Monday, July 1, 2019

Medical Myths, Lies, & Half-Truths: What We Think We Know May Be Hurting Us, by Steven Novella (author, narrator)

The Great Courses, July 2013 (original publication 2010)

We live in a sea of freely available information, easily accessed on the internet, and this can be a very good thing, especially with medical information.

Or it can be a bad things, sometimes, especially with medical information.

Much of what we think we know is wrong, or half-true, or even, sometimes, outright lies and fraud. One excellent example of the last is the anti-vaccine movement. It started in its current form in 1998 with the publication in  The Lancet of Andrew Wakefield's paper claiming to find a link between the MMR vaccine and autism. What Wakefield didn't disclose was that he had his own vaccine to promote, was getting paid by lawyers who wanted to bring lawsuits against the vaccine makers, or that he had, in fact, had to fake his results when he didn't get the results he wanted.

His paper was originally well-received, but once it was published, other researchers conducted the same research using the methodology he described, and could not reproduce his results. No one has ever been able to reproduce his results, because no, vaccines, whether MMR or others, don't cause autism. The link just doesn't exist. Wakefield lost his license to practice medicine in the UK, The Lancet officially withdrew that paper, something it has never done before in its history, and Wakefield still makes gobs of money promoting his anti-vaccine movement to the gullible and the vulnerable.

That's the example that ignites a burning rage in me, but it's just one small part of this audiobook. Many of the examples are honest misunderstandings (placebo effect really is all in your mind, with no real physiological effect), or have a basis in fact but are misapplied (honey really can be a good topical antibiotic, but shouldn't be used that way internally, that is, it shouldn't be used internally as an antibiotic, and yes, this means pregnant women should probably avoid it till the baby's born).

A persistent myth is about the supposed benefits of "natural" foods and herbal medications. Natural doesn't mean safe. Potatoes contain cyanide, and are perfectly safe as long as you only eat the potato, not other parts of the plant, they aren't green, they aren't spoiled, and you cut away the "eyes," or sprouts. This is why it took so long to figure out that mature, properly cooked potatoes are not only safe to eat, but quite nutritious. Almonds contain arsenic. There's a reason that people eat sweet almonds rather than bitter almonds, and it's not just because we tend to like sweet better than bitter. Sweet almonds contain a tiny amount of arsenic and are generally quite safe if you don't do something really crazy. Bitter almonds contain 42 times as much arsenic as sweet almonds, and are quite dangerous. That's why they were the source of the poison in so many mystery novels from the late 19th and first half of the 20th century.

Herbal medications: If it has any real pharmacological effect, it can do harm, too. And then there's the small matter of dosage, which can vary wildly between brands and even within the same brand, with no pesky FDA regulation to protect you. St. John's wort is widely touted for depression,but its measured effectiveness isn't very great. And it was being strongly promoted to AIDS patients for a while, who quite naturally can have real problems with depression and may be understandably reluctant to take more "drugs." Except St. John's wort, which may have a small effect on their depression, also interferes with the drugs that actually treat their AIDS. Oops.

Remember that herbal medicines are drugs just as much as the stuff you get from the pharmacist. And if it has any real effect, it can have bad effects, too. It can also have drug interactions as well, and if your doctor and your pharmacist don't know you're using them, they can't take them into account in planning and managing your care.

Other things may have some of the effects claimed for them, but the evidence just isn't there yet. They absolutely merit more study, but if your doctor isn't prescribing it, it's more likely because she's not persuaded by the so far minimal evidence than because she's part of a grand Big Pharma conspiracy.

Highly recommended. Steven Novella is a lot more fun to listen to talking about this than I am writing about his book. You'll learn a lot, too.


I bought this audiobook.

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