can not provide an answer (or people don’t like what they’re hearing) then people become open to being conned and sold false hope. Considering the anger that is part of the grieving process when someone is diagnosed with a fatal disease, it’s easy to see how this anger at doctors and science (and ultimately the disease) can be harnessed for profit and to turn patients against their oncologists and towards the JuicePlus salesman who’s selling them a cure (as long as their karma determines they’re good enough to live).

    Someone like pec is just the “alternative” version of a big pharma salesman and what he peddles is no less harmless, and in the case of cancer and AIDS often more harmful and ultimately usually even less likely to improve life or cure anyone at all.

  65. weing says:

    “That is why the new drugs almost always have side effects.”
    Huh?
    Every drug has side effects, even the old ones.
    BTW, have you accompanied your mom to every medical appointment?
    I routinely taper patients off antidepressants after about a year of remission and most of the time they are able to remain off of them.

  66. Fifi says:

    pec – “Chemicals that interfere with natural processes are used to treat everything from terminal diseases to minor annoyances. The chemicals focus on changing a specific variable or symptom, without regard for how the rest of the system may be effected.”

    Well, yes, death is a natural process that we use chemicals to “interfere with”. Sometimes some drugs can interfere with this natural process and preserve life. Deciding which side effects of living (pain, discomfort, joy) and so on are worth it to continue living surely needs to be a subjective call made by the patient.

    pec – “That is why the new drugs almost always have side effects. Watch the TV ads — a drug that promises to cure insomnia may cause diarrhea; a drug for diarrhea may cause nausea; the drug for nausea may cause insomnia, etc., etc.”

    Useful drugs have effects – the main one and then the less useful ones called “side-effects”. This is nothing new. Herbs that have effects also have side-effects. Anything without effect is, effectively, useless.

    pec – “You could easily wind up taking a dozen different drugs, just to treat side effects.”

    I’d get a second opinion if this is how your doctor prescribes. People often end up spending oodles of cash on a dozen different herbal remedies and expensive vitamins like JuicePlus to no healing effect rather than listening to their doctors who prescribe sensible eating and exercise.

    pec – “I saw real examples of this recently when investigating my mother’s medication. What a tangled mess. The hypertension drug can cause depression, the depression drug can cause hypertension and nausea, the nausea drug caused something else … Her MDs have had her on all these for decades.”

    So you’ve only now become interested in your mom’s health after decades of ignoring her lack of self care? You didn’t actually help her with diet and exercise decades ago? Yikes!

    pec – “Lifestyle changes were NOT recommended when my mother was diagnosed with hypertension. She was not told to stop smoking and start exercising — they just didn’t think that way. Instead she was started on a vicious cycle of poor mental and physical health and dependence on drugs.”

    Or your mom may not remember her doctor recommending she stop smoking and start exercising, particularly if she didn’t want to stop smoking and start exercising. I find it very hard to believe that over decades of treatment for these varied things that it was never suggested your mother stop smoking and start taking care of herself. Blaming your mom’s decline on drugs (rather than taking responsibility for your apparent negligence and disinterest over decades) seems like avoiding personal responsibility to me.

    pec – “Did you know that people cannot stop anti-depression drugs after being on them for years? Do you realize the medical industry is creating drug addicts who can never stop buying their drugs?”

    Certainly some people need to be on medication to function since they’re dealing with incurable conditions that the medication stabilizes and taking the medication is preferable to the alternative. Certainly there needs to be a managed withdrawal for many drugs that people take long term. The majority of people using anti-depressants as a temporary aid while undergoing cognitive therapy to address the root of their depression don’t have problems weening themselves off anti-depressants. People with a severe underlying neurochemical imbalance are obviously going to return to a state of imbalance when not taking medications. Anti-depressants are a treatment for depression not a cure.

    pec – “Even now, lifestyle is not emphasized. It’s much easier to prescribe a drug. Americans won’t exercise or eat vegetables anyway.”
    So it’s medicine’s fault that most Americans won’t exercise or eat vegetables? Or big pharma’s? I’m no fan of big pharma but that’s about the lamest excuse and justification for not being responsible for one’s own health I’ve ever heard. It’s just the kind of passive victim mindset that sends patients into doctors’ offices demanding that the doctor prescribe them a magic pill to make everything better and then get all mad at science and medicine when the magic pill they insisted on getting isn’t magic. That’s the problem with magical thinking, eventually reality will set in. As surely as death and taxes. (Putting discussion of replacement cyborgs and libertarian utopias aside for the moment).

