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On truth in science, health, and patient care

“I only believe it if research has shown it.”

“I believe research is ridiculous and not to be taken seriously.”

 

What can we actually know?

*** As a disclaimer before reading further: This blog post takes a critical look at the process of science and health science information and how these things are presented to the consumer in the dissemination of information and in clinical treatment. It is longer and dryer than my typical blog post. If you are trying to avoid something a bit technical and complex or if you want brevity, this would be a good place to stop reading.

 

One of my currently engaged patients (she is engaged in her treatment) likes to send me news articles. She heard me discussing the potential benefits of vitamin D for helping our bodies maintain strong health and immunity. She has expressed concern because she has read conflicting things about the benefits of vitamin D, especially when it comes to COVID-19.

 

One article she sent me states, vitamin D Is not an effective treatment for the corona virus. (https://scitechdaily.com/scientists-warn-against-high-doses-of-vitamin-d-supplementation-for-preventing-or-treating-covid-19/) I believe the article goes on to discuss how mega-doses of vitamin D might cause toxicity and calcium imbalance and other problems. I completely agree, and…

 

I believe the first documented case of COVID-19 came from China in November, 2019. That is why the, “-19″, is in the name. Even though most of the medical health research world is currently working on finding a solution to this global virus pandemic, there is a lot which is still not known. Effective research takes time and money and more time for scrutiny and for reproducing the same results across many studies to support the validity and accuracy of the initial research. Most research is designed simply to guide more research, until there is so much research, the scientific community begins to believe the research likely represents truth.

 

I wish the article had said, vitamin D is a vitamin and not a drug. It was never intended to treat any disease but is necessary for our health and is essential to our immune system. How effective it might be at reducing the effects of COVID-19 is not known at this time. If you want to know if you have healthy levels of vitamin D, a simple blood test can let your doctor know if your vitamin D levels are sufficient. If you do not know your levels, you should contact your doctor and get them checked. If you take too much, you might develop calcium problems and toxicity. If you have too little, you might become much sicker and more vulnerable if you become ill. You might even become ill more easily. Work with your doctor on this. If your skin is darker, you might need more vitamin D because darker skin produces D more slowly. If you are a larger person, you might need more. If you tend to not go out in the sun much, even in the Summer, you might need more. If you do not eat many vitamin D containing foods, you might need more. There are just so many factors to consider. This is why you should collaborate with your medical doctor on this and use established laboratory tests to know the truth about what is going on in your body rather than guess. The journalist who wrote that article and the journalists who have written many articles like the one mentioned above use dismissive and fear producing language. It would have been nice if they presented more in-depth information instead.

 

Something to consider. Would you spend hundreds of thousands of dollars to research a cancer treatment that costs $2? How would you make all that money back? I have been told the doctors least likely to have their bill questioned are oncologists. Cancer doctors. Italian oncologist, Dr. Tullio Simoncini proposed years ago he had some evidence cancer is a fungus. He argued this fungus lives in an acidic environment and enters our cells undetected and sets up shop, multiplying and affecting the physiology of the cell. Is this true? I’m not sure. Simoncini showed his cancer patients responded well to injecting their tumors with sodium bicarbonate solution. Many of these people were given only a short life expectancy based on their diagnosis. We know sodium bicarbonate as baking soda. I can purchase a 5-pound bag of the stuff for $10-$15. Simoncini, I believe, ultimately lost his license to practice medicine and went to jail. As an oncologist it is common for patients to die. This is because their patients have cancer and the scientific community still does not understand cancer well. One of my patients informed me when she was diagnosed with breast cancer she asked the medical doctor, “How did this happen to me? What caused it to grow in me?” The doctor responded to her, “Oh, honey, you will have to ask the lord. The lord is the only one who knows how and why this happened.” My patient said she was stunned at the doctor’s response as she understood medicine to be a scientific endeavor. My patient was confused and mores pressing was her need to solve the problem of the cancer. She ultimately had it cut out which was the only reliable way to reduce the chances of it returning. The medical scientific community only had statistics for her on removal and not in treating it or determining the cause. When using standard medical protocols based on the best research evidence, people with cancer still die. When Simoncini treated a patient and she died, he was jailed. His treatment was not a mainstream clinical protocol. Many of his patients however are reported to have thrived much longer than traditional care might have allowed. That I know of, his theories were never funded for any serious research. Is this because if shown valid, the treatment is too inexpensive to justify the money spent for investigation? Would your doctor give a treatment they thought to be superior when the consequence of being wrong is loss of license and prison? If you were told you had three or six months to live, should it be your right to go for a long shot?

 

David Lawrence Sackett, OC FRSC (1934-2015) was considered the father (or at least a father) of Evidence Based Medicine (EBM). He even wrote a textbook on it, “Clinical Epidemiology and Evidence-Based Medicine.” This is the term behind the idea the medical world should use established research to implement clinical treatment protocols. The push to use EBM has caused many if not most doctors use established clinical protocols rather than come up with creative solutions for their individual patients (this used to be called the art of medicine). It emphasizes the science part of medicine while downplaying the art of medicine. While this is designed to remove individual bias and personality from the arena of scientific medical treatment, it does not seem to be doing what it was designed to. One of his more famous quotes is: “Half of what you learn in medical school is dead wrong.” (https://en.wikipedia.org/wiki/David_Sackett)

 

