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.
via this link:
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.
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.
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.
erp, fantastic! Congrats to your husband! Did he do it without the boiled cabbage leaf lasagna?
I fear the mere notion of cabbage leaf lasagna would be enough to send him into cardiac arrest, but thanks for the laugh.
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.
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.
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.
Sort of being cynical huh, but I couldn’t agree more. The government needs to take a more active role in research and development.
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.
How Medical Boards Nationalized Healthcare:
https://mises.org/daily/1749/How-Medical-Boards-Nationalized-Health-Care
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
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
Hi Paul,
I have been looking into the vaccine topic recently. I came across this article on herd immunity http://www.vaccinationcouncil.org/2012/07/05/herd-immunity-the-flawed-science-and-failures-of-mass-vaccination-suzanne-humphries-md-3/
and generally been reading articles from the same site. I’m starting to think that vaccination is not as good as I once thought.
Check out Mercola and Kelly Brogan MD for excellent, well-referenced articles on vaccines. I’ve turned my head around from knee-jerk belief in the efficacy of vaccines to almost a complete reversal.
Regardless of efficiency or security, the most important issue is ethical. Nobody should be forced to receive a medical treatment, preventive or otherwise. It is not the case that someone has authority to sacrifice the few to benefit of the many, not even if the sacrifice does not involve an actual killing.
If vaccine theory and technology is as good as the experts claim, then there is no need to enforce that technology, because in a natural fashion people will choose and demand it.
Rather, you need force to forbid a good technology that people demand and use, or to impose a bad technology that people don’t demand. Of these two things, there are too many examples in history.
Truth does not need law.
I know several people who use alternatives like nosodes in the homeopathic community. Maybe this is a valid choice….if we still can make our own choices. Recent articles concerning mandatory vaccinations for both children AND adults make it seem like I’m living in a fiction novel….this is way too important an issue to force upon everyone. We need to advocate for our rights as parents. And even for our own well being, if we are not parents.
Medical profession has been corrupted, by whom?
At this point in my life, with my current knowledge and bias, I say it was corrupted by the State. I know this is not the place to do an anarchist rant, but here it goes anyway.
There has to be separation of Science and the State. And separation of Research and the State. And separation of Industry and the State. And, therefore, separation of the Fine Art of Medicine and the State. None of those things, science, research, industry or medicine (and art in general) have been benefited from State patronage. Rather, they have been misguided, obstaculized and corrupted by it. Have you ever heard some modern music or looked at a modern sculpture? If they have been financed by the State, music sounds bad and sculpture looks horrible. The same thing happens with research, and education, and production. I realize that “privately” funded research, science, education and production can suck big time. But, who, if not the State, enforces wrong scientific findings, even those funded by biased companies? The State knows much better than to enforce things directly and openly. They like to use convoluted and devious ways to make people act in the manner they want. And all this is achieved because Governments abuse their powers, and people go along with it. You, my admired Paul Jaminet, suffered very much and almost died because of the misinformation put forth by the State. How many people have been crippled or killed by drugs approved and pushed by the States, like statins? How many kids have been born sick and disabled because of utterly wrong “dietary guidelines” and misguided medical care?
Many superintelligent guys in science are so oblivious to this con that they claim that GMO’s are the best thing ever, because it is so scientific. The art of politics consists of telling everybode what they want to hear. Science guys should leave for a while their pride and look into this stuff, just as they demand of religious guys.
It is not, in general, that the State wants to corrupt things. The problem is that, by intervening, it impedes self-correcting, evolutionary behaviours to happen, in Medicine, Science, all industries, and research. They even corrupt religions, philosophy, fine arts, history, law, families, and the most important social institution: money.
Mr Jaminet, I know it is not your cup of tea, but I must ask, have you ever read anything by Robert Higgs?
Perhaps someday I find new ideas and recant my current opinions. But I need a very good theory in order to explain everything that has happened since Napoleon’s days up to now. Best explanations I have found come from: Robert Higgs, David Friedman, Michael Huemer, von Mises. The geniuses of Physics, Chemistry, Maths and Statistics barely can explain anything regarding humanity. Rather, they are part of the problem, as their intellect has been used many times to stir up trouble, by the State.
Sorry for ranting. I didn’t wrote all this in order to make you mad. So, please, don’t let yourself be hurt by my views.
Hi Steve,
We’re on the same team. Yes, I’m familiar with Robert Higgs.
This article is very interesting for me.
Best,
Johannes