HIV/AIDS Skepticism

Pointing to evidence that HIV is not the necessary and sufficient cause of AIDS

Posts Tagged ‘medicine is not science’

Medicine isn’t science — nor should it be

Posted by Henry Bauer on 2010/12/26

My graduate-studies mentor was Bruno Breyer, PhD (Bonn), MD (Padua). He carried on clinical research at a hospital as well as unrelated scientific research at the university. Quite often he would sigh, “The trouble with doctors is that they’re not scientists”.
He was talking about research, of course, not about the practice of medicine. Medical practice is fundamentally different from science: its focus is the individual, whereas science deals with universal laws, principles, theories.
Admittedly, medical practice can be informed by scientific knowledge; but it can equally be misled by mistaken scientific views. AIDS and HIV are exemplary in this respect — exemplary in the sense of representative, for there are ample other instances. Before the “HIV” era, AIDS patients were treated as individuals suffering from specific infections, and treated in some cases very successfully, as with Michael Callen who lived more than a dozen years after having been at death’s door. Following the adoption of the mistaken scientific belief that “HIV” was the cause of AIDS, medical practice has increasingly made antiretroviral treatment routine instead of treating individual patients according to their manifest individual ailments.
Modern medical practice is increasingly infected by a misguided, purportedly “scientific” mind-set. I’ve mentioned before how sicknesses and their treatments have been “scientifically” created and sold (Selling sickness and huckstering medications). I’ve just started reading Jeremy Greene’s fascinating account (Prescribing by Numbers — Drugs and the Definition of Disease, Johns Hopkins University Press, 2007) of how medical practice has become increasingly independent of clinical symptoms and diagnosis and increasingly dependent on “scientific” markers, so that heart disease is diagnosed by cholesterol level and not by chest pain, and hypertension is declared solely on the basis of pressures, moreover pressures that are perfectly normal for large numbers of people.
The present essay springs from a recent series of articles about chronic Lyme disease (“Lost in the Woods”: Salvos launched in Lyme debate; In search of hope, facts; The doctor of last resort), which afflicts some unknown number of individuals but is said by official medicine not to exist. The established view is that Lyme disease, caused by a spirochetes bacterium (Borrelia burgdorferi) transmitted to humans from deer ticks, consists of an acute infection that is satisfactorily treated by a few weeks of the oral antibiotic, doxycycline. The Centers for Disease Control and Prevention (CDC) call for treating acute Lyme disease with a regimen of 14 to 28 days, and another 28-day course if that doesn’t do the job.
“Most doctors, citing guidelines issued by the Infectious Diseases Society of America, believe nearly all cases of Lyme are acute, with the exception of a very small number of patients who have post-Lyme inflammatory illness. They take the position that chronic Lyme disease doesn’t exist; that short-term antibiotics decimate the spirochetes in all but the rarest of cases”. And those doctors respond to queries about chronic Lyme disease with “copies of The New England Journal of Medicine, talk about ‘evidence-based medicine’ and [they] say the crux of chronic Lyme isn’t Borrelia but rather the vagaries and vicissitudes of middle-aged, middle-class life”.
A minority of doctors (some 20%), though, have not pooh-poohed what their patients experience and what they observe in the way of symptoms: “an acute case of Lyme can develop into a crippling, chronic version of the disease that attacks the body and the brain, they believe. . . . They liken the naysayers to those who first labeled multiple sclerosis the ‘faker’s disease’”.
Those who are convinced that they suffer from chronic Lyme have campaigned to make long-term treatment permissible, successfully so in several states that have legislated protection for doctors who decide that their patients require such care.
How unscientific official practices are, how not evidence-based, is illustrated by the manner in which the CDC and State Departments of Health acquire — or, rather, do not acquire — knowledge about infectious diseases: There exist no regulations to require primary-care physicians, or specialists, or clinical laboratories, or hospitals to report instances of Lyme disease. As a result, it is almost a matter of chance, whether or when officialdom receives enough data to make possible an informed estimate of how common or rare it is and what physicians ought to know and do about it. That in itself ought to suffice to discount the arrogant certainty with which some authorities currently dispute the existence of a chronic form of Lyme disease.
Yet dismissive comments about individuals imagining their symptoms are not uncommon: “‘I think chronic Lyme seems to be an idea that’s infectious’, said Dr. Stephanie Nagy-Agren of the Veterans Affairs Medical Center in Salem”; and “the Infectious Diseases Society of America . . .  says there’s no evidence to prove it exists”. . . . “Dr. Thomas Kerkering, . . . . infectious diseases section chief . . . has spent much of the past decade ‘de-mything’ chronic Lyme, which he likens to chronic fatigue syndrome and fibromyalgia before it. He lumps the three into disease ‘catch-alls’, faux ailments designed to give a name to the stresses of daily living. . . . ‘Those of us who stick to the scientific evidence are pilloried’”. “Anecdote squared does not equal data”, Kerkering likes to say.
Kerkering proclaims himself to be an advocate of “‘evidence-based medicine’, the concept of applying the most scientifically sound research to clinical decision-making”. He treats acute Lyme disease only if the CDC-approved blood test is positive. Whereas another hospital in the same area reports seeing 25-30 cases of Lyme, Kerkering’s team has confirmed only 4 cases out of 50 suspected ones.

