Dr. Malcolm Kendrick is the Mark Twain of medical writers, wielding his own pen warmed up in hell. Hell, in this case, is a modern medical system designed to persuade doctors and the public that nearly everyone with a pulse is abnormal and in need of treatment. In fact, I can summarize Kendrick’s latest book Doctoring Data by paraphrasing Twain himself: “If your doctor doesn’t read the medical literature, he is uninformed. If he does read the medical literature, he is misinformed.”
I first became aware of Kendrick when Dr. Mike Eades recommended his book The Great Cholesterol Con.
I ordered a copy and expected to be educated. I didn’t expect to laugh my ass off while being educated, but that’s Kendrick’s style. He attacks nonsense with facts and logic, yes, but also with a razor-sharp wit. (If you don’t read his blog, you should.)
As Kendrick has made clear many times, he’s not anti-medicine. He is a doctor, after all. Take surgeries and the true wonder drugs out of the picture, and many of us would be far worse off, if not dead. I’d be limping around on a ruined knee, deaf in one ear, and unable to raise my left arm above chest-level. So much for doing farm work and playing disc golf on weekends.
But Kendrick is very much against the nonsense that pervades much of preventative medicine these days. The nonsense is driven by what he calls doctored data. In a nutshell, the system works something like this:
Even though you’re probably fine, you undergo a lab test at your doctor’s insistence, and lo and behold, you’re diagnosed with a previously unknown “disease” … which was discovered just in time to coincide with the approval of a new wonder drug … which was approved based on suspicious data … from a study designed and run by the drug-maker … which paid key opinion leaders to sit on a government committee that wrote the treatment guidelines … which instruct your doctor to prescribe the new wonder drug … which produces nasty side-effects … which must be treated with more wonder drugs. Oh, and you also need to stop eating anything that tastes good.
Here’s how Kendrick describes the situation in the book’s introduction:
It has become exceedingly difficult to enjoy life’s simple pleasures. Lying in the sun… “Do not do that, or you will die of skin cancer.” Eating a bacon sandwich… “You mad fool, the saturated fat in that will raise your cholesterol levels and you will die of heart disease.” Putting salt on food… “That raises blood pressure and you will die of a heart attack or a stroke.” Drinking an ice-cold gin and tonic after a hard day’s work… “If you drink more than 15 units a week you risk dying of cancer and liver failure.” Hey ho, what jolly fun.
At the same time we are being cajoled to undergo ever more screening tests to pick up the early stages of cancer and numerous other diseases. As if this were not enough, your GP will be haranguing you to have endless measurements of blood pressure, cholesterol, and blood sugar levels, to name but three. As if good health is only really possible through constant monitoring by the medical profession.
As for the elderly, it has become virtually impossible to find anyone taking fewer than four or five separate medications. One of my jobs is working in Intermediate Care where I help to look after elderly people, many of whom have suffered an injury or fracture of some sort. When patients enter this unit, the average number of medications taken is ten. That is ten different drugs, to be taken each and every day, some of them three or four times each day. I suppose it saves on buying food.
At the same time, the boundaries that define illness have narrowed inexorably. When I first graduated from medical school in 1981, a high cholesterol level was anything above 7.5 mmol/L. Over the years, this level has fallen and fallen to the point where a ‘healthy’ level is now 5.0 mmol/L. I suspect it will soon be 4.0 mmol/L. Anything above this figure, and you have an increased risk of heart disease – allegedly. Considering that over 85% of the adult population in the western world has a cholesterol level higher than 5.0 mmol/L this is a quite amazing concept. I will admit that I have never been that brilliant at statistics. However, it seems to me that attempting to claim that more than 80% of people are at high risk of heart disease stretches the concept of ‘average’ to breaking point – and well beyond.
The sad truth is that most of the advice we are now bombarded with varies from neutral to damaging. In some cases it can be potentially very damaging indeed. Advising people with diabetes to eat a low fat, high carbohydrate diet, for example. As a piece of harmful idiocy, this really could hardly be bettered.
How about frightening people to stay out of the sun, or slap on factor 50 cream at the first suspicion that a deadly photon may sneak through 10 layers of protective clothing? Not necessarily a good idea, because without vitamin D synthesis in the skin, from exposure to the sun, there is a significant danger that we can become vitamin D deficient, which can lead to all sorts of other problems.
And later in the introduction:
So you trust the experts… right?
No, I do not think that would be the best way to go. In fact, long sections of this book are dedicated to an exploration of the role of the ‘expert’ (chapter six). The bottom line is that experts are just as prone to grasping the wrong end of the stick as anyone else, then hanging on for blue bloody murder. Far more so, in many cases.
If truth be told, my view of medical experts has become extremely jaundiced. At times I feel they are like those highly decorated generals in North Korea with the funny hats. They look splendid and important, but the only point of their existence is to suppress dissent and keep an idiotic regime in place. In reality, you are not likely to get much nuance from an expert. You are more likely to be ‘educated’ on the party line. Room 101 lurks.
I don’t have to convince a bunch of Fat Heads to be skeptical of experts, but the question remains: when we’re bombarded with medical advice, or with headlines proclaiming New Study Says Blah-Blah-Blah, how do we separate the gems from the garbage? To a large degree, that’s what Doctoring Data is about:
Should you believe everything, or believe nothing? Trying to establish any type of system for establishing the truth is clearly not simple, and it is fraught with its own biases.
Having said this, I do think that there are certain ‘tools’ that you can use to analyse health stories and clinical papers. Using them will allow you to spot many of the manipulations and biases. These tools are not complete, and they are not some sort of mathematical formula, whereby a score of five means the paper is true, and a score of ten means it is untrue.
