Western medicine is known for being effective, even amongst practitioners of alternative medicine. However we may all be confusing what are obviously powerful and immediate effects on symptoms and signs with meaningful clinical efficacy.
If you or someone you know has any chronic disease managed by pharmaceuticals, the drugs are most likely not doing much to benefit or they are actively causing harm and setting the stage for further problems down the road. This sounds far-fetched, even like quackery, but all the data this assertion is based on is found in mainstream medical science.
Only a small percentage of western medicine is actually based on high quality evidence, the vaunted randomized controlled trials – it’s just too difficult to run huge trials to prove every theory.
The Cochrane Review concluded after an exhaustive study of published medical research that only about 10% is based on high quality evidence and another 37%
on moderate quality evidence, meaning just over 50% of modern medical practice is based on low or very low quality evidence (2).
The most common “treatable” chronic diseases are cancer, heart disease, diabetes, stroke, hypertension and mental illness. There are supposedly effective treatments for all of these, but “effective” doesn’t mean what you think.
The most extreme example is the management of type 2 diabetes with insulin.
Insulin is great at changing a number you see on a blood sugar meter, but It has never been proven that insulin treatment prevents death, heart attack, stroke or kidney failure. It is thought to prevent limb amputation in just 0.4% of patients over 5 years.
On the other hand there are many studies suggesting manifest harm from increasing insulin use. Weight gain is nearly universal and that itself leads to an increased risk of heart disease and stroke.
Insulin may also trigger cancer growth and hypoglycemic episodes are a major cause of hospitalizations, which will likely affect 100% of treated patients over a 30 year time span, in some cases many times.
It’s Not All Bad, Just Mostly
Most western medications are not that ineffective of course. At the other end of the spectrum some are very effective especially anti-infective agents for specific conditions like head lice where nearly everyone treated with permethrin is cured after 2 weeks. However most medications lie between these two extremes and are usually much closer to the negative insulin extreme than to positive permethrin one.
The overall efficacy can be distilled into the “number needed to treat” and the risks into the “number needed to harm”, although given systemic biases in research, the efficacy is universally overrated and harms are always underplayed (more on that later).
Please Pass The Butter
For example, in patients with high cholesterol without preexisting heart disease, no matter how many people you treat, no lives are saved. 104 need treatment to prevent 1 heart attack, 154 to prevent 1 stroke. On the other hand 1 in 50 will develop diabetes (itself a risk factor for heart attack and stroke) and 1 in 10 will develop muscle damage. Another way of looking at these numbers is that 98% of all patients see no benefit, and less than 1% of patients avoid a heart attack or stroke, while 2% develop diabetes.
The numbers for statins are somewhat better if you already have heart disease: 83 treated to save 1 life, 39 to prevent one non-fatal heart attack and 125 to prevent 1 stroke, but still you can clearly see that your chances of being that one person that benefits are quite low, in fact less than 5% overall.
It’s Not All About The Pressure
In hypertension you need to treat 125 people to prevent 1 death (0.8% chance of benefit), 100 to prevent 1 heart attack (1%) and 67 to prevent one stroke (1.5%), while 1 in 10 will experience an adverse effect.
Cutting Edge Cancer Chemicals
What about cancer drugs? Cytotoxic chemotherapy represents some of the most expensive modern drug therapy available, yet it’s average contribution towards 5 year survival rates across all adult cancers in the US has been estimated to be but 2.1%.
Admittedly there are some exceptionally treatable cancers such as teratoma of the testis and some types of lymphoma, at certain stages, where chemotherapy can contribute up to 80% towards 5 year survival, but these are rare and affect very few people. For the majority of patients chemotherapy extends survival by no more than days to weeks at the cost of significantly decreased quality of life due to severe side effects.
A Depressing Truth
Antidepressants: A “significant” but unnoticeable effect is found in 1 out of 9 patients given an antidepressant. There is no real world difference from placebo, based on meta-analyses done by psychologist Irving Kirsch on both published and unpublished trial data submitted to the FDA and explained in his 2009 book “The Emperor’s New Drugs”.
The “benefit” is statistically significant, but clinically identical to placebo, with differences in patient depression scores of around 2% on the Hamilton rating scale, which are too small for patients or physicians to even notice, and even that minor difference is likely due to bias as both patients and physician evaluators are usually able to figure out who is getting the placebo and who is getting the active drug in the clinical trials, based on side effects.
Trials run with placebos that had side effects similar to the antidepressants showed no discernible difference at all between drug and placebo responses. Unsurprisingly such trials fell out of favor rapidly.
Regarding the harms of antidepressants, Peter Gotsche, founder of the famous Cochrane Collaboration, estimated that antidepressants kill 2% of elderly patients a year.
Antidepressants used for anxiety show similar lack of efficacy and harm. While benzodiazepines used for anxiety are addictive and in the same article are estimated by Gotsche to klll 1% of elderly patients a year.
Acute Diseases Are Not The Exception
Even treatment for acute issues is highly ineffective. Take antibiotics for acute sinus infections: 6% chance of benefit, 12.5% chance of harm, in a condition that almost universally will resolve on its own without treatment. There are similarly dismal numbers or worse in all upper respiratory infections including bronchitis, sore throat, and ear infections.
Meanwhile due to indiscriminate use of antibiotics we are wreaking havoc on our healthy bacteria. Evidence suggests that the normal diversity of healthy colonic bacteria does not recover after each course of antibiotics.
Probiotics, while beneficial in their own way, do not replace what we lose and only remain in our gut for a couple of weeks. They usual represent at best a dozen species, while our bodies depend on thousands of varieties for their health promoting properties.
