Has the Medical Profession Been Corrupted?

There seems to be more soul-searching in the medical profession lately. A few pieces caught my eye.

The Money Scramble Corrupts Diagnosis

First, an editorial in the British Medical Journal begins:

Who decides what constitutes a disease and what is normality? Over the centuries such decisions have been the preserve of the medical profession, aided more recently by modern medical science. But the profession has grown too close to those who profit from developing drugs for new diseases and is no longer fit to make these decisions. [1]

The idea is that researchers, doctors, and drug companies are highly motivated to expand the medical industry by inventing new “diseases” that provide new scope for drug treatment.

The recent suggestion that statins be distributed over the counter at McDonald’s restaurants is one example of such a push. The editorial cites new diagnostic categories created by drug-company affiliated scientist-doctors:

[P]rehypertension [is] a condition that along with preosteoporosis and prediabetes has the potential to transform most of the world’s adult population into patients….

Of the US guideline committee that first created the diagnostic category of prehypertension in 2003, 11 of 12 members eventually declared multiple ties to industry. [1]

These “pre-diseases” could be given a more accurate name:  “wheat and vegetable oil consumption syndrome.”

Another example of an emerging disease is sarcopenia, or muscle weakness in the elderly. The New York Times reports:

[G]eriatric specialists, in particular, are now trying to establish the age-related loss of muscles as a medical condition under the name sarcopenia, from the Greek for loss of flesh. Simply put, sarcopenia is to muscle what osteoporosis is to bone.

“In the future, sarcopenia will be known as much as osteoporosis is now,” said Dr. Bruno Vellas, president of the International Association of Gerontology and Geriatrics. [2]

FuturePundit comments: “[B]y all means, label every change we experience while aging as a vile disease. How about hair graying and hair loss? Surely diseases…. Don’t feel as flexible as you used to? That’s a disease. Don’t have the energy of a 17 year old? Disease, horrible malady. Needs a cure. Finding yourself needing reading glasses in your early 40s? Don’t kid yourself. That’s a disease. Demand a cure. Stem cells, gene therapy, nano repair bots, whatever it takes.”

Has the Medical Industry Become Parasitic Upon Its Patients?

Somehow or other, we have developed a government-industry-medical complex that extracts tremendous amounts of money from taxpayers and patients, but damages health. Subsidies for wheat and soybeans and corn make toxic foods cheap; junk science like the “lipid hypothesis” promotes their consumption; elite doctors appointed supreme authorities by government bureaucrats declare biomarkers of wheat, corn, and soybean oil consumption to be diseases requiring drug treatment; the drug industry sells tens of billions of dollars of drugs to the afflicted persons.

Qui bono? Elites do well – elite doctors on the review and funding panels, bureaucrats, politicians, and pharmaceutical companies. Public health suffers.

Bureaucratization of Medicine

Bruce Charlton, the former editor of Medical Hypotheses, argues that medical research has been failing at its mission of making health improving advances in knowledge:

When people are asked about the success of modernity, they usually refer first to medicine….

I have even heard the whole thing boiled down to immunization and antibiotics, or to ‘anaesthesia’ – the existence of which are said to justify modernity against history; as in ‘how would you like to live in a world without ‘*’….

I have previously written about the failure of medical progress from the mid-twentieth century, and that for half a century we have been living through a medical research bubble –

http://qjmed.oxfordjournals.org/cgi/content/full/98/1/53

Yet the failure of medical research, defined as above, is stark: in broad terms we have not discovered any new classes either of antibiotics or pain killers for many decades. [3]

Medical research is very focused on incremental progress in an established research paradigm. Since many established research paradigms are mis-conceived – are cul-de-sacs that lead nowhere – incremental progress down these blind alleys translates into “no progress.”

When stuck in a cul-de-sac, one should reverse course and try some new direction. But medicine is increasingly unable to do this, Dr. Charlton says, due to the bureaucratization of medicine, and consequent stifling of independent creative research:

The reason we have failed to sustain medical progress are doubtless manyfold, but in essence I think it is because modernity has chosen bureaucratic expansion above creative individual discovery.

http://medicalhypotheses.blogspot.com/2010/04/cancer-of-bureaucracy.html

We prefer process over results – consequently we have a truly massive and expanding medical research process with zero or negative results. [3]

Nothing stifles creativity like a monopoly. Concentration of decision-making power in a few hands gives those hands an overwhelming incentive to obstruct change: for innovation could undermine the established social structure and deprive the decision-makers of power, income, wealth, and status. There is no surer way to achieve stagnation than a centralization of funding and decision authority.

As power has spread from individual doctors and researchers to distant bureaucracies, the medical profession has been demoralized:

As I look around medicine it is my impression that doctors know less, can do less, have less spirit, less sense of vocation (or none at all), are less able, make fewer breakthroughs, suffer greater losses of knowledge, have poorer judgment, do worse science, are less honest and have more wrong ideas than they did a generation ago. [3]

Conclusion

I have previously argued that we need a democratization of biomedical funding. Each taxpayer should be able to donate, say, $300 to the research of his or her choice. Projects seeking funding should be displayed on a public web site. This would force scientists to serve real people with real (or anticipated) health problems. This would create competition for public trust, and reward creative approaches to successful healing. No longer would the “old boy network” or peer-review clique control everything; a researcher would need only “1000 true fans”.

