In her latest Newsweek column, science writer Sharon Begley focuses on the work of Dr. John Ioannides, the Greek physician and researcher who has spent the last decade or so challenging the credibility of medical research.
Recently appointed chief of Stanford University’s Prevention Research Center, Ioannides is, as Begley aptly calls him, “one of medicine’s top mythbusters.”
Last fall, I sent Second Opinion readers to a profile of Ioannides that ran in the Atlantic. But I feel his work — and its message to us ordinary folk who are trying to figure out how to stay healthy from the tsunami of research findings that swamp us daily — is so important that I’m revisiting it today.
Here’s Begley explanation of the significance of Ioannides’ findings:
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? More and more scholars who scrutinize health research are now making that claim. It isn’t just an individual study here and there that’s flawed, they charge. Instead, the very framework of medical investigation may be off-kilter, leading time and again to findings that are at best unproved and at worst dangerously wrong. The result is a system that leads patients and physicians astray — spurring often costly regimens that won’t help and may even harm you.
Here are a couple more examples from Begley of just how wrong (and costly) those studies can be:
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.
(There was a media report that the publication of this particular column by Begley was delayed more than a month because of that reference to Lipitor, a product that had bought ad space in the financially struggling magazine. Two editors at Newsweek — which recently merged with the online publication The Daily Beast — denied that they held back the column to placate Pfizer.)
As Begley also points out, “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.”
Ioannidis proposes several solutions, most notably tightening the “shoddy statistics” used in studies. Some researchers, such as geneticists, have begun to mend their ways, Ioannidis told Begley, but others — those investigating surgical practices, for example — have barely begun to acknowledge the problem.
“I wouldn’t be surprised if a large proportion of surgical practice is based on thin air, and [claims for effectiveness] would evaporate if we studied them closely,” Ioannidis told Begley.
“Of course,” adds Begley, “not all conventional health wisdom is wrong. Smoking kills, being morbidly obese or severely underweight makes you more likely to die before your time, processed meat raises the risk of some cancers, and controlling blood pressure reduces the risk of stroke. The upshot for consumers: Medical wisdom that has stood the test of time — and large, randomized, controlled trials — is more likely to be right than the latest news flash about a single food or drug.”
You’ll find Begley’s column here and the earlier (and more detailed) Atlantic profile here.
I can’t help but wonder what it would do to the overall cost of medical care in our nation if we stopped enriching the pharmaceutical, medical device-manufacturers, and the highest paid physician specialists if we stopped routinely paying for these boondoggles, especially through medicare and Minnesota care.
It would probably be very useful if the efforts to “reduce the future cost of medical care” would involve the best possible information regarding many of these very expensive treatment options, but since changes of this sort would reduce the incomes of some very wealthy (and therefore, very powerful) people, such an approach will never be pursued.
No, instead, our “friends” who raise that issue as government “budget buster” will only address it by seeking to deny medical care to those most in need while continuing to protect those who need no such protection.
What was it former Rep. Grayson said about the new Republican medical plan for those who fall ill while poor being “die quickly?”
“I can’t help but wonder what it would do to the overall cost of” medical care, television, newspapers and magazines if the ads and spots for pharmaceutical drugs aimed at patients, one-half of which contain disclaimers and usage dangers, were prohibited.
Are patients qualified to make recommendations to physicians? Do physicians prescribe drugs requested by patients for fear of losing them as patients?
If we did not impart such a sense of divinity to medical research but rather accepted it as a changing evolving process of discovery we wouldn’t be so threatened to learn that, say, statins are a waste of money in the healthy– and probably the sick as well. Our problem is that we are fundamentally people of the book, whether it be the Bible or the PDR.
Great column. Thank you.