I saw this funny mug on my Facebook feed this morning, and it got me thinking:
Is this sage and sober advice, or an attempt by a paternalistic institution to intimidate its customers into compliance?
Obviously, you can find some pretty crazy stuff on Google. But then, you can also hear some pretty crazy stuff come out of the mouths of doctors.
So maybe the question shouldn’t be an either-or, but rather an exploration of how you decide what to believe.
Consider the Source
When you hear anything, you automatically consider the source. If you like and trust the person who’s speaking or writing, you’ll naturally lend more credence to their views.
Historically (meaning, for the last hundred years or so), doctors have maintained a monopoly on credibility, at least compared to their healthcare competitors like naturopaths, chiropractors, shamans, and nurses.
So when four out of five doctors recommended Camel cigarettes, or prescribed thalidomide for morning sickness, or Vioxx for arthritis, or Lipitor for women with high cholesterol without prior history of heart disease, or Prozac for mild to moderate depression, we’ve tended to believe them.
Until enough evidence emerged to indicate that these were (and in the last two examples, still are) really bad ideas.
If the medical establishment has a history of being spectacularly wrong, maybe we need to examine the source of their information.
Consider the Source of the Source
Basically, medical education is funded by pharmaceutical companies. Doctors are trained to look at people and see discrete disease states, and then prescribe a pill to deal with the symptoms.
(I want to make it clear that I'm indicting the system, not individual doctors, most of whom do the very best they can for their patients with the information they have.)
That’s why doctors learn nothing about plant-based nutrition as the most effective means of treating most chronic diseases. That’s why lifestyle medicine specialists are so thin on the ground. That’s why they continue to recommend and prescribe drugs whose benefit/risk ratios are terrible. They don’t know, and worse, they don’t know what they don’t know.
If doctors get their training (in med school, journals, conference, and continuing medical education courses) from drug companies, what’s wrong with that? Maybe the drug companies are doing the best research on how to make us well. After all, they’re a highly regulated industry, and every one of their products has to go through a rigorous vetting process by the Food and Drug Administration (FDA).
Oh, where to start?
First, pharmaceutical companies frequently use misleading statistics to convince doctors that their products are much more effective than they really are. (See my video The Sleaziest Number in Medicine for an example). And conveniently enough, doctors aren’t taught enough statistics to defend themselves against these half-truths.
Second, pharmaceutical companies get to perform multiple studies until they get the results they’re looking for. That’s right: a pill can be shown to be absolutely useless in 15 studies, but if it shows a statistically significant improvement over a placebo in only 2 trials, then the FDA will approve it.
Third, the FDA is basically a rubber stamp for the pharmaceutical industry. According to Forbes magazine, which has historically been a big booster of big pharma, the rejection rate for new drugs in 2015 was 4%, or a little over half the percent of Americans who believe that Elvis is still alive and the moon landing was a hoax.
Fourth, when none of the above will work, pharmaceutical companies have proven themselves quite willing to lie and doctor the data (interesting verb there) to protect their financial interests. Here’s a fun list of pharmaceutical fraud settlements in just the past 15 years. And those are the ones in which they got caught!
So What About Google?
Clearly, just going to your doctor and accepting their advice without doing your own research is a terrible idea. But is Google much better at providing unbiased, evidence-based information and advice?
Not really. When you search Google for medical issues or treatments, the sites that populate the top listings are either paid pharmaceutical ads masquerading as informational sites, or AMA-approved sites that parrot the official medical line like WebMD, Mayo Clinic, and the disease organizations.
For example, here’s the Google Search Engine Results Page (SERP) for the term “diabetes.”
I’ve sized my browser window to 720 pixels high, and the majority of the page is taken up by paid listings – that is, ads by drug companies. Below the three ads are the organic listings. As you can see, only one of them appears “above the fold,” meaning I don't have to expand the browser window or scroll down in order to see it.
(In the interest of space, I've cut off the second and third organic listings (Medical News Today and WebMD), but I'll talk about them below.)
The right column contains suggestions for additional searches, since “diabetes” can refer to several different disease states.
Ad #1: Trulicity
The first ad, titled “Blood Sugar and Diabetes,” clicks over to Trulicity.com, a site created by pharma giant Eli Lilly to promote their once-a-week diabetes pen Trulicity. After explaining how Trulicity works, the home page shares a couple of hopeful graphics showing how effective it is at getting the A1C level below the 7.0 threshold.
