As I was sorting out some old books, I came across this one entitled: “Confessions of a Medical Heretic” written by Dr Robert S Mendelsohn, which was first published in 1979 (1). This is an absolutely damning account of medicine and although it is based on the author’s experience in the USA, there are elements which apply to most other developed countries. While it is almost 40 years since it appeared, the critique is still valid. Arguably things have got even worse since then. The position in the UK is still some way behind that of the USA but all the indications are that it is moving in the same direction.
In this blog, I will just highlight some of the main themes covered in the book. I fully appreciate that there are many who will not accept the analysis and conclusions. However many important questions are raised which deserve to be considered and answered. The author introduces himself as follows:
“I do not believe in Modern Medicine. I am a medical heretic. My aim in this book is to persuade you to become a heretic, too.”
Doubts about modern medicine
He goes on to explain that when he was at medical school he believed what he had been taught and went along with the rest of the profession. Gradually he came to realise that many of the procedures which are widely used are not only ineffective but positively harmful. One example he cites is the use of radiation to treat a thyroid condition which clearly was responsible for the development of tumours. In his own words:
“I believe the Modern Medicine’s treatments for disease are seldom effective, and that they’re often more dangerous than the diseases they’re designed to treat.”
To make matters even worse, there is are numerous dangerous procedures which are widely used for non-diseases. It would be possible to dispense with 90% of Modern Medicine and the result would be an immediate improvement in public health standards. In one clinic in Cleveland over a one-year period, there were 2,980 open-heart operations, 1.3 million laboratory tests, 73,320 electrocardiograms, 7,770 full-body X-ray scans, 210,378 other radiological studies, 24,368 surgical procedures. The author states quite bluntly that none of these procedures has been proved to maintain or improve health. No doubt many would challenge this conclusion but there have been enough examples in recent years to indicate that he has a very valid viewpoint.
Modern medicine is a religion
The argument is presented that most people have faith in their doctors and Dr Mendelsohn concludes that Modern Medicine is neither an art nor a science but is essentially a religion. His justification is that this is the only possible explanation why so many people submit themselves to all sorts of treatments and procedures. He poses the following question:
“Would people allow themselves to be artificially put to sleep and then cut to pieces in a process they couldn’t have the slightest notion about—-if they did not have faith?”
There are many examples of procedures which according to Dr Mendelsohn do more harm than good. These include:
- Laboratory tests. In 1975, a nationwide survey by the Centers for Disease Control (CDC) reported that up to 40% of bacteriological testing was unsatisfactory and over one quarter of all tests were not accurate. The CDC only regulates 10% of laboratories which means there is even less control over the others. A study in New Jersey found that only 20% of laboratories produced reliable results more than 90% of the time.
- Although this book was written before statins appeared, “cholesterol lowering” was already established. The drugs in use at the time could cause all sorts of adverse side effects (ADRs) including fatigue, weakness, headache, dizziness, muscle ache, loss of hair, drowsiness, blurred vision, tremors, perspiration, impotence, decreased sex drive and rheumatoid arthritis. That time the following information was also supplied with the drug:
- “It has not been established whether drug-induced lowering of cholesterol is detrimental, beneficial, or has no effect on morbidity or mortality due to atherosclerotic coronary heart disease. Several years will be required before scientific investigations will yield the answer to this question.”
- Blood pressure (BP) measurement. Even though raised BP may be just a temporary blip drugs may be prescribed. Many of these have ADRs. However a study conducted in 1970 found that these drugs can cause non-fatal heart attacks and pulmonary embolisms, which were not outweighed by any reduction in mortality.
- Many women are subjected to breast X-rays despite the fact that this procedure is not justified for women under 50 years old with no symptoms and with no family history of breast cancer. This procedure is also of dubious value for women over 50 because the breasts are particularly sensitive to X-rays.
