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Post-truth medicine

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Last year was the start of something big, and it even gave birth to a new word: post-truth. Critics argued that much of the Trump presidential campaign was hallmarked by post-truths – and preposterous post-truths at that, such as President Obama being the founder of ISIS and opposition candidate Hilary Clinton running a paedophile ring from a pizza parlour.

Only a tiny handful of voters really believed Clinton was a paedophile mogul (or even ate pizza), one would hope, and their vote for Trump was perhaps more a rebel-yell emphasizing that it’s hard to believe anything we’re told. In that sense, our new post-truth era is an age of cynicism.

The neologism does, however, imply that, at some point, we were being told the truth. But truth has always been a slippery commodity, even back in the days when Pontius Pilate was deciding the fate of Jesus. The news that we watch and read isn’t so much the truth as a perspective, valuable though it may be.

Science is supposed to be the one place where truth can be established. The scientific method is objective, seeks independent verification and isn’t influenced by money, position or people doing the research. At least, that’s the theory. But we know the human factor does play a part, usually through a phenomenon known as a ‘paradigm’. The paradigm is the prevailing ‘truth’ based on the evidence amassed thus far. Paradigms can change, but only very slowly. In the meantime, it’s a brave or foolhardy academic who dares to utter that he’s discovered that our current view of reality isn’t quite what we thought.

Medicine prides itself on being a science, but it’s also a commercial enterprise, which means its ‘truths’ may be influenced more by money than by the position or reputation of the researchers. In fact, there’s good evidence to suggest that medicine is too often a for-profit undertaking that dresses itself in the cloak of science.

Around 70 per cent of all the medical studies published contain some element of fraud or spin and, sometimes, the paper isn’t even written by the researchers credited with running the study in the first place. Instead, drug companies hire marketing firms known as ‘medical education and communication companies’ (MECCs) to put the project together, find the subjects and come up with the right answer – which can only be a glowing testimonial of the efficacy and safety of the drug in question.

The New York Times newspaper once got hold of the transcript of a telephone call made between the MECC IntraMed and representatives of the drug company Norvartis. During the call, the IntraMed employee said: äóìWe would like to help draft this manuscript, and then submit it to you for your . . . editing and approval.äó In response, the Novartis representative replied that the company just wanted a äóìquick, down and dirty articleäó. Not quite the pure utterances of science.1

And yet, it’s hard to shake the belief – the hope, perhaps – that medicine is always a ‘good thing’. But, as Dr Marcia Angell reminds us in her excellent book, The Truth About the Drug Companies (Random House, 2005), äóìWe need to remember that much of what we think we know about the pharmaceutical industry is mythology spun by the industry’s immense public-relations apparatus.äó

Nevertheless, scientific trials are the basis of ‘evidence-based medicine’, as the new generation of doctors are calling it. Two of them recently railed against the herbal detox kits that can be bought at the local health shop after they treated a woman who had become critically ill after taking a cocktail of herbs and excessive amounts of water as part of a detox ‘cleanse’. äóìThe complementary medicine market is very popular in the UK and the concept of the New Year ‘detox’ with all-natural products is appealing to those less concerned with evidence-based medicine and more with complementary medicine,äó they wrote.2

So there you have it. Alternative and complementary medicine is quackery, and medicine is evidence-based – except, of course, it’s not, or not anywhere near as much as it should be.

All of this matters. With post-truths, we can elect presidents, go to war (remember the non-existent weapons of mass destruction?), and take drugs in the belief they are safe and effective.

Let’s hope that in this new post-truth age, we become a little more sceptical, so when we’re handed a prescription for a drug – especially a new one in the marketplace – we exercise a bit of caution too.




BMJ Case Rep, 2016; doi: 10.1136/bcr-2016-216348

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