• Modern Medicine: Two Steps Forward, Three Steps Back

    Posted June 28, 2014: by Bill Sardi

    Modern medicine appears to have not only reached a point of diminishing returns, when new medicines don’t beat the old, but a point in time when the overmedicalization of the population produces deleterious rather than additive results, when medicines and vaccines backfire and cause more disease than they prevent, when numbers like cholesterol and blood pressure are medicinally controlled but mortality rates don’t decline and patients are only exposed to side effects with no real health benefits.

    Much of this problem appears to stem from profiteering off therapies that treat but don’t cure, medicines that treat one disease but cause another, approved medicines based upon large population studies that do not apply to individuals and mortality reduction based upon estimated deaths rather than real body counts.  For example, statin drugs have never been shown to significantly reduce the risk for mortal heart attacks and only marginally reduce risk for non-mortal heart attacks. [LewRockwell.com]

    Reduce inflammation, raise the blood pressure

    A report published in the Journal of Cardiovascular Pharmacology & Therapeutics points a finger at the FDA for approving anti-inflammatory drugs like Meridia, Vioxx and Bextra that raise blood pressure.

    Robert Blankfield MD, a clinical professor of family medicine, says “it is unwise to allow medications that predictably increase risk to be marketed without adequate safety data.”  [Medical Xpress May 27, 2014]  Yet the FDA allows this problem to continue as it is not demanding drug companies report long-term safety data. [New York Times June 29, 2013] Government regulatory agencies are playing footsy with pharmaceutical companies.  Two steps forward, three steps back.

    Insulin no longer a major advance

    Over-reliance upon drugs (virtually every disease now is treated as if it were a drug deficiency) has produced such a problem that their side effects represent a significant portion of the demand for medical care.  For example, insulin, widely hailed as a breakthrough in the management of diabetes, is now results in hospitalization for more cases of hypoglycemia (low blood sugar) than hyperglycemia (high blood sugar). [MedScape July 1, 2013] Insulin is no longer an outright medical advance.

    Maintaining average blood sugar levels too close to normal in older patients may actually result in worse outcomes.[New England Journal Medicine June2008]

    Antibiotics are not only failing, they are backfiring

    Not only is modern pharmacology reaching a stage of diminishing returns (most new drugs work no better and often worse than existing drugs – only 17 of 984 new drugs developed since 1984 are deemed a real advance or better. – Reuters June 3, 2013] but modern medicine’s first “magic bullet” – penicillin and a host of other antibiotics drugs – are now deemed ineffective due to germ resistance.  The World Health Organization has warned against a “post-antibiotic era.” [Nature April 30, 2014]  Antibiotic resistance is now considered a bigger crisis than the AIDs epidemic.  [Daily Mail UK May 1, 2014]

    The realization that the overuse of antibiotics may have helped spawn the obesity epidemic is an example of kind of backfire that became worse than the original effort to prevent disease.  [The New York Times March 8, 2014]

    Abandon aspirin?

    Aspirin, a long-time mainstay in modern medicine, is no longer considered safe or effective.  Aspirin is no longer recommended to break a fever in children with the flu.  It can kill.  [National Reye’s Syndrome Foundation] A full-size aspirin tablet can cause bleeding gastric ulcers and is estimated to kill a few thousand people annually. [FDA Safety of Aspirin] Baby-sized aspirin does not prevent heart attacks among healthy individuals.  [FDA Consumer May 2014]

    Doctors treat even though there is no cure

    Then there are the many maladies for which there is treatment but no cure, in particular age-related brain disorders like Parkinson’s and Alzheimer’s and the most feared health threat – cancer.  With no promise for a cure, patients can only experience side effects.  The first rule of the practice of medicine – “first do no harm” – is violated from the date treatment is first initiated.

    Because there is demand something be done when incurable conditions like these are diagnosed, patients with age-related memory loss are prescribed drugs like Aricept that is no better than an inactive placebo tablet. [Bloomberg.com June 24, 2004]  Cancer patients and their loved ones, desperate for a cure, are offered chemotherapy which only makes a minor contribution to cancer survival. [Clinical Oncology Dec 2004]

    If these drugs were just ineffective their palliative use might be tolerated under the rationale that patient anxiety be allayed.  But these are not just benign medications.  Aricept can cause vomiting, diarrhea, dizziness, sleeplessness, tremor, slow heartbeat.

