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 Why Almost Everything You Hear About Medicine Is Wrong

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PostSubject: Why Almost Everything You Hear About Medicine Is Wrong   Why Almost Everything You Hear About Medicine Is Wrong EmptyTue Jan 25, 2011 8:06 am

Why Almost Everything You Hear About Medicine Is Wrong 1295644557793


Illustration by Jacob Thomas



If you follow the news about health research, you
risk whiplash. First garlic lowers bad cholesterol, then—after more
study—it doesn’t. Hormone replacement reduces the risk of heart disease
in postmenopausal women, until a huge study finds that it doesn’t (and
that it raises the risk of breast cancer to boot). Eating a big
breakfast cuts your total daily calories, or not—as a study released
last week finds. Yet even if biomedical research can be a fickle guide,
we rely on it.



But what if wrong answers aren’t the exception but
the rule? More and more scholars who scrutinize health research are now
making that claim. It isn’t just an individual study here and there
that’s flawed, they charge. Instead, the very framework of medical
investigation may be off-kilter, leading time and again to findings that
are at best unproved and at worst dangerously wrong. The result is a
system that leads patients and physicians astray—spurring often costly
regimens that won’t help and may even harm you.






Why Almost Everything You Hear About Medicine Is Wrong 1295644669032


Joe Raedle / Getty Images
Gallery: Medical Breakthroughs: The Good and the BadBreakthroughs and Breakdown



It’s a disturbing view, with huge im-plications for
doctors, policymakers, and health-conscious consumers. And one of its
foremost advocates, Dr. John P.A. Ioannidis, has just ascended to a new,
prominent platform after years of crusading against the baseless health
and medical claims. As the new chief of Stanford University’s
Prevention Research Center, Ioannidis is cementing his role as one of
medicine’s top mythbusters. “People are being hurt and even dying”
because of false medical claims, he says: not quackery, but errors in
medical research.



This is Ioannidis’s moment. As medical costs hamper
the economy and impede deficit-reduction efforts, policymakers and
businesses are desperate to cut them without sacrificing sick people.
One no-brainer solution is to use and pay for only treatments that work.
But if Ioannidis is right, most biomedical studies are wrong.




In just the last two months, two pillars of
preventive medicine fell. A major study concluded there’s no good
evidence that statins (drugs like Lipitor and Crestor) help people with
no history of heart disease. The study, by the Cochrane Collaboration, a
global consortium of biomedical experts, was based on an evaluation of
14 individual trials with 34,272 patients. Cost of statins: more than
$20 billion per year, of which half may be unnecessary. (Pfizer, which
makes Lipitor, responds in part that “managing cardiovascular disease
risk factors is complicated”). In November a panel of the Institute of
Medicine concluded that having a blood test for vitamin D is pointless:
almost everyone has enough D for bone health (20 nanograms per
milliliter) without taking supplements or calcium pills. Cost of
vitamin D: $425 million per year.








Ioannidis, 45, didn’t set out to slay medical
myths. A child prodigy (he was calculating decimals at age 3 and wrote a
book of poetry at Cool, he graduated first in his class from the
University of Athens Medical School, did a residency at Harvard, oversaw
AIDS clinical trials at the National Institutes of Health in the
mid-1990s, and chaired the department of epidemiology at Greece’s
University of Ioannina School of Medicine. But at NIH Ioannidis had an
epiphany. “Positive” drug trials, which find that a treatment is
effective, and “negative” trials, in which a drug fails, take the same
amount of time to conduct. “But negative trials took an extra two to
four years to be published,” he noticed. “Negative results sit in a file
drawer, or the trial keeps going in hopes the results turn positive.”
With billions of dollars on the line, companies are loath to declare a
new drug ineffective. As a result of the lag in publishing negative
studies, patients receive a treatment that is actually ineffective. That
made Ioannidis wonder, how many biomedical studies are wrong?


