One of the best books I’ve read in the past few years is Undoctored by Dr. William Davis. As I explained in my review, I drove up to Wisconsin to interview Dr. Davis for the Fat Head Kids project while he was still working on Undoctored, and he told me about it over dinner.
So the new book (which was untitled at the time) would include two major sections: The first section would explain to readers why the “health-care” system is more interested in their dollars than their health. The second section would arm readers with the knowledge and tools to monitor and improve their own health, and thus avoid ending up in the belly of the health-care beast. With all the bad advice coming from the medical establishment, people need to do their own research and direct their own health instead of relying on doctors to do it for them.
As a reminder, here’s a quote from the introduction of Undoctored:
I propose that people can manage their own health safely and responsibly and attain results superior to those achieved through conventional healthcare – not less than, not on a par with, but superior.
Naturally, that doesn’t sit well with many doctors. In fact, a doctor named Dhruv Khullar recently wrote an op-ed in the New York Times titled Do You Trust The Medical Profession? And in case you have any doubts about where Khullar stand on the issue, the subtitle is A growing distrust could be dangerous to public health and safety. Let’s take a look:
Trust, in each other and in American institutions, is vital for our social and economic well-being: It allows us to work, buy, sell and vote with some reasonable expectation that our behavior will be met with fairness and good will.
But trust has been declining for decades, and the most tangible and immediate damage may be to public health and safety. Mistrust in the medical profession — particularly during emergencies like epidemics — can have deadly consequences.
In 1966, more than three-fourths of Americans had great confidence in medical leaders; today, only 34 percent do. Compared with people in other developed countries, Americans are considerably less likely to trust doctors, and only a quarter express confidence in the health system.
I’m going to step out on a limb here and say that if trust in the medical profession is less than half of what I was in 1966, there’s a good reason for that — reasons Dr. Davis spelled out in Undoctored. But let’s read on:
Trust is the cornerstone of the doctor-patient relationship, and patients who trust their doctors are more likely to follow treatment plans. One study found that nearly two-thirds of patients with high levels of trust always take their medications, but only 14 percent of those with low levels of trust do.
Well, yes, if you have blind faith in the medical profession, you’re more likely to take that statin your doctor prescribed. That’s why I don’t want you to have blind faith in the medical profession. Dr. Khullar is simply assuming that taking your prescribed medication is always the best decision.
Trust is also critical for patient satisfaction, and makes it more likely that patients keep seeing the same doctor.
Well, duh! Of course I’m more likely to keep seeing a doctor I trust. But that doesn’t mean I should just blindly trust any ol’ doctor.
Perhaps most concerning is evidence that low levels of trust can weaken the ability of governments and public health agencies to respond to epidemics.
Researchers surveyed people in Liberia about their knowledge of Ebola, about how much they trusted the government, and how likely they were to take recommended precautions against Ebola. These precautions included adopting safe burial practices; abiding by restrictions on travel, social gatherings and curfews; keeping a bucket of chlorinated water at home; and avoiding physical contact with those displaying symptoms.
People who didn’t trust the government were much less likely to take recommended precautions.
So to prove how dangerous it is not to trust doctors, governments and public health agencies, he had to reach across the ocean and find an example of people ignoring advice about Ebola — in Liberia. Sorry, but that doesn’t convince me I should trust the USDA’s dietary advice, or the CDC’s sodium advice, or my doctor’s advice on the need to lower my cholesterol.
To his credit, the doctor writes that trust needs to be earned:
But there are steps medical leaders and public health officials can take to show they deserve to be trusted. People’s trust depends fundamentally on three questions: Do you know what you’re doing? Will you tell me what you’re doing? Are you doing it to help me or help yourself?
I think the first question is where the rubber meets the road when it comes to trusting doctors. Does the doctor know what he or she is doing? I’d say that depends. If I’m diagnosed with an acute condition such as pneumonia, or appendicitis, or a torn bicep tendon, I’m going to trust the doctor. But if I’m diagnosed with “high” cholesterol, or “high” blood pressure, or type 2 diabetes, or any other chronic condition, I’m going to do some research before I just blindly follow the doctor’s advice.
To explain why, I’ll quote from a recent blog post by Chris Kresser:
Conventional medicine evolved during a time when acute, infectious diseases were the leading causes of death. Most other problems that brought people to the doctor were also acute, like appendicitis or gall bladder attack.
Treatment in these cases was relatively simple: the patient developed pneumonia, went to see the doctor, received an antibiotic (once they were invented), and either got well or died. One problem, one doctor, one treatment.
Today things aren’t quite so simple. The average patient sees the doctor not for an acute problem, but for a chronic one (or in many cases, more than one chronic issue). Chronic diseases are difficult to manage, expensive to treat, require more than one doctor, and typically last a lifetime. They don’t lend themselves to the “one problem, one doctor, one treatment” approach of the past.
Unfortunately, the application of the conventional medical paradigm to the modern problem of chronic disease has led to a system that emphasizes suppressing symptoms with drugs (and sometimes surgery), rather than addressing the underlying cause of the problem.
Just today, I heard about another case of doctors not addressing the underlying cause of a problem. A co-worker told me his daughter suffered from irritable bowel syndrome for years. Doctors treated her with drugs, of course, which sometimes worked and sometimes didn’t. It was a family friend who finally suggested the daughter try a diet devoid of grains. You can guess the happy ending: no more irritable bowel syndrome. How many times have we all heard similar stories?
And of course, modern medical doctors sometimes want to treat a “problem” that isn’t a problem in the first place. Here’s an example I’ve mentioned before: Some years ago, I had a checkup that included (of course) a lipid panel. After viewing the results, the doctor told me I needed to go on a low-fat diet and consider taking a statin. I asked why.
“Your cholesterol is elevated.”
“Put a number on that, please.”
“Uh-huh. And what’s my HDL?”
“Let me see … it’s 64.”
“What about the triglycerides?”
“Hang on … 71.”
“So what you’ve just told me is that for a guy my age, my cholesterol profile is excellent. I’m not going on a low-fat diet, and no, I’m not taking a statin.”
This doctor knew less about how to interpret a cholesterol panel than I did. He saw one number — 203 — and decided my heart was at risk. Strike one. He thought the solution would be a low-fat diet. Strike two. Or a statin. Strike three.
Not trusting that doctor was the right decision. Same goes for my mom’s doctor, who recently put her on statins — again. My mom called and asked why she might be taking something spelled A-V-O-R-A—
“Statin,” I finished. “Avorastatin. It’s a statin. It’s to lower your cholesterol, and no, you don’t need it. There’s never been a single study proving that giving statins to women in your age group prevents any deaths.”
And yet there she was, taking a worthless drug that can screw up a person’s memory, despite the fact that she’s been having memory issues for the past couple of years. Doctor’s orders.
So let’s put two and two (plus one more) together: Dr. Khullar complains that trust in the medical profession is less than half what it was 40-some years ago. Chris Kresser notes that most people these days see doctors for chronic conditions. I’m pretty sure those are related. Too many doctors suck at treating chronic conditions. They mean well, but the advice still sucks.
Dr. Malcolm Kendrick put it nicely in his terrific book Doctoring Data:
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.
No wonder patients aren’t happy and full of trust.
Then there’s this additional problem, as described by Dr. Davis in Undoctored:
There is a continual push to medicalize human life. Shyness is now “social anxiety disorder” to justify “treatment” with antidepressant medication; binging in the middle of the night is now “sleep-related eating disorder” to justify treatment with seizure medication and antidepressants; obesity, declared a disease by the FDA, justifies insurance payments for gastric bypass and lap-band. Don’t be surprised if sometime soon, bad dreams, between-meal hunger and excessive love of your cat are labeled diseases warranting treatment.
I read recently that 20% of American boys are diagnosed with ADHD by the time they reach high school and two-thirds of them end up being prescribed drugs — apparently for being energetic males who annoy teachers. Talk about medicalizing what used to be considered a normal part of life.
Here’s another quote from Dr. Kendrick:
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.
Yes, it’s true: people don’t trust doctors like they once did. But it’s not because people are stupid. It’s because they’re smart. It’s because they can do their own research and share experiences with others online. It’s because they’ve learned the hard way that far too often, simply following the doctor’s orders doesn’t heal what ails them.
Personally, I think it would be great if surveys 30 years from now show a renewed faith in the health-care profession. But for that to happens, it’s the profession that needs to change, not the rest of us.