Why Almost Everything You Hear About Medicine Is Wrong

[somone]

http://www.newsweek.com/2011/01/23/why-almost-everything-you-hear-about-medicine-is-wrong.html

January 24, 2011
Why Almost Everything You Hear About Medicine Is Wrong
by Sharon Begley

If you follow the news about health research, you risk whiplash. First garlic lowers bad cholesterol, then — after more study — it doesn’t. Hormone replacement reduces the risk of heart disease in postmenopausal women, until a huge study finds that it doesn’t (and that it raises the risk of breast cancer to boot). Eating a big breakfast cuts your total daily calories, or not — as a study released last week finds. Yet even if biomedical research can be a fickle guide, we rely on it. But what if wrong answers aren’t the exception but the rule?... Dr. John P.A. Ioannidis, has just ascended to a new, prominent platform after years of crusading against the baseless health and medical claims. As the new chief of Stanford University’s Prevention Research Center, Ioannidis is cementing his role as one of medicine’s top mythbusters. “People are being hurt and even dying” because of false medical claims, he says: not quackery, but errors in medical research. This is Ioannidis’s moment. As medical costs hamper the economy and impede deficit-reduction efforts, policymakers and businesses are desperate to cut them without sacrificing sick people. One no-brainer solution is to use and pay for only treatments that work. But if Ioannidis is right, most biomedical studies are wrong.

In just the last two months, two pillars of preventive medicine fell. A major study concluded there’s no good evidence that statins (drugs like Lipitor and Crestor) help people with no history of heart disease. The study, by the Cochrane Collaboration, a global consortium of biomedical experts, was based on an evaluation of 14 individual trials with 34,272 patients. Cost of statins: more than $20 billion per year, of which half may be unnecessary. (Pfizer, which makes Lipitor, responds in part that “managing cardiovascular disease risk factors is complicated”). In November a panel of the Institute of Medicine concluded that having a blood test for vitamin D is pointless: almost everyone has enough D for bone health (20 nanograms per milliliter) without taking supplements or calcium pills. Cost of vitamin D: $425 million per year... “Positive” drug trials, which find that a treatment is effective, and “negative” trials, in which a drug fails, take the same amount of time to conduct. “But negative trials took an extra two to four years to be published,” he noticed. “Negative results sit in a file drawer, or the trial keeps going in hopes the results turn positive.” With billions of dollars on the line, companies are loath to declare a new drug ineffective. As a result of the lag in publishing negative studies, patients receive a treatment that is actually ineffective. That made Ioannidis wonder, how many biomedical studies are wrong?

His answer, in a 2005 paper: “the majority.” From clinical trials of new drugs to cutting-edge genetics, biomedical research is riddled with incorrect findings, he argued... Even a cursory glance at medical journals shows that once heralded studies keep falling by the wayside. Two 1993 studies concluded that vitamin E prevents cardiovascular disease; that claim was overturned by more rigorous experiments, in 1996 and 2000. A 1996 study concluding that estrogen therapy reduces older women’s risk of Alzheimer’s was overturned in 2004. Numerous studies concluding that popular antidepressants work by altering brain chemistry have now been contradicted (the drugs help with mild and moderate depression, when they work at all, through a placebo effect), as has research claiming that early cancer detection (through, say, PSA tests) invariably saves lives. The list goes on...

Ioannidis’s first targets were shoddy statistics used in early genome studies. Scientists would test one or a few genes at a time for links to virtually every disease they could think of. That just about ensured they would get “hits” by chance alone... Statistical flukes also plague epidemiology, in which researchers look for links between health and the environment, including how people behave and what they eat. A study might ask whether coffee raises the risk of joint pain, or headaches, or gallbladder disease, or hundreds of other ills. “When you do thousands of tests, statistics says you’ll have some false winners,” says Ioannidis. Drug companies make a mint on such dicey statistics. By testing an approved drug for other uses, they get hits by chance, “and doctors use that as the basis to prescribe the drug for this new use. I think that’s wrong.” Even when a claim is disproved, it hangs around like a deadbeat renter you can’t evict. Years after the claim that vitamin E prevents heart disease had been overturned, half the scientific papers mentioning it cast it as true, Ioannidis found in 2007...

[Taverner]

1. Baby meet bathwater?

[Zoeisright]

2. Science doesn't proceed in a straight line.

Any experiment, no matter how rigorously controlled, is going to have flaws.

Medicine's naysayers, however, cannot deny the fact that with the birth of modern medicine in the 20th century, our lifespans increased from about 45 in 1900 to 78 in 2000. Modern medicine is responsible for most of that increase.

Throwing the baby out with the bathwater indeed.

[bemildred]

3. There is far too much use of dubious statistical studies.

The results of which are thrown around like religious dogma. And money is much too influential. And there is an overfondness for drugs as bandaids for lifestyle and dietary problems.

OTOH, modern acute care is awesome, and treatment and prevention of many diseases is too, and modern psychiatric care - for all its defects - beats the heck out of nothing.

[saras]

4. One word answer - money

[laconicsax]

5. The problem couldn't possibly be related to the bad joke that passes for science journalism.

[xchrom]

6. excellent. nt