I generally enjoy Bill Maher. I mean, he seems like an ass, but I enjoy his shows—except when he talks about medicine. As any regular viewer knows, he regularly spouts the usual denialist canards about medicine. This week, he was interviewing Senator Arlen Specter, who, among other accomplishments, has survived Hodgkin’s Disease, a form of blood cancer. Maher had the bad taste to ask him is he was disgusted that health care is the third leading cause of death in the U.S. Had he said this to me, I would likely have responded, “Look, asshole, the American health care system just saved my fucking life!”

This is of the more popular canards propagated by cult medicine leaders and their followers. According to the wackos, modern medical care kills and injures more people than, well, just about anything. Joe Mercola and Gary Null have very long articles on their websites bemoaning the dangers of medicine versus the safety of woo. They love to make statements like, “It is now evident that the American medical system is the leading cause of death and injury in the US.”

What does this all mean? Should we, as the cultists suggest, abandon medicine for the cults of homeopathy, naturopathy, and chiropractic?

Probably not. Why do I say that? Because I’m a paid shill for the Big Pharm/AMA/FDA juggernaut? Well, no. Abandoning modern medicine for the cultists doesn’t make sense, either medically or statistically.

When cultists cite their terror statistics they leave out a few important facts. There is no doubt that medical errors, and even medical therapy without errors, can harm. No one would argue otherwise. The flip side is, it also helps—a lot. For example, one of the statistics often cited from the Institute of Medicine’s landmark study on medical error is that somewhere between 44,000 and 98,000 deaths yearly in the U.S. may be due to medical errors. Now, to put that in perspective, advances in the treatment of coronary artery disease reduced the number of deaths by over 340,000 in 2000 alone. And that’s just one disease. Of course there are risks to modern medicine—it’s active treatment, not placebo, so it can be expected to hurt some people. But it helps far more. Returning to the era of roots and berries is not likely to improve quality of life or longevity. Reducing medical errors is important, and is an active field of research. The solution to medical errors isn’t voodoo, it’s science. Anyone who tells you different is trying to sell you something.

Comments

  1. #1 Michael
    April 6, 2008

    Agreed but I think the one area where this argument has a point is the socio-political environment the medical system sits inside. The fact that in the US medicine Big Pharma DO have a larger influence than they should, the fact that there are tens of millions without insurance can only increase deaths due to medicine. For instance, if a disease is diagnosed much later chances are the only treatments left available are highly agressive ones.

    But of course you nail it on the head, the solution is obviously to make the medical system better.

  2. #2 Excluded Layman
    April 6, 2008

    Not to mention that if medicine had a perfect efficacy rate and the entire population was covered, the mortality/morbidity stats would be completely from medical errors. So, the expected change as perfect medicine is approached is a decrease in total deaths and death rates, with a climb on the death and injury rankings of mistakes–without the error rate climbing, of course.

  3. #3 Michael
    April 6, 2008

    Yep, it’s one of those cases of things appearing to get worse even though they get better — eg. the number of people dying from conflict may be increasing but the percentage of people is decreasing even more rapidly.

  4. #4 Ben_Wraith
    April 6, 2008

    Yeah, I find it quite painful watching Maher when he talks about alternative medicine. Normally I enjoy his show but sometimes the stupid really does burn.

  5. #5 Michael Chris Neglia
    April 6, 2008

    Although I agree mostly with your opinion, far too many of us have had very bad experiences in the US (and in my case abroad) with Allopathic healthcare. From one standpoint, there is a bad information technology problem in the medical industry. This problem is as much or more of an contributer to medical error than is poor diagnosis, treatment error or judgment. The way doctors and assistants handle information-multiple charts, information privacy leading to a non-sharing of medical history among themselves!-is very counter to their mission of excellent care. The industry seem to be very resistant to upgrade or change this.

    The net result is doctors have become very obviously more concerned with medical malpractice and liability than fast, efficient care. Overwhelmingly the concern is accountability and job security, second to that is personal integrity, and third to that the illusion of authoritative competence of the industry. After, these are modern medicine men and they have the final word. Since our society reinforces this authority, they become very arrogant and think they are right about things beyond medicine. This makes them very very poor at customer service since their time is felt to be more important than the patients (or anyone else’s)

    By treating patients like they are idiots, and trying to burden 100% accountability actually makes them liable for error; in other words, keeping patients in the dark by limiting their information does them a stark disservice. The medical industry wants to maintain it authoritarian unquestionability, but unfortunately it underestimates people’s ability to use information-rich resources like the internet/wikipedia to understand the truth of their conditions and treatment. (and yes the internet *can be* a good source of information when used properly)

