The dark secrets your doc­tor won't tell you

Which medicines claim more lives than they save? How is a dis­ease in­vented? What cri­te­ria is used to de­cide who re­ceives a donor or­gan? Worldof Knowl­edge ex­plores the dark secrets of medicine…

World of Knowledge (Australia) - - Front Page -

The con­tract does not re­quire a sig­na­ture, a spo­ken agree­ment or even a hand­shake to be valid. It au­to­mat­i­cally comes into force ev­ery time you set foot in the doc­tor’s surgery. The ‘con­tract’ be­tween doc­tor and pa­tient states that ev­ery doc­tor is obliged to pro­vide their pa­tient with clear in­for­ma­tion, to treat them to the best of their abil­ity and to keep them out of harm’s way. But what many peo­ple don’t re­alise is that doc­tors break this con­tract ev­ery sin­gle day. Of­ten un­wit­tingly, but some­times de­lib­er­ately. There are three main rea­sons for this: 1. IG­NO­RANCE: Even the most ground­break­ing of med­i­cal find­ings can take sev­eral years to fil­ter through to front­line doc­tors. An ex­am­ple: for three decades, stud­ies have found that the seda­tive di­azepam (Val­ium) is as ad­dic­tive as heroin – yet it is still be­ing pre­scribed to mil­lions today. 2. DIS­HON­ESTY: “What would you do if you were in my shoes?” Many doc­tors dread this ques­tion and fail to give an hon­est an­swer or of­fer pa­tients their true per­sonal opin­ions. An ex­am­ple: a sur­vey car­ried out at Duke Uni­ver­sity in North Carolina asked doc­tors whether they would rec­om­mend their pa­tients un­dergo the same bowel can­cer treat­ment that they would choose. The find­ings alarmed even the ex­perts: of the 500 physi­cians sur­veyed, a stag­ger­ing 40% ad­vised their pa­tients to have an op­er­a­tion that they would per­son­ally re­ject be­cause of the many neg­a­tive side ef­fects. 3. MIS­IN­FOR­MA­TION: In re­al­ity, more than 50% of funded drug stud­ies are in­flu­enced in favour of the phar­ma­ceu­ti­cal firms that fi­nance them. Joel Lexchin of York Uni­ver­sity, Toronto, an­a­lysed 30 re­ports on re­search funded by drug com­pa­nies and found that they were four times more likely to be pos­i­tive than in­de­pen­dently funded stud­ies. “We found that in al­most all cases there was a rather heavy bias in favour [of a drug] when the study was industry funded,” he said. That means doc­tors of­ten rely on bi­ased re­search, but this is rarely com­mu­ni­cated to those be­ing treated. Some­times doc­tors don’t re­alise this them­selves. Now one or­gan­i­sa­tion has de­clared war on this is­sue. The Cochrane Col­lab­o­ra­tion is a net­work of physi­cians and sci­en­tists that has been op­er­at­ing for the last 20 years. Dur­ing that time it has de­vel­oped into an un­of­fi­cial qual­ity con­trol in­sti­tute for med­i­cal prod­ucts and tri­als. The group’s name and ethos are in­spired by Dr Archie Cochrane, one of the found­ing fathers of ‘ev­i­dence-based medicine’. The re­searchers’ aim is to fil­ter the un­bi­ased and di­ag­nos­ti­cally con­clu­sive re­sults from stud­ies com­mis­sioned by phar­ma­ceu­ti­cal com­pa­nies ea­ger to get their medicines to mar­ket. To pre­vent this, sys­tem­atic check­ing and com­par­ing of dif­fer­ent stud­ies aims to con­trol the ef­fi­cacy and risks of a drug – and the health of pa­tients as a re­sult. Today, 37,000 sci­en­tists in 100 coun­tries con­trib­ute to the Cochrane Col­lab­o­ra­tion as un­paid vol­un­teers. Their goal: mak­ing sure medicines ac­tu­ally ben­e­fit pa­tients. “Some of the treat­ments I had been taught to give at med­i­cal school were ac­tu­ally harm­ing, and some­times killing, my pa­tients,” says the or­gan­i­sa­tion’s founder, Sir Iain Chalmers. “With the best of in­ten­tions, doc­tors and other health pro­fes­sion­als can do harm. Every­thing starts from that.”

On the fol­low­ing pages World of Knowl­edge, aided by lead­ing in­de­pen­dent med­i­cal ex­perts, re­veals how med­i­cal tri­als can be in­flu­enced, which in­for­ma­tion doc­tors would rather keep se­cret and how some doc­tors put at risk the most im­por­tant com­mod­ity a hu­man be­ing pos­sesses – their health.

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