How can so much stupidity about medicine be packed into one article?

I’m currently in Las Vegas at The Amazing Meeting. Believe it or not, I was even on a panel! While I’m gone, I’ll probably manage to do a new post or two, but, in the meantime, while I’m away communing with fellow skeptics at TAM7, I’ll be reposting some Classic Insolence from the month of July in years past. (After all, if you haven’t been following this blog at least a year, it’ll be new to you. And if you have I hope you enjoy it again.) This particular post first appeared in July 2007.

Mike Adams is an idiot.

There, I said it.

Adams runs the NewsTarget website, a repository for all things “alternative” medicine. In it, he rails against “conventional” medicine as utterly useless and touts all manner of woo as the “cure” for a variety of diseases. I generally ignore his website these days because I fear that reading it regularly will cause me to lose too many neurons, and, as I get older, I want to hold on to my what neurons I have remaining for as long as possible, or, if I must lose them, to do so in a pleasurable way, perhaps as a result of a fine bottle of wine. But, then MarkH had to go and point out an example where Mike Adams has surpassed himself in the amount of sheer stupidity and logical fallacies packed into a single article. The article is entitled, The false gods of scientific medicine revealed: It’s a cult, not a science.

The stupid, it really does burn.

Mark‘s done a great job of taking this idiocy down, but does that mean that there’s nothing left for me? Of course not! Get a load of this quote:

Take clinical trials, for example. These are supposed to be the “gold standard” of scientific study, and yet it has been well demonstrated that these studies almost always produce results beneficial to the organization providing the funding. The wishes of the study sponsors, not true scientific methods, determine the study outcomes. This is accomplished through an elaborate system of fraudulent trial design, selective reporting, dismissing study subjects who don’t produce the desired outcome, statistical distortions and the application of career pressure to the researchers who carry out such studies. (Researchers who don’t produce the desired results get blackballed by the industry.)

The end result is that today’s so-called “scientific medicine” has almost no resemblance to genuine science at all. The word “science” is simply used as a cover story for what’s really going on behind the scenes — a massive campaign of pro-drug propaganda, arm-twisting, public brainwashing, media control and regulatory failures that all add up to one thing: A system of medicine that is the greatest con ever perpetrated on the American people.

The “greatest con ever”? Wow. I had no idea. I’m particularly amazed that such an elaborate conspiracy can be held in place. I mean, really. There’s all this fraud in every clinical trial (which seems to be what Adams is saying), and almost nobody is aware of it, other than the brave, brave Sir Adam? Whatever the problems inherent in clinical trials and whatever problems conflicts of interest may cause in terms of the objectivity of studies, this is a massive overstatement, to the point where it buried the needle on the Crank-O-Meter to the point that the poor thing nearly blew up. Moreover, I would point out that, when problems are found with drugs, it’s not cranks like Mike Adams who find them. It’s scientists and physicians.

MarkH pointed out perhaps the biggest howler of all in Adams’ article, namely the claim that chemotherapy is worthless in curing cancer, pointing out examples that I like to trot out whenever deluded fools like Adams make this claim: the example of childhood cancers, most of which were death sentences in the 1960s and many of which are curable in as many as 90% of the cases, thanks to the dreaded chemotherapy. That’s an altie canard that really irritates me and to which I respond: What’s the survival rate in for childhood cancer in patients who use only alternative medicine? Although we can’t know for sure, I’m guessing it’s probably about the same as it was in the 1960s for conventional medicine, and probably not even that good. I will, in fairness, point out that Adams is partially correct when he says that “shrinking a tumor is not a meaningful measure of a cancer treatment’s success” but not to the extreme that he takes it. Patient survival does not always correlate with good initial tumor shrinkage, it’s true. However, it does in enough cancers that it’s still a useful marker, and, more importantly, if a tumor doesn’t shrink in response to treatment it’s a very good indication that the treatment is not working.

But this article is such a-shall we say?–target-rich environment that I can’t resist “cherry picking” a few of the stupidest examples:

There is currently no requirement whatsoever that surgical procedures be scientifically proven as either safe or effective before being widely performed on the public.

