Dabigatran/Rivaroxaban/Apixaban Doctoring Health Care Knowledge Reflection

Trust in science and medical experts

This week is a good time to talk about trust in expert opinion and science.

For the past forty years, nutrition experts in the US have warned us about cholesterol and fat. Eat too much of it and it will block your arteries, was the proclamation. Americans did what the scientists and experts said. They ate low-fat foods. You see how that worked out.

Now, the Dietary Guidelines Advisory Committee will soon tell the American people that they were wrong about saturated fat and cholesterol. Experts, who had based their recommendations on scientific evidence, will reverse course and say…oops. Our bad. The science was not that good, and, it turns out, human biology and atherosclerosis is more complicated than we thought. Eat your eggs.

More important here is not that science was wrong and that old discoveries were overturned by new evidence. That is normal. What bothers me is something Dr.David Allison, a public health professor at the University of Alabama at Birmingham, rightly said in the Washington Post piece.

… the problem in nutrition stems from the arrogance that sometimes accompanies dietary advice. A little humility could go a long way.

“Where nutrition has some trouble,” he said, “is all the confidence and vitriol and moralism that goes along with our recommendations.”

Confidence, vitriol and moralism are not just a part of nutrition advice. These human characteristics infect lots of other expert scientific recommendations. Ad hominem attacks followed my Growing Doubt on Statins post in which I questioned the value of statins for the primary prevention of heart disease. I was doing harm by doubting the benefits of a drug.

Maybe it is just me, but I sense a growing intolerance of dissent in medical science.

One problem with prevailing wisdom in medical science is that it gets into guideline statements. And in doing so, experts codify quality medical care. Here is a result: last week, an elderly patient was discharged with the diagnosis of congestive heart failure. His nurse collated 30-pages of discharge instructions on his 5 new medications–which were proven effective in clinical trials.

On those clinical trials–and proof: A piece of science news worth looking at is this week is a report from investigative journalist Charles Seife. He and his team of students found that not only was there evidence of scientific misconduct in clinical trials, the FDA knew about it, and did not notify the public or the medical establishment.

JAMA-IM bravely published these findings. Hardly a peep was heard on social media. Worse: Some of the “superior” drugs mentioned in the article sit as samples in my office, and their makers feed our office staff, and advertise on the evening news. The Brian Williams scandal pales in comparison to the scourge of direct-to-consumer big-Pharma ads.

(Staci, who is now on Twitter as @DrStaciM, and should be followed, reminded me to mention Multaq. Oh, and LifeVests, too.)

I have more. If you are reading this on a treadmill, get off and sit down: Cochrane Collaboration researchers discovered in 2012 that industry-sponsored clinical trials produced favorable results more often than independent studies. A shocker indeed.

And those are the published trials. Most trials do not get published, and non-publication is not random. This group of researchers found that negative trials are less likely to be published. Another surprise.

So, in honor of the cholesterol reversal and our reverence to all things scientific and expert, I will conclude with a link to my most important blog entry. Changing the culture of American Medicine — Start by removing hubris.


7 replies on “Trust in science and medical experts”

Good on ya again, Dr. J. for your consistent honesty and integrity on this blog.

As the practice of medicine migrates into the smothering embrace of mega-corporate culture, dissent becomes difficult or impossible.
Rote and impersonal medicine, with all it’s formulaic guidelines and mindless protocols, styled “evidence based medicine”, has become the norm, and a cover for the vast shortcomings of corporate assembly line medicine.

“Evidence based medicine” is certainly a misnomer, when the “evidence” is in reality an illusory “product” generated from an incredibly large number of faked studies and trial results, and expensive advertising and hype. Negative results are ignored and suppressed, so that the drug or procedure can be foisted off on the patient population despite the inevitability of harm.

It is all very discouraging. What gives me hope is the number of doctors and researchers who have somehow managed to retain their integrity despite the pressure to become lobotomized corporate shills.

Great post. Knowing this, who should we listen to with respect to something like nutrition (let alone anything else)?

To this day, there are experts who make compelling arguments that saturated fats are (still) dangerous to arteries (example: Michael Greger). Others argue the exact opposite (Andreas Eenfeldt).

Some blame fructose (Robert Lustig). Others blame wheat Davis and Perlmutter). Others say it’s all good but in small quantities (David Katz). Some argue it’s all about calories. And others say it depends on what the micro nutrient is (Taubes). And what, exactly, is really a “heart-healthy” diet now? I have no clue.

If you follow the money, it’s sometimes easy to see the rationale for various viewpoints: Ego, confirmation bias, being fin the pockets of some industry, etc.

Having spent the past two years personally trying to unravel the truth from all the misinformation and vested interests, I admit I’m no closer to knowing what’s healthy and what isn’t. Its’ very frustrating.

So true. I love your post on hubris. This is a good example of why we should always carry a healthy skepticism.

Despite all the good they’ve done, this seems to be a prevailing culture among experts in Public Health. Simplify the message and push it forward.

Thank you for the post! I am surprised that your office accepts samples and lunches from drug reps.

You are an inspiration for me. I am freshly minted primary care doctor out of GIM fellowship and although it is a struggle to get my colleagues to question guidelines when we teach residents, it really helps to read your column and reaffirm that what I’m doing is right and just because I’m alone in my questioning, I’m not wrong. Thank you so much

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