Below, I have copied an entire article from the BMJ, written by Dr Des Spence, who is a fellow Scottish GP. We communicate from time to time, and share a general view that medicine is heading in a very unfortunate direction with overdiagnosis and over-treatment/polypharmacy becoming a massive problem.
This is driven, in the main part, by the pharmaceutical industry. An industry that would like to see the entire population of the world taking medication every day….. forever. To achieve this they have, effectively, grabbed hold of medical research and twisted it to their own ends.
Anyway, please read this article. It encapsulates much of what I feel, and I believe it needs a wider audience [I have added a few comments into the text to ensure that I am not breaching copyright]
Evidence based medicine (EBM) wrong footed the drug industry for a while in the 1990s. We could fend off the army of pharmaceutical representatives because often their promotional material was devoid of evidence. But the drug industry came to realise that EBM was an opportunity rather than a threat. Research, especially when published in a prestigious journal, was worth more than thousands of sales representatives. Today EBM is a loaded gun at clinicians’ heads. “You better do as the evidence says,” it hisses, leaving no room for discretion or judgment. EBM is now the problem, fuelling overdiagnosis and overtreatment.
[This is now a major problem for GPs who are increasingly measured and monitored, and funded, according to how accurately we follow guidelines mk comment]
You see, without so called “evidence” there is no seat at the guideline table. This is the fundamental “commissioning bias,” the elephant in the room, because the drug industry controls and funds most research. So the drug industry and EBM have set about legitimising illegitimate diagnoses and then widening drug indications, and now doctors can prescribe a pill for every ill.
[As you can imagine, this makes it difficult not to prescribe statins mk comment]
The billion prescriptions a year in England in 2012, up 66% in one decade, do not reflect a true increased burden of illness nor an ageing population, just polypharmacy supposedly based on evidence. The drug industry’s corporate mission is to make us all sick however well we feel. [Absolutely true mk comment] As for EBM screening programmes, these are the combine harvester of wellbeing, producing bails of overdiagnosis and misery.
Corruption in clinical research is sponsored by billion dollar marketing razzmatazz and promotion passed off as postgraduate education. By contrast, the disorganised protesters have but placards and a couple of felt tip pens to promote their message, and no one wants to listen to tiresome naysayers anyway.
[Speaking as a tiresome naysayer I could not agree more mk comment]
How many people care that the research pond is polluted, with fraud, sham diagnosis, short term data, poor regulation, surrogate ends, questionnaires that can’t be validated, and statistically significant but clinically irrelevant outcomes? Medical experts who should be providing oversight are on the take. Even the National Institute for Health and Care Excellence and the Cochrane Collaboration do not exclude authors with conflicts of interest, who therefore have predetermined agendas. The current incarnation of EBM is corrupted, let down by academics and regulators alike. [If anyone has any suggestion how to improve regulation, please let me know mk comment]
What do we do? We must first recognise that we have a problem. Research should focus on what we don’t know. We should study the natural history of disease, research non-drug based interventions, question diagnostic criteria, tighten the definition of competing interests, and research the actual long term benefits of drugs while promoting intellectual scepticism. If we don’t tackle the flaws of EBM there will be a disaster, but I fear it will take a disaster before anyone will listen.
[There have already been many disasters, but nobody has yet listened mk comment]
Original article can be found here
Sorry about the intrusive comments, but I don’t want the BMJ jumping up and down on me – especially as they are the only major journal that seems keen to criticize the industry.
What Des Spence is saying, is what I have been saying for some time now. Evidence Based Medicine (EBM) could have been a great thing – so long as it was not enforced too rigidly. But the evidence has been manipulated and corrupted all the way along the line. EBM is now almost completely broken as a tool to help treat patients.
Some years ago I stated that I no longer believe in many research papers that I read. All I tend to do is look at the authors, look at the conflicts of interest, look at the companies who sponsored the study, and I know exactly what the research is going to say – before I have even read the paper.
I have also virtually given up on references. What is the point, when you can find a reference to support any point of view that you want to promote? Frankly, I do not know where the truth resides any more. I wish to use evidence, and the results of clinical studies, but I always fear that I am standing on quicksand when I do so.
We are at a crisis point. Medical research today (in areas where there is money to be made) is almost beyond redemption. If I had my way I would close down pubmed, burn all the journals, and start again, building up a solid database of facts that we can actually rely on – free from commercial bias. But this is never, ever, going to happen.
Happy New Year.
