Facts vs Medical Facts

Facts vs Medical Facts

Facts are not separate from human groupings.

Every fact has a specific history. Each fact developed as factual within a structure of human relations; there are no facts apart from the human relations that created them. Every fact is intimately entangled with a structure of implications which gives that fact meanings, just as every word has meaning in relation to other words. Facts are true for the group who creates, then adheres to them, but they may conflict with the facts of another group or groups. Here would be common examples of this group-relativity. There is but one god. : There are many gods. : There are no gods. Each of these statements points to a different reality. Whichever of these three statements bearing truth does not depend on the contents of the universe; it depends upon the membership group of the beholder.

Facts are socially maintained.

Facts — whether every day, religious or scientific — are justified. That is, facts are supported by the same measuresmany-religions of socialization of the young, social control, legitimation and authority that maintain all structures of human relations. Facts are parts of a human reality; facts supply a kind of proposition about the nature of that reality. Belief makes a fact a fact; but, believing is expected, taught, plausible, and enforced. For example, it can be a fact that human sacrifice brings rain and rain makes the crops abundant. We, in our society, most likely would receive the preceding statement with skepticism, because it is not justifiable within our structure of implications, our version of reality. We cannot believe this relationship, therefore it is not a fact to us.

In everyday life, we don’t do a lot of fact-checking.

Of course, many things that would not bear up to close scrutiny are facts within our reality. Some examples would include the following. The Biblical forbidden fruit was an apple. Global warming is not happening; or, if it is, it is not caused by human activity. Napoleon was short. Raising the minimum wage causes the loss of jobs. The mammals called bats are blind. Physicians know what they are doing when they treat patients. Hysteria was an actual disease. Microwave ovens cook foods from the inside out. Edison invented the light bulb. Flu vaccines are a good protection from the flu. The sun rises (and sets) – as contrasted with the effect of the earth’s rotation on our view of the sun.

Institutionalized fact-checking is at the heart of scientific fact-making.

Science and the rational worldview it spawns are the basis of modern western practical beliefs. This does not say thatScientific Method every interpretation placed upon the world by science will stand against all challenges. It does mean that the survival processes of modern world derive from well-tested science and engineering. It also means that if we want to invent innovative technology that works, and test to see if it is working, the scientific method will most likely have been involved someplace in the process. As a result of the vast material successes of this method, science has earned what may be called “cultural authority” (the broadly accepted capacity to create and define plausible facts and distinguish them from non-facts).

All that glitters is not gold; all who say “science” are not scientists.

In the early 1800s medicine was not a well-paying profession, nor was it uniformly esteemed. Its basic theories and treatments were two thousand years old often requiring bloodletting, were quite poisonous mercurial compounds or were addictive opiates — and never worked, anyway. Then there were the treatments for hysteria: genital massage to ease hysteria by bringing about “hysterical paroxysm” or clitoridectomies to stop hysteria. To have enough employment these physicians intruded into the fields of other service professions to engage in midwifery, bone setting, amputation, and even a bit of veterinary work here and there. For a few physicians there was the lobotomy.

On its way to respectability and professional sovereignty (U.S.: 1850-1930) medicine adopted higher and more uniform educational standards, strict licensure, and, importantly, the guise of science. In a complex way these changes encouraged greater cohesion within a previously divisive membership. As the profession quietly shed humoral theory and toyed with the new germ theory, it began to engage in interpersonal and political “impression management,” thereby raising its status in society.[1] In an earlier blog on this site (“Medical thinking is different from scientific thinking”) we discussed the fact that this medical makeover did not transform medical reasoning from its inductive form to the deductive form required for scientific thinking. Nor were physicians trained to be scientists; taking courses in this or that science, as they must, does not change one’s gaze upon the world, steep a person in scientific methodology, or elevate numeracy.Medical Capitalism