The two doses get 66% and 78% of subjects’ A1Cs below 7.0. Which sounds amazing, right? Not so fast – and I'll get to why this isn't so amazing in a bit.
Ad #2: Welchol
The second ad, “What is Type 2 Diabetes?”, takes us to the website for Welchol, a drug manufactured by pharmaceutical company Diaichi Sankyo Inc. According to the site, Welchol is proven to lower A1C levels when added to certain other diabetes meds.
Ad #3: Farxiga
The third ad, titled “Adult Type 2 Diabetes,” takes us to farxiga.com, a website created by AstraZeneca to promote its diabetes drug Farxiga (scientific name: dapagliflozin). Another page on the site explains that Farxiga lowers A1C levels and removes blood sugar.
Organic Listing #1: American Diabetes Association
The first “organic” (that is, not directly paid for) link takes us to the American Diabetes Association (ADA) website. The description of this organization on the SERP is: “Their mission is to prevent and cure diabetes and to improve the lives of all people affected by this disease.”
Click on Our Corporate Supporters to reveal the ADA's “Banting Circle Elite” donors who pony up a minimum of half a million dollars each per year. Here's the current list:
With this kind of industry influence, you might expect that the ADA would focus much more on drugs than prevention and reversal of type 2 diabetes through a diet proven to do so, the whole food, low protein, low fat, plant-based diet.
To put this hypothesis to the test, let’s click the “It’s Time to Eat Well America!” link and find out what the ADA recommends as the best diabetes diet.
The two featured recipes say it all.
Oh, and while this isn't about pharmaceutical influence, it's telling that two of the ADA's National Sponsors are Boar's Head and Dannon Light and Fit Yogurt.
Organic Listing #2: MedicalNewsToday.com
The second organic listing after the ADA is Medical News Today. Their diabetes main page is framed by advertisements on the top and right for an albuterol bronchospasm reliever made by Teva Pharmaceuticals:
This online source is funded entirely by advertising. I took a peek at their page for advertisers to see what sources of funding they are actively soliciting:
The top three advertisers mentioned are “pharmaceutical, biotech, and medical device companies.” And the copy promises them “access to our large, high quality, and information hungry audience of healthcare professionals and patients/consumers, carers, and family health decision makers.”
In other words, you and your doctor.
Organic Listing #3: WebMD.com
This trusted site is also funded entirely by advertising. As you can see, they target consumer package goods companies and pharmaceutical and medical device companies for direct-to-consumer access, and a special program including access to healthcare professionals.
WebMD couldn't be more blunt about the value of this access:
Consumers whose lives depend upon correct information are put in the palm of advertisers' hands. Hmmm. Looks like the free information available to moms, asthma sufferers, diabetics, and many others is just bait to get you into the clutches of pharmaceutical company advertising.
You might argue that advertising doesn't really matter. After all, major newspapers take advertising, but you can still trust their news coverage.
To which I'd respond: Can you really? And do you honestly believe that any of these advertising supported sources would publish information that would jeopardize their advertising revenue?
Alternative Sources of Information
So if your doctor and Google are both regurgitating drug company marketing, where should you go for truthful and useful information?
Here are four sites that you should get good at using:
PubMed is a site run by the US government, and allows the public to search the US National Library of Medicine at the National Institutes of Health. Meaning, you can get direct access to the abstracts of original research articles; the same articles that good-looking young drug reps (many former college cheerleaders) bring to doctors’ offices as they peddle the pill of the month. Sometimes the entire article is available to read or download, and other times it’s protected by a steep paywall.
Here’s the result of a search for Farxiga, the AstraZeneca drug we found during the Google search:
Armed with the drug's scientific name, dapagliflozin, we can look for studies that can help us decide if the risks and side effects of the drug (and every drug has risks and side effects) are worth the potential benefit. The title of the third listing includes a golden phrase, “long-term efficacy and safety”: that's what we're looking for. As a bonus, the article is recent (April 2015) and includes a free link to the entire article.
Unfortunately, when we get there we find that the only positive outcome measure that has been studied is weight loss; the rest are biomarkers (results of lab tests) like blood pressure and A1C levels. The drug does seem to cause urinary and genital tract infections.
But since the big problem with diabetes is death by coronary artery disease, we really want to know if the drug can reduce the incidence of heart attacks, strokes, and heart failure. The review article concludes, “A pivotal outcomes trial of dapagliflozin is expected to clarify its effect on cardiovascular endpoints.”