Dr. Malcolm Kendrick 
I recently bought 3 tubs of the supplement you have an interest in, ProKardia, with its main ingredient as L-arginine. Could you reassure me that ProKardia is safe, I only took it for a few days until I read the study below.
Is this study an example of conflicts of interest and therfore not to be trusted?
http://jama.jamanetwork.com/article.aspx?articleid=202136
“Results
Baseline characteristics, vascular stiffness measurements, and left ventricular function were similar between participants randomized to receive placebo or L-arginine. The mean (SD) age was 60 (13.6) years; of the participants, 104 (68%) were men. There was no significant change from baseline to 6 months in the vascular stiffness measurements or left ventricular ejection fraction in either of the 2 groups, including those 60 years or older and the entire study group. However, 6 participants (8.6%) in the L-arginine group died during the 6-month study period vs none in the placebo group (P = .01). Because of the safety concerns, the data and safety monitoring committee closed enrollment.
Conclusions
L-Arginine, when added to standard postinfarction therapies, does not improve vascular stiffness measurements or ejection fraction and may be associated with higher postinfarction mortality. L-Arginine should not be recommended following acute myocardial infarction.”
You make a very good point. I have been looking at this study. Previous studies have shown benefits of L-arginine. I am discussing the implications of the l-arginine study with the main Prokardia manufacturers. I will revert to this issue
Dr K. I want all NHS medics to follow this well thought out thread concerning the undue influences of medical research, and take the discussion onto their conferences, and/or political meetings, in an attempt to get these important issues thrashed out.
Your article, based on Dr Des Spence’s publication, draws together the conflicts discussed at length in your previous blog, “The State of the NHS today”, which became embroiled with topics far removed from your original text, but relevant to the discussion.
I am at a loss as to which research to believe, and like yourself, look to its origins. So, I feel that like-minded people may be interested in the BMJ research article, “Survival time of chocolates on hospital wards”, which received no external funding, costs being borne by the authors, and with no sponsorship whatsoever. —it is a little bit of light-hearted diversion for many of us who are feeling frustrated at the lack of progress in getting honest, unbiased, messages out to the confused public.
Two points:
I suppose I am broadly in favour of EBM ( think of the alternatives….. ). If only it was actually practiced.( For those that think it is, simply review statins in primary prevention and BP prescriptions. To name but two. )
What to do about the other issue raised re actually compiling the ‘evidence’? I think it may have been an idea written about by Gary Taubes. If I remember correctly, he suggested things are reviewed by an independent body i.e. nobody from the drug companies and – maybe as crucially – the medical profession would be allowed near it. They would simply present their evidence for review. Who should be on it? Actuaries would be good in my opinion, but also some lay people. If the evidence / findings could not be presented in a way the latter could understand then just maybe it isn’t evidence? Just a thought. Is it likely to happen? If the political will exists, yes. Does it ? Or maybe more pertinently, could it be influenced and changed in this way? Let’s not be silly…….
And finally: ‘The optimist proclaims that we live in the best of all possible worlds; and the pessimist fears this is true.’ ( James Branch Cabell )
Thanks
I fear that your logic is watertight. The fundamental problem is money: it creeps everywhere, and cannot be excluded – rather like helium. Originally a medium of exchange, it quickly became away of exerting power. To my way of thinking, asking relatively low-paid civil servants (or others) to regulate the activities of corporations with billions to spend is rather like trying to control a fusion reaction with stone or metal walls. All that happens is that your stone or metal vaporises rather quickly. What we need is something that plays the part of a magnetic bottle – but I cannot imagine what that might be in the world of money.
An obvious suggestion might be to impose a levy on industry and give the money to dispassionate, objective researchers. But who would control and manage them? If there are people in positions of command – which there always must be – corruption can and will happen.
At least you and others like Dr Spence are doing what you can to publicise the situation. Light is a great sterilising agent, so maybe at least you can make the populace more sceptical.
There is much I can add to this topic so will drip-feed my comments to avoid being boring (if this is possible). To get back to my quadruple by-pass of September 1990. The first few heart attacks were misdiagnosed as indigestion showing that medicine is more of an art than a science. My late wife, daughter, and granddaughter, were each initially misdiagnosed for their symptoms but they are now dead. When, eventually, it was discovered that the four main arteries to my heart were almost blocked at the point of entry to the heart (this was after being a vegetarian for 18 years) I was informed that I was counting the hours! Two weeks later, even though there was an 18 month waiting list for surgery, I was under the knife. At the time the medical profession knew (from Dr Hans Nieper) that there was a natural substance, Serrapeptase (generic name), that could dissolve plaque yet this information was not made known to me.
