Wednesday, March 12, 2014

Letter From a Doctor

Follow the Evidence
Guest Contributor: Gary E. Foresman, MD

I marvel each day at what people believe “real medicine” is. Complex biological systems such as you, and the “extended you” known as the environment require multi-factorial analysis to even approximate the conditions necessary to treat an ailing person. Yet we use reductionistic uni-factorial analysis A.K.A. the “randomized double-blind placebo-controlled clinical trial” (RDBPCCT) as the gold standard for “real medicine”. The sales pitch to the American public is that if an intervention isn’t backed up by a RDBPCCT, its “quackery”. Primarily these kinds of trials can be funded and completed (with numbers of patients that doctors consider “significant”) only on drugs and surgery, therefore only drugs and surgery will be evaluable and thus the only “real, evidence-based medicine”.

So what does evidence based medicine say about its own system? In “A New, Evidence-based Estimate of Patient Harms Associated with Hospital Care” by John T James, PhD in the Journal of Patient Safety Vol 9. No 3, Sept 2013 p 122-128, we have an updated estimate at the human cost of Western medicine. Based on analysis of 4 peer-reviewed studies, avoidable errors in hospitals account for 440,000 deaths per year in the United States! That is one sixth of all deaths in our country and the third leading killer behind cardiovascular disease and cancer.

Furthermore, hospital-based errors inflict serious harm (non-fatal adverse events) to another 4.4 to 8.8 million Americans! Every single patient killed and harmed got treated with the best that evidence based medicine had to offer. Thank goodness they did not use those unproven holistic approaches!

Please try to comprehend these numbers, and understand that the majority of errors in medicine occur in outpatients and these numbers are not even part of this analysis, which only evaluates hospital-related events. We are not talking about mortality related to the presenting problem here, mortality and harm solely from doctors using evidence-based medicine.

The point, intention, of this article lies not in an attempt to bash Western medicine. Factor in the profit motive of Western medicine, read “Bitter Pill” in Time, March 4, 2013. Steven Brill’s opening quote: “To understand why U.S. health care spending is out of control, you just have to follow the money. This in-depth investigation of billing practices reveals that hospitals – and the executives who run them – are gaming the system to maximize revenue and sticking patients with bills that have little relationship to the care that’s provided.

The free-market in American medicine is a myth, with or without Obamacare.” As hospitals get reimbursed for the treatment of the complications related to adverse events, there is no disincentive to prevent them. The 1999 estimate of 98,000 deaths per year by the Institute of Medicine has not led to any improvement in medical care; actual estimates now are obviously much grimmer. Treating the errors in medicine, especially treating the long-term morbidity of the 4.4 to 8.8 million patients per year who survive the complications of treatment gets reimbursed very well.

The point, intention, of this article is to rally you to the point of knowingness is that what is called evidence based medicine does not even really exist. True science does not exist in the for-profit world.

Read about publication bias in “Selective Publication of Antidepressant Trials and Its Influence on Apparent Efficacy” (Erick H Turner MD, et al. NEJM. Jan 17, 2008;358: 252-60). Not just with antidepressants, but with all medical trials that do not show positive results, enormous pressure gets exerted from Big Pharma to suppress the trial from ever being published! For a true science based doctor who reads her medical journals, she is only allowed to read the trials selected by Big Pharma! That is called advertising, not research!

The facts, truly, of what US Healthcare has become, what we call evidence based medicine is the following:
Big Pharma, Big Insurance, truly the 1% who controls these interests have created an enormously profitable business at the expense of your suffering under the guise of “science” – truly a modern belief in science, not science.

By creating the belief that only a RDBPPCCT can evaluate medicine, and pricing the cost of these trials only within a range of a few, a monopoly is created whereby all methods of healing that can’t be evaluated this way are suppressed, extinguished. These other systems are not expensive enough to give the profit margin of drugs and surgery so, on average are found of no interest, as profit and not care, is the driving motive.

If a RDBPCCT does not show the results we are looking for we suppress that research, therefore ending true, authentic science. The doctor now practices using advertising guised as comprehensive research.

As mainstream media serves as the mouthpiece of the 1%, the same interests that own the US healthcare system, selective use of “research” that supports a scientifically unsupportable bias is reported to create fear about nutrition and supplements and true preventive medicine.

Prevention is bad for business, follow the money.

Even when our own research that breaks through this maya/illusion of science, we continue to prescribe and practice in the same way as your doctor wants to believe in a system they thought was going to help them heal you, and they won’t use the “quackery” of other systems.
Why Western Medicine and the US Disease-Care System fails:

Western MDs are drug and procedure dispensers forced by Big Pharma and Big Insurance to believe only in RDBPCCTs, a reductionistic model of medicine suited only for the study of drugs and procedures, not for the care of complex multi-factorial beings known as humans.

Medical Education has become so expensive and so tied to the financial interests of the 1%, that the average MD must become an enslaved automaton of the system if they ever hope to pay off their massive debt. The smart MD knows that primary care and treating the under-served is not reimbursed in a way that they could ever escape the current high interest loans needed to pay for their education. They chose specialties with expensive procedures that cause 440,000 deaths per year and untold suffering, yet are reimbursed very well.

Mainstream media serves as the mouthpiece for the 1% who profit enormously from this system, hypnotizing the public and most of our doctors into an evidence based system that documents its own failures, yet we blindly beg for more of the same.

A for-profit, drug and procedure first approach to healing simply cannot heal human beings, but can help in the treatment of advanced diseases. One could write a book on the changes necessary for healing to occur. Our medical system’s failings lie in the context of the failings of our political and economic systems.

The first step comes in the recognition of a true structural failure and a grass-roots movement to reclaim healing practices that have been discarded such as Naturopathy, Chiropractic, Chinese Traditional Medicine and so many other systems that treat people, not just diseases and thus cannot be adequately studied by RDBPCCTs.
We must find creative ways to study these systems as well and reclaim an approach to health that starts first with your individual choices, finding health-care guides that do not lead with evidence-based failure of Western medicine. True Integrative Medicine will see primary care going to the Traditional medical systems with referrals to MDs when the lifestyle and holistic approaches have not worked. That is what the evidence tells us!

Your Journey to Health and Healing,
Gary E Foresman MD

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