The body is the house of God.
—Proverb of the Outer Temple of Luxor, Egypt
In the last century we’ve discovered antibiotics to cure deadly infections, surgical techniques to transplant hearts, and cures for most forms of infertility. Many of us alive today would have long since died were it not for some of the astonishing medical advances seen in recent decades. We live an average of twenty years longer than our great-grandparents. Calling modern medicine a scientific miracle is no exaggeration. That’s why I have used it, you have used it, and we should all be grateful that we can continue using it. We will also benefit from, and should therefore encourage, more medical research.
However, just as even the best individual drugs have some bad side effects, modern medicine has some unintended and harmful consequences. We are using too much of it; it can be risky; it is bankrupting us; and we have forgotten how remarkable our own bodies are at healing without medicine. For example, we’ve all heard about how bad it is to use antibiotics when we don’t need them. What you may not know is that this problem alone causes more than 700,000 deaths each year due to resistant superbugs. If we don’t act now to prevent this “antibiotics apocalypse,” the number of deaths is predicted to rise to 10 million by 2050. This is frightening, but it’s just the tip of the iceberg.
According to the most recent CDC metastudy surveying parents and pediatricians, one in seven boys in the United States is diagnosed with attention deficit hyperactivity disorder (ADHD)—and more than half of those diagnosed are treated with methamphetamines, either exclusively or in combination with behavioral therapy. One in ten adults in developed nations take antidepressant drugs that have harmful side effects and can lead to dependence. Statins are recommended for almost everyone over age fifty as a way to lower cholesterol in the blood, yet there is a debate about whether they work at all for people with low baseline risks. Some elderly (over age sixty-five) people get antipsychotic drugs to prevent dementia, although most will never experience it. More than half of elderly Americans, British, and Canadians take at least five prescription drugs each day, with some taking more than twenty, their lives a nonstop ritual of pill popping, then managing side effects.
All of this can be deadly. Prescription painkillers kill more people than heroin and cocaine combined in the United States; as I explained above, overuse of antibiotics is creating dangerous superbugs; and 80 percent of people who take several pills at a time have side effects ranging from shortness of breath to death. In fact, medical errors are the third leading cause of death in the United States, with fatal prescription-drug errors alone killing more than 100,000 people each year.
We all want treatments to help out-of-control young boys, but it is hard to believe that one in seven of them need methamphetamines to survive going to school. Most people would want the option of taking antidepressant drugs for serious depression, but do 10 percent of people in the developed world really need them? We all want to manage painful conditions, but if there are options that don’t lead to dependence and death, shouldn’t we explore them? And of course we want our elderly friends and family to remain mentally alert, but it is hard to believe that they all need to be given potentially dangerous antipsychotics to prevent dementia that may never appear. In fact, recent research is starting to show that when elderly people stop taking some of their prescription drugs, they fare better than those who carry on taking all of them. In spite of this harm caused by medicine overuse, 80 percent of research funding goes to finding more drugs while just a fraction goes toward preventing disease.
The overuse of medicine is not only unhealthy, it is in danger of bankrupting us. Americans spend more than 300 billion U.S. dollars on prescription drugs every year, Canadians spend more than 28 billion, and medical spending in the United Kingdom has almost doubled (in real terms) in the last decade. It’s become so bad that health-care spending has become a threat to national security in the United States.
Because of all this unnecessary treatment, expense, and harm, it is tempting to reject modern medicine altogether, and that’s just what some people do. Conspiracy theories about corrupt Big Pharma abound, with some claiming that all drugs are bad. This view is grounded in some valid facts. Glaring financial conflicts of interest guide the research agenda to areas that are profitable for the pharmaceutical companies but that are not necessarily health priorities. The same bad medicine that bankrupts individuals and undercuts national health services generates even higher profit margins for drug companies than banks.
Worse, some pharmaceutical companies have been shown to manipulate their results to make their drugs look more effective and less harmful than they actually are. Governments allow this to happen by turning a blind eye to regulation or not enforcing the regulations they have. This means that drugs are often approved based on shoddy evidence. Even basic data about the harms caused by statins are kept secret, and more than half of new cancer drugs are approved without sufficient evidence to show that they extend or improve life. Academic researchers who are supposed to be independent of financial conflicts are all too often tied to it. Big pharma, together with government and academic colluders, has become an out-of-control monster.
Scare tactics exacerbate the problem even further. It’s become common to take fairly normal mental traits, give them new names, and classify them as diseases so that they can sell pills they happen to have manufactured to solve these “problems.” For example, most of us sometimes have trouble focusing on things—it’s normal. Yet there is now a name for it: adult attention deficit disorder, which can be treated by methamphetamines. There is an increasing worry that diseases are being exaggerated and even invented to sell cures—this is called “disease mongering.” All this needs to change by aligning the interests of our health with those of profit.
