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All Medicines Are Poison!

That’s the title of a new book  by Melvin H. Kirschner, M.D. When I first saw the title, I expected a polemic against conventional medicine. The first line of the Preface reassured me: “Everything we do has a risk-benefit ratio.” Dr. Kirschner took the title from his first pharmacology lecture in medical school. The professor said “I am here to teach you how to poison people.” After a pause, he added, “without killing them, of course.” 

He meant that any medicine that has effects has side effects, that the poison is in the dose, and that we must weigh the benefits of any treatment against the risks. Dr. Kirschner has no beef with scientific medicine. He does have a lot of other beefs, mainly with the health insurance industry, the pharmaceutical industry, and alternative medicine.

 He explains the FDA, the standard drug approval process (phase I through III studies), fast-tracking, classification of drugs (Schedule I through V), black box warnings, drug recalls, off-label prescribing, the scientific method, package inserts, expiration dates, drug interactions, side effects, the role of sanitation in disease prevention, informed consent, developing resistance to antibiotics, placebos, immunizations, ethical issues, conflicts of interest, drug advertising, copycat drugs, why drugs cost so much, why “natural” doesn’t mean “harmless,” how dietary supplements can kill, how alternative medicine is not based on scientific evidence, chelation, DSHEA, NCCAM, the infiltration of CAM into medical schools and why we need a new Flexner report, what’s wrong with the American medical system (“What’s broken is the coverage system, not the care delivery system.”), and why “poison, cut and burn” is sometimes the only rational option. He does not like insurance companies, and he explains why. He ends by saying Lincoln’s characterization of our government as “Of the people, by the people, for the people” is now better described as

Of the people, Buy the lawmakers, For the corporations. 

I liked his comments on the natural herb that has caused more human grief than any other in history: tobacco. I liked his assertion that it would be redundant to label family practitioners as “holistic.” I didn’t like his discussion of automated lab tests because he missed the opportunity to explain how ordering panels of tests to screen patients can do more harm than good by finding false positives. 

I particularly liked his essay on “Doing Nothing.” Treatment is not always necessary and sometimes the decision to do nothing is actually doing something. It ties in with what I wrote about “Not Treating – A Neglected Option.”  

He says,

In my opinion, CAM is often neither complementary, alternative, nor medicine.

But his criticism of alternative medicine is weak. He falsely conflates chiropractic with massage. Instead of excoriating the idiocy of therapeutic touch he merely calls it a “treatment that sometime works but is actually doing nothing.” In criticizing CAM his approach is more like that of Caspar Milquetoast than like the respectfully insolent snarkiness of our esteemed colleague Orac.

 The book is derived from his previous writings over the last 60 years, everything from lectures to letters to the editor. It shows. It is fragmented, with short chapters on a variety of unconnected subjects. He has a lot of solid information and clinical wisdom to share, but his material is not well organized and suffers from an awkward, stilted style of writing. Some of the examples he uses are ill-chosen. 

That said, the book might appeal to laymen and it might serve to get some very important points across to the public. The catchy title might persuade people to read it who would not otherwise be exposed to these ideas.

Posted in: Book & movie reviews, Pharmaceuticals

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7 thoughts on “All Medicines Are Poison!

  1. windriven says:

    I believe that Dr. Novella is beginning to compile a similar volume that can certainly be expected to take no prisoners in the battle against woo. I hope he will take the opportunity to lay out his plan in this space and to let the community know how we can be of assistance in his effort.

  2. davishin says:

    I got this book by Dr. DelRe a couple weeks ago, so I thought I share with you:
    http://www.amazon.com/Rejuvenation-Increase-Vitality-Energy-Healing/dp/0615263275/ref=sr_1_1?ie=UTF8&s=books&qid=1250730123&sr=1-1
    Dr. DelRe’s an alternative medicine practitioner, and you’ll see that alternative medicine doesn’t “do nothing”. Instead of having to pay a lot of money for treatments that is high risk, you’ll find that there are better ways to treat your muscle pains, joint, ligament problems, and much more. I bought this book to learn ways I could treat my rotator cuffs and I am finding very good information on treating my rotator cuffs without having to pay a lot of money.

  3. Harriet Hall says:

    davishin said,

    “you’ll find that there are better ways to treat your muscle pains, joint, ligament problems, and much more.”

    How do you know they are better? If they had been scientifically tested and proven to be better, they would have been adopted by scientific medicine. There are many, many books by alternative practitioners making claims that are not backed up by acceptable evidence.

    Alternative medicine does indeed “do something” – it provides a lot of personal attention, handholding, and TLC; it “explains” things that have no scientific explanation; it entertains people while their symptoms go away on their own; it elicits a placebo response. If that’s all you’re looking for, alternative medicine can be very satisfying. If you’re looking for treatments that are demonstrably more effective than placebo, you must look to scientific medicine.

  4. davishin says:

    The book I mentioned has almost 300 scientific references which are ignored “medical science”. Is it “scientific” to prejudicially exclude research that proves you wrong? You said: “If you’re looking for treatments that are demonstrably more effective than placebo, you must look to scientific medicine.” When scientific medicine becomes rid of egos, money, coercion, back-scratching, human bias, prejudice, and capitalism, and when you take your blinders off and stop trying to push your narrow-focused point of view, then maybe I will buy your line. In other words, when “scientific medicine” is done by only by robots then maybe I’ll pay 100% homage to it. Humans can be selfish and flawed, and doctors are human. The book I mentioned is a good example of what you are missing, perfect as you may be.

  5. Harriet Hall says:

    Ah, yes! One of those books with information that mainstream science has missed. There are so many of those! I wrote about them at
    http://www.sciencebasedmedicine.org/?p=382

    That book may be the exception to the rule, or it may
    1. List 300 supporting references that don’t really support what he claims, or that are rejected by good scientists for good reasons.
    2. Fail to list other references that contradict his claims.
    3. Fail to explain the reasoning of scientists who reject the claims.
    4. Provide lots of testimonials.

    I am far from perfect, but people who write pseudoscientific books are even farther from perfect.

    You might want to try a simple exercise. Pick a statement from the book that most scientists would not accept, and look up the abstracts of the references on PubMed to see how well they support that statement. Then use the key words to search for other articles on the same subject.

  6. EricG says:

    Davishin said:

    “In other words, when “scientific medicine” is done by only by robots then maybe I’ll pay 100% homage to it. Humans can be selfish and flawed, and doctors are human. The book I mentioned is a good example of what you are missing, perfect as you may be.”

    until then i guess the only option is to accept non-medicine constructed by equally fallible, biased, greedy, narrow-viewed humans (pardon, “non-robots”) with their own “agenda” to push. you did…*buy* the book and/or *swallow the doctrine*, did you not?

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