Post operatively I was exceedingly ill for five years during which time I felt that I was not about to last each day; I slept throughout each day and slept at night. I suffered too from neurological problems which were dismissed by my GP as not being post-operative. He was about to refer me to another ‘specialist’ but after the experience of cardiac surgery I was scared to get caught on the fly-paper of the NHS for another problem.
One day (prior to the Internet) I decided to learn more about the medication which I was being administered when I became alarmed at the list of side-effects. This led me to study more on pharmaceuticals which prompted me to stop taking the medication when many of my symptoms dispersed. I read of a substance called Selegiline which, initially, I obtained from other countries and this cured the severe neurological symptoms. In addition, I also took the nutrient CO-Q10 at 100 mg daily (the recommended dosage at the time was between 10-30 mg) and remarkably within minutes my energy was restored when I was back (after five long years) to my normal self. The problem, thereafter, was battling with GPs (plural, as I moved home address) to justify the requirement for Selegiline.
The study of pharmaceuticals (and the personal testing of them) became a hobby of mine which subsequently progressed through different stages to natural products and dietetics and, today, at 83 I continue feel that I have a future.
To cap what has been said, has anyone ever heard of a waiting-list for Hospices?
Robert, I am fascinated by your story. I, too, have just stopped taking statins and started CoQ10. Tell me a bit about the supplements you take now. To hear an 83 year old feel that he or she has a future is quite motivational. So do you continue to believe that Serrapeptase can reverse plaque build up? What is your daily diet and supplement intake?
Thanks,
Counter-culture is gathering momentum.
A small but growing minority of patients and consumers are questioning the merit in the low fat / high carbohydrate dietary paradigm, and with sound evidence and reason that favours their logic. Counter culture seems to have gathered pace within the last decade in which some well-informed authors have published some excellent books:
* Gary Taubes; The Diet Delusion (2007) alt title Good Calories; Bad Calories (2007)
* Barry Groves; Trick and Treat (2008)
* Ben Goldacre; Bad Science (2009) & Bad Pharma (2012)
* Anthony Colpo; The Great Cholesterol Con (2008)
* Malcolm Kendrick; The Great Cholesterol Con (2006)
There are of course many more.
Eating fat is not only safe (does not raise cholesterol, and in any case cholesterol is not atherogenic, so saturated fats do not induce heart disease) and rather counter intuitively saturated fat in the diet doesn’t lead to a ‘spikey’ rise in blood sugar (glucose) or insulin after a meal.
Since glucose and insulin are co factors in the business of synthesising fatty acids for deposition ass body-fat it is actually carbohydrates in the diet raise prospects of weight gain. Dietary fats, the kind we have all been advised not to eat in the post (Dr Ancel) Keys era can be included in the diet to good effect to prevent the cofactors of glucose and insulin from becoming too liberally available in the body and encouraging weight gain. Being overweight is a very obvious indication a person has eaten too little fat not too much.
It is only right counter-culture should challenge dogma in these affairs.
Yet it is an odd thing I believe I am witnessing.
In the same period counter-culture is gathering momentum and gravitas, and more people understand and can see the expediency in leaving the low-fat / high-carb dietary paradigm behind industry is ramping up its anti-fat message and applying it to new spheres. Insulin, glucose intolerance, insulin resistance, homocysteine, and even amyloid plaques or amyloids have been identified as physiological ‘departures from the norm’ that associate with diabetes (type-2) and Alzheimers, and yet certain parties in academia seem at pains to taint the image of dietary fat in relation to these in the very face of the evidence and in a way that would have public consensus continue to see fat as the dietary villain it is easily perceived to be but is not.
Homocysteine is coming of age at the cutting edge of cognitive advances. Although a new book to be published on 18 Jan 2014 is targeting medically qualified people I think more lay people should have contact with it. While the books I listed above are excellent critiques of dogma the understanding of homocysteine emergent in the last decade actually lends credence to alternative, better, and more inclusive theories as to why chronic diseases proliferate as they do. So I highly recommend people place an advance order for this:
* Ed. Dr Kilmer McCully Homocysteine: Biosynthesis and Health Implications (18 Jan 2014)
Dr Ancel Keys set a [precedent. As part of that precedent he exemplified badly expedited science could trend to outright fraud. Bringing errant premises to discussion is one way to mislead, but so too should inclination to withhold premises from discussion be seen as being inclined to mislead. The willingness to incriminate fat in additional diseases should be seen as trending to fraud.
