A review of Shipwreck of the Singular
By Patrick D Hahn
Beginning in 2014, life expectancy in the United States dropped every year for five years straight. This was before the time of Covid, by the way. This is an absolutely unprecedented development which has been completely ignored by the mainstream media.
What is behind this staggering drop in life expectancy? David Healy, a professor of Family Medicine at McMaster University in Ontario, points the finger at a health care system which is centered not on delivering care to the ailing but diseases to those who didn’t even know they were sick – and which also is set up to deliver adverse consequences, up to and including death, with impunity.
The facts back up Dr. Healy’s argument. Forty percent of those over the age of sixty-five take five or more drugs per day, despite overwhelming evidence that being on five or more drugs shortens lives rather than extends them. The pharmaceutical companies have all but abandoned any pretense that they are in the business of saving lives. Since the World Health Organization compiled its first list of “Essential Medicines” in 1977, no new life-saving treatments have emerged other than Gleevec, Triple Therapy for AIDS, and treatments for Hepatitis C. That’s a rather puny haul, given that the cost of prescription drugs has skyrocketed, along with the cost of the system designed to deliver the drugmakers’ wares to us.
Dr. Healy points the finger at randomized controlled trials, which in the wake of the thalidomide scandal were held up as deliverance from drug harms but which instead have become a shield for the drug companies to protect themselves from the fallout of adverse drug events.
The same drug can have opposing effects on different patients: one may be put to sleep while another suffers from insomnia, or one may lose weight while another gains. All these disparate effects are erased when the mid-point of a confidence interval is confused with clinical reality.
The FDA required two positive randomized controlled trials before a drug could be approved – a seemingly fool-proof way of ensuring efficacy – but in fact the trials are conducted by the drugmakers and their paid agents who routinely conceal harms, including suicidality and truly horrendous birth defects. Trials have gone multinational, meaning there is no one on earth who can attest to the fact that all the patients in a given trial even exist.
And when all else fails (as Sally Laden, ghostwriter for the most infamous trial of all time, GlaxoSmithKline’s Study 329, cynically observed, “There are some data no amount of spin will fix”), entire studies can be deep-sixed if they fail to serve the drugmakers’ interests. The upshot of all this is that only the pharmaceutical companies have access to the data. The rest of us, including your doctor, have access only to statistical outputs from carefully selected sets of figures.
Along with the burgeoning industry of clinical research organizations paid to secure the official FDA stamp of approval is another burgeoning industry of ghostwriting companies which may wring as many as fifty separate journal articles from a single study (or one hundred from the two trials needed to secure FDA approval of a drug). These journal articles, published under the names of top-rated scientists who have never seen the actual data, become the basis for official guidelines always requiring more and more patients to be given more and more drugs. Clinicians who exercise their clinical judgement and ignore the guidelines may find themselves out of a job, while patients may find their doctors are becoming increasingly nasty when the need for yet another drug is questioned.
This is how we got to the point where we now have more hospitalizations for hypoglycemic episodes or falls on antihypertensives than we have for diabetes or hypertension. Treatment-induced death may now by the modal cause of dying, and treatment-induced disability may be the greatest cause of disability.
Dr. Healy notes that medicine once entailed a judicious assessment of risks, weighing the risks of a poison (medicine) or a mutilation (surgery) against the benefits. Now health services have switched to risk management, which actually means covering risks to the service.
Dr. Healy offers several solutions to these problems, number one being access to all the data from trials we the people have participated in (and paid for, he might have added), averring “This data should be as inalienable as our vote.” He also suggests making the pharmaceutical companies withdraw from marketing, noting that “drugs that save lives or clearly enhance function need little marketing.” But he warns us these changes won’t come easily:
Health services, whom one might have thought shouldn’t want drugs that don’t work, as they operate at present, won’t support this move. Shrinking the iceberg of unmet need would leave a lot of managers drifting on ice floes in open waters.
As I read this passage, I immediately was reminded of anthropologist David Graeber’s recent book Bullshit Jobs. Health services may well be our society’s biggest repository of bullshit jobs, and the folks who hold these bullshit jobs pretty much by definition are a well-organized, well-financed group. In the opposite corner is an assortment of patient advocates, most of who never wanted to be patient advocates but found themselves forced into that role after they (or a loved one) took medication in good faith, as prescribed, and suffered devastating consequences.
This conflict may well become the defining struggle of the Twenty-First Century. Stay tuned.
Buy “Shipwreck of the Singular” on Amazon
Shipwreck of the Singular
by David Healy
Shipwreck of the Singular: