Medical Myths and the Popular Imagination II
"Truth is stranger than fiction, but it is because Fiction is obliged to stick to possibilities;
"You can straighten a worm, but the crook is always in him and only waiting."
In my last newsletter I discussed our vulnerability to false or misleading facts often reported in the scientific literature, misinformation slavishly and immediately copied by the Internet and the media. We are all average consumers of information without reliable filters to distinguish myths, rumors, phobias, and falsehoods, from verifiable fact. Following are examples, some from my previous writings.
Unproven dangers of diagnostic and other low-level radiation
Fear of exposure to low level ionizing radiation still dominates our most prevalent phobias. Fear of radiation exposure should never be invoked as a reason for omitting any indicated radiological procedure. For doses received in various radiologic imaging procedures see here. On the average each of us receives about 300 mrem (3 mSv) a year, ten times that of most radiology procedures. These levels when taken individually are so low compared to normal background radiation, and the amounts permitted radiation workers (up to a thousand times more) as to be meaningless. Denver, in the Rockies, has double the radiation level and lower death and cancer rates than most of the country .Should we evacuate Denver? Pilots and passengers of jet aircraft experience temporary exposure to high levels of cosmic rays, although nothing like the high doses received by astronauts. Such populations whether experiencing terrestrial or atmospheric exposures have not been shown to have increased cancer or other disease incidence The cancer risk of ionizing radiation has been so overhyped for the last 50 years, it is almost impossible to persuade people it is a prime example of a persistent belief, unsupported by any scientific evidence. See my previous newsletter.
Serious Questions about Prostate Cancer Screening
Each year 30 million American men undergo testing for prostate specific antigen. According to Dr. Richard J. Ablin, the man who invented the PSA test 40 years ago, in a York Times Op-Ed article this year. "Prostate screening is inaccurate and a waste of money. While 16% of men have a lifetime chance of receiving a diagnosis of prostate cancer, they have only 3% chance of dying from the disease."
Last year the New England Journal of Medicine published the two largest studies of the screening procedure, one in Europe which showed that 48 men would have to be treated to save one life. Even the American Cancer Society whose recent president, Dr. Otis Brawley, a prominent urologist, urged more caution in using the PSA test, which detects only a small percentage of cases, and cannot distinguish between the cancers that kill and the vast majority which grow so slowly that 97% of men will die of something else. Certain subsets of patients, e.g. those with a family history of prostate cancer, patients after treatment with rising levels should be tested, of course. But this is quite different from subjecting a normal population to widespread screening. Tens to scores of thousands of men who will not die of prostate cancer can no longer function sexually or stay out of the bathroom for long thanks to unnecessary cancer "treatment."
Dr. Ablin asks why PSA screening is still used, and answers his own question: "Because drug companies continue peddling the tests and advocacy groups push prostate cancer awareness" by encouraging men to get screened. Increasing numbers of early screening proponents, like Thomas Stamey, a well-known Stanford urologist have come out against routine PSA testing,
Fibromyalgia: Fact or Fantasy?
The doctor who wrote the now classic 1990 paper defined fibromyalgia as widespread pain, mostly of middle-aged women, of unknown origin, without definite physical or laboratory findings, now claims he was wrong, that the disease does not exist. He accurately predicted that Lyrica, on which Pfizer spent $50 million in 2007 to advertise, and other drugs, antidepressants like Prozac, Cymbalta, and Savella, taken to relieve sufferers will be consumed by millions of people who do not need them. Yet advocacy groups, many partly supported by drug companies, and tens of thousands of physicians who treat fibromyalgia estimate that 6-12 million Americans suffer from the disorder.
The argument over fibromyalgia brings up many thorny questions I have previously addressed in my newsletters, in particular, the medicalization of America and "disease mongering." Once the existence of a disease, disorder, or diagnosis is "legitimized" by receiving an ICD-9 designation and therefore a billing code, can a condition, having received this official imprimatur safely be called fictitious or invented? Not according to the fibromyalgia enthusiasts.
Reduced to the ultimate choice for the medical establishment, if not the public: Do we ignore millions of patients by depriving them of their disease and possible treatment, or do we save them from the exposure to more potentially risky, even life-threatening drugs and billions of dollars of needless medical attention?
Should we take Antioxidants?
I have previously reported on a study published in the JAMA analyzing data from 68 large trials involving 232,000 adults given antioxidant supplements. In some studies: "Treatment with beta carotene, vitamin A, and vitamin E may increase mortality. The potential roles for vitamin C and selenium on mortality need further study." (Vitamin C had no effect on mortality, the team found.) Has America's love affair with antioxidants proved dangerous for our health? Not likely, other experts say.
Yet other studies of healthy adults taking antioxidants have proved disappointing. After tracking nearly 40,000 women for a decade, researchers at Harvard found those taking vitamin E were just as likely as others to suffer cardiovascular disease and cancer. "There still may be subsets of people who are very responsive to the benefits of antioxidants," said Dr. Jeffrey Blumberg, a nutrition professor at Tufts who serves on scientific advisory boards for some supplement companies.
Perhaps it's time for us to give up the fantasy that high dose supplements, including, but not limited to antioxidants, will provide us with a magic bullet against disease. Any diet with average amounts of fruits and vegetables supplies ample antioxidants. There seems to be little evidence that taking antioxidants as food supplements or in their naked pill form will do anything to promote our health or longevity. Indeed, in excessive amounts they may even be harmful.
Is Salt Killing Us?
In a new report, the Institute of Medicine declares that reducing daily sodium consumption to 2400 mg. could reduce deaths by 100,000 annually, saving the country $73.4 billion. Others writing in the Annals of Internal Medicine say that a voluntary effort by the U.S. food service industry to reduce salt in processed foods 9.4% could have far-reaching implications for the health of Americans, "preventing strokes and heart attacks in nearly a million Americans and saving $32.1 billion in medical costs."! (Note the spectacular precision of these imaginary numbers, derived from...nowhere).
Among many critics is Professor Michael H. Alderman, an epidemiologist from the Albert Einstein College of Medicine who asks if the available research justifies a population-wide restriction on sodium in food. He points out that no clinical trials actually link sodium intake to increased mortality in people who are otherwise healthy. All the trials conducted so far involved only heart failure patients. Moreover, at least 13 studies on sodium consumption have been conducted with conflicting results. "Without any data on how sodium reduction would affect the general population, these clinical trials have zero relevance to public health policy," writes Alderman.
George Bakris, MD, president of the American Society of Hypertension, and a professor of medicine at the University of Chicago reminds us that the real issue is the inherent limitations of observational studies. "You would need 100,000 people followed over 20 years to get a definitive answer. The reality is that there will never be such a study."
Rumor edging into myth, misinformation, and especially junk science represent equal opportunity infections. Sadly, once wrong or unproven belief goes "viral" it takes on a life of its own, becoming hardened by repetition, habit, and time. Thus, when these beliefs are later questioned, or proven wrong, new evidence is ignored, buried in the zeitgeist of popular theology. Potentiating this basic problem is our obsession the health effects of diet and life style. In the profoundly wise words of Marcia Angell, MD, former Editor, New England Journal of Medicine, "... we have come to believe that no one gets sick anymore just because of bad luck. Instead, we see health as largely a matter of doing the right things, with the corollary that illness is a failure of some sort."
Martin F. Sturman, MD, FACP
Copyright 2010, Mathemedics, Inc.
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