Kerkering happens to be fundamentally wrong about what evidence-based medicine is. That phrase has become a sound-bite wielded by those of Kerkering’s ilk who wish to emphasize how authoritative their views are, when in point of fact the push for evidence-based medicine was launched in the 1990s because so little of medical practice is actually based on evidence. And that has hardly changed in the meantime; see, for instance, Carey, “Medical guesswork — from heart surgery to prostate care, the health industry knows little about which common treatments really work”, Business Week, 29 May 2006; and for a comprehensive overview, see Centre for Evidence-Based Medicine.
It could not be otherwise, because scientific experiments cannot be carried out on human beings, and so it is a long, slow, uncertain process to gather and weigh the evidence as it accumulates fitfully, unsystematically, from the actual experiences of individuals and their individual doctors. The history of medicine is actually the history of placebo; there were no “scientifically sound” treatments before aspirin, sulfa drugs, and antibiotics (Shapiro & Shapiro,  The  Powerful Placebo — From Ancient Priest to Modern Physician, Johns Hopkins University Press, 1997). Moreover aspirin was “discovered” because of its presence in folk remedies used since times immemorial, and modern “scientific” drug development remains a matter of trials and errors, still often guided by folk traditions of medicinal plants.

It is the chronic sufferers and the maverick doctors who treat them who are practicing evidence-based medicine. The evidence that should count is what a patient experiences, not the generalizations that officialdom promulgates on the basis of inadequate data. In medicine, it is precisely anecdotes that count, the stories we tell our doctors when we consult them, the very reasons why we consult them.
Kerkering cites the strength of the placebo effect, and that by converse (nocebo, psychosomatic illness) people can talk themselves into being ill when they are actually experiencing nothing more than the stresses of everyday life. Absolutely correct. But were Kerkering to practice what he preaches, were he being truly scientific, then he would test his diagnosis of “talking themselves into it” by listening to what they say, telling them he knows what the problem is, and giving them the remedy that will have them cured in a week or two — not telling them that this remedy is a placebo:
— If they come back uncured, he would then have to change his diagnosis.
— If they are cured by the placebo, then Kerkering would have done what a doctor is supposed to do: Heal his patients, even if — or perhaps especially if — it’s “all in their minds”.

Officialdom’s acknowledgement, that “in the rarest cases” the short-course antibiotic doesn’t eliminate the spirochetes and that “a very small number” of patients suffer “post-Lyme inflammatory illness”, is tantamount to admitting the reality of chronic Borrelia-caused disease. Beyond that, it is not clear to this lay person why it should seem impossible that a spirochetes infection might sometimes go undiagnosed for too long and then cause a variety of symptoms including mental confusion; after all, that’s the case with spirochetes-caused syphilis: if it isn’t diagnosed and successfully treated soon after infection, in its secondary and tertiary stages it does precisely the things that chronic Lyme disease is held responsible for by those who suffer from it and the maverick physicians who practice evidence-based medicine with them.

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Doctors aren’t scientists, and medicine isn’t science

Posted by Henry Bauer on 2008/11/25

That doctors aren’t scientists is entailed by the training that doctors experience, which is appropriate for practicing medicine but not for carrying on research [“Nobel Prizes illustrate that doctors are not scientists”, 19 October 2008]. I’ve understood that for many years, so I felt quite chastened when the clearest support for that distinction occurred to me only recently: there’s a very obvious and clear-cut difference of principle between scientific knowledge and medical knowledge:

Scientific knowledge is universal, whereas medical knowledge is local.