  67. pec says:

    I was a child when my mother was diagnosed with hypertension. It was quite a while before I became a skeptic regarding standard medical treatments (and I am ALSO, by the way, a skeptic about alternative treatments!)

    My mother quite smoking long ago — but was never told by her MD that it might have caused the hypertension. When I eventually found out that physical exercise is absolutely necessary for health (long before MDs starting recommending it) I of course recommended it to my mother.

    No I don’t go to all my mother’s doctor appointments with her. I have a full time job so I don’t see how that would be possible. I still had some faith in her MD until recently — I was on vacation so I went with her. It was really a shock. He refused to believe any of her problems were side effects of Lyrica and he recommended various tests and specialists. It turned out he was completely wrong.

    I have tried to have some faith in MDs for people with serious diseases. But I have been losing what little faith I had.

    I would see an MD only for certain types of problems, which rarely occur. For example, injuries requiring surgery or serious infections requiring antibiotics.

  68. pec says:

    “So it’s medicine’s fault that most Americans won’t exercise or eat vegetables? Or big pharma’s?”

    Of course not. But Americans have been convinced that the medical industry is giving them “longer and healthier lives.” So they assume the important thing is getting regular checkups and taking their doctors’ advice. And that advice usually involves taking pills.

    If the medical industry were not claiming all the credit for our wonderful health and longevity, I think Americans would take more responsibility for lifestyle changes.

    There has been a gradual awakening to the importance of lifestyle, thanks to the increasing influence of CAM and disillusionment with standard treatments for heart disease and cancer.

  69. weing says:

    You are overgeneralizing here. Lifestyle has been important from day one in medicine, at least going back to the early 70s when I went to medical school. That was way before the current quackery industry called CAM started. Lifestyle is not everything however.

    The longer and healthier lives are mostly due to our public sanitation system.

    Medical advice does not usually involve taking pills.

    If all you go to the doctor for is when you are in need of an antibiotic or require surgery, no wonder you get those.

    BTW, how do you know you need an antibiotic and not the tincture of time?

  70. Fifi says:

    pec – “I was a child when my mother was diagnosed with hypertension. It was quite a while before I became a skeptic regarding standard medical treatments (and I am ALSO, by the way, a skeptic about alternative treatments!)”

    You never sound equally skeptical about “alternative” treatments, you actually don’t sound skeptical at all. You sound like someone more interested in “faith”.

    pec – “My mother quite smoking long ago — but was never told by her MD that it might have caused the hypertension. When I eventually found out that physical exercise is absolutely necessary for health (long before MDs starting recommending it) I of course recommended it to my mother.”

    Funny, my mother raised me to eat sensibly and exercise if I want to be healthy. Funnily enough, she’s a doctor. She advised the same thing to her patients, it wasn’t what most of them wanted to hear since that would involved them doing something rather than her doing something. I distinctly remember government sponsored ads on TV from when I was a kid (back in the 60s and 70s) promoting “participaction” (eating right and exercising to stay healthy).

    pec – “No I don’t go to all my mother’s doctor appointments with her. I have a full time job so I don’t see how that would be possible. I still had some faith in her MD until recently — I was on vacation so I went with her. It was really a shock. He refused to believe any of her problems were side effects of Lyrica and he recommended various tests and specialists. It turned out he was completely wrong.”

    It really is a pity it took you decades to be interested in your mother’s ongoing decline. Often old people, when they feel neglected, will get depressed. I’m sure it’s much easier for you to deal with your mother’s mortality by blaming her doctor, who’s been picking up your slack for the past couple of decades.

    pec – “I have tried to have some faith in MDs for people with serious diseases. But I have been losing what little faith I had.”

    Yes, I see that for you it’s all about faith and someone else doing the healing (or being to blame for any unpleasantness, including the inevitability of death). It’s foolish to have faith in any human individual you don’t know, doctors are not gods. They are people and should be treated accordingly. Trust is something you build up over time as people prove themselves trustworthy. Stop looking for miracles and you won’t be disappointed when reality occurs instead. Really, a little bit of self responsibility and common sense would go a long way in your family.

    pec – “I would see an MD only for certain types of problems, which rarely occur. For example, injuries requiring surgery or serious infections requiring antibiotics.”

    That’s your choice. Too bad that you’re going to bother some doctor at all though if you do get sick and desperately need treatment. All things considered, it shows an extreme lack of faith in your own arguments against conventional medicine.

  71. weing says:

    Getting back to the post:
    I think direct to consumer advertising has convinced a lot of people to demand a pill {antibiotic) when they come to see their doctor.
    Are patients aware that they are manipulated by the commercials?
    Do patients think they are immune to the manipulation by pharmaceutical companies?

  72. weing says:

    Are patients aware they are being conned by the CAM quacks?

  73. Fifi says:

    weing – “I think direct to consumer advertising has convinced a lot of people to demand a pill {antibiotic) when they come to see their doctor.
    Are patients aware that they are manipulated by the commercials?
    Do patients think they are immune to the manipulation by pharmaceutical companies?”

    All good points and certainly direct to consumer advertising by pharmaceutical companies and companies that sell “wellness” products and services both sell the illusion that sparkling health and longevity are just a pill/formula/powder away (bit it Zoloft or JuicePlus they’re selling). Of course, there’s even less oversight and testing of the “alternatives” and the advertisements for them than there are of conventional treatments or products so it’s even easier for quacks to con people.

  74. pec says:

    Some really bizarre intentional misunderstandings of what I said.

    “If all you go to the doctor for is when you are in need of an antibiotic or require surgery, no wonder you get those.”

    Did I SAY I get those??? I said I WOULD go for those.

    “It really is a pity it took you decades to be interested in your mother’s ongoing decline.”

    I said I don’t go to ALL my mother’s doctor’s appointments. That means I wasn’t interested for decades??? My mother’s health problems have been MY problem all my life. You’re lucky if you have healthy parents, and you have no idea what life is like when you don’t.

    “it’s foolish to have faith in any human individual you don’t know, doctors are not gods. ”

    This is stupid. I assumed doctors could be trusted to some extent. I never trusted them like gods and if you read any of my comments you would know that.

    “Too bad that you’re going to bother some doctor at all though if you do get sick and desperately need treatment. All things considered, it shows an extreme lack of faith in your own arguments against conventional medicine.”

    I have said over and over and over that conventional medicine is great for some things. There is absolutely nothing in anything I said here that would suggest I have anything at all against using conventional medicine when surgery or antibiotics are needed.

    Some of you are displaying an extreme example of what I wrote about earlier — the fact that humans, of any educational level, can be amazingly irrational.

  75. pec says:

    And if someone doesn’t go to ALL of their mother’s doctor appointments, how is that neglect? Most people don’t even live near their parents, and don’t go to ANY of their parents’ doctor appointments. How often do you go, since we’re getting completely off the subject and on to judgments of character?

  76. weing says:

    Sorry for the misunderstanding. So you’ve never required an antibiotic? Good. Lucky.

  77. Fifi says:

    pec – I wouldn’t argue that humans can be irrational. Nor do I actually believe “being rational” is the end all and be all (or even the best part) of being human. Since you were the one saying that “I have tried to have some faith in MDs for people with serious diseases. But I have been losing what little faith I had.”

    Seriously, what does your “faith” have to do with anything other than your need to believe? And perhaps your reactionary anger when your “faith” is shattered by reality. It really does sound like you’re looking for someone to be responsible for both your mother and your own (apparently) horrible childhood. As well as looking for a new repository for your “faith” that will provide miracle cures and absolve you of personal responsibility. It’s rather funny that you are both bemoaning the average American’s lack of personal responsibility for their health while looking for someone to blame at the same time! It’s your logic that’s falling apart and frayed around the edges pec, only to reveal your super victim costume hidden beneath your “regular guy” disguise.

  78. pec says:

    Fifi,

    You’re truly nuts. You obviously have not read any of my comments on this post, or any other, and are reading all kinds of nonsense into what little you did read.

    I never had tremendous faith in conventional medicine. But I can’t force friends and relatives to follow my advice. They live the American lifestyle and get sick and require drugs. I had hoped that their doctors were moderately rational. But I have found, increasingly, that doctors love to prescribe drugs. They believe in the drugs, the evidence supposedly shows the drugs are safe and effective.

    This post was about how we have reasons to doubt the objectivity of drug research funded by drug companies. I have been saying yes that’s true, and gave some examples.

    I almost never go to MDs myself. Yes I needed antibiotics recently for an insect bite, but that was the first time I ever took them, and I am over 50. I never get checkups to see if my blood pressure and cholesterol are low enough. I pay attention to how I feel and try to get enough sleep and exercise, unlike the average American. I am healthier now than when I was young, because I understand health a lot better now. I have a holistic philosophy regarding health — I think you have to consider the system as an intricate and complex whole, and looking at it simplistically is a mistake.

    I have not been in control of the health of my mother, or close friends and relatives. I can’t become everyone’s life coach and force them to live my way. I try to set a good example and provide information when asked.

  79. weing says:

    So you get what you go for, medications. You don’t go for screening?

    I hate to burst your bubble but lifestyle is not everything no matter what your CAM quacks have been telling you. I know plenty of patients with the right lifestyle still develop cancers and heart disease. I’ve had colleagues, who took care of themselves better than I did even going back to our college days, drop dead of a heart attack while exercising.

  80. Fifi says:

    pec – Thanks for your non-professional internet diagnosis of my mental health. I find it hugely entertaining coming from someone such as yourself, particularly in light of the fact that you contradict yourself in your ongoing promotion/defense of CAM and claims to be impartial. Oh, and also because you seem to consistently get confused about science since you seem to see it as analogous to faith and religion.

    pec – “I have not been in control of the health of my mother, or close friends and relatives. I can’t become everyone’s life coach and force them to live my way. I try to set a good example and provide information when asked.”

    Ah, so you admit that people can’t be forced (or even convinced by someone they love) to live in a healthy manner or by someone else’s rules (no matter how sensible they may be). No doubt you’ve informed them of the dangers of their lifestyles, why do you think a doctor would have more power over any of these people than someone they love does? Apparently your close friends and relatives are finding something about your message or the way you deliver it pretty unappealing, or the example you’re setting isn’t a lead they want to follow.

    Btw, if you’d treated that insect bite with a bit of common sense it’s highly unlikely it would have gotten so infected that you’d actually need antibiotics. I’d have to wonder just how septic your body is or what horrible things you were doing to the bite to have it turn into an infection that requires antibiotics. A little bit of common sense really does go a long way and an ounce of prevention really is worth a pound of cure.

  81. trrll says:

    Well trrll, not everyone shares your absolute certainty

    Yes, I am sure that there are many people don’t share my certainty because they have picked up nonsense from people such as yourself, rather than from working with actual molecular geneticists or reading the actual scientific literature. Which doesn’t include Wikipedia, by the way, although it can sometimes be a useful starting point for learning. But even taking the (rather mediocre by Wikipedia standards) Wikipedia article, it states

    In molecular biology, “junk” DNA is a provisional label for the portions of the DNA sequence of a chromosome or a genome for which no function has yet been identified.

    Which parts of the words “provisional” and “yet” do not understand?

    See — “much” of the “junk” is thought to have no purpose

    The article actually says that much of it “may be an evolutionary artifact that serves no present-day purpose.” Which part of the word “may” do you not understand?

    Once again, there is good reason to believe that junk DNA exists, and strong evidence that there is a lot of it in some species, but that does not provide a basis for assuming that any particular sequence is junk. My point remains: every molecular geneticist that I’ve ever met or worked with, when confronted with an unknown sequence in DNA, begins with the hypothesis that it has some kind of function, and considers the “junk” hypothesis only when all efforts to demonstrate some kind of function have been exhausted.

  82. Fifi says:

    Eh, what I meant to write – rather than the hanging sentence I did post – is…
    I wouldn’t argue that humans can be irrational. Nor do I actually believe “being rational” is the end all and be all (or even the best part) of being human. Since you were the one saying that “I have tried to have some faith in MDs for people with serious diseases. But I have been losing what little faith I had” you seem to be the one who has an irrational and faith based belief (and now disbelief) in doctors and conventional medicine.

    pec wrote – “And if someone doesn’t go to ALL of their mother’s doctor appointments, how is that neglect? Most people don’t even live near their parents, and don’t go to ANY of their parents’ doctor appointments. How often do you go, since we’re getting completely off the subject and on to judgments of character?”