People can afford, now, to think that exerting political pressure en masse, and even thinking about compiling witness statements in potential allegations of conspiracy to defraud is the righteous way to go. If we think about this the accounts of misery induced by satins that Dr Duane Graveline has amassed are just that; witness statements submitted by victims of fraud.
Add “Overdosed America” by John Abramson, MD – reading at the moment, strongly recommend. Good examples how research data can be twisted, misinterpreted and presented to medical professionals and the public.
Evidence based medicine is being used to dismiss extremely sick patients too. Try having a thyroid problem in the UK with a TSH less than 10. I don’t know where the magic number of 10 came from, but in every other developed country in the world thyroid problems are treated with a TSH substantially less than that. (If you have symptoms you can be treated with a TSH of 2.5 – allegedly.)
Not only that, but there are three main treatments for thyroid problems – levothyroxine (T4), liothyronine (T3) and natural dessicated thyroid – and only one is readily available in the UK (T4). If you don’t get well on that then you are clearly a malingerer or a liar or there is “something else wrong with you” – CFS or ME for instance. And once you have that diagnosis on your records you may as well shoot yourself.
There are thousands of people in the UK who are self-treating thyroid disease because they have no other choice. There are conspiracy theories galore amongst sufferers as to why this situation should have risen. One of the main ones is that there is little money in thyroid treatment, so pharmaceutical companies persuade doctors to keep the patients sick so that they can be treated – profitably – for all the consequences of under-treated thyroid disease. Do I believe this? I’m really not sure. I can’t come up with any logical reason for thyroid treatment to be so bad in the UK!
I have been looking at this area in more detail recently. I am not quite sure what to think, but it does seem that the medical profession is utterly inflexible in this area. I am considering measuring T3 levels and treating low levels with T3, even if TSH is normal. My concern is the dreaded GMC.
The cost of T3 to the NHS is another mystery. Over £100 for 28 pills? That is corruption on a massive scale. It can be bought in many European countries without a prescription, over the counter, for a few euros a packet. If any doctor dared to prescribe on a named patient basis it could be sourced from France for a pittance in comparison to what the NHS is charged..
Go on, dare me.
I believe there is simpler and better way, developed by my own endo in the U.S., Kenneth Blanchard, Ph.D., M.D. He has been experimenting with T3 and thyroid extract for decades, and I can personally attest to the effectiveness of his methods compared to standard T4-only therapy, which I suffered through for years.
He has found that the great majority of hypothyroids need a little T3 supplement in addition to T4, but not nearly as much as pig thyroid extract contains. He has also found that thyroid labs (particularly T3) are not very helpful in planning therapy, except that he uses TSH and free T4 to avoid gross overdosing or underdosing and to provide clues to the proper direction of dose adjustments (one reason labs don’t help much except at extremes is that they measure blood levels rather than the tissue levels that really matter; another is the large variation in optimal levels between individuals).
He will also attempt a low dose T4 trial on any person who shows signs or symptoms consistent with hypothyroidism, regardless of blood work (barring of course frank hyperthyroidism). Cheap, safe, and provides the answer. Many more innovations, too, such as seasonal dose adjustments, time-release thyroid extract compounding, evening dosing, etc. People come from all over the world to see him because of the results he achieves.
I highly recommend his latest book, which explains his methods in detail so other doctors can try them and see the results for themselves:
You will find the book amusing, e.g. his discussion of the “quadruple blind” clinical trials used to discredit T3 therapy. He is a pariah in his field–except for us patients of course. You will like him, a maverick who took the chances and did the hard work to find a better way for his patients.
I am one of those conspiracy theorists based on nothing more substantial than there can be no other plausible explanation. Myself and another Scottish woman have petitioned the Scottish Parliament about the parlous state of thyroid ‘care’ here. We have support from world class doctors, including a fabulous submission from Dr Kilmer McCulley. Something no thyroid patient needs to hear is ‘your bloods are normal’ or ‘it’s fibromyalgia’ or ‘somatoform’. I was a fit and well 39 year old when my thyroid was removed due to alleged Graves disease. After the hypothyroidism set in, so too did the Fibro diagnosis, the high cholesterol, the high blood pressure, the obesity, the baldness, the chronic pain and insomnia. All gone now that I refuse to ever ingest another levothyroxine. Natural dessicated thyroid has removed all repeat prescriptions, including Tramadol, beta-blockers, statins, Amitriptyline, Zopiclone and so on. So, £10 a month pig thyroid versus £200 a month pharma meds that kept me sick? Medicine no longer heals while pharma rule the roost and it’s not our doctors fault but they collectively can do something about this. Des Spence is a beacon of light in a long dark night.
