Evidence-based medicine? Wishful thinking

It is simply no longer possible to believe
much of the clinical research that is published,
or to rely on the judgment of trusted physicians
or authoritative medical guidelines.
I take no pleasure in this conclusion,
which I reached slowly and reluctantly
 over my two decades as an editor
of   The New England Journal of Medicine
— Marcia Angell, “Drug companies and doctors: a story of corruption,”
New York Review of Books, 56 #1, 15 January

A corollary of Angell’s conclusion is that some part of contemporary medical practice, promoted or endorsed by mainstream institutions, is based on misleading information and thereby either medically harmful, or just medically useless but wasteful of time and money, or occasionally medically helpful but only by coincidental chance.
Proponents and groupies of mainstream medicine like to use the phrase “evidence-based medicine” as though it described contemporary practices. It doesn’t, far from it. Evidence-based medicine is a venture that was launched about a quarter century ago precisely because so little medical practice was based on sound evidence. There has been no appreciable improvement.
AIDS Rethinkers and HIV Skeptics are familiar with the discrepancy between the HIV=AIDS theory, promoted by all official bodies, and the actual data about HIV and about AIDS: “HIV tests” do not detect “HIV”; the epidemiology of positive “HIV” tests shows that “it” is not infectious and not sexually transmitted; there is no correlation between “HIV” numbers and “AIDS” numbers; etc. etc. etc. But this discrepancy between official pronouncements and the actual facts —findings published in the primary medical-science research literature — is not unique to HIV/AIDS. Rather, it illustrates the degree to which current medicine is misguided and often harmful.
For example, individuals with “high” cholesterol are routinely administered statins, in absence of evidence that “high” cholesterol is in itself harmful and actually bespeaks cardiovascular disease. Moreover the statins have such serious “side” effects as mental confusion, muscle weakness and eventually muscle wasting, and more:

A report from the Institute of Medicine (Evaluation of Biomarkers and Surrogate Endpoints in Chronic Disease, 2010) points out that all the measures currently used as indicators of cardiovascular disease are not valid measures of cardiovascular disease: blood pressure, cholesterol (total, “bad”, ratio . . . ), C-reactive protein, troponin — none of them is a valid indication of heart disease, still less are any of them causes of heart disease. Cholesterol does not cause cardiovascular disease, whether it be high, low, bad, good, or anything else. “High” blood pressure does not cause heart disease or heart attacks or strokes. It is just that all those things are correlated with one another — correlated primarily because all of them increase naturally, normally, with age. The Institute of Medicine report mentions that 243 risk factors have been identified for cardiovascular disease. Risk factors are correlations, symptoms, not causes. Therefore it should not be surprising that the presently routine treatments — blood-pressure lowerers (antihypertensives), cholesterol lowerers (statins), and more — have not been proved to be of benefit:

“there are no valid data on the effectiveness” of
“statins, antihypertensives, and bisphosphanates”
[the last are prescribed against osteoporosis]
Järvinen et al., The true cost of pharmacological disease prevention,
British Medical Journal, 342 (19 April 2011) doi: 10.1136/bmj.d2175

All this comes from the primary, peer-reviewed medical-science literature, and it is at odds with “what everyone knows”, and with what we hear from the doctors and the drug companies and the National Institutes of Health and the media. That’s an extraordinary thing to say, but anyone can confirm it for themselves by looking at the publicly available medical-science publications.

An impetus for me to do that was the experience of having planned surgery called off at the last moment because my blood pressure was said to be too high, about 190/90. My protests that stress has this effect, that my pressure goes up several tens of points just from being in a doctor’s office, fell on deaf ears. So for many weeks I monitored my blood pressure frequently, and found that it varies between 120 and 180 systolic and between 70 and 90 diastolic, during the day and from one day to the next, even without any unusual stresses that I’m aware of. Literature and Google searches soon delivered a wealth of information concordant with those observations, most notably that it is perfectly normal for blood pressure to increase with age. Indeed, some decades ago, the medical rule of thumb had been that systolic pressure approximates 100 plus one’s age — which would have made 180 normal for me.
Current data suggest a somewhat lower rate of age-induced increase, but the essential point is this: It has been known for more than a century that blood pressure normally increases with age, yet the official guidelines define hypertension — blood pressure too high — without taking this into account. The consequence is that perfectly healthy, symptom-free seniors are liable to be diagnosed with hypertension and subjected to medication: one third of Americans, and 75-80% of those aged 60 or more, are defined to suffer from hypertension and require treatment:

One of the pervasive and severely damaging problems with contemporary medical “science” and practice is the confusion of correlation with causation. The notion that high blood pressure, pre-hypertension or hypertension, means higher than the average healthy 25-year-old is absurd on its face, and reflects that pervasive confusion. EVERY ailment and disease becomes more prevalent with age, so all those are correlated with one another: hearing loss, dementia, heart disease, cancer, blood pressure, organ failure, etc. etc. etc. Those correlations are no basis for claiming that high blood pressure causes any of those things, any more than that dementia (say) causes cancer or that hearing loss causes heart disease.

Cholesterol and blood pressure, then, are two illustrations of Marcia Angell’s reluctant conclusion that “It is simply no longer possible . . . to rely on the judgment of trusted physicians
or authoritative medical guidelines”. So what does one do?

One has to search and digest the literature for oneself and weigh those data against official proclamations and doctors’ advice. That’s what M. Aziz did when circumstances of his own family led him to realize the neglected importance of vitamin D. He relates his experience in Prescribing Sunshine: Why vitamin D should be flying off the shelves, soon to be available in paperback, currently available at $2.99 for Kindle.
Some time ago, official guidelines for the recommended intake of vitamin D were increased considerably, but Aziz suggests that even more would be beneficial. His book is well worth reading for its cornucopia of citations from the medical-science literature, some of them revealing connections previously unknown to me, for example between vitamin D and immunity, and telomeres, and cholesterol, and HIV/AIDS; as well as the fact that vitamin D is a steroid and hormone-like. And the fact that under sunlight we manufacture vitamin D in the skin from . . .  cholesterol! By lowering cholesterol, we may even be accentuating deficiency of vitamin D. . . .
Of course one needs to be skeptical and judicious with all claims, those from alternative or complementary medicine as well as from mainstream sources. Thus one should not accept without further ado the claim that lowering cholesterol could even bring on Alzheimer’s disease, which is suggested by Henry Lorin because cholesterol is an essential component of all cell walls: Alzheimer’s Solved (www.booksurge.com; ISBN 1-4196-1684-6).