    So, it makes sense that eventually people would turn on the medical industry from years of poor service, poor insurance coverage ($1000 for a bag of salt water??). The ‘wackos’ you mention, the anti-allopaths, cynics as well as adherents to alternative medical practices, are coming out of the woodwork. Sure, some may have a selection bias based on their experiences (ie: my friend’s grandfather died in the hospital from a misdiagnosis/treatment of clostridium dificil which was entirely preventable if the doctor had ‘listened better’ and taken it seriously…grandmother got it too (from him) and almost suffered the same fate were it not from the guidance and angry assertiveness of my friend the granddaughter), but we keep hearing more and more of these stories and believe there is something wrong with hospitals and the service there. The internet may have an effect on ‘sensationalizing’ those stories or ‘amplifying the exceptions to the rule’. BUT if the medical industry took a six-sigma approach to healthcare instead of posting statistics (from the medical industry itself- ie NIH an inherent conflict of interests mind you) then I suspect those stories would become nothing but an unfortunate rarity.

  6. #6 Mike Huben
    April 6, 2008

    Michael Chris Neglia writes:
    From one standpoint, there is a bad information technology problem in the medical industry.

    As opposed to the CAM information technology solution: reselling mailing lists of suckers who have bought the snake oil.

  7. #7 PalMD
    April 6, 2008

    Medical informatics is an issue. We in the U.S. tend to be very suspicious of anything that collects personal information, to the point of paranoia.

    Small hospitals are usually able to quickly install good electronic medical records. Large hospitals have more difficulties. Small practices have trouble affording EMRs.

    Individuals could carry a health card with their history and medications on them. Right now, pharmacies don’t communicate with each other, leading to possible prescription errors.

    Many medical errors involve information problems, and are “systems” errors rather than individual errors.

    We need to be a little less paranoid around here (but cautious, of course)

  8. #8 DuWayne
    April 6, 2008

    MCN -

    By treating patients like they are idiots, and trying to burden 100% accountability actually makes them liable for error; in other words, keeping patients in the dark by limiting their information does them a stark disservice.

    I think that this is very much dependent on one’s primary care physician. I also suspect that the current insurance paradigm is partly to blame for it.

    My family’s primary care physician when I was growing up, was an awesome source of information. This extended to some very frank discussions about the interaction between prescriptions, OTCs, illicit drugs I was using at the time and medicinal plants I was into taking.

    He was also invaluable when we found out my partner was pregnant with our first child. Though I was not even his patient anymore, he sent us a lot of great information about the safety of vaccines and then gave us a call to make sure we didn’t have any questions.

    I suspect that in large part, the problem today is that people are often forced to forgo altogether, having a family physician. While our kids are able to see the same doctor every time, my partner is relegated to seeing whoever happens to be on duty in her office. When I last had access to healthcare, it was much the same. I was unable to see the same doctor when I went in, even if I tried to set the appointment for the same doc. As I have been looking into insurance plans that would cover all of us, I have been unable to find one that’s remotely affordable, that would also allow us to use the same doctor.

    The problem with this is that it tends to lend itself to exactly this sort of information problem. It means that the doctors we might see are dependent on the information that the last doctor wrote down. It means that we don’t develop the sort of relationship with a doctor, that lets the doctor work out exactly what the patient is going to be interested in knowing. I daresay that my primary doctor from childhood, didn’t provide all of his patients with the amount and sort of information that I was interested in. He did so with me, because he knew my preferences.

    I also agree that there are serious problems with the transfer of patient files from one location to another. There seems no reason to me, that files aren’t all digital, standardized and relatively easily and securely transfered. This really came home to me with the pregnancy of our second child.

    As soon as we found out my partner was pregnant, she requested her files from our first, born across the country in Lansing MI (we’re in Portland now). Over the course of our second’s gestation, she put in no less than seven requests, the files never came through. This forced doctors to make decisions based on very incomplete information. Normally this wouldn’t be a huge problem, but there were some complications with the first pregnancy, that led to a c-section. Momma has also been on antidepressants for several years now.

    Everything went reasonably smoothly, excepting that there were significant problems with anesthesia. And the only information they had about the same problems with our first, was what I could remember. Keeping in mind that I was, of course, distracted from that stuff by the anticipation of my first child’s birth. So I didn’t know what all had been given her, I just knew that she’d had four epidurals with no effect and that the anesthesiologist was extremely concerned about our first tolerating all the drugs he had to pump into her.