I think I am going to get dragged into this whole thyroid thing – even if I don’t want to. (I have tried to avoid being a skeptic in too many areas, it makes it easier for me to be dismissed by the mainstream). The more I read, the more I think that the conventional treatment of thyroid disease/disorders, is bunk.
Ben Goldacre does not endorse a LCHF diet, nor does he advise people to stop taking statins. He writes about the abuses of science, and the perils missing data in the pharmaceutical industry. He is not anti-big-pharma, and does not belong in this list of “counter-culture” writers.
Signe,
By all means re-read the comment only this time discern the intended inference. Not one of my words was intent on implying Ben Goldacre belonged to counter-culture, but that he numbered amongst authors who are informing patients and consumers, through the writing of well-researched books and pertinent books, and through pointing to failings, weakness, and dogma is encouraging lay-people to question conventional wisdom. The willingness to ‘question’ over merely ‘accepting’ is the essence of counter-culture. I welcome the opportunity to clarify my intended meaning. I hadn’t realised I had been unclear.
Ben, I think, has attained some measure of influence over the political establishment, exemplified by that promptly arranged and other wise impromptu debate with science minister (Lord Drayson (?)) and chaired by Simon Mayo. I agree I have observed at times Dr Goldacre is not a big devotee of the (macro)nutrient debate, and I tend to classify Ben as having a foot in each camp; half establishment and half counter-so.
If an author thoroughly researches their chosen topic, establishes their facts, constructs a sound and justified argument, and has their perception trend ever closer to reality compared to the lazy legacy of dogma then that is not so much counter-culture as it is much needed cognitive advance. I do not regard any of the authors above as being counter-culture, instead they are beleaguered protagonists who are endeavouring to lead a change in collective belief and culture since that is all the ‘truth’ requires.
Are you a practising medical professional? If so, and even if not, the point behind the remark may have passed you by. It was to strongly recommend the latest (soon to be) published work on homocysteine. Homocysteine, it’s link with cortisol, cholestane triol, and cortisol’s feedback links with insulin, hold promise to have patho-physiology of heart disease link with the so-called multiple lifestyle risk factors for it in ways that the fat / cholesterol hypothesis cannot. If you took the hint could see the promise, or perceive it to be an exciting cognitive advance you didn’t say.
What Groves and Colpo exemplify is that a lack of under-grad or post-grad study given to a particular subject is not in itself a barrier to usurping academia and ‘experts’ upon some matter. It may even permit freedom from bias or plain fatheadedness.
There is hope for all of us, for at all times we could all make better use of the level of intelligence we have available to us. Mostly I say this for the benefit of the ‘experts’ willing to offer errant directions on just about anything.
(If you have symptoms you can be treated with a TSH of 2.5 – allegedly.)
I should have said (If you have symptoms you can be treated with a TSH of 2.5 in Sweden – allegedly.)
Diagnosis and treatment of thyroid disease is one example of doctors being forced to diagnose and treat according to what big pharma wants. Bloods tests that were not validated are used, mono (synthetic) treatment for all (no such thing as an individual when it comes to the medical profession it appears). If it were not true it would be unbelievable. The Royal College of Physicians cannot even provide any evidence to back up their statement which many doctors view as strict guidelines, despite claiming overwhelming evidence. When the likes of the RCP make wildly unsubstantiated claims then what hope for the rest of us? To patients who are suffering because of such statements they feel like victims let down badly by a system that does not treat individuals according to their needs.
We must all question what is happening in the medical profession today. GPs seem scared to do what they trained to do. It appears that they are being forced to do what they are told by big pharma and the likes of the RCP whether or not they feel they are doing the right thing by their patients. It is like so many other aspects of life today, it is all about risk management. As Edmund Burke said, “the only thing necessary for the triumph of evil is for good men to do nothing”. He also said, “no power so effectually robs the mind of all its powers of acting and reasoning as fear”.
It’s not just medical research, doc; consider “Climate Science”.
Perhaps the problem arises when science stops being a hobby for modest numbers of enthusiasts, but becomes an institutionalised career for many.
I have considered climate science. For pragmatic reasons it is an arena I do not enter. However, I find it fascinating that all of the tecnhiques used to silence criticism of the mainstream view are exactly the same as those used to silence medical ‘mavericks.’ Perhaps ‘experts’ from all fields of scientific endavour go on special training courses somewhere on how to best crush dissent. I have this vision of a massive brooding castle somewhere in the Alps, run by an evil conspiracy designed to crush the public, and control the world. Mwahahahaha! Or, maybe I am just getting paranoid.
