MEDICAL GUIDELINES HAVE BECOME A
GET RICH & FAMOUS SCHEME
DR. JOHN IOANNIDIS got the ball rolling by revealing just how influential medical guidelines really are. One of the examples he used was that a simple change in the definition of what constitutes a specific disease (for instance, lowering what's considered "normal cholesterol levels" --- something that's been done numerous times over the past three decades) has the power to dramatically increase both doctor visits (specialists included) and prescriptions of an array of drugs, including ever-controversial STATINS. The specific diseases he listed include but are not limited to.....
- GERD: This one is interesting because thanks to mountains of research, the dangers of the drugs used to treat it have been increasingly exposed by the media over the past two or three years. Unfortunately, the average physician doesn't really understand the physiology of ACID REFLUX or the PPI DRUGS commonly used to treat it.
- DIABETES: There are over 30 million diabetics and another 70 million functional diabetics (PREDIABETES / METABOLIC SYNDROME) living in the US. Change the guidelines of what constitutes normal blood sugar, and huge numbers of pre-diabetics are magically converted to diabetics with the stroke of a pen. Doctors are obligated to follow a whole host of treatment rules with diabetics that they are not with pre-diabetics (i.e. diabetes is a cash cow). What's even more telling is that we've known for some time that diabetic drugs are doing little beyond changing surrogate endpoints without significantly altering morbidity or mortality (HERE).
- DEPRESSION: Nowhere are recommendations for who should be on antidepressants and who should not more scrambled than our nation's DEPRESSION GUIDELINES. This coming from a class of drug that has been shown in repeated meta-analysis to be all but totally worthless (HERE).
Although there were several others mentioned, what interested me most was that all fell under the category of INFLAMMATORY DEGENERATIVE DISEASES or AUTOIMMUNE DISEASES --- diseases that people can typically change / improve through diet and lifestyle (HERE). After sharing that the phenomenon of altering disease definitions has the potential to add billions to our already burgeoning healthcare budget, Ioannidis went on to ask the question; "Should the specialists of the respective field be the developers for such influential articles?"
On Wall Street, being an "insider" can have you thrown in jail (HERE). On the campuses of our pharm-funded medical research institutions, you had better be an insider if you hope to gain recognition or access to real money. Dr. I's paper also discussed how not only are the most commonly-cited scientific papers for any given year medical guidelines, but these guidelines often have dozens or even scores of authors, in some cases exceeding one hundred. Listen to how he described it.
"Hundreds and thousands of designated guideline coauthors share in the society-wide power game across a large portfolio of guidelines and statements that improve, fine tune, or manipulate disease definition and management. Tens of thousands of society members then cite these articles. This creates a massive, clan-like, group self-citation network."
Ah; the good-ole-boy network. When I hear that term, my mind automatically slides back to clips from 1988's MISSISSIPPI BURNING; a historical portrayal of a good-ole-boy network that was more Klan-like than clan-like, with everyone covering (lying) for each other, knowing that if one of them went down, the dominoes might start falling, with everyone ending up in prison. What would the medical experts that create the guidelines --- the "superstars" of their respective specialties if you will --- need to cover up en masse?
The word superstar is in quotes because it was used by the author to describe doctors / researchers that have even one study cited by over 2,000 other study's authors. Interestingly, Ioannidis provided evidence that the average Nobel Prize winner had no more than one such paper (obviously the one they won their prize for). In other words, it's a rarity. That is, unless you happen to be authoring the "clinical guidelines, disease definition statements or disease statistics" that the profession is essentially forced to read and follow (see quote at top of page).
Ioannidis not only had an interesting chart titled A Sample of the Most-Cited Authors in Cardiovascular Medicine, but it contained "6 scientists who have coauthored 8 or more guidelines with over 2,000 citations each." A few had more. What does this really mean? It means that a small group of academic elites are running the show. This might not be a big deal in and of itself, except for their ties to industry. Makes me wonder if we are talking about medical guideline authors or the United States Congress?
Remember back a few months ago when I showed you how some of America's top cancer doctors (MD Anderson / Sloan Kettering / others) were being paid extraordinary amounts of money to conduct and report cancer research in a certain manner (HERE) --- a situation that becomes even starker once you realize fewer than 10% of these studies can actually be reproduced (HERE)? Something similar is going on with large numbers of the creators of our medical guidelines. And honestly, it's not just the guideline creators themselves, but the journals that carry them. There are huge financial incentives for the journals that publish medical guidelines. After picking on European journals first (Ioannidis is, as his name would imply, Greek) he took a swipe an the worst-offending American journals, including the very journal carrying the paper we are currently discussing, Circulation (the official journal of the AHA).
"In the US, similarly, most of the top-cited articles in Circulation are disease statistics, disease definitions, and American Heart Association/American College of Cardiology guidelines. Nine of the 10 articles contributing the most to the 2016 impact factor of European Heart Journal and 8 of the 10 articles contributing the most to the 2016 impact factor of Circulation are guidelines, disease definitions, or statistics.... Some professional societies are behemoth financial enterprises. Massive producers of medical guidelines and of disease definitions tend to be the largest financial players, again with cardiology being the leading example. For example, the annual American Heart Association budget in the fiscal year 2016–2017 was $912 million, 20% of which came from corporate support."
I have oft-written about the ridiculous and blatant corruption in both the AHA and the ACC, hidden behind their ivory towers and white coats, putting out scientific-sounding studies like THIS, THIS or THIS. As far as corporate support, Ioannidis simply showed us another case in a steady stream of cases of the fox guarding the henhouse. The author did say that guidelines have the potential to be useful before revealing that most such guidelines have "one or more red flags that either make them overtly unreliable or should at least raise suspicion among potential users." Again, reread the quote at the top of the page.
Dr. I went on to list some of the things that make guidelines untrustworthy; but honestly it would take volumes to compile them all for you (I've done my best in THESE FIFTY-PLUS POSTS ON EBM). Suffice it to say that once you grasp the almost endless number of ways you're being screwed by BIG PHARMA, BIG GOVERNMENT, BIG RESEARCH, BIG CHEMICAL, BIG FOOD, BIG HEALTHCARE, big guidelines, big etc, big etc, big etc, you may, like exponentially increasing numbers of others are doing, start questioning everything that's recommend; CRAZY VACCINE SCHEDULES INCLUDED!
Although there were plenty of ideas kicked around to put an end to this fiasco, I'm not holding my breath that it will happen anytime soon. There's simply too much money at stake ---- something I showed you in a link provided in this recent article (HERE). My hope is that you do what it takes to stay healthy so that guidelines aren't something you even need to think about.
My recommendations / guidelines are somewhat different. I simply provide some ideas, point you in the right direction, get you thinking and researching a bit differently (a bit off the beaten track), and watch cool things start to happen (HERE). If you enjoyed this post or know people who would love to break free from the medical merry-go-round they're living on, point them to our site. And be sure to like, share, or follow on FACEBOOK as well since it's still as good a way as any to reach those you love and value most.