Drugs, Surgeries and Other Medical Interventions that Don't Work

Some medical practices may be totally useless, or even harmful. That's not just my opinion. It's shared by a group of doctors and researchers who analyzed over 3000 trials published in leading medical journals and published what they found. If you're taking medication or are about to undergo a medical procedure, you need to be up to speed.

Causing Harm and Eroding Trust

The comprehensive review was led by Dr. Vinay Prasad, hematologist-oncologist and Associate Professor of Medicine at Oregon Health and Science University. The results were published in eLife in June. He and the other nine members of the team looked at studies published between 2003 and 2017 in three of the most prestigious medical journals in the world: the Journal of the American Medical Association (JAMA), the Lancet, and the New England Journal of Medicine. They identified 396 common practices that, in medical parlance, are reversals, meaning they are are no better than standard procedures, or are only as useful or may even be inferior to placebos (in other words, no better than nothing, or even worse). The most common reversals involved drugs, while the discipline with the greatest number of reversals was cardiovascular disease. And new, it turns out, is often not better. Medical reversals often occur with new drugs or procedures. The team’s findings come on top of a previous review which found 146 reversals in the studies they looked at between 2001 and 2010. Examples of reversals include:

• Surgery for uveitis (eye inflammation) performs worse than existing drugs
• Drugs to relieve insomnia produce poorer outcomes than cognitive behavioral therapy
• Thigh-length graduated compression stockings either make no difference or make things worse in reducing the risk of deep vein thrombosis after stroke
• Mammography screening every one to two years for women ages 40–49 is not warranted
• External hip protectors are not effective in preventing hip fractures in the over 70s
• Wearable technologies for weight loss make it less likely people will succeed in losing weight
• Surgery for a meniscal cartilage tear is no better than physical therapy

The researchers believe these kinds of practices "can result in physical and emotional harm [and] undermine public trust in medicine." And yet, they write, “once an ineffective medical practice is established, it is difficult to convince practitioners to abandon its use.” They add that eliminating such practices “occurs slowly and with resistance.”

New, Expensive Cancer Drugs no Better

Two separate articles on new vs. existing cancer drugs were published in JAMA Internal Medicine in May. The first found that of the 93 new cancer drugs granted accelerated approval by the FDA in the 25 years up to 2017, just 19 showed any improvement in overall survival over existing drugs, yet only five of the 93 have been withdrawn. In the second study, the authors were critical of granting approval to new cancer drugs on the basis of tumor shrinkage when they should be focusing on clinical benefit as the preferred outcome. (It’s common for cancer treatments, both conventional and alternative, to shrink the size of tumors without extending survival time.)

Should Unproven Drugs be Released?

In an invited commentary on these two papers, Dr. Ezekiel Emanuel from the University of Pennsylvania, with two colleagues, found the FDA is too keen to approve drugs without enough proof they work. "Drugs with unproven effectiveness," they write, "sell false hope to desperate patients, who are likely paying thousands of dollars out of pocket for them. "Exorbitant drug prices are bad enough for treatments that work. Charging vulnerable patients for drugs without evidence that they actually improve patients’ survival and quality of life is unconscionable." To be fair, patients and their families put the FDA and politicians under enormous pressure to allow the use of unproven drugs in patients with a very poor prognosis (essentially, no hope). Likewise, the authorities are pressured to lower the bar for proof on drugs that treat rare diseases affecting only a few people. In general, it doesn’t pay for drug companies to spend vast sums of money to see these experimental drugs to market.

The Government’s Role is Harmful

My view is that drug companies should be required to prove a drug is safe, not necessarily effective. This would enable many alternative remedies to be legally sold and used to treat diseases as the doctor and the patient see fit. The FDA considers tons of clinical, case studies, and even placebo-controlled trial evidence for various treatments “unproven.” 

The FDA demands an arduous series of trials that often prove nothing at all but cost hundreds of millions. In effect, the “unproven” treatments are, in reality, often proven – and the proven “treatments” usually don’t work. Because the FDA insists a treatment be safe AND effective – and also due to many other bureaucratic hurdles – it costs a stupefying amount of money to bring a new drug to market, which is impossible with most alternative treatments. The drug approval process for cancer drugs is essentially a sham. A cancer drug has to add only a few more months – or even just weeks -- to a typical patient’s life to be proclaimed “new and better.” The reality is that it’s no better than existing drugs that are off-patent and cheap. The trial where the new drug outperformed the existing drug was just a statistical fluke. There’s also evidence that chemotherapy for late-stage cancer does not extend life. Those patients would be better left alone – or doing alternatives. Yet the fraud goes on and on in which untold billions of dollars are spend on treatments that make the patients more miserable than they are if untreated. The FDA’s onerous approval process is the main reason drugs are so expensive, they send patients into bankruptcy.

Summary

 

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1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6559784/
2. https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2733561
3. https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2733563
4. https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2733557?resultClick=1