    Survival times for cancer may be slightly prolonged with chemotherapy, but overall survival is shortened.  For example, cancer chemotherapy drugs are so toxic that any proposed gain in life expectancy may be countered by increased mortality due to drug-induced heart failure. [Annals Oncology 2010]

    Cancer chemotherapy can lead to a scenario where the oncologist disingenuously explains to the patient’s family “that the tumor shrunk in size but your father must have had a weak heart and succumbed to heart failure.” The treatment, not the disease, led to the death of the patient.

    Researchers at the University of Pittsburgh went so far as to say the etiology of many diseases may be rooted in the very drugs prescribed. The side effects of many drugs may persist long after a drug is discontinued. [Medical Hypotheses Nov 2009]

    Did the patient benefit, survive?

    Let’s examine the hypothetical case of a 65-year old African-American man recently reviewed in a medical journal.  [Journal American Board Family Medicine May-June 2010]

    He has been diagnosed with adult-onset diabetes who is a non-smoker, non-drinker with no apparent clinical or organ involvement who is fatigued and experiences frequent urination.  He is overweight, has high blood pressure, high cholesterol and blood sugar, but no involvement in his eyes, heart or kidneys that are often distressed in diabetics.

    According to guidelines this subject should be advised to take at least three medications — aspirin, a beta-blocker, and an ACE inhibitor.  Other drugs such as cholesterol-lowering statins, blood thinners like warfarin and sugar-controlling drug like metformin may also be prescribed.

    Physicians estimate the absolute risk for a heart attack for this patient over the next 10 years is 36% and that any of the above medicines might reduce that relative risk by 20%.  For example the first medication would reduce his risk by 7.2% absolute risk reduction (20% of 36% = 7.2%).  So his absolute risk for a heart attack has been reduced to 28.8%.

    The use of a second medication would reduce that 28.8% figure by another 5.8% and any third, fourth or fifth medication by 4.6%, 3.7% and 2.9% respectively.   Use of six medications would reduce this man’s absolute risk for a heart attack from 36% to 9.4%.

    So in simple language his risk for a heart attack might be reduced from 1-in-3 to 1-in-10 over a decade but he would have to take 6 pills a day.

    While all of these medications reduce his risk for a heart attack are they all needed?  The use of any three of those medications would accomplish most of the risk reduction (-66.6%).  More than 3 medications/day would not reduce his risk for a heart attack by very much. [Journal American Board Family Medicine May-June 2010]

    But will the patient even benefit from the use of the three drugs?

    First, a problem with the way physicians think here is that these medicines may be proven to reduce risk individually but there is no study showing how well they work when combined.

    Second, the patient may still drop dead the next day as these drugs may reduce the risk of a non-fatal heart attack by lowering blood pressure (ACE inhibitor), preventing clots (blood thinners) or lowering cholesterol (statins), but not sudden-death heart attacks which are often induced by electrical heart problems.

    Third, the patient is being subjected to myriads of side effects posed by the use of these drugs which is rarely considered.  Drug side effects are now responsible for nearly 5% of all hospital admissions. [American Medical News May 21, 2011]

    These drugs may induce more than mild side effects such as headache or fatigue.  For instance, the use of a beta blocker in this man may increase his risk for a blinding eye disease by 71%. [Science Daily May 28, 2014]  Beta blockers and aspirin may also increase the risk for breathing problems. [WebMD]

    Bottom line, the narrow view is that these medications are scientifically substantiated and reduce health numbers associated with increased health risks but the broader view is that it becomes more difficult to determine whether the overall health and survival of the patient has been improved.  Two steps forward and three steps back.

    Doctors like to prescribe drugs because it garners a drug consultation fee from insurance plans and they bring patients back to the office for checkups and prescription renewals.

    Final notes

    Modern medicine is worse than ineffective.  Its medicines can bite you harder than the disease they are intended to treat.

    Researchers at Hebrew University of Jerusalem note that the proportion spent on drug marketing versus research is 36% and 11% respectively, making one wonder if any drug’s hype is more powerful than its science.

    These investigators say “powerful and cheap health-promoting activities, poorly supported by industry because they are too cheap and not patented, are markedly underutilized technologies…. For the sick, the poor and the least educated, free market successes appear to pose unsolvable challenges to social justice in public health.”  An objective of the pharmaceutical companies appears to be to try to extract as much money as they possibly can from the healthcare system. [International Journal Psychiatry 2008]

    And indeed, doctors, hospitals and clinics pursue profits ahead of cures.  So much so that the US health care system ranks last among developed nations while spending $8508 on healthcare per person. [CBS News June 16, 2014] -©2014 Bill Sardi, Knowledge of Health, Inc.

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