- The widespread use of antibiotics. Very often penicillin is prescribed for conditions such as the common cold even though this is a viral infection which is not affected by the treatment. Nevertheless it can cause reactions including skin rash, vomiting and diarrhoea. Tetracycline was being overused so much in the 1970s that the FDA had to issue a warning because of the damage it could cause during the development of teeth during pregnancy and early childhood. We are now having to cope with the extensive resistance to many antibiotics which has occurred which means that many antibiotics are no longer effective to deal with the genuine threats of bacterial infections.
- Many drugs have ADRs and many individuals have suffered because of their use. For example, there was a high rate of vaginal cancer in the daughters of women taking diethylstilbesterol (DES) and the women themselves had an increased death rate from cancer.
One specific issue highlighted is the cozy relationship which existed between the drug companies and the doctors. At that time the companies were spending an average of $6,000 per annum on every doctor in the USA in order to influence them to use their drugs. Since most of the information on the efficacy and ADRs of these drugs is based on information generated by the companies themselves, there has to be serious doubts about the quality and reliability of the data. An investigation by the FDA found that 205 of physicians doing clinical trials were guilty of unethical practices, including giving incorrect doses and falsifying records. In one third of the reports checked the trial had not actually been conducted. In another third, the correct protocol had not been followed.
Dr Mendelsohn is highly critical of the medical profession. In his view they have allowed themselves to be corrupted and are much more interested in making money than in protecting and helping their patients.
Things are no better to-day
Although it is well over 30 years since this book was written, there have been numerous reports which not only confirm what Dr Mendelsohn has described but conclude that things have deteriorated since. For example, in his Reith lectures, delivered in 2014, Dr Atul Gawande described a comparison he made between the medical facilities in 2 Texas communities (2). One was McAllen and the other was El Paso County. Both of these counties have a population of roughly seven hundred thousand, similar public-health statistics, and similar percentages of non-English speakers, illegal immigrants, and the unemployed. Yet in 2006, Medicare expenditures which is the best approximation of the costs of health care in El Paso was $7,504 per enrollee—half as much as in McAllen (3). There was no evidence to indicate that the treatments and technologies available at McAllen were any better than those found elsewhere in the country. The annual reports that hospitals file with Medicare show that those in McAllen and El Paso offer comparable technologies—neonatal intensive-care units, advanced cardiac services, PET scans, and so on. Public statistics show no difference in the supply of doctors. In fact Mc Allen actually has fewer specialists than the national average.
Dr Gawande eventually gained access to commercial insurance data which revealed that compared with patients in El Paso and the country as a whole, patients in McAllen were given more diagnostic testing, more hospital treatment, more surgery and more home care. More detailed information was obtained from Medicare payment data. This showed that between 2001 and 2005, critically ill patients received almost fifty per cent more specialist visits in McAllen than in El Paso, and were two-thirds more likely to see ten or more specialists in a six-month period. In 2005 and 2006, patients in McAllen received 20% more abdominal ultrasounds, 30% more bone-density studies, 60% more stress tests with echocardiography, 200% cent more nerve-conduction studies to diagnose carpal-tunnel syndrome, and 530% more urine-flow studies to diagnose prostate troubles. They received one-fifth to two-thirds more gallbladder operations, knee replacements, breast biopsies, and bladder scopes. They also received two to three times as many pacemakers, implantable defibrillators, cardiac-bypass operations, carotid endarterectomies, and coronary-artery stents. And Medicare paid for five times as many home-nurse visits. So Dr Gawande had absolutely no doubt that the primary cause of McAllen’s extreme costs was, very simply, the across-the-board overuse of medicine.
Clearly Dr Mendelsohn takes an extreme view. If a person is involved in a motor vehicle accident or is having difficulty breathing then medical assistance is definitely required and can make a big difference. So there are times when it is essential. However, this does not mean that much of what is presented here can be discounted.
All the indications are that much of what he says is correct. The current approach is so deeply embedded and reinforced by powerful vested interests that it will not be changed easily.
- Robert S Mendelsohn (1979) “Confessions of a Medical Heretic”. Warner Books: New York