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  • Lutz Kraushaar

How medical science has become a risk factor.

Updated: Jun 22, 2018

First, do no harm!

Its a pledge that medicine does not live up to.



Much of what medical science offers, be it a drug, a treatment or some advice about supplements or diets, will probably not work for you and possibly do you some harm.

If I was the only one telling you this, you could be forgiven for just waving me off. But if a Stanford professor of medicine, health research and statistics tells you "Why most published research findings are false" you may want to listen [1]. So, when Prof. Ioannidis published in 2005 that “…false findings may be the majority or even the vast majority of published research claims" he may have stated one of the most important health facts you probably never heard of.

That John Ioannidis is also the editor-in-chief of the European Journal of Clinical Investigation lends additional weight to his observation.


Others, equally qualified and credentialed, have come to similar conclusions. Paul Glasziou, professor and former director of the Oxford Center of Evidence Based Medicine, makes a convincing case for "85% of health research being avoidably wasted" [2].

That is, health research being wasted on studies that are never published, poorly designed, incomplete or inaccurate. Each one of these issues can hurt you when you base your health or medical decisions on missing, incomplete or inadequate information.


Medicine's obsession with treating risk factors makes matters worse. Be it cholesterol, blood pressure or any fancy biomarker, they all have one thing in common: "minimal predictive value" [3]. That's a fancy way of telling you something that you should really understand:


When you take a drug to lower one of your risk factors, it doesn't mean that it lowers your risk, say, of a heart attack or stroke. Even if the risk factor reacts in the desired direction.


There is a number to show you the size of the problem:

More than 200 people need to take a statin (a drug that lowers blood cholesterol) to prevent just one person from suffering a heart attack. It's called the Number Needed to Treat (NNT) [4]. More interestingly, for every person saved from a heart attack by a statin, there is one person who develops diabetes because of taking the drug. The Number Needed to Harm (NNH) is the same as the NNT.

Ironically, having diabetes escalates the risk of suffering a heart attack, the very risk that we try to reduce by giving a statin in the first place.


To make matters worse, for every 21 people taking a statin, one will suffer muscle damage [4]. That's a lot more harm than help.


That's how medicine doesn't live up to its pledge of doing no harm. It's why medicine has become a risk factor of its own.

Now, don't get me wrong. I'm not at all against medical science. On the contrary. I am simply against medicine's tunnel vision on treating risk factors, because the treatment itself becomes a risk factor in its own right.


The most attractive alternative is to focus health care on building robustness against risk factor load. The tool to do this is functionomics, a new discipline aimed at optimizing and maintaining function. How this strategy enables us to treat the mother of all risk factors - aging - is the subject of another blog.


Until then, stay skeptical, stay robust!

Risk Factor Medicine


References

[1] J. P. A. Ioannidis, “Why most published research findings are false,” PLoS Medicine, vol. 2, no. 8. pp. 0696–0701, 2005.

[2] I. Chalmers and P. Glasziou, “Avoidable waste in the production and reporting of research evidence,” Lancet, vol. 374, no. 9683, pp. 86–89, Jul. 2009.

[3] J. P. A. Ioannidis and I. Tzoulaki, “Minimal and Null Predictive Effects for the Most Popular Blood Biomarkers of Cardiovascular Disease,” Circ. Res., vol. 110, no. 5, pp. 658–662, 2012.

[4] S. Yusuf, et al., “Cholesterol Lowering in Intermediate-Risk Persons without Cardiovascular Disease,” N. Engl. J. Med., vol. 374, no. 21, pp. 2021–2031, May 2016.

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© Dr. Lutz E. Kraushaar, Werbach, Germany