Metaphorically I fear you’re right!
It is very hard to discuss climate change, because there are large numbers of well meaning and committed people who believe in the concept of climate change like a religion. It is very hard for them to accept that it is just another trick to transfer money from the poor to the rich.
Happy New Year to you too.
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Dr. Kendrick, as you know, I admire you very much. I think though that you discount the major breakthroughs in medicine and pharmacology that have saved so many lives. I have to agree that medicine seems more of a business than one where saving lives and doing no harm are the number one priorities. But are you of the opinion that pharmacology has no place in society at all? And what sir would you put in it’s stead when considering new drugs and their applications? You say you would start over. How would you profess to do that and how would you ensure the legitimacy of studies on drug trials? I am a bit confused and do wonder if maybe you are beginning to stand in your own way. If you could change it all…what and how would you do it? Tom Welch makes an excellent point. Money fuels the world, so how do you take that out of the equation? It is a good thing you do here. However, offer some alternatives that are do able. Make a plan and things get done. So, if you could change it all, what would you do? Believe me, you are probably doing more than your fair share, but take it a step further and tell us.
Mary, your point is very valid. Of course there have been very many breakthroughs in medicine and phamracology – although I am struggling to think of anything really major in the last few years. I think that medical research was good, but has been almost completely derailled in the last ten or twenty years. I think, in major part, because the improvements have become incrementaly smaller. When pencillin appeared, no-one needed to to a study. When pivmecillinam appeared there were already hundreds of antibiotics that it had to prove itself to be superior. So, as difference between medications have narrowed and narrowed, manipulation of studies, and data, has become the lifeblood of the pharmaceutical industry. I shall be proposed some more realistic solutions later.
Mary, what you say may be true of the not too distant past, when independent researchers were working tirelessly, seeking “cures” to help mankind. But now that most (all?) research is funded and controlled by pharmaceutical companies you surely must realise that they have not altruistic motivation.. unless it somehow helps sell their products and make profits for their shareholders? They are in business to make money.
I understand that some countries have a model whereby Lottery Corporations, Casino’s and the like, are required to give a percentage of their profits to organisations devoted to helping those affected by gambling addiction. I do not believe that the Lottery Corporation etc.. has any say as to how, or where that money is used.
Similarly, taxes raised from tobacco and alcohol sales can be used to help those affected by these products… again, outside the control of the tobacco and alcohol manufacturers.
Why not adopt a similar model with drug companies? Place a levy on profits, which is diverted into impartial research? It’s money they are spending on “research” anyway — albeit some of it coming from their advertising budget — or as grants to prestigious Universities, honoraria etc…
When the Harvard School of Nutrition is bought and paid for by General Mills cereal giants, you have to stop and ask how impartial they can be. Why is this even allowed?
Sure we can use their money, for the public good, but they should have no control as to how it is spent.
I realise that this raises the specter of “big brother” government and regulations which, it seems, is particularly distasteful to those on the USA side of the pond and I completely agree that this would not be a perfect system but at least it does provide a modicum of distance between big-pharma and research… ideally using a publicly accountable system, with checks peer-review, feedback, and critical access to all potential conflicts of interest.
As I read in your recent Who shall guards the guardian’s post Dr Kendrick (https://drmalcolmkendrick.org/2013/08/02/who-shall-guard-the-guardians/), we need to recognise that too many of these “committees” are not impartial, appointed bodies of trustworthy experts but rather a self-selected group of (in this case) pro-statinators with a vested interest in drug sales and a clear agenda… an influential agenda which has since been adopted as policy, in too many countries around the World
Somehow we need to break back out of the system where the only “experts” (or so it seems) are the ones with a vested interest… when the banks collapse, governments turn to bankers as the experts on banking! Similarly those who seem to know the most about food are the food manufacturers, Drug “experts” = drug companies etc… etc…
The proverbial fox in charge of the hen-house.
Independent thinkers are “dissenters” from the consensus, which seems to be the rule these days.
There is such a folly in relying on what pharma reps tell us. Medical school is no help with this, as the lectures are often sponsored by pharma. So, as you learn about heart disease (and they feed you lunch) you learn about how wonderful it is that we have their brand statin. It starts so early and goes on in perpetuity.
