Why drugs that work, don’t work.

Drugs that work, don’t actually work!


Alan Cassels drug policy researcher at the University of Victoria in British Columbia, has recently published his book Seeking Sickness: Medical Screening and the Misguided Hunt for Disease he shows how individuals that are not actually sick could experience more harm than benefit from so-called health screening. These health screens will often place individuals on medication for conditions that may never have manifested any symptoms, in addition the various screening processes and scans, carry a certain risk and so do the follow-up procedures e.g. biopsies using surgical techniques taking tissue samples etc.

The following conclusion from an analysis of 16 trials, 14 of which had available outcome data (using 182,880 participants) from the highly respected Cochrane Collaboration was published online on 17 OCT 2012, stating that:

General health checks did not reduce overall morbidity or mortality, nor specifically for cardiovascular or cancer causes, although the number of new diagnoses was increased. Important harmful outcomes, such as the number of follow-up diagnostic procedures or short term psychological effects, were often not studied or reported and many trials had methodological problems. With the large number of participants and deaths included, the long follow-up periods used, and considering that cardiovascular and cancer mortality were not reduced, general health checks are unlikely to be beneficial.

How come medical authorities spend money on ineffective procedures?

More significant however is the analysis as to why this appears to be happening, after tests and extensive trials how can the medical profession invest vast sums of money on procedures that may often do more harm than good? One problem is in the way that the pharmaceutical industry and consequently the rest of the medical profession assess what ‘works’.

Drugs are often developed to stop specific symptoms in the hope this will have a beneficial effect overall. So for example if researchers believe raised cholesterol will predispose you to heart problems, strokes and ultimately death, then producing drugs that are able to reduce cholesterol will reduce the liklihood of those outcomes; heart disease, strokes and associated deaths.

So initial trials assess how good the drug is at reducing blood cholesterol compared to a placebo (a dummy pill), and that’s often where the trials end. BUT, compared to the overall picture, if heart disease, strokes and deaths are not reduced then reducing the cholesterol is of no consequence. The measure of cholesterol is known as a surrogate outcome, it’s not the outcome we are really interested in. Therefore it is only after more long-term trials are conducted, looking at these overall affects, do we really know how effective our drug is. So a drug that doesn’t do what we want, is one thing, but if we then factor in side-effects, we may have created something quite tragic. In an article at mercola.com the comments from Dr Andrew Oxman in a recent reuters interview illustrates the point well.

Even if they reduce the lab value, you can’t be sure they reduce your risk of heart attack or stroke or fracture,” Oxman, who wrote an editorial about the new findings, told Reuters Health. “There are lots of examples where things start to be used and have entered the market based on surrogate outcomes and then actually proved harmful.”

Dr. Andrew Oxman of the Norwegian Knowledge Centre for the Health Services in Oslo.

He mentioned the heart rhythm drugs encainide and flecainide, which for many years were given to people with acute heart attacks. But then trials showed they were actually bad for these patients. “These drugs were given by well-meaning clinicians, but they actually killed more people than the Vietnam War did,” Oxman said.

This is one reason why medical procedures, creating more problems than they solve, make it onto the market, paid for by our governments.

But even more importantly; why don’t short term medical goals reach the long-term goal?

Yes there is still more to be learned from this scenario, because in the pharmaceutical industry, with the production and marketing of drugs to treat medical conditions, surrogate outcome testing is common place. But there are many examples of how this does not translate into overall benefit for the patient. And we could also wonder why this is, why do these drugs not confer overall benefit if they work at producing the short-term effect desired by the medical profession?

The reason is because pharmaceutical intervention is aimed at stopping symptoms and these symptoms are for the most part intelligent reactions of the body aimed at keeping you alive, the goal of suppressing symptoms is based on the assumption that the body is going ‘wrong’ in disease rather than understanding that the body is reacting to an adverse situation. So the bigger picture relating to the function of symptoms is mis-understood. 

Consequently once you assess the overall impact of these interventions on long-term health and mortality we find the interventions are often making things worse. Once we understand that cholesterol is part of a repair mechanism, fever part of an important immune reaction, insulin resistance an adaptation to sugar over-load, inflammation involves tissue repair and toxin elimination, we approach short-term AND long-term goals differently. There are many examples of this, and it is a key issue in undertstanding the difference between pharmaceutical and holistic approaches to health care. Read more about the intelligence of the body in disease in the articles on this site and in The Science of Health and Healing.



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