Thursday, January 29, 2015

The State of Science

Mr. X came in last week to tell me about his sad experience with a medical doctor--a scientist if you wish. Unfortunately, it represents that of many other patients through our country. According to Mr. X his doctor dismissed him from his practice because he refused to take a statin drug. The doctor berated him on his preference for natural therapies: “There is no evidence that they work!” Of course, it is a doctor’s right to dismiss a patient from his/her practice.

But, the matter did not end there. The doctor wrote in the patient’s chart, an official document that can have serious consequences on a patient’s health care, that the patient was deluded and depressed and needed to be treated with an anti depressant. He added that the patient was arrogant in his belief that he knew more about him, that is, the doctor.

For sure; the patient did know more about natural therapies. [1] But, why was the doctor not familiar, or receptive, ar at least tolerant of his patient’s wishes ans preferences? Many journals recommend a more consiliatory and cooperative approach when it comes to natural products:

HERBAL:

H onor patients’ choices

E ncourage proven practices

R ead about Complementary Alternative medicine

B e honest about what you read

A void criticism

L ist non-pharmaceutical therapies on chart. [2]

In my opinion this encounter reflects a rigidity seen in all fields of Science, not just Medicine. With due apologies to those open minded scientists and doctors who have not succumbed to the pervasive PC attitudes seen in Science, let me elaborate.

Throughout history we find a constant tug of war between the physical world and the non material realm. This struggle is beautifully illustrated by a painting of Raphael depicting Plato and Aristotle in the center of a room crowded with scientists and thinkers taking sides in this ancient argument as Plato points up and Aristotle points down. At times history has favored a more concrete approach like Aristotle’s. At other times a more pensive and spiritual approach has reigned supreme. The Reformation was a Platonic era, while the Enlightenment was more Aristotelian. There is nothing wrong with either approach, if they are tempered by each other. Hence, the balanced figures seen in the middle of Raphael’s painting.

But, alas, such balance is rare and ephemeral. Arguably, the most recent example of this ideal integration of opposites was the dynamic and exciting period when Einstein and his fellow physicists discovered the very boundary between matter and energy, that is, the unseen connecting to the material world. Many of those physicists were deeply spiritual and in awe of the endless implications of their discoveries. They viewed Science as an approximation to truth, not a final proclamation.  They humbly proclaimed they faced a mystery they hoped future generations would embrace and perhaps solve.

Don’t hold your breath. Today, Science is firmly entrenched in a Aristotelian extreme where ideas that do not fit a certain orthodoxy are marginalized and even “excommunicated.” Scientists who question the status quo are cut off from funding to pursue their research, fired, and worse, discredited as quacks. No doubt there are charlatans in all fields of endeavor. They muddy the waters for those who do not bother to look for answers themselves. Therein lies the basic problem: Science in entrenched in a dangerous rut where dogmas are unshakeable despite facts that may point to the contrary. This is not Aristotle’s fault, nor Science’s. It is a failure of understanding our own human nature. We are all susceptible to the self-preserving drive to seek security and shun uncertainly, particularly when the latter may threaten our livelihood.

The following issues may trigger an emotional response in you. In listing them I do not endorse them nor reject them. I only wish to point out how the mere mention of them tends to halt a rational, level-headed discussion. Labels are thrown around and hostility clouds vision. Here we go: MMR vaccinations and Dr. Wakefield, homeopathy, chiropractors, water fluoridation, global warming, near death experiences, consciousness outside the brain milk, GMOs, etc, etc. We could even throw in the Illuminati, UFOs and Elvis’ sightings!

Again, the quick dismissal of these issues without looking at both sides is more a reflection of dogma than of a clear, unclouded and rational evaluation of all the facts available. After, all, a true skeptic scientist does not dismiss any idea until he/she is satisfied with his/her own analysis of the facts, regardless of others’ opinions and pronouncements. Of all the issues that are too quickly dismissed as “alternatives” and lacking in Science, the one that bothers me the most and with which I am daily confronted and challenged, is NUTRITION

I will never forget the day when a cardiologist shook his finger at me: “Hugo, there is no evidence that nutrition has an impact on heart issues!”

An article published in the Salt Lake Tribune January 30th 2015 illustrates the above concepts well. It reports that many doctors are refusing to see patients who choose to forego the MMR vaccination. These doctors argue that “they do not want to be responsible for someone’s death from an illness that was preventable.”

Amazing… What about all the deaths from poor nutrition that could be prevented?

Despite overwhelming evidence that NUTRITION is the most effective, economic and rational tool to help patients, it is routinely dismissed in favor of treating symptoms with drugs. No doubt a pharmaceutical approach helps many patients, especially those in an acute health crisis and those who are unable, or unwilling to change their diet patterns and toxic lifestyles. But, to ridicule a patient and suggest he needs to take an antidepressant because they want a less pharmaceutical approach should give us pause.