His answer, in a 2005
paper: “the majority.” From clinical trials of new drugs to cutting-edge
genetics, biomedical research is riddled with incorrect findings, he
argued. Ioannidis deployed an abstruse mathematical argument to prove
this, which some critics have questioned. “I do agree that many claims
are far more tenuous than is generally appreciated, but to ‘prove’ that
most are false, in all areas of medicine, one needs a different
statistical model and more empirical evidence than Ioannidis uses,” says
biostatistician Steven Goodman of Johns Hopkins, who worries that the
most-research-is-wrong claim “could promote an unhealthy skepticism
about medical research, which is being used to fuel anti-science
fervor.”






Even a cursory glance at medical journals shows
that once heralded studies keep falling by the wayside. Two 1993 studies
concluded that vitamin E prevents cardiovascular disease; that claim
was overturned by more rigorous experiments, in 1996 and 2000. A 1996
study concluding that estrogen therapy reduces older women’s risk of
Alzheimer’s was overturned in 2004. Numerous studies concluding that
popular antidepressants work by altering brain chemistry have now been
contradicted (the drugs help with mild and moderate depression, when
they work at all, through a placebo effect), as has research claiming
that early cancer detection (through, say, PSA tests) invariably saves
lives. The list goes on.





Despite the explosive nature of his charges,
Ioannidis has collaborated with some 1,500 other scientists, and
Stanford, epitome of the establishment, hired him in August to run the
preventive-medicine center. “The core of medicine is getting evidence
that guides decision making for patients and doctors,” says Ralph
Horwitz, chairman of the department of medicine at Stanford. “John has
been the foremost innovative thinker about biomedical evidence, so he
was a natural for us.”





Ioannidis’s first targets were shoddy statistics
used in early genome studies. Scientists would test one or a few genes
at a time for links to virtually every disease they could think of. That
just about ensured they would get “hits” by chance alone. When he began
marching through the genetics literature, it was like Sherman laying
waste to Georgia: most of these candidate genes could not be verified.
The claim that variants of the vitamin D–receptor gene explain
three quarters of the risk of osteoporosis? Wrong, he and colleagues
proved in 2006: the variants have no effect on osteoporosis. That scores
of genes identified by the National Human Genome Research Institute can
be used to predict cardiovascular disease? No (2009). That six gene
variants raise the risk of Parkinson’s disease? No (2010). Yet claims
that gene X raises the risk of disease Y contaminate the scientific
literature, affecting personal health decisions and sustaining the
personal genome-testing industry.





Statistical flukes also plague epidemiology, in
which researchers look for links between health and the environment,
including how people behave and what they eat. A study might ask whether
coffee raises the risk of joint pain, or headaches, or gallbladder
disease, or hundreds of other ills. “When you do thousands of tests,
statistics says you’ll have some false winners,” says Ioannidis. Drug
companies make a mint on such dicey statistics. By testing an approved
drug for other uses, they get hits by chance, “and doctors use that as
the basis to prescribe the drug for this new use. I think that’s wrong.”
Even when a claim is disproved, it hangs around like a deadbeat renter
you can’t evict. Years after the claim that vitamin E prevents heart
disease had been overturned, half the scientific papers mentioning it
cast it as true, Ioannidis found in 2007.





The situation isn’t hopeless. Geneticists have
mostly mended their ways, tightening statistical criteria, but other
fields still need to clean house, Ioannidis says. Surgical practices,
for instance, have not been tested to nearly the extent that medications
have. “I wouldn’t be surprised if a large proportion of surgical
practice is based on thin air, and [claims for effectiveness] would
evaporate if we studied them closely,” Ioannidis says. That would also
save billions of dollars. George Lundberg, former editor of The Journal of the American Medical Association,
estimates that strictly applying criteria like Ioannidis pushes would
save $700 billion to $1 trillion a year in U.S. health-care spending.





Of course, not all conventional health wisdom is
wrong. Smoking kills, being morbidly obese or severely underweight makes
you more likely to die before your time, processed meat raises the risk
of some cancers, and controlling blood pressure reduces the risk of
stroke. The upshot for consumers: medical wisdom that has stood the test
of time—and large, randomized, controlled trials—is more likely to be
right than the latest news flash about a single food or drug.
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