In other words, we have no idea.
DailyMed (not DailyMed.com, which is a newsletter) is the US government's library of drug information, including the clinical trials based on which the drug companies produce their marketing.
While there are a lot of problems with drug trials, some of which we've already examined, the published trials at least contain some raw data. This allows us to peek behind the statistical curtain and see how the Wizards of Ads are manipulating that data.
Here's the DailyMed search result for Trulicity:
The trick here is to scroll down to the section titled “Clinical Studies.”
Click on the plus sign to open that section, and scroll down to view all the published clinical trials on the drug.
At this point, you may need some instruction and practice to make sense of the clinical data. So let's do it.
Remember that lovely graphic from Trulicity.com, showing the high percentage of patients who got their A1C below 7.0 using Trulicity? Well, here's the data table where those numbers came from:
Here's the key takeaway. While the two doses of Trulicity did get 66% and 78% of patients to 7.0 or lower, an older drug achieved that same result in 52% of patients. And – here's the kicker – a placebo, an inert sugar pill, accomplished the same feat in 43% of patients studied. So the actual effects of Trulicity aren't as impressive as they seem on the Trulicity website.
This NNT (Number Needed to Treat) calculator helps you separate the hype from the reality in interpreting drug trials. NNT is a very intelligent and underused way to think about the risks and benefits of various treatment options. Basically, NNT answers the question, “how many patients need to be receive this treatment for one person to get the particular benefit under study?”
Let's plug in the Trulicity numbers and see what they tell us:
This says that three people would have to take Trulicity 1.5mg for one person to benefit from the treatment. In other words, your chances of being helped by Trulicity are the same as choosing the winning curtain in The Price is Right: 1 in 3.
And that's the most favorable comparison. Go to Clinicalc and enter two other comparisons (Trulicity 0.75mg vs placebo, and Trulicity 1.5mg vs Exenadine 10mcg) and you'll see the following:
Trulicity 0.75 vs placebo
Now we need to treat more than four people for one to benefit. Your chances of benefiting are now about 23%.
Trulicity 0.75mg vs Exenadine 10mcg
If you're on the low dose of Trulicity, you have just a 14% chance of doing better than on Exenadine.
TheNNT.com also deals with NNT and percent chance of being helped, but unlike the drug studies, the researchers at TheNNT.com deal only in clinically significant outcomes: help and harm.
They also don't look at individual drugs, but entire classes of treatment. So in the case of glycemic control of type 2 diabetes, which is the mechanism by which all the drugs we've looked at act, TheNNT.com compile data from multiple studies to tell us if it's a good idea.
As you can see, it most emphatically is not:
The entire strategy of A1C control to treat diabetes doesn't prevent death, or stroke, or heart attack, or kidney failure. It prevented limb amputation in 1 out of every 250 patients. And at the same time, the treatment harmed 17.5% of patients who needed to be hospitalized for the severe hypoglycemia caused by the various meds. In the highlighted footnote, the authors note that the number harmed by hypoglycemia would be 35% if the data extended out another 5 years.
What About Other Options?
As you can see, both Google and the medical establishment will typically lead you down a primrose path of overpromising and underdelivering pharmaceutical drugs.
When you explore the data for yourself, you can determine just how effective and/or dangerous the treatments are.
But there's really no reliable search engine for what actually works. It's not easy, for example, to find links to Dr. Neal Barnard's clinical trials showing complete reversal of diabetes in 24 out of 25 study participants. Or various other studies showing the benefits of a whole food, plant-based diet.
Lifestyle medicine (ie, “What got us into this mess is what's going to get us out”) is still a hit or miss concept in our society (mostly miss). Obviously, there's a lot more money to be made from disease than wellness, from pills than produce, from chronic management than cure.
And until the medical profession feels obligated to share objective information so you can make informed choices about your health, you'll have to do the best you can for yourself.
One More Credible Source
Or you can work with someone like me. Yeah, I'm a three-times published health author, and five-times published marketing author, but here's what's more important: who pays me.
When we work together, I use a pure fee-for-service model.
That means you're the only one paying me. Not drug companies, not device manufacturers, not cold cut or dairy conglomerates. Just you.
Since I don't have any conflicts of interest, I get to work for your best interests. I share unbiased information and help you make the best healthcare decisions for yourself and your loved ones.
If you'd like to chat about working with me to develop your own ninja health-sleuthing skills or to use mine on your behalf, fill out the form below and we'll schedule a time to chat.