A gutsy doctor speaks out on behalf of patients

A respected physician who speaks out for sound science is a valuable asset today, especially as our healthcare and our health information becomes increasingly driven by marketing and politics. This Op-Ed at ABC News is incredible, not just because of the fortitude the author demonstrates, but that it was published at all.

Dr. Nortin M. Hadler, M.D., gives the straight scoop on the most popular health risk factors and drug intervention as he writes:

If There’s No Benefit, Why Tolerate Any Risk?

We have all grown accustomed to the scare of the week. Each week we learn about another hazard that is lurking in our environment. We learn of something we are not doing that we must do — or else. We must eat fish, but not all fish. Last year if you fed your child butter you were negligent; this year if you feed your child margarine you are negligent. Tomatoes are health foods, or not.

We, the healthy, are taught that life is a minefield. We, the healthy, seem to have an insatiable appetite for scares of this sort. We leap to our own defense regardless of the reliability of the scare, the validity of the remedy or the expense. With increasing fervor, the ill amongst us are learning a corollary lesson. The vaunted American health care system can be hazardous to your health.

First we learned that hospitals were dangerous places; if evil infections don't get you, errors by the staff might. But you don't need to be hospitalized to be at risk from modern medicine. Every week we have learned that another device or another pill was a Trojan horse, waiting to unleash some horror down the road. Today I want to consider the question that should precede an assessment of hazard. In order to weigh a hazard, one must have a handle on the benefit. The more the benefit, the more we might countenance some hazard. Likewise, if there were no important benefits then we would tolerate absolutely no risk....

This entire lengthy article is well worth reading here.

He doesn’t just leave us hanging without offering some advice, though:

The lesson is obvious. We, all of us, need to demand that no drug be licensed without a demonstration that it is meaningfully effective. Today, the game is to generate evidence of any effect. We should demand much more than evidence for a surrogate effect such as lowering cholesterol or lowering blood sugar. We should demand more than evidence of an infrequent benefit that is not that crucial. We should demand robust evidence for a meaningful effect....Then we would all be better off.

Dr. Hadler's patients must love him. He’d make a mighty fine Surgeon General, too, and one who would follow the soundest scientific evidence. Instead, it appears we’re going to get one who believes childhood obesity is the biggest health concern facing our nation. :(

Postscript commentary: The scramble to preserve a major money-making pharmaceutical, which seems to have included calling in every favor imaginable over the past week, has become a media circus. Things have gone far beyond a discussion of the science. It has been more than unsettling to watch, even for medical professionals, and probably moreso for patients. The “thou doth protest too much” phenomenon has served to erase doubts for many that this is primarily about marketing. It is reminiscent of the all-out dysinformation spin campaign by vested interests to preserve the “obesity” crisis” that ensued after CDC researchers exposed it as a grossly exaggerated and fabricated scare campaign. The most illogical argument that was raised this week was that the medical journal was remiss for publishing a meta-analysis about Avandia because of the inherent weaknesses in data dredges. That might have been a credible point except for the fact that practically all studies that are funded and published today are crappy data dredges with even less to support them than this one had. The critiques about meta-analysis are correct (relative risk versus absolute, etc.) and we can't soundly base clinical practice on a meta-analyses. All of which makes the lack of good clinical outcome data frustrating. Adding to unsettledness, however, are that the arguments against the paper focus on the fact it found higher risks for heart attacks, but glaringly ignore the larger figure of higher cardiovascular deaths. If a drug actually improved outcomes, then it would be unlikely that simply pooling patients would have shown the opposite in more deaths. Sadly, the drug company’s refusal to share its clinical trial data with researchers for independent review is more than disconcerting and perhaps could have prevented much of this controversy years ago. The medical journal was also criticized for bowing to a political agenda, but — given the millions of studies and stories in the medical literature supporting the government and pharmaceutical industry-funded war on obesity — it’s doubtful that anyone took that point credibly. The ad hominum attacks, a tactic of those unable to argue the science, against the author, however, were most troubling, especially when it was revealed this week that a senior communications consultant at the FDA had sent out smear emails to key health reporters.

The behavior of all concerned in response to the doctor's paper has shaken the public’s trust in medications, in government health agencies to do what’s right and sound, and in the science of medicine itself. Meaning, the biggest loser in all of this is has been our patients.