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The Revolution Will Be Kuhnian.

Doctors Are Not Scientists and Related Confusion

More from the NYT report about heart disease and updated guidelines for cholesterol:

No one has ever asked in a rigorous study if a person’s risk is lower with an LDL of 70 than 90 or 100, for example.

Doctors say: I don't care about science, I care about being able to control my patients:

Dr. Rader and other experts also worry that without the goad of target numbers, patients and their doctors will lose motivation to control cholesterol levels.

In case you had any doubts about what motivates the anti-statin crowd, two doctors wrote a letter to the editor in response that reiterates the same point that I highlighted in yesterday's post:

Perhaps more dangerous, statins provide false reassurances that may discourage patients from taking the steps that actually reduce cardiovascular disease. According to the World Health Organization, 80 percent of cardiovascular disease is caused by smoking, lack of exercise, an unhealthy diet, and other lifestyle factors. Statins give the illusion of protection to many people, who would be much better served, for example, by simply walking an extra 10 minutes per day.

First, notice that all the good potential arguments fail utterly: 

  1. The argument is not that statins don't save lives, the letter authors agree they do.
  2. The argument is not really that statins are harmful, because while the letter writers mention side effects, they don't even try to claim such effects outweigh the benefits (and on the rare occasion that the side effects outweigh the benefits, patients go off the drug, duh).
  3. There's the suggestion that this is all about drug company profits, but that's just a lie. The most popular statins are no longer under patent protection. Cheap generic Lipitor is now available!

All that remains is hand waving and the sideways claim that statins cause smoking, sedentary lifestyles, and bad diets. The evidence? None. The mechanism? The magic powers invoked by "false reassurances", of course!!!

So why are these doctors taking time out of their day to worry that immoral smokers might receive life saving drugs, whining that it's all a scam to sell drugs? Because they are selling something else, a book:

John D. Abramson, a lecturer at Harvard Medical School and the author of “Overdosed America: The Broken Promise of American Medicine,” serves as an expert in litigation involving the pharmaceutical industry. Rita F. Redberg is a cardiologist at the University of California, San Francisco Medical Center and the editor of JAMA Internal Medicine.

Is there a worse credential in the world than "lecturer at Harvard"? Those who can, do; those who can't, teach; those who can't teach, get paid $2k a semester to cover a section of Intro To Anatomy and then brag on LinkedIn about teaching at Harvard!

Meanwhile, go back to the article about generic Lipitor. The problem isn't that the drugs are too expensive. The problem is that doctors refuse to prescribe the generic because they let reps from Merck fill them up with steak and bullshit. Why aren't we doing something about that?

Should we devote money and time on efforts to force addicts to stop smoking and start daily exercise? Or should we try persuade doctors to pay just a tiny bit of attention to science? The first is more or less impossible, the second is something that medical schools tell us is already true. Making it true in reality seems like a job for the AMA. Think that's what they're up to?

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