Can Medical Science be Utterly Wrong? Yes, it can

Is it possible that we can applaud and accept medical treatments which will later turn out to have been gravely mistaken?

 

Those who doubt this should examine the case of the late Antonio Egas Moniz (1874-1955), awarded the Nobel Prize for medicine in 1949. For what was he given this tremendous honour, which to this day has not been rescinded? It was (in the words of the citation)  ‘for the discovery of the therapeutic value of the leucotomy in certain psychoses’.

 

Leucotomy? What’s that? Well, it’s what you’ve probably heard of rather more often as a ‘lobotomy’, a violent, crude assault on the brain tissues, performed with sharp steel instruments inserted into the skull,  on the basis of neurological theories of amazing crudity, and used for 20 years on thousands of people supposedly ‘diagnosed’ as being mentally ill. Maybe they were objectively mentally ill before the operation. It’s hard to say. But they were certainly mentally ill afterwards, because their brains had been irreparably mutilated. Some accounts suggest that Dr Moniz ( a former politician, amazingly) devised his technique after being shown two chimpanzees which had been rendered docile by surgical removal of the frontal lobes of their brains (lobotomy/leucotomy generally involved driving a blade or probe into the brain, sometimes using a mallet,  so effectively separating the frontal lobe from the rest of the brain, rather than actually removing it).

 

Others deny that this episode influenced him, pointing out that the general idea had been discussed by many neurologists at that time, had been the subject of several rather inconclusive experiments on human patients (one wonders how consent was obtained) , and the origins of the idea that ignorantly hacking about with brain tissue might be good for the victim went back to the late 19th century.

 

Many, many people  endured it. Many, many relatives reluctantly agreed to allow it. One of the most famous such victims was Rose Marie Kennedy, sister of JFK, lobotomised on her father’s initiative in 1941 at the age of 23 (she died in 2005 after 64 heartbreaking years of almost total detachment from human society). One of the doctors who carried out the operation described it thus : ‘We went through the top of the head, I think she was awake. She had a mild tranquilizer. I made a surgical incision in the brain through the skull. It was near the front. It was on both sides. We just made a small incision, no more than an inch. The instrument Dr. Watts used looked like a butter knife. He swung it up and down to cut brain tissue. "We put an instrument inside," he said. As Dr. Watts cut, Dr. Freeman put questions to Rosemary. For example, he asked her to recite the Lord's Prayer or sing "God Bless America" or count backwards. ... "We made an estimate on how far to cut based on how she responded." ... When she began to become incoherent, they stopped.’

 

We must remember that the people who did this believed with total conviction that they were acting benevolently, as did the relatives who authorised it. They also believed that they were guided by medical science, though it is now perfectly clear that they had no real idea of what they were doing. How, we must ask ourselves, do we fool ourselves into doing or allowing such things? And, if we did it before, could we do it again? The answers are : easily; and yes, we can.

 

This horrible procedure continued in widespread use for many years (though it is rather humbling to note that the Soviet Union, despite being a Stalinist chamber of horrors at the time,  banned it in 1950, long before Western medicine had turned its back on it).  You might also look up ‘Insulin Shock therapy’ for another example of medical arrogance and human gullibility.

 

And I am personally highly sceptical (as are qualified doctors such as Peter Breggin) of the continuing use into our own times of Electro-shock therapy (or Electro-Convulsive Therapy, ECT), a procedure which has been described as the medical equivalent of kicking the TV set when it goes on the blink (or on the fritz, as I believe they say in the USA), which was used a few years ago on a colleague of mine, in a very fancy private hospital. I cannot say that it did him much good. All that was wrong with him was that his beloved wife had died after a long and gruesome illness, through which he had nursed her, and he was overcome with sorrow, as anyone would be.

 

I mention this gruesome episode, and the appalling popularity of lobotomy over many decades,  mainly to point out that our trust in medicine is sometimes misplaced. Of course, we need to trust doctors. When we are ill (if it is not already catastrophic) , our trust in the doctor is a vital part of our recovery . A cure can often be more than halfway complete by the time we have told the doctor what is wrong with us. By the time we have the prescription, we are already feeling better. This is because our problems have been taken seriously, and recognised as real, by a reassuring professional. When we go to the pharmacist to get the pills, our recovery is still more advanced. I believe studies have shown that many medicines start working before they are actually taken.

 

The mind is the seat of many cures. Of course, this will not work for a cancer or a grave injury (though the mind is still at work : men badly wounded in battle are often known to perform the most extraordinary feats some time after they might have been expected to be dead or unconscious, and sometimes do not feel the pain of their wounds for minutes after they are inflicted. Morale is usually vital to recovery from major surgery or injury). For some people, there is no doubt that visits to shrines and relics can have a similar curative effect.

 

Medicine would not work half as well if we did not have this trust, which is why this trust is in general a good thing, which I support and welcome.

The trouble is that such trust can be, and is, abused.

 

If a doctor tells you that he knows what is wrong with you, and that a certain pill or procedure will put it right, you will generally believe him. If that pill (for instance) has severe and unpleasant side-effects, you will endure them for the sake of the cure.

 

But what if the side-effects are the only real, that is to say objective, effects?

 

This may well be the case with ‘Antidepressants’. In The book I am here discussing (Cracked - Why Psychiatry is doing more harm than good’, Icon Books, ) the author, James Davies, says (on page 98) : ‘…we do know that anti-depressants have effects. Mostly they have placebo effects and side-effects. We also know that for many people they can have sedating or numbing effects’.

 

There are several implications of this important statement. Some of the responses to my first article on this have maintained (apparently from the point of view of patients taking these pills) that the drugs have done them good. Well, the research certainly shows that patients who take pills often feel better.

 

It’s very difficult to argue about this. Measuring subjective mood and mood changes is virtually impossible, in any way that could be called ‘proof’.

 

But it *also* shows that patients in blind trials who take dummy sugar pills get pretty much the same benefits as those who take the real thing (which, as we have already pointed out, is based on a wholly unproven theory about chemical imbalance in the brain, and has no proper scientific basis at all). This suggests that the curative effect is largely a matter of concern and trust, as described above.

 

This raises an interesting ethical puzzle. Would doctors be justified in knowingly prescribing dummy pills to such patients, if everyone in the industry would keep quiet about the truth? If the patients were cheered up by the pills, and no harm was done, then what would the objection be?

You’ll have to answer that one for yourself.

 

But outside the tests, it doesn’t arise. Because the real pills are the ones that are prescribed, and they are far from being inert. They contain potent chemicals that have known physical effects, including – in some cases -  a tendency to make the patient think seriously of taking his or her own life.

 

Mr Davies’s book does not address this side of the question, which is probably a good thing – because hardly anyone in the public, the media or politics is prepared to believe that anything so horrible could be happening, We will probably have to get a good deal further down the road of exposing the uselessness of ‘antidepressants’ before anyone will begin to consider the possibility that they may be harmful.

 

Like a number of relatives, doctors, psychiatrists, coroners and pathologists, I have looked into the worrying correlation between antidepressant use and suicide. I study inquest reports in search of it ( and found another instance this morning – usually I come across three or four a month in local and national outlets, and would no doubt see many more if I had a means of scanning every local newspaper or every inquest transcript. I often see several more in which the Coroner simply has not bothered to inquire but where the circumstances are highly suggestive).

 

I also know that the standard pro-drug riposte ‘Of course they would be suicidal. They’re depressed, for goodness’ sake!’ is invalid for several reasons,  not least the known and undisputed evidence of what is called ‘suicidal ideation’ among people who have taken some antidepressant drugs.

 

But he does say (after, rather bizarrely, claiming that caffeine alters our state of mind – where does he get his coffee?)(P.98-99) ‘These pills , in other words, don’t cure us – they simply change us. They can throw us temporarily into a foreign state of mind, into an altered version of who we are.

 

‘From this standpoint, antidepressant medications do not return us to health as medical pills aim to do- they rather manufacture a new state of mind, an often unnatural state’. These thoughts, by the way, form part of a highly disturbing discussion of the case of a bereaved man who ceases to be able to weep after taking medication.