This expense and harm might be justified if there was a clear benefit. But for almost the first time since World War II, life expectancy is going down in the United States and has stopped going up in the UK, while rates of depression are soaring in all developed nations.
Rejecting all pharmaceutical drugs, however, goes too far. Many drugs work: morphine reduces pain; adrenaline successfully treats anaphylactic shock; statins prevent heart disease in high-risk individuals; and polio vaccines prevent polio, to name just a few. The problem arises when we allow pharmaceutical companies to evaluate their own products. If we let them get away with this, we should not blame them for coming up with results that suit their interests. The answer to the conflict-of-interest problem is to campaign for the independent and transparent evaluation of drugs.
This is starting to happen, perhaps most notably owing to the AllTrials campaign, and after reading this book you’ll be qualified to detect bad evidence. And we can’t forget that we need the pharmaceutical business for innovation, because academics are simply too slow (trust me). Finally, there are actually some good pharmaceutical companies out there, with the Mario Negri Institute for Pharmacological Research in Milan leading the way. Following Jonas Salk, who refused to patent the polio vaccine—he famously said, “You can’t patent the sun”—Mario Negri refuses to patent their discoveries in order to make their drugs affordable to all. These stories are just a few showing it is not true that all drug companies are evil.
Another way people reject modern medicine is by becoming too trusting of alternatives. Some forms of alternative medicine, especially acupuncture for back pain, have been scientifically proven to be effective and are safer than many more “conventional” options, such as surgery. Alternative practitioners are also often better at exploiting placebo effects and the benefits of mind-body self-healing than practitioners of conventional medicine.
But it’s not true that all alternative treatments benefit people, and there is rarely proof that they work better than conventional options. Also, the alternative medicine industry is exactly that: an industry. As such, they fall prey to the same conflict-of-interest problems as pharmaceutical companies, albeit on a much smaller scale because there is less money in it. Finally, many alternative healers often ask patients to accept a spiritual worldview that some find hard to swallow.
The good news is that there is a middle way that neither condemns all pharmaceutical drugs nor praises all alternatives. The middle way transcends that dichotomy and uses modern medicine’s method (megastudies called “systematic reviews”—more about these in Chapter 2) to investigate mind-body self-healing. I have spent the last ten years doing these systematic reviews, and I’ll go into much more detail about them in the upcoming pages, but here is a summary:
Other researchers have also conducted systematic reviews in this area and have shown that relaxation and meditation can reduce symptoms of asthma, anxiety, heart disease, depression, insomnia, diabetes, back pain, and stress and increase a sense of well-being. A systematic review with fifty-three trials showed that placebo surgery was as good as “real” surgery more than half of the time. Another systematic review with more than 300,000 people found that people who had closer connections to family and friends lived longer than those who didn’t, and that being socially isolated is as bad for health as smoking. Yet another study showed that doctors who take the time to interact with diabetic patients can reduce blood sugar levels by as much as drugs. Positive thinking, empathy, and placebos can no longer be viewed as fuzzy imaginings that affect “soft” outcomes: there is even evidence that they affect your brain and your DNA. Much of this was previously considered “alternative medicine,” but my book shows that it should be recognized as evidence-based medicine.
The problems with too much medicine, combined with the growing science of mind-body medicine, have reached a tipping point, and people are taking notice. In October 2017, the problem with deadly prescription painkillers was declared a national emergency in the United States and the Executive Office of the President estimated that the crisis costs $504 billion per year. The Mayo Clinic has started giving daily ‘take care of yourself’ advice, while Dr. Wayne Jonas (a senior US military physician) is promoting mind-body self-healing on a large scale. In October 2016 the telegenic Dr. Chris van Tulleken (a celebrity doctor in the UK) presented a BBC television show called The Doctor Who Gave Up Drugs. Chris met patients who were taking pills for depression or pain and told them, “I can do anything for you . . . except give you pills.”
In one instance, a woman named Sarah had been on antidepressants for eight years and could not get off them. Among other treatments, Chris had her swim in an ice-cold lake and she was able to stop taking pills. Another woman named Wendy had chronic shoulder pain for twenty years. Chris replaced her drugs with placebo pills and had her do daily exercises and her pain went away. Watching this show confirmed that I was not alone in thinking that there is another way for medicine. The evidence for mind-body self-healing points us in a direction that can make us happier and healthier and can save us a lot of money. The upcoming chapters of Doctor You explain all this science in a way that you can understand and use.