Kitabı oku: «What Doctors Don’t Tell You»
WHAT DOCTORS DON’T TELL YOU
The truth about the dangers of modern medicine
LYNNE McTAGGART
Copyright
Every illness and every patient is unique. This book is intended as a source of information only. Readers are urged to work in partnership with a qualified, experienced practitioner before undertaking (or refraining from) any treatments listed in these pages.
Thorsons Element
An Imprint of HarperCollinsPublishers 1 London Bridge Street London SE1 9GF
www.harpercollins.co.uk
and Thorsons are trademarks of HarperCollinsPublishers Ltd
First published by Thorsons 1996
This revised and updated edition 2005
© Lynne McTaggart
Lynne McTaggart asserts the moral right to be identified as the author of this work
A catalogue record of this book is available from the British Library
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Source ISBN: 9780007176274
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Praise for What Doctors Don’t Tell You
‘This groundbreaking book … has potential to save lives. Stunning stuff!’ Kathryn Marsden, author of The Food Combining Diet
‘A hugely impressive book, and the finest critique of modern medical practice I have yet read. Lynne McTaggart takes a scalpel straight to the heart of medicine’s most cherished dogmas. Essential reading …’ Peter Cox, health campaigner and bestselling author
‘A mine of subversive information … irresistibly argued. Lynne McTaggart is a very big thorn in the side of the medical propaganda machine.’ Dr Keith Mumby, allergy specialist and author of The Allergy Handbook
‘Introduces some welcome sanity by its critical appraisal of the value of many diagnostic and treatment procedures, especially the unbelievable escalation in the use of symptom-suppressive drugs. Excellent, stimulating … and a thoroughly good read.’ Dr John Mansfield, former President of the British Society for Allergy and Environmental Medicine
‘Extremely provocative and meticulously researched … should be part of the medical cabinet in every household in this country. I have long admired Lynne McTaggart’s pioneering spirit, vision and courage, and this book exemplifies it.’ Kitty Campion, practitioner and author
‘A courageous book! I congratulate Lynne McTaggart on her passion, research and indefatigable efforts to bring information to the public that can help people to take control of their own lives.’ Leslie Kenton, broadcaster and bestselling author
‘This book dispels so many harmful medical myths and gives people back the freedom of informed choice. Essential reading for those facing medical intervention.’ Patrick Holford, director of the Institute for Optimum Nutrition
Praise for Lynne McTaggart’s newsletter What Doctors Don’t Tell You
‘What Doctors … has an impressive track record for alerting readers to potential problems …’ Women’s Journal
‘Information that is scientific yet easy for parents to digest is sparse … What Doctors Don’t Tell You provides much damning evidence.’ Guardian
‘Every month What Doctors Don’t Tell You … rings the alarm bells on procedures well before they become the stuff of national panic.’ Observer
‘What Doctors Don’t Tell You … brings together unpublicised medical information.’ Independent
‘What Doctors Don’t Tell You has easy to read and up to date reports on drug side effects.’ Daily Mail
‘A voice in the silence.’ The Times
Praise from her readers
‘Well done with all your efforts to educate, inform, guide and empower people to be active carers and protectors of their own health. Keep the momentum growing and growing.’ I. L., Suffolk
‘An excellent, compelling and informative read. It should be essential reading for everyone!’ E.W., East Sussex
‘I had a reasonable knowledge of the possible pitfalls of drug therapy, but your wide-ranging, well-written and easy-to-understand information has heightened my awareness of this most important subject and you are performing a much-needed and vital service to us all.’ M. G., Bedfordshire
‘As a medical doctor, I am really pleased with What Doctors … and the special work you are doing.’ Dr M. S., Beirut
‘Several years ago I was diagnosed with multiple sclerosis … A chance discussion put me on the track of your newsletter, which linked MS-type symptoms with the Pill I’d been taking. Had I listened to my GP and neurologist, I would probably be in a wheelchair. Thank you, What Doctors Don’t Tell You, for saving my life.’ D. J., Norfolk
‘Recently, my mother-in-law was diagnosed with breast cancer. I cannot tell you how encouraging your newsletter was to the whole family … She is faring well and confident she is making the right decisions thanks to your timely advice.’ J. B., Jersey
‘Instead of suffering from asthma, unwillingly forced into the last-ditch resort of taking steroids in order to have any sort of liveable life, I am virtually free of it and, to boot, have lost a surplus two stone. This is all attributable to your informative publications.’ M.B.C.P.-B., Cornwall
‘After a wonderful uncomplicated start in life, my baby contracted whooping cough. Thank you, WDDTY, for putting together so much information. It was you and your publication which put me on the path of being informed. My son made a full recovery. I will be for ever indebted.’ Janet, Berkshire
‘My husband was given three months to live two years ago due to prostate cancer. By reading your newsletter and the information you provide, I contacted the right people and he started an alternative therapy. It succeeded and he was later told that he was clear of cancer. Thank you for being you.’ M. R., Dyfed
‘Two months ago I could barely walk more than 50 yards or stand in the queue at the Post Office. Chronic lower back pain was the problem … now thanks to WDDTY I ramble and cycle miles and miles without pain.’ R. P., Norfolk
‘I was told I had glaucoma and was going blind. I developed a diet and supplement programme based on your information, and two months later I had my eyes examined again, and there was no sign of glaucoma any more.’ G. R., Edinburgh
Contents
Cover
Title Page
Copyright
Praise for What Doctors Don’t Tell You
Dedication
Introduction
Part I: medicine’s False Science
Chapter 1: The Un-science of Modern Medicine
Part II: Diagnosis
Chapter 2: Diagnostic Excess
Chapter 3: Prenatal Testing: Dead Certainty
Chapter 4: Catching It Early
Part III: Prevention
Chapter 5: Crazy about Cholesterol: Medicine’s Red Herring
Chapter 6: Vaccination: Knee-jerk Jabs
Chapter 7: Hormonal Mayhem
Part IV: Treatment
Chapter 8: Miracle Cures
Chapter 9: Dental Medicine: Safe until Proven Dangerous
Part V: Surgery
Chapter 10: Standard Operating Procedure
Chapter 11: Gee-whizz Technology: The Video-games Wizard and Blocked-drains Mechanic
Part VI: Taking Control
Chapter 12: Taking Control
Keep Reading
Index
Further Resources
Acknowledgements
About the Author
Notes
Also by the Author
About the Publisher
Dedication
For Bryan
Introduction
This book was born from a grand passion I once had: a passion to get better.
