Many people are decrying the advancement of Donald Trump to front-runner for US President. Some observers claim to be shocked by the number of voters who respond to his simple, hard-line solutions. Some claim he’s just acting, but
there’s a reason he’s chosen to play thi s role. It works.
If we wonder why we got Donald Trump, we can look to the way people accept modern medicine. The Amazon summary of a new book, Snowball in a Blizzard by Steven Hatch, says
“The key to good health might lie in the ability to recognize the hype created by so many medical reports, sense when to push a physician for more testing, or resist a physician’s enthusiasm when unnecessary tests or treatments are being offered.” In his book Overdiagnosed, Gilbert Welch questions the usefulness of diagnostic tests. Study after study shows that annual medical exams don’t affect mortality rates.
The truth is, “preventive medicine” (sometimes written as “preventative medicine,” as if the extra syllable lends authority to a nebulous concept) doesn’t exist. Scans, screening and exams rarely prevent anything. They sometimes reduce risk and allow early detection. Sometimes the risk reduction is on the order of 3% or less, which most scientists would agree isn’t clinically significant. Often early detection doesn’t affect outcomes. In his book Less Medicine, More Health, Gilbert Welch explains that cancer comes in at least three varieties: the “birds,” which grow so fast you’re doomed by the time you’re diagnosed; the “turtles,” which grow so slowly you might be dead before you can do anything; and the “rabbits,” which have an impact when caught and treated in the early stages. That’s why so many women get cancer despite annual mammograms.
In his new book, Snowball in a Blizzard, Steven Hatch points out that blood pressure medication prevents stroke in something like 2% of people who take the meds: 20 out of 1000. The other 980 people might be harmed by the medications, which can cause problems with balance that lead to deadly falls in elderly people.
It’s unlikely that a doctor will share these odds with you during an office visit. And it’s unlikely that most people want to know.
I had a conversation with a lawyer at a dog park. She said she always had a mammogram every year because she wanted to be “sure.” I started to tell her about the books and articles that question the value of mammograms, but she cut me off. “I don’t want to know. I want to believe that I’ll be protected.”
She’s an educated woman. Many doctors would praise her “health literacy.”
And the truth is, many doctors don’t understand statistics either. They spend months memorizing molecular structure, yet have just a course or two on statistics. Many don’t know the difference between absolute and relative differences, a concept explained in many YouTube videos. You can google “Gilbert Welch Medical Statistics YouTube” and get an education.
Even worse, this desire for magical certainty has been built into the legal system. Companies demand “wellness exams” that supposedly reduce risks. Workers who refuse tests that have questionable value can be required to pay more for insurance.
Doctors are held to “quality standards,” which include testing people for conditions for which there is no statistically meaningful treatment, let alone cure.
If you enter a hospital for surgery you might be required to take pre-op tests, including cardiograms. In this case you’re not dealing with small numbers or significant. Studies actually demonstrate that these tests have no value in predicting surgical outcomes. Cardiograms come with an 80% false positive rate, which means if something looks dicey, 80 out of 100 times it’s a false alarm. Yet you might be ordered to take invasive tests with significant risks to make sure you’re okay.
On a national scale, CPR has become an industry. From flight attendants to fitness instructors, CPR has become mandatory. When you look at the statistics, a very tiny percentage of people emerge from CPR with cognition and mobility intact. Some medical people say they’d like to tattoo “No CPR” to their chests. Yet nobody questions the acceptance of this problematic intervention.
We’re looking for magic. Medicine promises magic. And so does Donald Trump.