One of the norms of science that Robert Merton identified in the late 1930s is its universality: chemists and physicists believe and teach the same facts and theories everywhere. Atoms and electrons and molecules are described everywhere under identical laws. The movements of the solar system, when accurately described, are the same for Europeans as they are for Asians or Americans. The photoelectric effect, Brownian motion, X-ray spectroscopy, etc., etc., etc., have no regional or national variations in description (facts) or in explanation (theory).

Please note that I said, re solar system, “when accurately described”. There are some dishonest scientists, and there have been some fraudulent publications in science, and at times there have been politically imposed ideologies to which scientists at times have had to bow, like Lysenkoism in the Soviet Union or “Deutsche Physik” in Nazi Germany. But no scientist with un-addled brain regarded those as constituting science. Left alone, science is universal. [Of course, I’m not saying that everything scientists believe is true. Scientific understanding changes and progresses. What I’m saying is that there are no culture-specific facts or laws of chemistry or any other science.]

Whereas science left alone is universal, medicine left alone — in the unfettered professional hands of doctors — is not universal. What doctors believe to be the best treatment for a given condition varies from country to country, because the understanding of what that condition is, the explanation of that condition, also varies from country to country.

I’m not speaking of differences often referred to between Western medicine and Chinese medicine, or between “modern” and “traditional” or “folk” medicine; I’m speaking of differences between what is regarded as modern, “scientific” medicine in so-called developed countries. Anyone who has incurred similar illnesses in the United States and in Britain is likely to have encountered some of the differences I’m talking about here. When I’ve had urinary-tract (or other) infections in the United States, antibiotics were prescribed immediately; when I had one in Britain, the doctor told me that these are usually self-limiting, that it’s best not to use antibiotics unless absolutely necessary, and to come back if the infection hadn’t cleared itself within a few days. In the United States, my wife had been offered an hysterectomy whenever she was ready, because of occasional pain; in Britain, the gynecologist was aghast that anyone would contemplate so drastic an operation at so early a stage of occasional and minimal discomfort. At a time when acupuncture was still regarded as quackery in the United States, around 1960, a friend of mine was permanently cured of migraines by a practitioner of acupuncture in France. Nowadays, homeopathy is a respected technique in several European countries, but it’s viewed as quackery or pseudo-science in the United States.

When it occurred to me to footnote my earlier post with this to-me-new insight, it also occurred to me that it would be good to have something more than such anecdotes to support the assertion that medical knowledge is local whereas scientific knowledge is universal. I enquired of a former colleague, the medical historian Ann LaBerge, and was rewarded by being referred to a truly marvelous book on the subject: Medicine and Culture — Varieties of treatment in the United States, England, West Germany, and France by Lynn Payer. I recommend it unreservedly to all and sundry. One indication of its value may be that it was first published in 1988, revised in 1996, and remains in print (the author died some years ago, though).

As Payer herself acknowledges, medical practices change continually, and differences between nations don’t remain the same; thus acupuncture has gained a foothold in the United States, for example. But Payer does much more than delineate differences, she lends insight into the reasons. For instance, the attitude among Anglo-Saxons towards “natural dirt” is one of horror focusing on the “dirt”, entailing a great emphasis on disinfectants, frequent washing, and the like; whereas French medicine emphasizes the “natural” part and considers a certain degree of exposure to “dirt” as beneficial toward the acquisition of a robust immune system. Again, I would not have imagined that, 20 years ago, Germans would have been consuming 6 or 7 times as many heart medications as Americans, yet Payer has the data to prove it — as well as an intriguing suggested explanation rooted in cultural context.

Unfortunately, there don’t seem to be radical differences between countries regarding HIV/AIDS theory. There are some minor discrepancies as to “HIV” tests, of course; Val Turner has pointed out succinctly and clearly that there are about a dozen different criteria in use in different regions and laboratories for what supposedly constitutes a “positive” Western Blot [“HIV tests: danger to life and liberty“, 16 November 2007; for a very detailed critique, see “Valendar Turner’s evidence in chief” (1.2 MB pdf)].  There are also differences in criteria for an AIDS diagnosis: in Africa under the Bangui definition, clinical diagnosis doesn’t need the support of an HIV test; and few if any other countries agree with the CDC’s decision to regard, as AIDS patients, asymptomatic HIV-positive individuals with CD4 counts below 200. On the central mistaken points, though, that HIV causes AIDS and that HIV is sexually transmitted and that antiretroviral drugs are a good thing, there seems to be trans-national agreement.

Still, the general point, that medicine isn’t science, is fully illustrated by the sad tale of HIV/AIDS.

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