Just after Dr. Sackett’s death, Dr. John P.A. Ioannidis at Stanford university (https://profiles.stanford.edu/john-ioannidis ) wrote a medical journal article based on an ongoing conversation he was having with Dr. Sackett, “Evidence-based Medicine Has Been Hijacked: A Report to David Sackett” (J Clin Epidemiol. 2016 May;73:82-6. doi: 10.1016/j.jclinepi.2016.02.012. Epub 2016 Mar 2.) “…As EBM became more influential, it was also hijacked to serve agendas different from what it originally aimed for. Influential randomized trials are largely done by and for the benefit of the industry. Meta-analyses and guidelines have become a factory, mostly also serving vested interests. National and federal research funds are funneled almost exclusively to research with little relevance to health outcomes. We have supported the growth of principal investigators who excel primarily as managers absorbing more money. Diagnosis and prognosis research and efforts to individualize treatment have fueled recurrent spurious [false/fake] promises. Risk factor epidemiology has excelled in salami-sliced data-dredged articles with gift authorship and has become adept to dictating policy from spurious evidence. Under market pressure, clinical medicine has been transformed to finance-based medicine…”

 

So, why should any of us trust research? When it comes to healthcare, this is a particularly difficult question to answer. The United States ranks 37th of 191 countries (just under Costa Rica) for the health of our citizens (https://www.who.int/healthinfo/paper30.pdf Pgae 18). The USA ranks 34th in life expectancy, 26th in infant mortality, and spent $3.6 Trillion in healthcare in 2019, up from $2.0 Trillion in 2005 (https://www.healthcaredive.com/news/us-healthcare-spending-estimated-to-grow-to-36t-this-year/555658) The USA has the most expensive healthcare system in the world. Why?

 

I believe in the early 1980’s, healthcare represented about 2% of the national budget. It now represents about 36% of the national budget and many articles have been written out of concern Medicare alone could bankrupt the country. In a 2018 NY Times article the author wrote, “The 1980s deregulatory agenda was evident in states as well. Many abandoned health care price and capital investment controls. Managed care — in the form of health maintenance organizations — was the free-market replacement to government regulations. Investor-owned, shareholder-driven, for-profit companies became common in health care for the first time. They focused on revenue and profit maximization, not cost control.” (https://www.nytimes.com/2018/06/04/upshot/reagan-deregulation-and-americas-exceptional-rise-in-health-care-costs.html) I believe around that time in the early 80’s, then president Ronald Regan signed a bill (please correct me if I am wrong) allowing hospitals which were, until that time non-profit organizations, to be for profit.

 

When it comes to laws about healthcare, what influence does the interest of the individual consumer have? In 2015 the pharmaceutical industry spent $150 million on law-influencing lobbyists. The American Medical Association spent about $155 Million in 2015 on law-influencing lobbyists. The American Hospital Association spent $130 million on law-influencing lobbyists. The health insurance industry spent $70 million on law-influencing lobbyists (https://www.beckershospitalreview.com/finance/top-20-healthcare-lobbyists-by-spending.html). These organizations represent the interest of industry in lawmaking for the USA. Who represents the interests of the consumer? Members of the US Congress represent interests of the American consumer. Congress members have many issues to deal with. Healthcare is only one issue out of many. “When you have a high-profile issue like a health-care bill, there are five or ten lobbyists per congressperson…” (https://www.rd.com/culture/25-secrets-your-congressperson-wont-tell-you/) In comparison to industry, law-influencing lobbyists for congress and therefore for healthcare consumers… the individual, are tiny.

 

What about funding for scientific healthcare research? According to a Berkeley University article on understanding science, “Almost 75% of U.S. clinical trials in medicine are paid for by private companies.” (https://undsci.berkeley.edu/article/who_pays) This fact likely has an influence on what research is funded and for what purpose. Does this mean science is bad? I say science is good. The funding issue represents a risk of investigating predominantly issues that benefit industry. One effect of this phenomenon is the items not researched are often looked at as invalid. While this may be true some of the time, it may simply be that valid methods never received funding or support for adequate research allowing them to be labeled valid in the scientific community. This poses a big problem.

 

The scientific method itself is excellent and distilling truth. Truth is skewed when research is limited to the interests of industry or presented in a manner more conducive to a research organization receiving additional funding than elaborating details of findings which might jeopardize further funding. Often, universities, research scientists and their staff are paid, and their employment is dependent on funding for research projects which stand to benefit industry. Because of this, Dr. John P.A. Ioannidis at Stanford University came up with the discipline of Meta-Research or Evidence Based Research (https://en.wikipedia.org/wiki/John_Ioannidis). This new branch of research is designed to research the research to see if research results are reproducible when re-performing the research or if expert opinion (the lowest form of research) was used to change how the results of research are presented and implemented by the scientific and medical community.

 

Chiropractic can’t help the immune system because they have no research showing it can. Actually, this is not true. What is true is chiropractic has not been able to fund high profile research studies to show in an iron clad manner that chiropractic care can stimulate the immune system. Research does exist but it is not research of the caliber taken seriously by the evidence based medicine (EBM) community. It would be accurate to say chiropractors have some evidence and much observation that chiropractic treatment is helpful to the immune system but there has been no funding for large scale research to state this as absolute truth. Unfortunately, the media portrays the situation as chiropractic does not help the immune system. This is likely to be false but with the standard of high money research it is not a provable statement. What is a consumer to do?

 

When it comes to a strategy for healthcare people seem to either trust the word of their doctor religiously or question their doctor by seeking second opinions and even gaining alternative healthcare perspectives. While a person could live a long healthy life following their doctor’s orders, I believe questioning healthcare professionals to make care more individualized is essential. More and more doctors are asked to follow equations in acting out expected protocol for implementing treatment. Sometimes these equations turn out not to be ideal for each individual patient.

Leonard Siskin

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