Healthy Skepticism The Best Medicine
Erik Rifkin & Edward J. Bouwer
February 28, 2008 Atlanta Journal and Constitution - Health risks abound in modern life. But are the decisions we make to preserve our health supported by solid science? Not always. Consider the recent clinical trial demonstrating that the cholesterol-lowering drug Zetia (and a drug that contains it, Vytorin) does not effectively reduce fatty deposits in arteries. These findings raise doubts and concerns about a basic tenet in medicine: Lowering cholesterol will lower the incidence of heart disease. Our analysis of critical published studies supports the contention that elevated blood serum cholesterol levels do not correlate well with an increase in coronary heart disease. The alarm bells ring almost daily. With great conviction, experts tell us we can protect ourselves by taking tests to defect cancer and by swallowing statin drugs and antioxidant vitamins An unmistakable veneer of certainty is attached to such advice. But peel away that veneer, and you'll find a shadowy realm filled with uncertainty. Some recent examples:
There has been general agreement in the medical community for decades that diabetics should lower their blood sugar to decrease their risk of dying from heart disease. But results of a recent federal study have cast doubt on that premise. In fact, the study found that lowering blood sugar levels resulted in a significantly higher death rate.
The highly touted painkiller Vioxx was taken off the market when it was determined that there were increased numbers of heart attacks in individuals taking this drug.
Acceptable exposure to carcinogenic contaminants such as dioxin and benzene is based on not exceeding the arbitrary value of one additional cancer per million people--a value never originally intended to be used for regulatory compliance.Dozens of other examples can be found in which medical decisions and environmental actions lack scientific evidence. Why has this happened? Because researchers in the past have made astonishing strides in medicine and environmental health, consumers and public officials have come to expect similar "miracle breakthroughs" for a wider array of ills. Yet in recent decades a subtle but critical shift in focus has taken place. Rather than continuing to concentrate on diseases such as polio and malaria, where a direct cause is known, researchers have turned more often to chronic debilitating ailments such as heart disease, cancer and diabetes. Precise cause - and- effect relationships for many of these diseases remain elusive. According to risk-assessment specialists, doctors and other authorities need to explain uncertainty to patients and communities. But this rarely occurs, and the reasons are rooted in our need for concrete answers. Having health information--including information about uncertainty--available in a readily understandable format will enable us to determine what level of benefits and/or risks we find acceptable when it comes to preserving our health. As a difficult but necessary first step, health professionals must acknowledge that the public has a right to this information. But at the same time, consumers must take an active role in digging beneath the Illusion of certainty that continues to cloud medical and environmental decisions. Eric Rifkin, a Baltimore-based environmental consultant, and Edward J. Bouwer, chairman of the department of geography and environmental engineering at Johns Hopkins University, are national experts in human health-risk assessment. They are authors of the book 'The Illusion of Certainty: Health Benefits and Risks."
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