Kathryn Alexander

D.Th.D; Adv. Dip. Naturopathy

www.getalife.net.au

News of medical breakthroughs for new treatments that have been scientifically proven usually excites the vast majority, especially when the general risk of developing that disease may be high. Apparently, 90% of those over 55 are at risk from developing high blood pressure, so a drug that can fix this would surely be to our advantage. The old naturopaths refer to this fostering of a belief that drugs give health as ‘superstition’ as their creed dictates that the causative factors of disease are a “violation of Nature’s laws” – in other words poor nutrition and inappropriate life-style practices cause disease and that unless these are corrected, then health will continue to erode.

So we have two opposing notions: superstition, which according to my dictionary is a belief or notion entertained regardless of reason or knowledge, and scientific fact which refers to proving cause and effect. The question is, who is correct?

Most of us are not under the illusion that drugs confer health, but many believe that they at least reduce the risk of future chronic degenerative disease. If they didn’t, then why would you take them, why would GPs prescribe them and why would government bodies endorse them? They can’t all be wrong, or can they?

So I thought I’d explore the “worried well” market – this is a target group of those that do not have a disease but are frightened of getting one, in other words, the over 50s. Starting with heart disease, the high risk factors we need to watch for, according to the medical fraternity, include high blood pressure and high cholesterol. I find that the actual risk of suffering a heart attack without high blood pressure is 3-4%, and with high blood pressure, 5-6%. These risks in the high blood pressure group can be reduced by 1-2% if you take long-term medication, possibly for life. You will likely be informed that you can reduce your chances of developing heart disease by 33% - but in absolute terms this is only by 1-2%. ¹

Next comes high cholesterol. For females that have never had heart disease but do have high cholesterol levels there is no evidence of any benefit with the cholesterol-lowering drugs. In other words, these drugs do not reduce the chances of heart disease. In those who already have heart disease, women may lower the risk of a heart attack from 18% to 14% and men, from 15% to 13%. But as you can see, there is a huge majority with high cholesterol that do not go on to have heart attacks. ² This begs two questions: how much of a risk is high blood pressure and cholesterol in heart disease; and do the miniscule benefits outweigh the side-effects of long term medication?

Now we come to the scientific proof. Yes both blood pressure and cholesterol-lowering drugs do reduce blood pressure and blood cholesterol. However, as these are not major risk factors for heart disease, the scientific proof in a clinical setting (i.e. will this drug prevent me from developing heart disease) doesn’t prove anything. If you are already chronically ill and have other diseases such as diabetes, then they may be of some benefit, but even then, how much benefit depends upon the interpretation of statistical gimmicks.

Let’s move on to the medical condition known as menopause. Apparently, this hormone deficiency crisis leads to increased risk of osteoporosis, heart attacks, senile dementia and colon cancer. By fixing this deficiency with HRT women are assured that the diseases now associated with hormone deficiency are curable and preventable. It is scientifically proven that HRT does fix oestrogen deficiency, but does it fix the barrage of diseases that have been linked with it?

In 1998 the HERS trial produced its findings. This trial of 3,000 women with heart disease concluded that HRT did not prevent heart attack, but actually increased its incidence. ³ Furthermore, the publicly funded Women’s Health Initiative trial of 16,000 healthy women backed the findings of the HERS trial and concluded that HRT did more harm than good, it increased the incidence of heart attack, blood clots, strokes and breast cancer, and doubled the risk of dementia from 1%-2%. ⁴ Osteoporosis fares marginally better where 8:1,000 suffered fractures while on HRT compared to 12:1,000 on the placebo. This is a 0.4% reduction but in relative terms a staggering 33% reduction! ⁵ The same is true for the drugs used to prevent fracture; the incidence of fracture on the drug was 1%, and on the placebo 2%.⁶ A reduction of 1% or in relative terms 50%. More often than not the consumer is fed the relative statistics and not the absolute statistics.

Scientific fact seems to fall wide of the mark when it comes to “does it work?” So why is it that we continue to spend billions of dollars on pharmaceuticals (and by this I mean the blockbuster drugs which generate most of the profits for drug companies) when the results are almost meaningless.

To answer this you need to switch your thinking from “health” to “product” where the primary goal of the drug company is to maximize the sale of a drug. The first hurdle is making the average consumer worried about a condition that your drug just happens to address. Your plan of action is three-fold: you need to brand the condition, cultivate the market for acceptance and gain regulatory approval. Branding inextricably binds the “disease” with the drug with an emotive message: think of menopause, HRT and the elixir of life; or ADHD, Ritalin and getting your kids to do better at school; and SAD (social anxiety disorder), Aropax and successful life-style with no more anxiety. 

Cultivating the market is easy: you fund experts, grass root campaigns, educational pamphlets, patient advocacy groups and celebrities to shape public perception about major health problems. Celebrities and advocacy groups who provide real-life stories are not bound by regulatory requirements to disclose accurate information about the disease or product (unlike the drug companies); this ensures your commercial message is stronger than the scientific view of the product’s value. And you need to knock-out your opposition by making sure that the focus on the specific chemical imbalance and its treatment takes attention away from other effective ways of dealing with the condition. 

Finally, seeking drug approval is easier if you fund the regulators (FDA, TGA) and if you have already fostered a consensus about the condition and created public demand for your product. Once you have broadened the guidelines which define a disease (for example, bone density guidelines are currently based on those of a 30 year old; will our blood pressure be based on that of a 3 year old?) you need to orchestrate third party groups to lobby and convince the government and health insurance providers to fund your product. Let’s face it, would we pay the costs for those tests and products – particularly if they didn’t achieve much and had nasty side-effects?

So perhaps our medical culture is more about the commercial message than scientific proof. Does this constitute superstition? I think it does. I have made a list of superstitions - maybe you can add some more.

·        Drug therapy offers an effective treatment without addressing the cause

·        Drug therapy is the best therapy

·        The benefits outweigh the risks

·        Disease is a chemical imbalance with a chemical solution

·        Scientific fact is more important than clinical evidence

·        There is no cure for Chronic Degenerative Disease

What should you do?

When faced with a product, try to match any scientific evidence and product-related claims against your own diagnosis and unique circumstances. Most importantly, try to determine whether the associated risks for the product are worth while from your own perspective.

This article was inspired by the book Selling sickness: How Drug Companies are turning us all into patients; Moynihan, R., Cassels, A., Allen and Unwin, 2005; ISBN 1-74114-579-1

The in-text references are from this publication 

1.      P 91

2.      p 13

3.      p 56  (see also http://heartdisease.about.com/library/weekly/aa072300a.htm; Hormone Replacement Therapy and Heart Disease)

4.      p 57 (compare the following articles at http://mentalhealth.about.com/library/sci/1002/blestrogen1002.htm;

Long-Term Estrogen Replacement Therapy in Postmenopausal Women with Alzheimer's Disease and http://mentalhealth.about.com/library/sci/1102/blalzhrt1102.htm; Lower Rate of Alzheimer's in Women on Long-term Hormone Therapy)

5.      p 152

6.      p 151