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medical myths

One of the mysteries to me has been why doctors and patients stubbornly hold onto certain beliefs about medications and medical care in spite of overwhelming evidence against those beliefs. Dr. Abramson, in his book Overdo$ed America, offers the concept of myths. Or more specifically, the "folk model" of medicine.

In medical school, doctors learn the steps of the "biomedical model" until it becomes second nature to consider all disease through this model. This model says that all disease can be traced to some tiny organism that is not doing what it should be doing. The trick is to discover what that organism is and find a treatment that gets it back on track. The medical literature is full of "breakthroughs" of this nature, of studies of drugs or other treatments that affect certain diseases, and these studies are written by established, prestigious doctors. Therefore, a doctor will tend to look for the latest medical knowIedge as presented in forums and publications and apply that knowledge to his practice. I am oversimplifying for the sake of space but I think I have summarized it adequately.

The problem with this model is that this approach is not always the only way or even the best way to treat disease. Because he did it so well, I am reprinting a section of this book here - an example and then an explanation:

...(W)hen I mentioned to a colleague that Vioxx causes 21 percent more serious complications overall than naproxen, he immedicately fired back, "I don't believe it." I told him that the data from the manufacturer's own study showed this, and I could show him how to get the information on the FDA's website. He reiterated, "I still don't believe it." This exchange reminded me of the Richard Pryor comedy routine in which his wife walks into their bedroom and finds him with another woman. As she stands there aghast, trying to make sense of what she is seeing, Pryor says to her, "Who are you going to believe, me or your lying eyes?"

The evidence that Vioxx causes significantly more serious medical problems than naproxen, and that the ALLHAT study shows that there is no benefit to tripling the number of Americans taking statin drugs are as clear as any scientific evidence can be. But for practicing doctors even to consider the possibility that the experts and the most respected medical journals might be leading them astray represents a broader challenge to the integrity of what we think of as medical knowledge. Even more important, it's a challenge to the integrity of the process by which we come to believe that new medical information is true. For doctors, this is the ultimate Pandora's box. Once a doctor starts questioning accepted medical knowledge, he or she immediately risks becoming an outsider, a boat-rocker, losing the respect and legitimacy earned during those long years of training. It wasn't the facts about Vioxx that my colleague couldn't believe; it was the need to trust the system that produced and sanctioned his professional knowledge. Without this, he would have become paralyzed with doubt by each of the myriad decisions that he had to make every day. He couldn't let himself believe that his trusted sources of information had so misled him that three years after the publication of the VIGOR study in the NEJM, he was still unaware of the serious risks posed by treating patients with Vioxx.

In what has beome a classic paper, "The Need for a New Medical Model: A Challenge for Biomedicine," published in the journal Science in 1977, Dr. George Engel wrote, "The historical fact we have to face is that in modern Western society biomedicine not only has provied a basis for the scientific study of disease, it has also become our own culturally specific perspective about disease, that is, our folk model." "Folk model" takes some of the shine off the great progress that has bene made in biomedicine, ut it is the only way to describe the intensity of our commitment to providing and receiving so much suboptimal medical care.


- Overdosed America, pp. 203-204

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