Safe and effective

Maybe understanding where the deception lies assists with future discernment

I confess these are ideas in evolution as I seek to help those vulnerable to being deceived.

A consequence from even physicians being deceived of late is a rejection of more traditional medicine in favor of alternative medicine. I am not opposed to alternative medicine. I am in favor of what works and what is safe. We have a menu, or buffet, to choose from and I’m burdened for all of us to have discernment regarding how to make our choices.

I’ve concluded the major source of deception is whether individual therapeutics are safe or whether they are effective. This is where even physicians got deceived.

Physicians trained in traditional medicine should understand anatomy, physiology, biochemistry, pathophysiology, and principles of diagnosis. Properly trained, we should be able to reason out why something could be effective. We then rely on the scientific method to observe whether our hypothesis that it is effective is true and whether the side effect profile satisfies a benefit-greater-than-risk ratio meriting its use.

As an anesthesiologist, I get to observe this in real time as I care for my patients. If I want to treat post-operative nausea and vomiting (PONV), for instance, it is my responsibility to know mechanisms causing PONV and mechanism of action of certain drugs to treat PONV. As I use those drugs, I observe whether they are, in fact, effective and I also observe their side effects, helping me determine scenarios in which benefit is greater than risk of their use.

For drugs outside my experience of frequent observation, I am reliant on the reported observations of others, i.e. published data or scientific research. This is what we have realized can be faked or misrepresented. Prior to the crisis of the last three years, I believed when I read a study characterizing the safety and efficacy of a therapeutic regimen that the authors had accurately presented their observations. We’ve learned, however, that perverse motives, such as greed or simply wanting to support a favored hypothesis, have resulted in inaccurate characterizations in the medical literature, and even outright faking or hiding of data, leading physicians astray. Our busyness has dissuaded us from doing our own deep dive on some subjects because we believed study conclusions or synopses of various studies were trustworthy.

The opioid crisis was my first realization that characterizations of studies and of the medical literature are not always trustworthy. As physicians, we can understand the mechanism of action and observe the effectiveness of opioids in relieving pain. The important question was whether they were safe to use for any length of time. We were reassured “a definitive study” in the medical literature demonstrated they were. In truth, this was a simple retrospective observational study that was misrepresented and, through a real-life game of “Telephone,” the misrepresentation was magnified. We, as physicians, were duped and we have an opioid crisis to show for it.

One lesson for physicians is the need for more in-depth evaluation. We must look at the data and read the studies to determine whether their claimed conclusions have merit. We cannot rely on the game of “Telephone.” We have the skills, experience, training, and expertise to do this. We have just failed to do it. We trusted the scientific literature. We trusted the “authorities.”

Our being deceived resulted in the public being deceived, and many in the public are now at a loss over who to trust. I admit I have been at a loss to defend why they should trust individuals in my profession until I began, once again, to analyze the vulnerable points of deception: safety and efficacy.

Because I realize I have been deceived by characterizations of the safety and/or efficacy of certain therapeutics, without proper personal knowledge and examination of those therapeutics, I have been much more open to exploring therapeutics I have not examined before. In that spirit, I recently attended a natural medicine conference. I was the only traditionally trained physician in attendance. Of all the lectures, only one made mechanistic sense to me. The rest seemed to rely on either questionable mechanism of action, questionable methods of diagnosis, or both. But how to explain this to those in attendance, most of whom were the lay public, to whom the lectures “made sense”?

My concern is the reaction to deception is simply making people vulnerable to other deceptions. Because I went to this conference and because I’ve demonstrated an openness to alternative medicine, I now get sent and get to explore all kinds of information defending it. Some of this information presumes that traditional medical practitioners have been blind to physiologic, anatomic, biochemical, and pathophysiologic mechanism. The tone is that we have failed to observe how the body works and we need to be re-educated given our blindness. In fact, many of these proposed mechanisms revert from depth to superficiality.

Before we had in-depth tools of observation, such as microscopes, electron microscopes, ultrasounds, x-rays, CT scans, MRIs, PET scans, and a vast variety of laboratory tests, we had hypotheses from the outside without the ability to look inside. Traditional medical training is a looking inside, with cadaveric dissection, microscopy, and all the diagnostic tools of the trade. Procedural specialties, such as surgery or anesthesiology or intensive care, are live physiologic and anatomic laboratories of observation. We are not presuming and guessing how the body works. We have the privilege of seeing it.

Just as you may try to tell me the earth is flat when I have observed otherwise by flying around it, hypotheses and mechanisms that are counter to what I have directly observed are easily rejected. I realize, however, they are easily rejected by me but not by those who do not have the access or experience in seeing what I see. Such declarations quickly inspire the accusation of arrogance. I’ve heard it. I’ve read it. If a traditionally trained practitioner pushes back against a new alternative mechanistic proposal, it is because we are arrogant and closed-minded.

Everything that has happened in the last three years has made me want to go deeper in examination and to consult with those who are more specialized. If I think there is a gap in my understanding of virology, I talk to a virologist; pathology, a pathologist; biochemistry, a biochemist; cardiology, a cardiologist; drug development, an experienced drug developer; hematology, a hematologist. I could go on and on. Granted, I have had to practice discernment as well. I have been blessed with a network of physicians and scientists who want to fairly examine and observe in-depth. They do not want to rely on hearsay, because hearsay has hurt us, profoundly.

I am at the mercy of computer scientists, mechanics, pilots, plumbers, and electricians because I do not understand the mechanisms of their trade. Unfortunately, many are at the mercy of medical practitioners because they don’t understand the mechanisms of their trade. They are vulnerable to those who present questionable mechanisms of action or questionable practices and procedures of diagnosis. They are at risk of losing time, money, health, and even life if they are deceived into believing something is safe when it is not or effective when it is not. I’m longing to be helpful to the vulnerable and deceived. I’ve confessed these are still ideas in evolution.

Maybe a means of discernment is reflecting on how someone stands to profit by the advice they give? A worker is worthy of his wages and medical practitioners need to make a living, but if their advice constrains you to a product they offer, without alternative, maybe that is an appropriate red flag? Maybe simple claims of safety and/or effectiveness that seem too good to be true are, in fact, too good to be true.