Doctors need more freedom to follow their clinical judgment. Let patients, not juries or medical boards, review doctors’ competence. Fear of loss of career and income – of sanctions from juries or medical boards – prevents doctors from prescribing unconventional treatments and engaging with their patients in the cooperative clinical experimentation that in the past led to so many breakthroughs.

Dispersal of power would have major benefits: increases in conversation, and of knowledge. Needing to find true fans, scientists would engage the public in conversation. Provided with funding power, fans would be motivated to learn how to use that power.

The medical profession is suffering from institutional centralization and stifling of individuals by elite authorities.  It needs a healthy dose of creative destruction.

References

[1] Fiona Godlee, “Are we at risk of being at risk?” BMJ 2010; 341:c4766. http://www.bmj.com/content/341/bmj.c4766.full.

[2] Andrew Pollack, “Doctors Seek Way to Treat Muscle Loss,” New York Times, August 30, 2010, http://www.nytimes.com/2010/08/31/health/research/31muscle.html.

[3] Bruce Charlton, “The decline of medicine refutes modernity,” http://charltonteaching.blogspot.com/2010/09/decline-of-medicine-refutes-modernity.html.

Leave a comment ?

16 Comments.

  1. Paul, I couldn’t agree more that the way we fund medical (and almost all scientific) research needs to be changed, but you are giving way too much credit to taxpayers if you think we’ll be able to make informed decisions. If your model were to go into effect, every cockamamie nutcase would be lobbying for us to fund their causes.

  2. Hi erp,

    Sure, a lot of con artists would get funded. But a lot of higher-class con artists get funded now …

    I wouldn’t mind something like the current model, where to be funded you have to be affiliated with a research institution that meets government standards. The government could even vet individual researchers, and provide peer reviews of funding proposals. The main thing would be to get some kind of competition for money going. Researchers could always pool their funds and work cooperatively to get enough together.

    I think we’d have lots of private reviewers making recommendations also – something useful for the American Heart Association to do. Most people would either fund researchers they know, or would fund the five-star researchers in fields where they or their family have disease. I think it would work out fine.

    The key would be preventing fraud — e.g. kickbacks to donors, or false-front researchers, that kind of thing.

  3. It’s wonderful that you’re so optimistic. My husband saw his oncologist, a young guy with a young family, today and he’s also optimistic. BTW – he got an excellent report and we’re celebrating.

  4. erp, fantastic! Congrats to your husband! Did he do it without the boiled cabbage leaf lasagna?

  5. I fear the mere notion of cabbage leaf lasagna would be enough to send him into cardiac arrest, but thanks for the laugh.

  6. I love to see others write aticles like this. We understand this all too well. We watched our child come out of autism three weeks into a grain-free diet (it turned out I had Celiacs too). Most folks in the medical community here have a look of horror when they find out we’re not feeding our child poptarts and boxed macaroni & cheese. The media has done a good job convincing everyone that “diets don’t work for autism”. I have a forty year old brother with autism as well. I know his life will be the fate of most of these children and my heart just breaks. It’s like the medical community has turned their backs on them. I really think so many could be better with the right diet. But special diet don’t pay for re-elections or make anyone rich.

  7. I like your generally skeptical outlook here, but I think you go too far in your criticism of creeping disease-ification. You seem to have embraced the idea that we should ignore damage and decay to the human body if it is somehow “natural” — i.e., major muscle loss in the aging and elderly. But this is silly. Human suffering, decreased quality of life, and death are problems whenever they occur. Now, maybe the “disease” model isn’t always the best way to think about these questions. But I can’t imagine why we would want to carve out certain forms of decay and suffering as parts of the human experience to tolerate rather than try to avoid — with whatever imperfect means we can.

  8. Hi Christopher – On the contrary, I don’t accept decay to the body at all. I believe everyone can and should become a healthy centenarian, and one object of this blog is to help people achieve that.

    I just don’t believe that drugs are helpful. And the “disease” model is designed to enable drug treatment, not actual repair of the health problem.

    I think we’re agreed on the goal though.

  9. Perfect Health Diet » The Philosophy of this Blog, With A Parable - pingback on September 14, 2010 at 10:19 am
  10. Sort of being cynical huh, but I couldn’t agree more. The government needs to take a more active role in research and development.

  11. Thanks for these references and summary of the problem. Very helpful!

    However, I can’t say I agree with your conclusion. You said “Nothing stifles creativity like a monopoly” but your solution does nothing to eliminate the monopoly. You say “Dispersal of power would have major benefits” but you don’t recommend anything to disperse the power.