    The neglect has nothing to do with not going to doctor’s appointments with your mother, it has to do with simply loving your mother and supporting her physical and emotional health. (You, btw, are the one who got personal by using your personal experience with your mother as an example. Incidentally, it’s a ploy to paint one’s argument with the evocative tones of personal victim status – and to try to render all those offering opposing viewpoints as “mean” or “heartless – that I saw used very recently by someone else who advocates CAM and super juice cures for cancer.) You seem to want to blame your mother’s physician for her poor health (everything from her hypertension to her depression is someone else’s fault) even though your mother made unhealthy lifestyle choices for herself. If she’s a capable adult then she’s responsible for her lifestyle choices just like the rest of us are and what they contribute to her ill health on top of any genetic weaknesses she (and you) may have inherited.

  83. trrll says:

    Lifestyle changes were NOT recommended when my mother was diagnosed with hypertension. She was not told to stop smoking and start exercising — they just didn’t think that way. Instead she was started on a vicious cycle of poor mental and physical health and dependence on drugs.

    Are you sure? This recommendation has been part of the standard of medical care for patients with hypertension for decades. I suppose that there might be some doctor somewhere too incompetent make the standard recommendation, but I’d find it much easier to believe that her doctor made the usual recommendation to her, and she chose not to mention it to you, perhaps because she didn’t want to do it, and didn’t want you nagging her about it.

  84. Fifi says:

    pec – “And, as I said, we don’t even know if the new drugs are doing any good. Maybe they just cause a little less harm than the older drugs. You are comparing newer drug to older drugs. You don’t really know how the patients would have done with no treatment at all.’

    Actually, yes we do and it’s incredibly silly to propose otherwise (since it’s so obvious why and how we know). Patients given no treatment at all would die in the same way they did before the treatments being used were developed.

  85. Fifi says:

    Eh, clearly my editorial proofing function is not on today…

    “I wouldn’t argue that humans CAN’T be irrational.”

  86. daedalus2u says:

    When pec says dietary lifestyles were not recommended, perhaps they were simply not recommended in a way that his mother could understand. If pec takes after her that would be easy to understand. Here is a paper demonstrating a low salt diet lowers hypertension written in 1949.

    http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2051822

    It seems like the trial was only single blinded, but the details of blinding are not clear. No doubt according to pec the results cannot be trusted because they were obtained by 3 MDs, using that “dead-end” research pathway of evidence based treatments where they changed only one variable, they removed salt from the diet. Nothing at all holistic about that! Unless they removed salt from the whole diet. But that would make it a wholistic dietary change.

  87. pec says:

    “why do you think a doctor would have more power over any of these people than someone they love does? ”

    Because I am not a medical doctor, and I don’t have the facilities to treat serious diseases, and the doctor has access to diagnostic technology that I do not have. Also, if the doctor recommends drugs and I recommend exercise, it’s easier to follow the doctor’s advice.

  88. pec says:

    “your close friends and relatives are finding something about your message or the way you deliver it pretty unappealing, or the example you’re setting isn’t a lead they want to follow.”

    I feel that way about you.

  89. pec says:

    “if you’d treated that insect bite with a bit of common sense it’s highly unlikely it would have gotten so infected that you’d actually need antibiotics.”

    You are nasty and evil. I was talking about Lyme disease, which anyone can get from a tick bite (not technically an insect) even if their lifestyle is excellent.

  90. pec says:

    So the only thing I needed an MD for, in my entire adult life so far, was something completely unrelated to lifestyle.

  91. pec says:

    “Here is a paper demonstrating a low salt diet lowers hypertension written in 1949.”

    Oh yes, of course, that was the only thing her doctor recommended — a low salt diet. And of course she has followed that advice her whole life.

    But the low-salt diet idea is total baloney.

  92. Fifi says:

    Fifi wrote – “why do you think a doctor would have more power over any of these people than someone they love does? ”

    Pec responded – “Because I am not a medical doctor, and I don’t have the facilities to treat serious diseases, and the doctor has access to diagnostic technology that I do not have. Also, if the doctor recommends drugs and I recommend exercise, it’s easier to follow the doctor’s advice.”

    So, you feel that doctors are more informed and able to diagnose and respond to serious diseases than you are due to your own lack of expertize?

    It’s already been established that it’s standard medical advice to suggest lifestyle changes when people suffer from conditions like hypertension or diabetes that can be effectively managed through lifestyle changes so trying to blame the doctor yet again is really just more avoidance on your part (if this whole story isn’t a fabrication, which it may well be from how weak at the seams it is…though I don’t discount that your family may have a culture of blame and denial that you’re valiantly carrying forward).

  93. pec says:

    “The neglect has nothing to do with not going to doctor’s appointments with your mother, it has to do with simply loving your mother and supporting her physical and emotional health.”

    So you don’t go to all your mother’s doctor appointments either? Yet you can criticize others.

    And I can’t imagine where you get the idea I don’t “support” my mother’s health. But I’m just one person fighting against massive institutionalized idiocy. I can’t even convince my best friends to exercise and sleep and avoid drugs. No matter how much I love someone, I cannot force health on them. You must be extremely immature if you think it’s possible to control people.

  94. Fifi says:

    Fifi wrote – “your close friends and relatives are finding something about your message or the way you deliver it pretty unappealing, or the example you’re setting isn’t a lead they want to follow.”

    pec wrote – “I feel that way about you.”

    That’s not surprising, I’m not trying to be appealing to you and you’re clearly not interested in common sense or science based medicine so it’s not surprising you wouldn’t like what I am saying.

    My friends and family however don’t have the kinds of issues with me or how I communicate that your friends and family seem to have with you and your message. And I’ve actually helped all kinds of people with making healthy lifestyle changes – both professionally and just because I care about the people around me and pay attention. You may not like me or what I say but I’m apparently much more effective at helping people make healthy lifestyle changes than you are. And, because I’m not a missionary for CAM, I accept that the adults around me can make their own choices about how they live and die rather than feeling the need to “force” my choices onto them.

  95. pec says:

    http://www.amjmed.com/article/PIIS0002934305010466/abstract

    The low-salt craze, like the low-fat craze, was based on some really stupid science.

    The real dietary villains are refined carbohydrates. It’s very sad that so many people have been misled.

  96. pec says:

    And it’s yet another example of the reductionist, non-holistic approach. MDs noticed a correlation between high blood pressure and artery disease. Never stopping to think the high blood pressure might be a result, rather than a cause, they raced ahead and declared war on high blood pressure. And having noticed that salt can raise blood pressure, they immediately decided that reducing salt intake would help prevent artery disease. Talk about a wild chain of logical errors.

  97. Fifi says:

    pec – “So you don’t go to all your mother’s doctor appointments either? Yet you can criticize others.”

    You obviously don’t read. My mother IS a doctor, she talks to her doctor doctor to doctor.

    pec – “And I can’t imagine where you get the idea I don’t “support” my mother’s health. But I’m just one person fighting against massive institutionalized idiocy. I can’t even convince my best friends to exercise and sleep and avoid drugs. No matter how much I love someone, I cannot force health on them. You must be extremely immature if you think it’s possible to control people.”

    So you’re blaming “massive institutionalized idiocy” for your mother’s poor decisions about her health now? You said your mother has been sick for decades and that it’s essentially her doctor’s fault, now it’s the system’s fault. If your mother managed to raise you without you ever needing medical attention then she doesn’t sound like nearly as big an idiot or patsy of the system as you keep making her out to be. I have no desire to control people and the only reason we’re talking about control is because you apparently think you’re in a life and death power struggle with the medical establishment to control an adult woman who clearly doesn’t want to be controlled by you (and no doubt brings up her doctor as a way to deflect your attempts to control her).

  98. pec says:

    I don’t try to control my mother, or anyone. I give her advice and she can take it or not. She comes from an era when people had blind faith in MDs. Thank goodness that era is coming to an end.

  99. pec says:

    “My mother IS a doctor, she talks to her doctor doctor to doctor.”

    Oh, so you have an excuse. And your mother probably isn’t old and sick, if she is still working. It’s easy to pass judgment on others when you have it easy. See how you feel about it some day if you’re working full time and people expect you to take days off every time your mother has a doctor appointment. See how you feel if you’re trying to live a normal life, but have to constantly be ready for emergencies.

    If you deal with all that perfectly, then you might be qualified to judge others.

    I saved my mother’s life a couple of years ago because some doctor had put her on Neurontin, which she could not tolerate. It was a little surprising when I found out recently her gp had her on Lyrica, a related drug. He denied that her symptoms — dizziness, nausea, vomiting, confusion, could be related to the Lyrica. He said it was old age and possibly a gall bladder problem. I decided to take her off Lyrica without asking him — it was obvious he is totally brainwashed to be pro-drug.

Comments are closed.