Specific alterations in gut bacterial populations, like probiotic fingerprints, have been implicated in conditions like inflammatory bowel disease, various autoimmune conditions, obesity, depression, diabetes, Alzheimer’s dementia, Parkinson’s disease, etc.
We don’t yet know which way the causality runs, but it stands to reason that in these admittedly multifactorial diseases, one of many factors is likely antibiotic use, knocking out specific protective bacteria that help prevent these diseases.
Martin Blaser is the Director of the NYU Human Microbiome Program, former Chair of the Department of Medicine, Professor of Microbiology at New York University School of Medicine and author of the book “Missing Microbes”. He writes “(o)veruse of antibiotics could be fueling the dramatic increase in conditions such as obesity, type 1 diabetes, inflammatory bowel disease, allergies and asthma, which have more than doubled in many populations.”
It’s a Pain
What about over-the-counter medications for minor aches, pains, headaches, etc? Studies of Tylenol show it isn’t much better than placebo (a sugar pill) for pain and headache. NSAIDs, like ibuprofen, are somewhat effective for some types of pain, like headache, but only 1 out of 6 people find relief when taking them for back pain.
Meanwhile a 2013 study showed that people who took Tylenol had greatly increased risks of death, heart toxicity, gastrointestinal bleeding, and kidney damage. Association is not necessarily proof of causation, but importantly, people who took more Tylenol suffered more damage suggesting a typical dose response relationship.
Similarly NSAIDs injure the small intestine and harm the microbiome; in one study, 71% of NSAID users showed small intestinal damage, compared to 10% of non-users. Damaged intestines can lead to intestinal permeability, or “leaky gut.” Leaky gut has been linked to depression, ADHD, allergies, skin disorders (eczema/psoriasis/acne) and others.
Population Healthcare vs. Personal Health
These examples of common pharmaceuticals serve just to highlight a pervasive problem throughout modern medicine. Our doctors are often not treating us, but rather the population at large.
One medical study touting a remarkable 25% reduction in repeat stroke due to statins boiled down to an absolute risk reduction from 4 in 100 patients having a stroke to only 3 in 100 when given the statin, i.e. 1% of treated patients missed having a stroke. Sure it’s a 25% reduction for those 4 people, but probably not for you and especially not if you are one of the healthier members of the 100 that need to be treated for 1 to benefit.
The biased mainstream reporting and heavy marketing of medical studies such as the above could be described as criminally misleading in any other industry.
What The Science Shows
The data described above, often from the highest quality clinical studies and large meta-analyses (studies combining multiple other studies) are sobering enough on their own, but even the marginal benefits upon which many modern pharmaceuticals have gained their FDA approvals have been cast into significant doubt as of late.
In 2005 John Ioaniddis, MD, professor of Neurology at Stanford, published his seminal paper “Why Most Published Research Findings are False”, which rocked the foundations of the scientific community and formed the basis for the entire field of meta-research.
It quickly became the most downloaded technical paper from the journal PLoS Medicine and far from being controversial made Ioannidis something of a celebrity in research circles, and a highly sought after speaker at conferences, as he had formally clarified an embarrassing, publically unspoken fact that had been bothering many research scientists for decades – the lack of reproducibility of most research studies in the modern sciences.
Ioannidis, in the introduction to his paper, wrote: “There is increasing concern that most current published research findings are false … (s)imulations show that for most study designs and settings, it is more likely for a research claim to be false than true. Moreover, for many current scientific fields, claimed research findings may often be simply accurate measures of the prevailing bias.”
In a separate 2005 paper, Ioannidis went on to analyze “49 of the most highly regarded research findings in medicine over the previous 13 years”. His paper compared 45 landmark studies that claimed to have found effective interventions with subsequent studies conducted with larger sample sizes: 16% of the initial studies were later completely contradicted, 16% had effects that were significantly larger in the first study than the second confirmatory one, only 44% of studies were actually replicated, and 24% remained mostly unchallenged (neither confirmed nor denied) by any further research.
Modern Medicine or a Pill Plague?
No wonder it has been estimated that the 4th leading cause of death in the US after heart disease, cancer and medical errors, is properly prescribed prescription drugs.
In fact the harms are likely underestimated. The study from which this estimate was taken, did however, point out that often innocuous seeming, common side-effects, such as dizziness in elderly patients, may often be the initial precipitating factor in a causal chain leading to death. For example by way of frequent falls which eventually lead to fracture and hospital-acquired infection culminating finally in an untimely death.
Summing up years of experience evaluating the current state of evidence based medicine, Ioannidis wrote in 2016 in the Journal of Clinical Epidemiology, “(w)ith 20% of GDP being spent on health and health care so inefficiently, with such limited evidence or with conflicted evidence, medicine and health care can become a major threat to health and well-being.”
Correctly prescribed medications are the 4th leading cause of death in the US. Is it time to rethink our reliance on pharmaceuticals? See this article for details on how many common drugs may actually be causing more harm than good. #Wellness… Click To Tweet
The Way That Works
The good news is that rather than feeling helpless in the face of this information, we can and should feel empowered to take back our health, rather than depending on medications that are of little benefit to most who take them and at best give us a false sense of security.
Currently 60% of Americans have a chronic disease and 40% have more than two. The U.S. Centers for Disease Control and Prevention (CDC) estimates that eliminating just three risk factors: poor diet, inactivity, and smoking, would prevent 80% of all heart disease and stroke; 80% of type 2 diabetes; and 40% of all cancers.
But why stop there? Lifestyle changes can get most people all the way back to vibrant health. Despite what the medical establishment would have you believe, the mystery isn’t really why we’re sick, but why our bodies naturally heal when you remove what is preventing heath from happening. Health is our birthright, we just have to reclaim it.
In part 2 I’ll tell you about Real Medicine.