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Dr Kendrick, I know that GP practices in the UK are rewarded for the number of flu jabs they administer to patients. Are GPs incentivised for prescribing statins?
yes
I am curious as to how big this incentive is per patient.
Do GP’s get more if you use a higher dose?
Do you think this has big effect, or is it more that if you don’t put someone on statins, and they get a heart attack or stroke, there could be trouble?
A few pounds per patient, no more if higher does. Doctors are uber-conventional and once told they should do something by an ‘authority’ they do it.
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Well I have one suggestion that can be easily implemented. All published papers should make their raw data available to reviewers and critics. All of it. Let me see what you’ve got. Let me take a crack at interpreting your data. Of late, I often can’t make heads nor tails of some of the so-called studies I try to read. I’m left with more questions than answers.
Good idea. Fat chance. GSK trumpets its desire to share all its data with mankind…. but, then, doesn’t. They know the will is not there to force them to do so. So they make PR statements about how open they are being, and it works. The public, in general, do not yet care. And may never do so.
Not only should the data be published, but so should any software that was written for the project. One feature of climate research was that attempts to obtain data and software by FOI were delayed for years. At one point they were even claiming that the raw global temperature data was confidential! In the end, it was shown that the software contained a mistake that produced a spurious resulr, but like Ancel Keys and his cherry picked graph, the myth seems to live on long after the truth is exposed. This related to a graph that purported to show that global temperatures had remained constant for the last 800 years. It became known as the Hockey Stick Graph and was reproduced all over the world.
I sort of didn’t want this to become a potical arguement, nor to digress into Climate Change – Global warming etc. However, these thing inevitably do. I suppose the reason why is that the techniques used to protect sacred scientific hypotheses are the same – no matter what the field of endeavour. Firstly, ignore any criticism. Or state that ‘all the worlds experts agree’- with whatever the favoured hypotheses may be (similar to ignoring). Or state that any critic does not understand what they are talking about – because they are not experts. Then attack the motives of the critics – they are trying to make money. They are deranged cranks, they are in the pockets of….someone. Whatever you do, don’t engage them in disucssion of the facts. That gives them legitimacy. You can keep doing this for years – decades….perhaps evern centuries.
Other techniques involve – keeping the raw data secret for some reason or another. Commerically sensitive, we don’t really own it, patient sesnsitive data….blah, blah, blah.
Ignore research you don’t like. Either just ignore it, or state that it is flawed in some way or another
Create ad-hoc hypotheses to protect your main hypothesis e.g. the Earth isn’t currently heating because warm water is trapped at the bottom of the oceans. ‘But I thought warm water rises….’ Don’t be so stupid. etc. etc. etc.
Mainly you use the ‘We are powerful and knowledgable and you, minion, can just shut up.’ Argument. This is known, in the medical field, as Eminence Based Medicine.
The only solution of the prolem is ending socialism and welfare state. We have to totally cut public spending on medical science and close all government health agencies. People must know that they are totally on their own. Now people belive that wise scientists and government officials are caring after them. This is much worse and dangerous situation. In Poland we have a saying -“socialism is desperately fighting against problems not known in other systems”.
Janusz,
Where would you get your vaccines against typhoid, polio, cholera,etc under your prefered system? With no public sanitation, just how long do you think modern large urban populations could survive?
Depending on your age, you possibly suffered badly under socialism, but there is no perfect system. People simply aren’t ‘on their own’, and without government tribes and gangs would form – and fight.
What always struck me when delving into research on health, and diets especially, was the sheer quantity vs quality of studies. There are so many studies and they are almost invariably done in a very haphazard manner, self-reported, small sample size, lousy control, large dropout, etc etc. The system is designed for everyone to do a little study in order to maintain tenure with the results being essentially noise. Then someone (probably from Harvard) comes along and cherry picks all these crappy little studies into a meta-study that proves that eating red meat causes cancer and it gets front page news.
Here’s a fine stishy about blood pressure, doc.
http://www.forbes.com/sites/larryhusten/2014/01/13/minority-report-five-guideline-authors-reject-change-in-blood-pressure-goal/
What is the layman to think? Or the GP?
Reblogged this on Lorraine Cleaver and commented:
Yet more (well deserved) praise for Dr Des Spence and his BMJ article on EBM
Thanks for your reply Dr Kendrick. I’m mindful of not turning your blog in to a Thyroid tirade, even I get weary of the fight and I have no choice but to fight on.