 

Here we touch on the wider issue of the whole DSM (Diagnostic and Statistical Manual) which, as edition follows edition, has classified more and more normal human states of mind and being as ‘illnesses’, just at the time that the drug industry has begun to produce pills which claim to control or counter these complaints.

 

Thanks to my own interest in this subject, I was not shocked by Mr Davies’s revelations about how this book comes to be compiled. It is the shame of my trade of journalism that his detailed exposure of this process will come as a surprise to most readers.

 

I could easily reproduce most of the book here. But I will just mention a couple of other features which seemed to me to be especially interesting. You really, really should read it.

 

I won’t return here to the vast scandal of ‘ADHD’, a scandalous ‘diagnosis’ of a subjective complaint, followed by objective drugging,  which still, amazingly, has its defenders. But I will mention a Canadian study into that supposed 'disorder’ (p.41) which showed the following:  Instances of ‘ADHD’ among school-age children  rose,  in a steady diagonal on the graph, the younger the children were.

 

Let me put that another way: ‘the younger you are in the class, the more likely you’ll get the diagnosis’ .This truth was replicated in studies of the USA and Sweden (I know of none here). It is hard to see how, if this were a genuinely individual ‘diagnosis’ or a genuine ailment, that this could be so.  But it is.

 

As Mr Davies says ‘The relative immaturity of the younger children was. In effect, being wrongly recast as psychiatric pathology’.

 

I’ll say no more about ‘ADHD’ at this stage. I usually need to spend a week or two in the gym before taking on the ‘ADHD’ lobby, not because their case is any good,  but because there are a lot of them and it is exhausting countering the same bad argument over and over again.  Those who wish to have a go at me in defence of this appalling fantasy are directed here  http://hitchensblog.mailonsunday.co.uk/2010/05/the-adhd-fantasy-posted-once-more.html . I shall be surprised if I have not anticipated any point they choose to make, and answered it fully.

 

The ‘ADHD’ problem is, however, a good example of the pact between lazy doctors, guilty people and greedy businessmen which has created the scandal of modern psychopharmacology.

 

I do not (as some claim) reject the concept of mental illness. Nor do I argue that nothing can be done about it. Nor do I dispute that in a few small areas, neurology has managed to penetrate some of the secrets of the brain. Modern brain surgery is responsible, highly-skilled and curative, and we owe a great debt to those with the skill and courage to undertake it.

 

I just think that the current dissemination of poorly-understood pills, backed by dubious research and cynical promotion, is wrong and needs to be exposed as such.

 

The difficulties of doing so are summarised above. Most people feel a natural suspicion of large companies whose gigantic profits depend on the continued sale of these pills. Many have learned to be a bit suspicious of doctors who need some way of sending unhappy patients home happier than they were when they came in, and who can receive cornucopias of goodies , free trips and the rest if they play along with those large companies.  But the greatest obstacle to a serious debate is the complicity with the doctors and the drug companies of many of the patients themselves. They have been persuaded to believe that they have been helped by medications which have certainly had an effect on them. But what is that effect?  

 

Let me here stress, once again, that patients worried about such medication should under no circumstances simply cease taking the pills they have been prescribed. Sudden withdrawal can produce severe effects. Cessation should only take place under qualified medical supervision.

 

It is virtually impossible for someone in my position to counter the claim that ‘It made me better’ or ‘You don’t understand that depression is a real illness’ or  ‘I rely on these pills for my happiness’. Statements of this kind cannot be tested, and so cannot be disputed.

 

These statements tend to be unconscious regurgitations of drug company advertisements (legal in the USA) or indirect publicity spread through compliant medics (the usual method in the United Kingdom), material, current now for many years.  I can only refer these patients to the objective information we do know - the studies done on the reported effect of these pills, on the suppression by the drug companies of research showing that they have no greater effect than sugar pills, on the significance of that suppression itself ; and on the emptiness of the endlessly repeated claim that depression’s cause is known, and that it is a ‘chemical imbalance’ in the brain.

 

And I can urge them to read this book. It is the gateway to wisdom and understanding on a major topic of our time. And, in a debate where billions of pounds are at stake,  I can readily declare that I have no interest in this subject, apart from a  desire to speak the truth.