The international medical profession is witnessing its worst decay, according to. Dr Peter Gotzsche, Director of the Nordic Cochrane Centre and a Professor at the University of Copenhagen, in a searing interview with Citizen News Service.
“There is a lot that needs to change in healthcare,” Gotzche said. “It is one of the most corrupted sectors in society. In Denmark, for example, we have thousands of doctors who are on industry payrolls – they are consultants, they sit on advisory boards – but in reality it is a soft form of bribery because if you do not behave as expected you will no longer be on the payroll.”
Gotzsche, speaking at the sidelines of the 22n Cochrane Colloquium, is one of the sanest voices in a medical fraternity striving hard to bring evidence-based medicine, ethics and integrity back into fashion The Cochrane Collaboration is an independent charitable international organization named after Archie Cochrane (1909-1988), a British epidemiologist who advocated the use of reliable evidence from randomised controlled trials in informing decisions about healthcare. The 22nd Cochrane Colloquium was held in Hyderabad sept. 21 to Sept. 26.
Normalization of practices that stink of what he called “soft bribery” such as gifts, incentives or other financial favors from pharmaceutical companies and other medical manufacturers to medical professionals is a slap on the face of medical ethics, he said. The conflict of interest between pharmaceutical companies/medical manufacturers, and public health is seldom made evident.
“This contributes to using expensive drugs, or at times using drugs that are not totally rational, or even using drugs instead of thinking of other evidence-based treatments,” he continued. “This has been well documented. I have tried to change attitudes towards accepting industry money. We should learn to say, ‘No, Thank you’.”.
Not just corrupted, but medical practices are often not evidence-based. Despite strong evidence pointing to the contrary, they remain popular as some strong opinion makers in medical field keep propelling them. Despite the Cochrane review showing that directly observed therapy for anti-tuberculosis treatment has no edge over self-administered therapy, there was no hesitation in aggressively promoting what we knew will not give any better results.
Similarly mammography screening for breast cancer remains popular despite research evidence pointing against it.
“We have done research on using mammography screening for breast cancer for over 15 years and have documented that mammography screening does more harm than good.” Gotzsche said. “I am only waiting for the first country to stop mammography screening in wake of the existing strong evidence. We found that mammography screening leads to 50 percent over-diagnosis. All these additional 50 percent of women diagnosed with breast cancer (which probably they do not have) are just harmed by getting a cancer diagnosis. Many times we have found that breast disease disappears by itself and it would not have bothered many of these additional women who got detected by mammography screening.
Radiotherapy is very good for use against dangerous breast cancer not detected by screening, he said.”But when we use radiotherapy on healthy women we kill some of them through increasing their likelihood of developing lung cancer, heart disease and other cancers. Radiotherapy is lethal when we use it on healthy women.”
Mammography screening does not seem to have any mortality benefit because even if it had any effect on breast cancer deaths, the increase in deaths due to treating additional 50 percent over-diagnosed women far outweighs any benefit.
“We also have false positives if we use mammography screening for breast cancer. If we screen 10 times for over 20 years, a quarter of all women will get at least one false positive diagnosis. What my colleagues at Copenhagen found was that even three years after false positive diagnosis, the women are still worried and anxious about it, and their anxiety lies between those who have breast cancer and those who were told that everything is fine on screening. So we should factor-in the psychological harm that hits one quarter of all women who go to such screenings. Also it is likely that it has no mortality benefit. Mammography screening is definitely harmful and it should definitely be stopped.”
Is this another manifestation of gender-based inequalities in our patriarchal society?
“It is a gender issue too. Males have been honestly informed that screening for prostate cancer is a very bad idea because there is no evidence that it has any benefit. We do not do prostate cancer screening in Europe but women have never been honestly informed about harms of breast screening. They have just been told ‘come to screening’. This is a patronizing attitude that I do not understand but which women have accepted.”
There is no additional benefit from general health checkups, he said.
“People think general health checks are like sending your car for servicing every year. But it is not the same because human beings can heal themselves at times which a car can never do,” Gotsche continued. “We did a Cochrane review on general health checks and to our big surprise there were actually a number of very large trials out there. When we analyzed them we found that it does not work at all and does not decrease mortality. It leads more healthy people to get diagnosed that would not help them, but that might harm them. Because of our review Danish government decided not to introduce general health checks.”
He added: “We were in a fortunate situation because the new Danish government had plans to introduce general health checks and then it is much easier to say ‘no’ when you have the evidence. Whereas in the UK they had introduced general health checks few years back and they did not pay any attention to our reviews which came later — because that is how politics is –- when you have introduced something like that it is almost impossible to stop it again. Issue of general health checkup has come up again in Denmark because soon we will have general elections.
The UK’s health minister has not paid any attention to the Cochrane review based upon evidence from 240,000 individuals, he said. “The whole idea is political – as it is popular to offer something to the population that they think will help them. This can give them votes. We have reacted strongly citing strong evidence against general health checks.”
gOTSZCHE and his PhD students were the first in the world who got access to unpublished clinical studies at the European Medical Agency – no one had ever got access to such studies anywhere in the world. The agency. He said, wouldn’t give them access because they wanted to protect commercial interests.
Our health authorities do not think about protecting patients but they think about protecting the health industry, which is very bizarre,’ Gotzsche said. “We complained to the European Ombudsman and the process took three years, after which the European Ombudsman accused the European Medical Agency with maladministration. Then they needed to do something and they changed their policy and we got access.”
He is also working in the European parliament trying to influence the European trials directive, giving him access to much more data from all trials from 2016.