    Government involvement is the problem, government uninvolvement is the solution. Pseudo-democratization of the medical field is not what we need. What we need is a free market free of government interference. You don’t need to create a government sanctioned and funded “public trust” because the “public” already has their own trust. We will spend our money on what works, and in a free market (which we do not currently have) the medical business that works (heals people) would earn money, thus creating the incentive for research. Government involvement, in any form, including your suggestion, only hinders that.

    We have already shown that the essence of democracy is to be found neither in the electoral system, nor in the discussions and resolutions of national councils, nor in any sort of committee appointed by these councils. These are merely the technical tools of political democracy. Its real function is to make peace. Democratic institutions make the will of the people effective in political matters, by ensuring that its rulers and administrators are elected by the people’s votes. Thus are eliminated those dangers to peaceful social development which might result from any clash between the will of the rulers and public opinion. Civil war is averted through the operation of institutions which facilitate a peaceful change of the government. In the economic order based on private ownership in the means of production no special institutions, such as political democracy has created for itself, are needed to achieve corresponding success. Free competition does all that is needed. All production must bend to the consumers’ will. From the moment it fails to conform to the consumers’ demands it becomes unprofitable. Thus free competition compels the obedience of the producer to the consumer’s will and also, in case of need, the transfer of the means of production from the hands of those unwilling or unable to achieve what the consumer demands in to the hands of those better able to direct production. The lord of production is the consumer. From this point of view the capitalist society is a democracy in which every penny represents a ballot paper. It is a democracy with an imperative and immediately revocable mandate to its deputies.

    -Mises
    http://mises.org/books/socialism/part4_ch31.aspx

  12. Systemic Problems with the American Medical Association | Contrast - pingback on February 10, 2014 at 1:09 pm
  13. Dear Paul,
    As a mother of three children, we have been scrutinizing the immunization dilemma….to vaccinate or not, and if so, which ones. Having done some delving into this controversial subject online, as well as use alternate scheduling based upon Dr. Sears book, I’m remain conflicted. Do you address this subject or can you offer credible sources to assist me. I’m really on the fence with our overdue booster shots for our teens and whether to continue vaccinating our now four year old. Thank you.
    Lisa

    • Dr. Thomas Levy, MD shows in his book on Vitamin C that every infection that we vaccinate against has been effectively cured with IV Vitamin C. He also discusses the benefits of Vitamin C in protecting against vaccination side effects if you do choose to vaccinate:

      http://www.amazon.com/Curing-Incurable-Vitamin-Infectious-Diseases/dp/0977952029/ref=sr_1_1?ie=UTF8&qid=1404747705&sr=8-1&keywords=vitamin+c+levy

      It should also be noted that the last three diseases addressed—diphtheria, pertussis, and tetanus—are the same three diseases targeted by the DPT (diphtheria-pertussis-tetanus) vaccinations routinely administered to infants in the United States and across the world. Many individual reports of adverse reactions to this vaccine have been reported, including encephalopathy with permanent brain damage and sometimes autism. Vaccinations also generally present some degree of toxin insult to the body. Kalokerinos (1981) observed that vitamin C-deficient Aboriginal infants were often pushed into an acute state of scurvy because of the additional vitamin C demands placed on their bodies by the vaccination injections, resulting in sudden death. Kalokerinos was also able to determine that regular administrations of vitamin C would prevent sudden death and eliminate many of the toxic effects associated with vaccination. The work of Kalokerinos argues strongly that sudden infant death syndrome (SIDS) is often a complication of too many vaccinations given over too short a time and injected into bodies that are just too small to cope with the cumulative toxic insult. However, regardless of the actual frequency of such vaccination complications, it is important to keep in mind that the proper use of vitamin C would probably completely prevent any need (perceived or otherwise) to vaccinate against these diseases at all. It is doubtful that there are any diseases for which vaccinations are presently administered that will not be easily prevented and/or cured by the optimal dosing of vitamin C. No negative outcomes following a vaccination will ever occur if no vaccination is ever given. However, if you must receive a vaccination, the toxicity is greatly lessened and the desired immune response definitely enhanced by giving generous doses of vitamin C before and after the vaccination.

      Levy MD JD, Thomas E. (2011-08-31). Vitamin C, Infectious Diseases, and Toxins:Curing the Incurable (Kindle Locations 1877-1890). Xlibris. Kindle Edition.

    • Hi Lisa,

      I generally support vaccination. I think at the margin you can wonder about whether it makes sense to delay vaccinations or avoid them in specific diseases for specific individual circumstances, but for most kids and most diseases, getting the vaccine has a huge payoff. It also benefits others through herd immunity.

      Best, Paul

Leave a Comment


NOTE - You can use these HTML tags and attributes:
<a href="" title=""> <abbr title=""> <acronym title=""> <b> <blockquote cite=""> <cite> <code> <del datetime=""> <em> <i> <q cite=""> <strike> <strong>

Notify me of followup comments via e-mail. You can also subscribe without commenting.

Trackbacks and Pingbacks: