Indoctrinated Doctors Tough Questions About Modern Medical Education

Indoctrinated Doctors
Tough Questions About Modern Medical Education
By Helke Ferrie
Vitality October 2006

Becoming a doctor takes many years.  They learn an awful lot. But just exactly what do they learn? And who decides what they are supposed to know? Any discussion of medical education starts with Dr. William Osler, who originally set the standard. In fact, McGill University is now trying to re-introduce an Osler-based program “to make doctors more humane” (Medical Post, Oct. 18, 2005). Dr. Osler’s 1892 textbook, Principles and Practice of Medicine, trained doctors throughout the world until 1950, at which time Harrison’s Principles of Internal Medicine, now in it’s 16th edition, replaced it. Sir William Osler is generally acknowledged to have been one of the greatest doctors in history.

Last year, my husband, who specializes in Post Traumatic Stress Disorder, discussed with a fellow doctor the possibility of having a workshop on PTSD for local physicians in our area.   “Sure!” was the reply. “Contact a drug rep and have him set it up. All you need to do is mention a couple of drugs and they’ll pay for the event.” My husband, who is in his 37th year of practice and never allowed a drug rep into his office, said: “What?!”, to which his colleague replied, “That’s the way we get our continuing medical education now. They always give us a nice dinner.”

My husband’s presentation on how to treat PTSD successfully would have gone over like a lead balloon with Big Pharma, as it would have included the recent research results which show why it is best to never  prescribe SSRI antidepressants; the risks include increased rates of suicide, murder, cancer, heart disease, sexual dysfunction, weight gain, diabetes, birth defects, and babies born with a full-blown addiction syndrome. Instead, his work focuses on truly effective treatment for PTSD which always includes getting the patient off drugs safely; he agrees with Dr. Osler who observed a century ago, “The person who takes medicines must recover twice: once from the disease and once from the medicine.”

Considering the quality of Big Pharma’s “education” of our modern doctors, it is revealing that the German Institute for Evidence-Based Medicine found that 94% of the information in the manufacturers’ brochures sent to doctors on the 520 most commonly used drugs had “no basis in scientific evidence.” (Arznei Telegram, March 2004).

Dr. Osler had clear advice on this in the late 1900’s: “One of the duties of the physician is to educate the masses not to take medicines. Consider what surprising reactions may occur in the laboratory from the careless mixing of unknown substances.  Be as considerate of your patient as you are of the test tube. To modern pharmacy we owe much, but the profession has no more insidious foe than the large hinterland pharmaceutical houses  who have become a huge parasite. We all know too well the bastard literature which floods the mail, every page of which illustrates the truth of the axiom: the greater the ignorance the greater the dogmatism.”

In Dr. Osler’s days, most deaths were due to tuberculosis and pneumonia. Today, according to research from Johns Hopkins Medical School, which he co-founded, the leading cause of death is improperly prescribed drugs and inappropriate surgery, annually killing about 800,000 people in North America. (Heart disease and cancer kills about 700,000 and 500,000 respectively. Sources in Dean 2004.)

The British Medical Journal reported on June 10, 2000, that death rates in Israel dropped by close to half when physicians went on a three-month strike. Funeral homes complained to the government, asking to have the contractual dispute settled. The same decrease had occurred during the 1983 strike. Only in the city of Netanya did death rates remain “normal”; doctors there have a “no-strike” clause in their contracts.

Medical Schools Financed by Big Pharma

Given these startling facts, we are entitled to ask some hard questions about current medical education. One answer comes from Dr. Drummond Rennie, one of the editors of the Journal of the American Medical Association , who said that “medical education is down the toilet” because the research taught to the medical profession cannot be trusted anymore; its data are “doctored” to satisfy the drug companies, which pay for about 60% of all medical research, as well as for most continuing medical education programs. In the year 2000, 314,022 pharmaceutical industry sponsored conferences were held, but only a few hundred independent events took place. The medical schools themselves are largely financed by Big Pharma as well, and 70% of the committee members generating practice guidelines have direct financial ties to the drug companies whose products they recommend.

JAMA’s Dr. Rennie observed: “This practice stinks.” According to Drs. Marcia Angell and Jerome Kassier, both editors at the prestigious New England Journal of Medicine for many years, medical education relies completely on Big Pharma. Most universities have even eliminated courses in pharmacology, so “doctors aren’t even taught basic principles of drug action and use”. In fact, medical school administrators refer to “students as consumers” and “to education and research as products” (Washburn). The free hand-outs and perks cost Big Pharma about $30,000 per year, per doctor, in the US. Is this the education we want our doctors to have? Especially when the evidence suggests that for Big Pharma, “human life is just road-kill on the highway to profit”, as former Health Canada safety expert, Dr. Michelle Brill-Edwards, puts it. The milestones on that highway are as follows:

  • In the early 1970’s, drugs companies went onto the stock market, and sickness – not health – became a profitable commodity.
  • In the 1980’s Prime Minister Brian Mulroney extended drug patents to 20 years (previously only 6 months at the turn of the century) inviting the full-scale gouging of patients and Medicare.
  • On January 6, 1996, Diana Marlow, Health Minister at the time, had an Order in Council passed without public or parliamentary debate, which made all safety information on drugs “proprietary information”, and thus protected from public scrutiny. Accountability in the health care system was thus flushed down the toilet.
  • Direct-to-consumer-advertising started in the US and New Zealand a few years ago and increased spending dramatically; a lot of gullible, healthy people could start to wonder if maybe they were sick after all. It is no surprise that by 2001, drugs and medical mistakes were recognized as the major cause of death.
  • In 2005, Canada’s drug bill was $28.4 billion, compared to $3.8 billion in 1985 (CMAJ July 4, 2006). Since the 1970’s, drug profits surpassed all other Fortune 500 companies and outperformed Standard & Poor’s 500 Index by 10% every year. The industry hopes to grow to $842 billion by 2010; but maybe Big Pharma’s profitability has peaked, just as the world’s oil has. The Wall Street Journal reported on September 9, 2006, that Brystol-Myers Squibb’s shares have dropped by 56% since 2001, Pfizer’s share price is down by 43%, and roughly 100,000 law suits are currently running against unsafe drugs. Maybe killing customers is not good for business after all.

The Shifting Agendas of a Classic Medical Text

This “down the toilet” trend is traceable also in the qualitative information by which doctors are trained, namely the textbooks which supposedly represent the gold standard of clinical practice. I compared some key items in several of the 16 editions of Harrison’s Principles of Internal Medicine from the 1950’s to today, being guided by Dr. Osler’s observation that “the history of progress is a history of a struggle with one’s own delusions”, from which struggle medical experts are not exempt. Here is some of what I found:

  • The 7th edition from 1972 weighed 5 lbs. It has 37 entries on nutrition, 67 on vitamins and minerals and their essential functions are well discussed. Doctors were taught that corticosteroid therapy in Crohn’s disease didn’t work well at all, but dietary approaches (as successfully pioneered in the 1940’s by Dr. Crohn himself) were recommended as having the best results. Migraine were also best treated with dietary modifications and heavy-duty (natural) painkillers as needed. Asthma was already seen as an environmentally-mediated disease and treated as such. Except for the tremendous advances in surgery and antibiotic treatment, this edition is rather like an extension of Dr. Osler’s classic.
  • The 9th edition of 1980 also weighs 5 lbs and has expanded sections on nutrition, including candidiasis. It has extensive new information on environmental and chemical toxins, advising the reader to always inquire into a patient’s workplace and home environments. Hypersensitivities to environmental toxins are well discussed, and the list of chemical poisons given is as relevant today as it was 26 years ago. The index has 110 poisons, including pesticides. Asthma is seen as an environmental illness and steroids are to be used with great caution. Crohn’s Disease is still best treated with diet and only in extreme cases with surgery.
  • The 10th edition weighs 3 more pounds and the 12th edition in 1991 adds on yet another pound and a half. In-depth discussions on pharmacology, adverse reactions, and a fabulous section on how diets affect a whole range of diseases appears now. New are also considerations of statistical analysis and some depressing material on Medicare: obviously something has happened, but it is not clearly identified. (That something is Big Pharma’s booming success on the stock market.) The adverse drug events information is very good. The Recommended Daily Allowance (RDA) is handled with excellent criticism and almost dismissed as irrelevant because a one-size-fits-all approach is totally rejected by the authors as they insist that supplement needs differ when pregnant, aging, following surgery etc. Gluten-free, lactose-free, low-fiber diets are recommended for various conditions including Crohn’s, along with cautious use of steroids. Amidst all this intelligence we suddenly find pages and pages devoted to supporting formula milk complete with the (unnecessary) names of all the manufacturers. Asthma and migraine therapy has not changed much. One shrill note is sounded when the assertion is made that too much Vitamin C might cause kidney stones – without references! Poisons in the index are strangely down to 45, while all over the world they are up by tens of thousands of new chemicals. However, EDTA chelation for metal toxicity is discussed and recommended, and even mercury dental amalgams are considered a bad idea.
  • The 15th edition of 2001 weighs in at 9 1/2 lbs. The new sections include a friendly discussion of alternative medicine, limited to Chinese medicine, Aryuveda, massage etc. Also new are sections on medical ethics, conflicts of interest and a fabulous section on the “Influence of Environmental and Occupational Hazards on Disease”. Virtually all the diseases featured in the rest of this huge book are now also discussed in terms of potential environ mental toxicity as causes. Wow! In the adverse drug events section the great range of individual reactions to drugs are discussed. The myth that vitamin C may cause kidney stone is debunked authoritatively, but in another section we read that all orally consumed vitamins are absorbed 100% — again, without references.  Similarly, there is an excellent discussion on homocysteine (as opposed to cholesterol) as the most reliable marker for cardiovascular disease; but weird to behold, a few hundred pages later we have the strongest criticisms of “so-called” health food stores. The adverse drug reaction section is astounding in its exhaustive detail.  The index on poisons includes more drugs than before, but for Crohn’s disease the treatment is now just steroids and surgery. Funny – did all those patients in the past, who were helped by diet suddenly evaporate? Thankfully, the reader is told the RDA is a guide and nothing more.
  • The 16th and current 2005 edition weighs 10 1/4 lbs. What it took on in sheer physical bulk it sure lost in qualitative content, and what has increased in verbiage parallels the increase in disease incidence. Gone are discussions on ethics, conflicts of interest, economics; complementary medicine is dismissed with a nasty diatribe – again without evidentiary support. Yet, the discussions on vitamins and minerals later on are factually good; even St. John’s Wort, Echinacea and Saw Palmetto are treated with respect. But suddenly the RDA is now “overly generous”, supplements carry “potential risks”, and it is hammered in to the reader that the amount of each vitamin (e.g. 80 mg of C per day, no matter what the circumstances) must be the total derived from food and supplements. Doctors are told that we get all we need from our diets. Perhaps, the food industry wrote this section. Crohn’s disease has become part of Irritable Bowel Syndrome – an industry invention according to Moynihan and Cassels. However, Chronic Fatigue made it into text. And even though Health Canada and the FDA published hair-raising advisories in 2004 on antidepressants, this 2005 textbook only mentions a few without numbers, references, cautions (e.g. sleep disturbance, sexual dysfunction, jitters). No wonder doctors are still prescribing them.

Modern Medicine Focused on Disease Management – Not Health

 What ever happened to all the good results reported 30 years earlier with so many diseases treated with good nutrition and nursing? What about the results reported in all those learned journals devoted to environment and health? The World Medical Association and the World Health Organization don’t seem to exist for Harrison’s either. They endorse and support natural medicines and accept only some 300 (all non-patented) drugs as useful for the whole world.

I guess, Big Pharma now has its very own textbook. This happened once before: Dr. Jozef Krop, an environmental medicine expert, told me the other day, that in 1964, when he started medical school in Poland, the textbooks had changed from one year to the next  The textbooks used by the students of the previous year were filled with botanical medicine, while his texts only discussed drugs; merely four herbal medicines were retained.

What the 17th edition will contain is anybody’s guess. But this is certain: an industry based on selling sickness is not a viable industry. Medicine is undergoing a revolution in ethics. The “consumer” is getting smarter and goes elsewhere: to naturopaths and doctors who are too busy curing people naturally to read Harrison’s. And those trying to control the training of young doctors best remember Proverbs 11:29: “He who troubles his own house shall inherit the wind.”

Sources and Resources:

M. Angell, MD, The Truth About the Drug Companies, Random House, 2004

M. Bliss, William Osler – A Life In Medicine, University of Toronto Press, 1999

C. Dean, MD, Death by Modern Medicine, Matrix Verite, 2004

S. Ellison, Health Myths Exposed, Author House, 2005 (single best source by a former drug designer showing how standard treatments are fraudulent and which treatments can be trusted)

D. Healy, Let Them Eat Prozac, Lorimer, 2003

J. Kassirer, MD, On The Take: How Medicine’s Complicity With Big Business Can Endanger Your Health, Oxford, 2005

R. Moynihan & A. Cassels, Selling Sickness, Nation Books, 2005

W. Osler, MD, Sir, The Principles and Practice of Medicine, 1892, Classics of Medicine, 1978

J. Washburn, University Inc.: The Corporate Corruption of Higher Education, Basic Books, 2005



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