A half truth. One reason is that a surgical procedure is may be different in different hands, because all surgeons do their procedures a little different. Another reason is that surgical research is much more difficult to carry out in many ways than medical research. For one thing, it’s virtually impossible to blind most surgical trials. The surgeon knows what operation he or she did and how, and the patient knows if he was operated on or not. Second, it’s ethically problematic (to say the least!) to do sham surgery as a control. That’s not to say that such trials can’t be done (indeed, they have been done for a number of conditions), but the increasing IRB requirements make it harder and harder to get approval for such studies. I’ve discussed the issues involved in surgical innovation versus research in depth before, and it’s worth revisiting. Another point to consider is what, exactly, do we mean by “scientifically proven as either safe or effective.” For drugs and medical devices, this is not so difficult to define. Surgery, on the other hand, always carries risk, and the amount of risk that is tolerable depends on the risk of doing nothing.

Nearly all pharmaceuticals receiving FDA approval today have been tested on only a few thousand people for a very short period of time (as little as six weeks in some cases). Yet, from such limited testing, the FDA declares the drugs to be safe for everyone, even for long-term use, without a shred of evidence that such long-term use is safe.

A huge misrepresentation. First, the FDA does not declare drugs to be “safe for everyone” on the basis of pre-approval clinical trials. That’s just a load of, well, bullshit. Ever read the package inserts of drugs? The cautions and warnings there come out of pre-approval clinical trials mandated by the FDA. Moreover, there is post-approval drug surveillance mandated by the FDA. We can argue over whether it’s good enough or strict enough, and there are good reasons to think that it is not (particularly given the underfunding and understaffing of the FDA, who seemingly can’t even stop Jim Tassano from selling home brew experimental chemotherapy via his website after nearly five months), but it’s false to imply that the FDA declares drugs safe for everyone forever based on just pre-approval testing.

Most drugs don’t work on most people. Claims of benefits are highly exaggerated by reporting their relative percentage rather than absolute percentage of efficacy. For example, if two people out of 100 normally get breast cancer, and a drug causes that number to be reduced to one person out of 100, the drug company will claim a “50% reduction in breast cancer!” when, in reality, it’s a 1% reduction across the population. Yet the drug will be marketed to everyone as a breast cancer “prevention” strategy. And yet 99% of the people who take it will experience no benefits from it. Most drugs are useless. A drug only has to work on about 5% of test subjects to receive FDA approval.

This is, of course, another bunch of half-truths. I also can’t help but wonder whether Adams applies this very same argument to the increased risk of cardiovascular complications from drugs like Vioxx and Avandia. After all, those risks were less than 1%, and I could easily flip his argument around and use his very same argument to claim that those drugs weren’t that bad. For example, the Avandia study reported a relative risk of 1.43 for myocardial infarction and 1.64 for death from cardiovascular events. In fact, if you look at the study itself, you’ll find that, depending on the study, the risk of death from cardiovascular disease ranged from 0.17-0.38% in the control group and from 0.14-0.46% in the Avandia group, depending upon the specific study type in the meta-analysis. Thus, we’re looking at an increase in cardiovascular-related deaths and complications that is less well under 0.5% of people taking the drug. Come on, Mike, Avandia causes cardiovascular complications only a minuscule fraction of the people taking it!

Somehow, I doubt that Adams would buy that line of reasoning, but, whether he realizes it or not and whether he admits it or not, it’s the same line of reasoning he uses to attack the use of drugs like Tamoxifen to prevent breast cancer, even though they are only used in women who have strong risk factors for developing breast cancer, and they benefit more patients than he says. I would also point out that many patients, even when told that taking chemotherapy would increase their odds of long term survival by only 2-3% on an absolute basis (which is indeed the case in early stage breast cancer), they will still opt to take the chemotherapy. In fact, even if told the survival advantage is only 1%, more women than not will opt for chemotherapy. Apparently, Adams is all for “health choice” except when it’s a choice he doesn’t like.

In any case, MarkH also nailed this canard by pointing out that even small differences can add up to many lives saved in common diseases that affect millions of people. (The converse is that, when millions of people take a drug like Avandia, small increases in complication rates can translate into many thousands of patients injured.) This is true of chemoprevention drugs like Tamoxifen, and it’s true of cholesterol-lowering agents like Liptor. Why this is true is the same reason that, even though the increased risk of cancer and other diseases from second hand smoke is fairly modest by epidemiological standards, it is still significant because of the millions of people who are exposed to it. (Don’t worry; I haven’t forgotten about the promised article on the topic.)

It’s time to leave for work (this article will autopost later in the day.) I leave it as an exercise to my readers to have some fun with the other logical fallacies and misinformation in Mike Adams’ article. Consider it an exercise in critical thinking.