Earlier this week, I highlighted two articles that exposed the dubious history, medical ineffectiveness and potential health dangers of popular alternative “therapies.”
“When you visit a doctor, you probably assume the treatment you receive is backed by evidence from medical research,” writes Epstein. “Surely, the drug you’re prescribed or the surgery you’ll undergo wouldn’t be so common if it didn’t work, right?”
Wrong, as Epstein explains:
For all the truly wondrous developments of modern medicine — imaging technologies that enable precision surgery, routine organ transplants, care that transforms premature infants into perfectly healthy kids, and remarkable chemotherapy treatments, to name a few — it is distressingly ordinary for patients to get treatments that research has shown are ineffective or even dangerous. Sometimes doctors simply haven’t kept up with the science. Other times doctors know the state of play perfectly well but continue to deliver these treatments because it’s profitable — or even because they’re popular and patients demand them. Some procedures are implemented based on studies that did not prove whether they really worked in the first place. Others were initially supported by evidence but then were contradicted by better evidence, and yet these procedures have remained the standards of care for years, or decades.
Even if a drug you take was studied in thousands of people and shown truly to save lives, chances are it won’t do that for you. The good news is, it probably won’t harm you, either. Some of the most widely prescribed medications do little of anything meaningful, good or bad, for most people who take them.
Epstein describes the results of several recent reviews of common clinical practices that found such practices were often unnecessary, unhelpful and/or potentially harmful — “from the use of antibiotics to treat people with persistent Lyme disease symptoms (didn’t help) to the use of specialized sponges for preventing infections in patients having colorectal surgery (caused more infections).”
Many of these treatments were hailed as being “breakthroughs” when they were first approved, but were found in subsequent research to be inferior to the practices they replaced.
By then, though, the treatment had become so ubiquitous that doctors — and patients — were reluctant to accept the evidence that it didn’t work.
From specifics to broader issues
There’s so much information in Epstein’s article that it’s difficult to know what to focus on in a summary. Many readers will be interested in reading his detailed examples of specific medical practices that have been shown to be unnecessary and potentially harmful, including:
- Stent implantation surgery for patients with stable heart disease (patients not in the throes of a heart attack)
- The use of atenolol and other beta-blockers as first-line treatment for high blood pressure
- Partial surgical removal of the meniscus for knee pain
- The use of the cancer vaccine Provenge to stop the progression of advanced prostate cancer
- Deep brain stimulation as an aid to improving cognitive function in individuals with memory disorders
But Epstein uses such examples to raise broader issues, such as:
- How published studies on new therapies tend to overestimate the treatment’s benefits and underestimate its potential harms
- How difficult it is for researchers to get medical journals to publish studies that found a common and popular drug or medical treatment doesn’t work
- How treatments that give patients better “numbers” (like lower blood pressure readings) don’t necessarily result in better outcomes (preventing heart attacks or extending life)
- How — and why — it can take 10 years or longer “for large swaths of the medical community to stop referencing popular practices after their efficacy was unequivocally vanquished by science.”
The article also discusses how challenging it can be to get doctors and other medical professionals “to do the right thing when they’re paid to do the wrong thing” (as it is in other professions).
But patients have to take responsibility for unnecessary and unhelpful medical treatments, too. As Epstein explains, too many patients refuse to take their doctor’s word that they don’t need a drug they saw advertised on television or a surgical procedure a friend or relative underwent “successfully.” Instead, they shop around until they find a doctor who will give them the drug or do the procedure.
A lowering of standards
Here’s one final major point that Epstein discusses at length: The growing pressure from Congress and the Trump administration to lower the standards for determining whether a medical treatment is safe and effective. Writes Epstein:
The 21st Century Cures Act — a rare bipartisan bill, pushed by more than 1,400 lobbyists and signed into law in December — lowers evidentiary standards for new uses of drugs and for marketing and approval of some medical devices. Furthermore, last month President Donald Trump scolded the FDA for what he characterized as withholding drugs from dying patients. He promised to slash regulations “big league. … It could even be up to 80 percent” of current FDA regulations, he said. To that end, one of the president’s top candidates to head the FDA, tech investor Jim O’Neill, has openly advocated for drugs to be approved before they’re shown to work. “Let people start using them at their own risk,” O’Neill has argued.
So, while Americans can expect to see more drugs and devices sped to those who need them, they should also expect the problem of therapies based on flimsy evidence to accelerate.