During their transition to a modern persona, physicians remained members of a fee-for-service, treatment-providing, capitalistic profession. The medical profession simply cloaked itself in the symbolism of science and flung about the term “medical science” — leaving out the hard work of obtaining knowledge about the precision of its beliefs and the efficacy and safety of its practices. Over nearly a century, medicine changed its reputation and treatment modalities, but retained its penchant for treating patients with practices of unknown efficacy and questionable safety. From time immemorial the profession has claimed more positive knowledge than it has had, and professed more efficacy than it could deliver. By this chicanery it successfully took cultural authority. It fooled us into seeing “medical science” as a facticity, medical knowledge and treatments as fact-checked, and the entire enterprise of medicine as scientific fact-making.

Where is evidence based medicine?

When David Eddy, MD, PhD (mathematics) and “father of evidence-based medicine” coined the term Evidence Based Medicine (EBM) in the early 1980s he was in the midst of discovering empirically that medicine was only just barely evidence-based.[2] Eddy’s first estimates were that a mere 15% of medical protocols rested upon scientific evidence.introduction-to-evidence-based-medicine-4-728 As late as 2006 he retained his estimate of 15%. Exacerbating the lack of foundational evidence is the poor quality of biomedical research and the several faces of fraud [3] that have shaped published findings.[4] John Ionnidis, MD, PhD (mathematics) charges that, “…as much as 90 percent of the published medical information that doctors rely on is flawed”.

By now, a kind of discipline has arisen around fact-checking medical claims of efficacy (and safety). These efforts may be called meta-research. Meta-researchers seek the evidence surrounding treatments, overtreatments, over diagnosis, and iatrogenics.[5] Among the critical examinations of the bases of medical knowledge, there perhaps is a broad consensus that 20% – 35% of medical protocols rest on evidence. Unfortunately, not all of that basis supports efficacy, as contrasted to evidence of harm. Further, new techniques and protocols are entering medicine in a continual stream, and only rarely are they properly tested.[6]

Let us look at a pie chart breakdown of nearly 3,000 treatments [7] that Clinical Evidence (an institution of the British Medical Journal with recurring, published updates) selects to examine for efficacy and safety in the light of published randomized controlled trials (RCT). In many cases there are no RCTs, or no adequate RCTs, and these treatments may be placed in the “unknown effectiveness” portion of the pie chart.

BMJ Clinical Evidence Chart

http://clinicalevidence.bmj.com/x/set/static/cms/efficacy-categorisations.html , accessed 12/30/2015

We see that fifty percent of the selected treatments have “unknown effectiveness,” twenty-four percent are only likely to be beneficial, five percent are unlikely to be beneficial, and three percent are likely to be ineffective or harmful. If the above percentages are added together, the sum is 82%. That means 82% of treatments have degrees of uncertainty about their intended use; further, 7% have a known tradeoff between benefit and harm, and some unstipulated proportion is harmful.

From the pie chart above, we find that a mere 11% of treatments are “beneficial.” Does this 11% allow medicine to rise to its self-proclaimed title of “scientific medicine?” If medicine is evidenced-based, as the profession declares, with the above evidence, what ethical move should it make next?

What did the literature say about licensed and approved drugs that have now been withdrawn from the market? In which Clinical Evidence category would they be placed? Of course they were said to “beneficial” (and safe). When tested on the population, however, they were killers. An abbreviated list of Medssuch withdrawn drugs includes Alatrofloxacin (2006), Aprotinin (2008), Cerivastin (2001), Cisapride (Propulsid, 2000), Phenylpropanolamine (Dexitrim, 2000), Propoxyphene (2010), Rofecoxib (Vioxx, 2004), Valdecoxib (Bextra, 2004), etc. Four vaccines have been withdrawn relatively recently due to dangers. All vaccines are inherently dangerous, these particular ones were simply “too dangerous.”

The CDC suggests that adverse drug reactions (ADR) to prescription drugs bring over 700,000 ER visits per year and that, of these, 120,000 patients are hospitalized.[8] About 4% of hospital bed capacity is used by patients admitted for ADRs and for those who experience them during their stay (14% – 20% of patients). Drug errors and reactions frequently lead to prolonging hospital stays.