However, I believe that they can guide you, and give you a much clearer picture of what is really happening out there in the murky world of medical research, a way of looking at the world to try and establish the truth. Or something as close to the truth as can be achieved.
The truth toolkit: Ten things to remember, to help you make sense of a medical story; they are also the chapters of this book.
• Association does not mean causation
• Lives cannot be saved; we’re all going to die
• Relative mountains are made out of absolute molehills
• Things that are not true are often held to be true
• Reducing numbers does not equal reducing risk
• Challenges to the status quo are crushed – and how!
• Games are played and the players are…
• Doctors can seriously damage your health
• Never believe that something is impossible
• ‘Facts’ can be, and often are, plucked from thin air
The rest of the book is like an in-depth version of Science For Smart People. Kendrick guides the reader through the process of how studies are conducted and how the numbers are crunched. Then he shows how everything gets turned upside-down and sideways so researchers can declare that a new wonder drug or procedure will “save” hundreds of thousands of lives … even if “saving” a life means extending it by an average of three months.
Statins, blood-pressure medications, various cancer screenings … as Kendrick repeatedly demonstrates with actual study results (minus the medical-industry spin), many of the sacred cows of “preventative” medicine don’t seem to prevent much of anything:
Those involved in cancer screening have even created their own, virtually-impossible‐to-understand language, in order to make their figures look stunning. Stunning they may look, but luckily there are other people out there who are less than stunned, and who choose to look a bit more closely.
The United States Preventative Task force reviewed all the data on Prostate Cancer screening (using the prostate specific antigen (P.S.A.) blood test) and came to the conclusion that it does more harm than good.
Lo, it turns out that the prostate screening test, which improves survival from 68% to 99% does not actually save lives – at all. Fantastic sounding cure rates, which completely bedazzle doctors, are simply meaningless.
In the chapter titled Challenges to the status quo are crushed – and how!, Kendrick cites examples of how results that challenge prevailing medical opinion are squashed … or fudged, or simply ignored. For example, one study was published with the title Excess deaths associated with underweight, overweight, and obesity.
Well, there you go: you clearly don’t want to be overweight or underweight. If your doctor glanced at the journal article, that’s the conclusion he or she would draw. Just one little problem: the actual study data showed that people in the overweight category (BMI of 25 to 30) had the longest lifespans. But wait, it gets even better:
You may note that, in this study, even those in the obese category (BMI 30-35) had a lower mortality than those of ‘normal’ weight.
The overwhelming belief in the medical community is that being overweight is bad for you. It causes a host of diseases, which will inevitably result in premature death. To state that being overweight means that you live longer is the scientific equivalent of standing up and shouting that the Emperor is not actually wearing any clothes at all.
So why did the paper’s title declare that the risky categories are underweight, overweight and obesity? As Kendrick writes:
If they dared to write a paper with this title… Excess deaths associated with underweight, normal weight, and obesity. …one of two things would have happened. Either the peer reviewers would have rejected it, or, had it been published, their names would be mud in the world of obesity research.
If the medical world crushes people who say being overweight won’t kill you any sooner, imagine how it treats people who say statins won’t save your life. Time to call in the North Korean generals with the funny hats.
In the chapter titled Doctors can seriously damage your health, I finally learned the origin of a colorful phrase that means giving someone a load of nonsense:
If someone was close to death, or even apparently dead through drowning or suchlike, conventional wisdom was that you could save their life by blowing tobacco smoke up their rectum with a pair of bellows. So strong was this belief that hundreds of set of bellows were hung up around the Thames to revive those who had fallen in and drowned.
The hell with CPR, just blow smoke up someone’s backside, that’ll do the trick. How idiotic does this now sound? Pretty idiotic I would think. However, very intelligent people believed it was true. Doctors thought it to be true… Not, of course, that I would necessarily confuse doctors with intelligent people.
Sadly, each generation easily convinces itself that such arrant nonsense has become thing of that past.
But such arrant nonsense isn’t a thing of the past. Doctors used to blow smoke up our arses; now they prescribe statins to beat down our cholesterol. I’d rather take the smoke.
That’s the point of Doctoring Data: there’s still a lot of nonsense in medicine – perhaps more than ever. I can barely turn on my TV these days without seeing a commercial for some new drug, always ending with the line Ask your doctor about SuperlaBlex or whatever it’s called.
No, don’t ask your doctor if you need the new wonder drug! The entire system of studies, reviews, approvals, guidelines, etc. is designed to convince your doctor that you’re ill and need that new drug. You simply can’t count on your doctor (unless you’re lucky) to be skeptical of modern medicine. You have to be the skeptic. Doctoring Data teaches you how to be an informed skeptic. As Kendrick writes in his closing:
How can Dr Kendrick be right, and all the highly decorated experts be wrong? Well, obviously, they are right about many things. However, when it comes to the area of preventative medicine it seems that every stick that can be grabbed at the wrong end, has been grabbed at the wrong end. Alongside this, experts seem obsessed with simplistic ideas where cause and association are hopelessly muddled. It has become a mess, in part driven by money. Things that are high should be lowered, things that are low should be raised. Yes, we have a drug for that… Kerrching. ‘Look for underlying causes? What idiot said that?’
So I decided to try and expose, if that is the right word, how data are produced. How statistics are used to terrify people, or falsely reassure them. Also, what are the drivers for this behaviour? I know I will be attacked for some of the things I have said. That is inevitable. However, that does not matter. What matters is that you, once you have read this book, can understand more clearly how and why data are ‘doctored’. You can then understand the headlines more clearly. Two sausages a day increase your risk of bowel cancer by 50%. Shock, and horror, and bollocks. You can make the decisions for yourself about what you can and should do to live a longer, healthier and happier life.