Map of life expectancy at birth from Global Education Project.

Monday, June 06, 2005

medical science, quackery, and democracy

A few months back I read a full-page ad in the NYWT, attacking the pharmaceutical industry, placed by Matthias Rath, M.D. For the most part, the ad made valid or at least defensible points. I got a minor tickle of pleasure from seeing somebody spend a lot of money to say many of the same things I have said here, but in a place where a few people might actually read it.

Yes, drug companies use misleading advertising to sell overpriced and even dangerous products to people who don't really need them. Yes, they invest billions in developing new drugs that offer marginal benefit to humanity but which they can overhype in order to extend their patent monopoly. Yes, they neglect to test, develop and market natural products with therapeutic promise that they can't control by patent and which therefore offer limited potential for profit. Yes, they conceal or underplay the risks and harms of their products. Yes, they manipulate physicians by bribery and deception. Yes, they use the immense profits they extract from the sick and suffering to control politicians and capture the regulatory apparatus.

So why am I not cheerleading for a medical doctor with the guts and resources to take them on?

Because he is even worse. Rath claims that antiretroviral drugs cause AIDS, and that large doses of vitamins prevent HIV disease. He is an important force behind the skepticism over HIV pharmacotherapy in South Africa, where, by an interesting coincidence, he markets his vitamins -- no doubt that helps to explain how he can afford full page ads in major newspapers. He claims that nearly all diseases are caused by a deficiency of lysine and vitamin C. There is a scientific term for Dr. Rath's claims: bullshit. Dangerous, deadly, destructive bullshit.

But Rath, Deepak Chopra, Andrew Weil, and other prominent dissenters from medical orthodoxy, are seen by many people as politically and socially progressive. Medicine is indeed big business. It has traditionally been paternalistic, hierarchical, authoritarian. Many of its ideas seem impenetrable to average people. It extracts enormous wealth from society, and physicians get a major chunk of that. By most people's standards, doctors are wealthy and highly privileged, they inflict pain on us and give us potions that frequently make us sick, and most of the time, they can't cure us of our most troubling problems.

To many people whose instincts are to distrust authority, to denounce privilege, and to promote the power and autonomy of ordinary people, Rath and the gang seem to be offering a message of liberation, to be standing with the peasants against the feudal lords. In fact, they are nothing but thieves. Worse than that really, if they convince people to forgo effective medical treatments in order to pursue their phantasms of hope.

Medicine is imperfect. It is corrupted in many ways by avarice. It is infested with stultifying traditions and prejudices. It is undemocratic, mysterious, insular, self-involved, sometimes inhumane, sometimes incompetent. But it does have an essential saving grace: the fundamental attitude of science. In the end, medical practice will stand or fall based on reference to reality. Experimentation, systematic collection of data, logical analysis. The drug companies may sell us snake oil for a few years, surgeons may perform unnecessary procedures because their financial self-interest subtly influences their decisions, effective treatments may go unrecognized for a time because the financial incentive to pursue them is lacking. But the truth is out there, and it can only win in the end.

The problem of democratizing science and medicine is one of the most critical challenges we face, not only in the U.S., but as a species. I'm almost as afraid of technofascism as I am of the horrifying rise of superstition and willful ignorance as popular movements. But replacing science with nonsense is the opposite of a solution.

Visit quackwatch for a boatload of info and opinion. Dr. Barrett goes a little too far sometimes (he's a man on a mission), and he sometimes doesn't realize that he's suffering from the disease I call the orthodoxy of skepticism (there are certain things that skeptics are supposed to believe, even if the evidence is thin). But on the whole, it's a great resource.

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