You said you were not quite sure what to think, that the medical profession seem utterly inflexible in this. Well, when my father had a heart attack in 2012, he received great care but after a while complained to his cardiologist of the muscle pain and brain fog from the statins. His cardiologist tweaked his meds and when the reduced blood pressure meds didn’t resolve things, accepted his desire to drop the statins, albeit with a small fight. Dad was thrilled, especially as cholesterol had never been raised in the first place. He keeps well now.
When I developed the aforementioned issues, some very severe, on Levothyroxine now that I was missing my thyroid, I reported to the endocrinologist and was dismayed and confused when he calmly stated this was not thyroid related. None of the myriad new issues were entertained for a second as thyroid related. I was told to have CBT or it must be fibromyalgia. I was blamed, it was my fault for not getting well, the magic beans, I mean pills, must not be questioned. Now why are these two professions taking such opposing attitudes to their subjects? How come the doctor treating my dad is accepting of the ongoing issues his patient may have and yet the endocrinologist outright refused to entertain the possibility, even though all my symptoms were documented hypothyroid symptoms? Why was the late Dr Skinner who saved my life continually called before GMC fitness to practice meetings? Why did the RCP refuse to attend the Scottish Parliament petitions committee with a rather rude one paragraph email saying they had already discussed their stance in England several years earlier (yeah, good for you RCP but we in Scotland have a separate NHS and always have had)?
I’ll hazard a guess. We develop heart disease, diabetes and Dementia. No, the levothyroxine won’t make pharma rich but the ever more serious chronic illness treatments will.
As we wrote to the petitions committee – We note that Novo Nordisk, manufacturers of diabetic insulin, awarded their Jacobaeus Prize in 2012 to British Endocrinologist , Professor Anthony Weetman. This is the same endocrinologist who declared that many hypothyroid patients are suffering from
somatoform disorder. This is medical speak for ‘it’s in their heads.’ This company work
closely with the Scottish Government and departments of health, providing diabetic
training and care widely across Scotland. “Partnership with the pharmaceutical industry
can provide access to skill sets and training that can help the successful implementation
of the diabetes action plan. These could include marketing, business planning, project
management and team working. Novo Nordisk already offers and delivers some of
these services to our customers in Scotland.” Also from this document, “ Novo Nordisk
will support more training and education for medical staff on the wards, and this could
be an area for increased partnership with the pharmaceutical industry. http://www.scotland.gov.uk/Resource/Doc/318403/0101594.pdf
I don’t mind a bit if you can’t publish this, I just felt it was important to throw some light on what is going on here in Scotland. I used the private sector and NHS, they both failed me and thousands like me.
The book, Pharmageddon by David Healy. continues this story in great detail, and is truly frightening to a layperson./
Ray
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Dear Dr Kendrick,
Although there is no doubt that medical research is woefully skewed and distorting some truly excellent studies and trials are done and I would like to point out one that was published in the British Journal of Nutrition just last week. Although small in size the design of this Crossover RCT (randomised controlled trial – the gold standard of trial designs) the results were completely clear and unequivocal, and of course confirm the clinical experience of a great many individuals and practitioners like myself. Take a look at my husband’s article about it on my blog here: http://www.rosemarycottageclinic.wordpress.com where you can also find a link to the paper itself.
Dr. Kendrick,
Thank you for your clear and powerful opinion on the hissing “loaded gun” of EBM. We at TheMedicalRoundtable.com continue in our mission to give the expert clinician a voice in the dialogue – particularly about “adding experience to the evidence.”
Our soon to be published roundtable on the EBM guidelines in the hypertension area by different societies will address some of these issues.
Please contact me should you entertain a roundtable discussion on the matter.
Tony
Oh my goodness! Amazing article dude! Thank you so much, However I
am encountering issues with your RSS. I don’t know why I am unable to subscribe to it.
Is there anyone else getting the same RSS problems?
Anyone that knows the solution will you kindly
respond? Thanx!!
Nice post. I learn something totally new and challenging on websites I stumbleupon everyday.
It’s always interesting to read content from other authors and practice something from other web sites.
Dear Doctor Kendrick,
There is such a simple solution to all this: let us destroy the concept of intellectual property. All countries should ignore all patents, all copyrights, all trademarks, all trade secrets. No Court of Law will hear any claim regarding these kind of issues.
That’s it. No more “wonderdrugs”. No more psychopathic doctors writing guidelines and lining their pockets by hijacking the law. And no more politicians screwing up peoples’ lives with “good intentions” backed up by “Science”. And no more revolving doors. Well, at least for a while.
Take a look at this: http://levine.sscnet.ucla.edu/general/intellectual/against.htm
To end corruption, we just have to be generous.
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