Medical errors were recently reported in the New York Times as being the third leading cause of death in the United States, behind heart disease and cancer, causing an average of 251,454 deaths per year. But medical falsehoods in the healthcare system may be just as dangerous: the misinformation of doctors, clinicians, and patients is one of the main issues contributing to these medical errors.
“We are at a very unique point in the history of the global health care marketplace,” says Ira S. Pastor, CEO Bioquark Inc. “As we close in on $7 trillion in total annual health care expenditures around the globe ($1 trillion spent on pharmaceutical products; $200 billion on new life science R&D), we are simultaneously witnessing a paradoxical rise in the prevalence of all chronic degenerative diseases responsible for human suffering and death.”
Some medical mishaps are due to incompetence or human error, but problems related to treatment options and clinical studies, as presented in medical journals, are just as much to blame. Current estimates of pre-clinical and clinical research that is “irreproducible” is estimated close to $100 billion annually, according to Pastor, meaning that doctors are attempting to treat patients with information that, more often than not, is false.
Where Does the Problem Lie?
The reason why information in medical journals may be incorrect is complex and multi-faceted; it is difficult to pinpoint where the issue actually comes from.
“For the most part, I feel that researchers who are writing their medical articles want to publish accurate information,” says Dr. Matthew Brennecke, MS, ND Rocky Mountain Wellness Clinic. Somewhere, either during the study or when the study is being reported, misinformation is circulated, and this opens up the possibility for doctors to make mistakes.
“Medical professionals rely on medical journals to give us accurate information when it comes to choosing treatments,” says Brennecke. “If the information being published in medical journals is 50% false, like the editors of the British Journal of Medicine and the New England Journal of Medicine have claimed, this puts a huge question mark on the validity of evidence-based medicine.”
Medical Errors at the Study Level: Money
For the most part, medical studies are paid for by pharmaceutical companies who want to put their product on the market, making them biased at their very inception.
“This is a conflict of interest, since the researchers are being paid or are employed by the very company wanting to push that drug into the public,” says Brennecke. While Brennecke concedes that financial gain is not the only way in which these studies can be flawed -- inadequate test samples, selective publishing, and falsifying results are all possibilities -- the fact of the matter remains that many of the tests upon which clinicians base their diagnoses and treatment plans are flawed from the outset.
To add insult to injury, medical journals themselves have no way of validating each individual study. “Unless the research journals replicate each study that it publishes to verify if it is valid or not, there is no true way to really know if the research that is being published has been compromised by money,” Brennecke says.
Problems at the Reporting Level: Overgeneralization
Even when a study is completed honestly, it may not show the whole picture. Pastor cites overgeneralization in these studies as a major issue that affects a study's ability to help most patients.
“Clinical studies continue to use definitions of disease that are excessively inclusive and are based on disease characterizations from decades ago, while at the same time are excessively exclusive of major segments of the patient populace,” he explains. "A study will be crafted to show that results are homogenous by choosing patients who resemble each other in certain key ways."
In other words, a clinical study will often automatically report that Drug A 'works' for disease B across the board, whereas the actual study pre-selected people for whom the drug would likely work. He gives the following example:
“Drug A, effected some pathologic output of disease B (blood sugar, inflammation, etc.), in a carefully chosen subset of patients (no elderly people, no females, people without heart disease, people who have not taken steroids, etc. etc.) who also possess genetic differences C, D, E, F, G, H, etc.. (which we know very little to nothing about at this point in time) which will affect the degree to how well the drug works, and its side effect profile, between each individual patient.”
Studies can address one symptom of one disease as presented in one subset of the population, and the report presented in the medical journal will extrapolate that this treatment is the perfect treatment for this disease across the board.
Patients as Doctors
Yet another issue linked to these medical errors is the idea of the involvement of a patient in his or her treatment.
In the U.S., more than in other countries, patients are encouraged to be their own advocates, for example via television and magazine advertising for individual medications. The U.S. and New Zealand are currently the only countries in the world where prescription medications can be advertised directly to consumers.
While it can be useful for patients to be informed, it is also a double-edged sword. “Patients being their own advocates is a great thing, for the most part,” says Brennecke. “The problem is that patients see drug advertisements on television and in magazines that make them think that this new drug will solve their problems.”
“In my own opinion, drug advertisements to the public should be illegal as they put added pressure on the doctors to prescribe when patients insist on that particular medication,” he says.
The Solution: Treat the Patient, Not the Illness
The various studies published in different journals have one thing in common, as Pastor explains: while there are many treatments for various symptoms, relatively few cures for actual diseases have been discovered.
“The reductionist approach that is used to identify disease mechanisms or therapeutic targets continues to ignore the fact that disease is rarely (if ever) a simple consequence of an abnormality in a single gene product, but rather, is an emergent state involving multiple biological processes that interact in complex networks,” says Pastor.
“With the exception of diseases with underlying single gene causes, like sickle cell anemia for instance (single gene mutation based diseases represent only about 1% of all diseases) the majority fall into this category as all chronic diseases are multi-genic,” he says.
It is important, as opposed to seeking treatments for symptoms, to uncover root causes of diseases and to treat patients, not as a list of symptoms, but as individuals.
“The more we learn, the more we realize that every patient’s disease is a ‘rare disease,” says Pastor. “A major personalized medicine shift towards a patient / physician centric “n-of-1” drug development model is the only way out of this situation,” he says.
Work also needs to be done in ensuring that the source material from which our physicians are working is correct.
Brennecke cautions against continuing to allow independent drug companies, often also seeking symptom treatments as opposed to cures, to publish their own trials without an outside source replicating the research.The more we pay attention to the trustworthiness of published medical information, the more our medical professionals will have the tools to treat without medical errors.
“This is biased research we're getting," and Brennecke says that "inhibits the validity of healthcare treatment options available to medical professionals.”
Medical image via Shutterstock