“There is no place for dogma in Science. The scientist is free to ask any question, to doubt any assertion, to seek for any evidence, to correct any error. Where Science has been used in the past to erect a new dogmatism, that dogmatism has found itself incompatible with the progress of science; and in the end the dogma has yielded, or Science and Freedom has perished altogether.” Oppenheimer.



[1] A statin a day keeps the doctor away: comparative proverb assessment modelling study,” BMJ 2013; DOI: 10.1136/bmj.f7267. Available at: http://www.bmj.com. One apple = statin in preventing ~9K deaths in 5 yrs.

Drug Discovery and Natural Products: end of an era or an endless frontier?” J. Science 2009;325:161

[2] J. Family Practice Recertification 2000;22:32 #9

Herbal medicine in Europe,” New England Journal of Medicine 2005;352:1176

How to discuss herbal supplements with your patients,” J. Patient Care, July 2004, p20

Monday, January 5, 2015

Money Matters in Medicine

“Entering” the New Year has renewed my cravings for new visions and new paradigms. This is singularly imperative since the old ones are not serving us well. Finishing the book ENTERING THE SHIFT AGE by David Houle about this time has helped me crystallize these ideas. Houle notes that societies have progressed through these stages:

Agriculture

Industrial

Information

“Shift” as he defines the coming age.

He means a shift into a more conscious, or more socially responsible, cooperative way of living.

Perhaps “Consciousness,” or “Cooperative” age might have been more to the point."

Houle’s book, added to the recent exceptional article “How 21st century capitalism is failing us (BMJ 2014;349:g7516) should give you reason to ponder as you too look into your own crystal ball.

Before you read, on please understand that like the rest of you I am a Capitalist. The problem today is not Capitalism, but Crony-corrupted Capitalism. It is not serving us well anymore. This article was published in a medical journal by doctors who understand that our dysfunctional Health Care system is but a reflection of larger economic, social, political, and even spiritual problems rotting our society.

The authors use the same tools I do to arrive at their conclusions: books written by the best thinking minds of our time. For those who follow my radio show you will be familiar with the three books highlighted in this article. And now, let's step aside and quote from it:

“[Capitalism] requires a thoroughgoing democratic transformation. It leads to unfair inequality

1. “The popularity of Thomas Piketty’s book Capital was perhaps the publishing surprise of the year, but it is paradoxical for three reasons.

Firstly, its 700 academic pages are hardly an inviting bedside read.

Secondly, its appeal was primarily to people already worried by rising inequality.

Thirdly, slower economic growth leads to faster rises in inequality.”

2. Naomi Klein’s latest book, This Changes Everything--Capitalism vs the Climate

“Large corporations, particularly fossil fuel companies, have bought off governments and many environmental groups, watering down policy proposals, legislation, and international environmental agreements.”

3. Nicholas Freudenberg’s Lethal but Legal.

“Food, alcohol, tobacco, automobile, pharmaceutical, and gun industries are now the main sources of damage to public health.

Endless conflicts between public and corporate interests.

Corporations use their huge advertising wealth, media, and political influence to defend themselves.

They pack regulatory systems with people who will defend their interests, they buy politicians, and continue to maximise the sales of their products in the face of massive evidence of harm—from obesity, drunkenness, smoking related disease, environmental damage, and so on.”

“Antisocial behaviour of big corporations is a large political problem, their record on tax evasion provides it.

In 2008, the US Government Accountability Office reported that 83 of the country’s biggest 100 corporations had subsidiaries in tax havens.

“[There is a] status competition among consumers… Status anxiety is intensified by greater income inequality… more unequal societies give higher priority to buying status goods. They also work longer hours, save less, get into debt more.

“Rather than benefiting from further economic growth, health and happiness in rich countries is now better served by improvements in the quality of social relations and community life.

“Greater equality would reduce consumerism and improve the social environment.

Production is undertaken in the service of the public good, humanity, and the planet.

The obstacle is that large corporations are so powerful that our democratically elected politicians are afraid to touch them.

“Lobbying politicians and regulators by pharmaceuticals, food processing, arms, energy, alcohol compromises the democratic political process.

Solution: companies owned and controlled directly or indirectly by some or all of their employees, companies with varying degrees of employee representation on boards, consumer cooperatives, mutuals, and credit unions.

Around half the member states of the EU have at least some legal provision for employee representatives on company boards or remuneration committees.

“Democratic companies not only have smaller income differences within them but also enjoy higher productivity… Wholly employee owned companies are also part of the solution to the increasing concentration of capital ownership… More democratic businesses are more ethical.

Perhaps then our salvation lies in a thoroughgoing democratic transformation of capitalism.”

This is the only way we will fix our broken health Care system.