Friday, November 20, 2009

The Day Science Died

I've always been considerably mistrustful of "evidence based medicine", although I could never quite put my finger on why. As is too often the case, it is only in retrospect - when it appears it may be too late to do anything constructive - that I see the reason.

Benjamin Disraeli, First Earl of Beaconsfield and conservative 19th-century British Prime Minister once famously quipped that "There are three kinds of lies: lies, damned lies, and statistics. As I've become a student of public health statistics, I've found that Disraeli was right on target. Statistics in medicine is, more often than not, the science of deception using what should be the most unassailable of all techniques: mathematics. A skeptic of mathematics is, of course, immediately dismissed as an idiot or a nut or both. Nevertheless, I find myself in that dwindling group of physicians that views "studies", the new intellectual currency of medicine, through doubtful eyes.

This week's shocking reversal of opinion about the importance of screening for breast and cervical cancer by no less an authority than the American College of Obstetricians and Gynecologists (ACOG) indicates that I and my fellow heretics were right to be skeptical. This comes hard on the heels of the head-spinning announcement by the American Cancer Society that, on the basis of "studies", the benefits of routine screening for preventable cancers have likely been overstated, and that treatment of these cancers in the early stages may, in fact, do more harm than good.

Really? Three years ago, the American Cancer Society repudiated a British researcher's "evidence" that there was minimal benefit to screening for breast cancer in women under 50. This study, it should be noted, concluded that the undeniable benefits of early detection in women under 50 were outweighed by...cost (

It would not be insane to at least consider the political context in which these recent statements were made. If and when health care becomes a government industry, they have a strong financial interest in cutting costs. What is the real meaning of these recent announcements? They are the first evidence of health care rationing. When cost-containment is a primary concern, there are some patients who are cheaper if they will simply die before they get expensive.

The medical establishment has now completed its transition to government surrogate. Propagating their own brand of dubious evidence and pseudo-scientific "evidence", ACOG leaders can now attend the same lavish Washington cocktail parties attended by the other members of the enlightened collectivist intelligentsia and manmade-global-warming devotees. Real doctors - the men and women who actually treat patients every day - have been betrayed by the societies created to facilitate the effective treatment of disease. We can no longer trust our own societies. And sadly, patients feel they can no longer trust us.

Where do real doctors go from here? It's a pretty bleak picture. Real doctors are few. Having spent centuries mastering the science of medicine, we lost our way somewhere along the road and forgot what science was. Science is observation. Our real-life observations of our patients and their experiences, however, have been denigrated by the medical establishment for decades. "It's only anecdotal," they would say. "Where's your real evidence?" Generations of doctors have emerged from their training as automatons - depending on others to be their eyes and ears. We always assumed that those hired eyes and ears were working for the benefit of patients as we were. Instead, they were being paid to sign their name to ghost-written research. They were on the payroll of for-profit companies. They were on the payroll of a government who now shows its true motive - to become one giant cost-obsessed insurance company. Only now does my gut instinct about "evidence-based medicine" find things placed into focus. I pray it isn't too late for our profession and for our patients.

The first step is to do everything in our power to distance ourselves from the hopelessly corrupted medical establishment - and fast. They had already sold us out for transparent government promises; now our patients are their new targets. They must not be allowed to use our memberships as tacit approval of their actions. Cancel your memberships. They are worthless anyway.

We must, as real doctors with real patients with real concerns, secede from our "profession" and return to what we were entrusted to do. If the government and Big Insurance won't allow the market to work on the large-scale, we must endeavor to do it on the small-scale. I can do examinations for a low price for as many patients as will pay me a fair price for my services. If patients pay for their own mammograms, I'll bet we can find willing radiologists to read those tests for a discount - and end up better off in the end by-passing the endless paperwork and red tape. The increased demand for these procedures would, of course, lead to lower costs per procedure. I would be surprised if some enterprising pathologist wouldn't be willing to do the same regarding Pap smears. Nothing says that we can't do this on our own, if there are simply enough of us left. We don't need permission from the President, the HHS Secretary, or the insurance companies. We only need the approval of our patients. But most of all, we need their trust. If we start now, we can still salvage what is left of it and be real doctors again. If we start now, we may yet rescue our science from death by the strangulation of greed and corruption.

If we start now.