However low the proportion of protocols supported by evidence might be — 11%, 15%, 35% — the raw truth is that these concerns for evidence were not raised about medicine until the 1980s, and the term “evidence-based medicine” was not widespread until 1990. A second element of this situation is that the concern for evidence was imposed upon the routines of medical judgment and practice; it was not organic. Medicine was forced to show concern about treatment efficacy by the searchlight of publicity. [9] The first Cochrane Center did not open until 1992 and the Cochrane Collaboration did not begin until 1993. The Institute of Medicine did not publish To Err Is Human until 2000. For a profession that has for long billed itself as practicing “scientific medicine,” and more recently declared itself “evidence based,” these proportions and dates are appalling. Yet, in the end, there have been no institutional changes in the ancient profession of medicine.

Medical facts are not actual facts.

Medical facts allow the profession to paint a beautiful picture of itself. Medical facts give rise to the mythology of medicine that allot to it the cultural authority over life and death decisions. Medical facts, not actual facts, support vaccine mandates and declarations of vaccine safety. The medical myth is so powerful, we cannot comprehend that error is inherent in medical beliefs and practices, rather than occasioned only by atypical blunders
If we discover that medicine as practiced routinely is actually the leading cause of death in the U.S. [10], can we finally and absolutely say that medical facts do not align with the actual facts? Should we withdraw our social and legal trust of this profession?

Citations

[1] Paul Starr. The Social Transformation of American Medicine, Basic Books, 1982, Chapter Three.
[2] It is worth noting that just exactly like medicine’s affixing “science” to its reputation, the profession liked the phrase “evidence based medicine” and co-opted it as self-descriptive. Medical professionals use the badge of EBM proudly and freely. We cannot but perceive: medicine excels at fact-making, but utterly fails at truth-telling.
[3] See blog, this site: “Major vaccine danger uncovered: Media Blackout”.Attribution
[4] For an excellent and acclaimed example of meta-research see Peter C. Gotzsche, Mammography Screening: Truth, Lies and Controversy, Radcliffe Publishing, 2012. See also Vinay Prasad, MD, et al., “A decade of Reversal: An Analysis of 146 Contradicted Medical Practices”, Mayo Clinic Proceedings, 2013, pp. 790-798; Daniel J. Morgan, MD, “Update on Medical Practices That Should Be Questioned in 2015”, Journal of the American Medical Association, Internal Medicine. Published online 11/23/2015, pp. E1-E5.
[5] J.P.A. Ionnidis, “Why Most Published Findings Are False, PLoS Med,” http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.0020124 , 2005; John P. A. Ionnidis, “Contradicted Initially Stronger Effects in Highly Cited Clinical Research”, Journal of the American Medical Association, 294(2), 2005, pp. 218-228; David H. Freedman, “Lies, Damned Lies and Medical Science”, The Atlantic, November 2010.
[6] Off label drug prescriptions are one of the many examples of unsupported treatment choices.
[7] Three thousand is a very large number. Three thousand approximates the number of stars visible to a person with good eyesight while viewing the sky in a dark area with no ground light, on a moonless night.
[8] CDC, http://www.cdc.gov/medicationsafety/adult_adversedrugevents.html, accessed 5/8/2014. All the numbers and rates on ADRs in this paragraph are from CDC websites.
[9] The next blog will examine the deadly uterine morcellation scandal.
[10] When many forms of iatrogenic death are brought together from scattered pieces of research, and extrapolated to the population, unnecessary medical intervention (a form of error or abuse) and “medical error” become the leading cause of death in the U.S. See Gary Null, et al., Death by Medicine, Axios Press, 2011; cf. IOM To Err is Human 2000. The IOM book uses a less complete study as the basis for saying that medicine is the third leading cause of death in the U.S.