Vioxx, the Scientific Method, and the Atheists
November 24, 2007
Lots of people, if you levied a $4.9 billion fine on them, might look for a bridge from which to jump. But when Merck, the pharmaceutical company, struck a deal with lawyers to settle 27,000 lawsuits for that amount, legal and financial types were ecstatic. It could have cost so much more. I've heard 25 billion. I've even heard 50 billion. This is how you do it! one market analyst gushed. This is how you come back from a defective product. You fight each case no holds barred for a few years to discourage plaintiffs. Then you offer to settle for a lowball amount. Merck's stock rose 2.3% the day they announced the move, even while the overall market was sharply down.
Medical and ethical folks were less enthused. Like Dr. Eric Topol, for example, the cardiologist who in 2001 co-authored a JAMA paper warning of heart attack risks associated with the drug company's Vioxx. “I think they’ve gotten off quite easily, frankly, for the problems that they’ve engendered,” he said. A large clinical trial that ended in 2000 showed that Vioxx was much riskier than Aleve, an older painkiller. Four more years were to pass before Merck took the drug off the market, pulling the plug on their Young Rascals jingle "It's a Beautiful Morning" when it seemed the morning might not be so beautiful after all.
But if Dr. Topol groused, you should have heard Dr. Katherine Di Angelis. "What people should learn from this is you don't believe anything, not one thing, put out by a pharmaceutical company. Just don't believe it," she said on National Public Radio. "You start from there." She estimated probably 5-10 % of the people who were taking it really should have been taking it. The other 90% raised their risk of a heart attack or stroke with no significant benefits. "When you want to make money by selling products to people who don't need it....then you're going to get into this kind of trouble"
Dr Di Angelis is Editor in Chief of the Journal of the American Medical Association.
Now, this sticks in my craw even more than it might normally because I've just been squabblingwith a flock of atheists who worship science. Of course, they would never use that term - I can hear them sputtering now - yet what they do so closely resembles worship that I can't tell the difference.
"You don't believe anything, not one thing, put out by a pharmaceutical company," she advises the public. Okay. Good advice. Did she have counsel more harsh for medical doctors? After all, you could not get this drug over the counter. A doctor had to prescribe it. The general public can be excused for being duped by drug hype. But what of medical doctors, those high priests of the scientific method? The atheists I mentioned positively gush over the scientific method, the ultimate test of truth. Yet here we see that it's foremost representatives in the medical field, doctors, are every bit as susceptible to error as the average Joe. They uncritically swallow any bilge handed down to them.
My skirmish with the atheists was with regard to alternative health treatments: chiropractic, acupuncture, homeopathy. All hoax, they insist. They know that because they and their scientific allies have subjected such techniques to the Scientific Method - double blind repeatable controlled studies - with very unspectacular results. The fact that more and more people are choosing these therapies over conventional medicine means nothing to them. Those folks have only testimonials to offer, say the atheists, or even worse, anecdotal evidence. Absolutely worthless, they insist rather dogmatically; it only goes to show how gullible people are.
Tell it to the 27,000 plaintiffs who allege injury or even death of their loved ones from Vioxx. If alternative therapies fail, they simply fail. It's very rare for them to do harm.
One alternative that has gone from cult to mainstream within my lifetime is chiropractic. It's every step forward was fought tooth and nail by the American Medical Association, (AMA) which attempted to use its science stature to label the competition quackery. It took a lawsuitwhich ultimately went to the U.S. Supreme Court to end the iron fist.
As burdensome as the "quackery" namecalling was the financial hit one incurred in seeking chiropractic care. Insurance rarely covered chiropractic. Patients paid out of pocket. Imagine: medical care could be had for free (or with small co-pay); chiropractic care you paid for yourself. People chose chiropractic care. (To this day, a cynical friend swears by the rule: if it works, insurance won't cover it.) It wasn't superstitious dolts choosing the alternative therapy, which I suspect the science camp would love to maintain. No, it was the more educated and well-heeled, the only persons who could ignore the financial implications of seeking chiropractic care.
To this day, devotees of medical science grouse that chiropractic fails their tests of proof. Some grudgingly allow that it can serve a limited purpose in the case of back pain, but nothing more. Meanwhile, one constantly runs across persons crippled for life by disc removal surgery, (I know some of them) the mainstream medical practice that dominated for years. (still does, I think) How did chiropractic become so well accepted? Largely through the avenues my atheists despise: testimonial and anecdotal evidence. Thirty million people in the United States seek chiropractic care. Are they all fools?
Many areas of alternative medicine are more art than science. Didn't we once refer to all medicine as "healing arts"? They draw on the subtle uniqueness of each individual, not on the broad similarities which we all share. But therein lies a problem for scientific verification. If every single patient is different and your health care is attuned to those differences, that's a problem for the scientific method, which is most useful when there are common attributes readily grouped and measured. Alternative medicine is more like your child who does something irresistibly cute, so that you want to show him off. Will he do the same thing for relatives or friends or camera? Not a chance. How do you apply the scientific method to individual attributes, when it is those very attributes that form the basis of this or that treatment? Insisting alternative medicine conform to the scientific method is a bit like playing an away game, on someone else's turf with all their fans booing you. Better to play on your own field.
Then again, it could be that conventional science simply ignores what is too contrary to prevailing wisdom. This apparently happened withthat studyconcluding the placebo effect is overhyped. It made front page news one day in 2001, then it vanished without a trace, like a mafia don with concrete boots. Nobody ever mentioned it again. Might this be the case with alternative treatments, whose supporting evidence is ignored by the AMA people?
Inconceivable, says my science-adoring atheist: "The vast majority of scientists revel in what they don't know because it provides them with an opportunity to find out what's happening and explain it. Prove one wrong and he or she will be ecstatic," he tells me.
No, I don't think so. Science does not purge humans of human nature. Max Planck the physicist offers a more realistic assessment: "People think new truths are accepted when the proponents are able to convince the opponents. Instead, the opponents of the truth gradually die, and a new generation comes along who is familiar with the idea."
I'm not opposed to conventional health care. I'll see a doctor when sick (unlike Pop). But it's not the monopoly on truth that it would like us to believe. Alternatives work too well. I've seen, heard, and experienced it. When testimonials become overwhelming, you don't reject them simply because it's not the type of evidence you would prefer.
Vincent McCabe's book Let Like Cure Like (1997) discusses principles underlying most alternative therapies (homeopathy in his particular case): These philosophies, both thousands of years old, have yet to be proved scientifically because of the limitations of science, not because they are not true. p 17
Awake!, on the other hand, the JW publication, stays above the fray. Often it discusses matters of health. Invariably it states it does not endorse any specific treatment, but discusses what it does for informational purposes only. In other words, let's not have anyone take my views and think it represents all of Jehovah's Witnesses.
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