In the early eighties, after an extraordinary patch of bad choices, I underwent a prolonged bout of stress. In every profoundly important area of my life, green lights I’d always taken for granted suddenly began turning red. If I had taken one of those little tests you find in women’s magazines that add up your stress quotient – with death, marriage, divorce and moving the most stressful situations – my sums would have leapt off the chart.
In rapid succession I’d struggled under an impossible book deadline, married Mr Wrong, divorced Mr Wrong, bought the wrong flat, accepted the wrong job, suffered the death of a close friend, incurred several large debts, and spent a prolonged period of intense isolation in a foreign country. I couldn’t, in those days, even get a good haircut.
Shortly after emerging from the eye of this personal squall, I began to experience strange symptoms, at first your workaday ‘female problems’ – everything from ferocious premenstrual tension and irregular periods to cystitis and almost constant vaginal infections.
As time wore on, my symptoms multiplied: eczema, hives and allergies to a load of food and chemicals; diarrhoea and an irritable bowel; insomnia and night sweats; and severe depression. I had felt powerless for so long that my body seemed to be reacting in parallel, caving in under any sort of microbial onslaught.
For nearly all of the three years that I was ill, I made the rounds of medical circles – first the standard ones, then the periphery, with nutritionists and homoeopaths, and finally the very outer rim, from breathing specialists to Bioenergeticists. By the autumn of 1986 I was hacking my way though the dense thicket of New Age therapies. I tried breathing from the abdomen. I had the negative emotions Rolfed out of me. Somebody tried to diagnose me by subjecting my hair sample to radio waves. I ploughed through autogenic training, colonic irrigation and even a form of psychotherapy – a mixture of Wilhelm Reich and what felt like being tickled on the face. I learned something about my relationship with my mother. But I did not, at any point, get better.
By the summer of 1987 a sense of hopelessness descended over me. The worst part of being chronically unwell without a diagnosis legitimatizing it is that a lot of people don’t believe you, or view your symptoms as imaginary – as a puerile sort of attention-getter. And in this land of stoics, if your illness isn’t hard-core, like cancer or leprosy, you’re supposed to learn to live with it, to dysfunction quietly, without complaint.
At some point it began to dawn on me that there was no miracle remedy out there that was going to turn my health around. If I was going to get better, I was going to have to take charge of the entire process myself – from diagnosis to, possibly, even the cure. Somehow I would have to figure out what was going wrong with my body and find whatever tools were necessary to cure myself. It began to make sense that I should take control of my health, since no one else would care about its outcome so passionately.
I began reading up on allergies and female problems, and one day came upon a newly discovered illness whose symptoms matched almost every one of mine. When a specialist I consulted wasn’t familiar with it, I searched out a renowned GP specializing in allergies and nutritional medicine, whose battery of tests and diagnostic sensitivity confirmed my own suspicions, and rooted out other contributory problems besides.
What I seemed to have inside me was, essentially, thrush of the body, or polystemic chronic candidiasis. Candida albicans is a yeast that lives in the upper bowel of most of us without doing good or harm, kept in line by our immune systems and the friendly bacteria that coexist with it. But, according to current theories (and that’s all they are at the moment), when the immune system is weakened and the good-guy bacteria fall in numbers, these yeast can start multiplying out of control, sending out toxins that eventually interfere with a range of bodily functions.
Whether or not candida was the main cause of my illness, the root of the problem appeared to be an immune system that wasn’t functioning at full throttle. Prolonged severe stress tends to have a depressant effect on the immune system. That, and a bunch of long dormant allergies, including an allergy to wheat, which probably came to the fore as a result of stress, meant that I was poisoning my body every day with substances it could no longer tolerate. I’d also become sloppy about my diet, and was low in a large number of nutrients.
My treatment consisted of taking large doses of a well-tolerated drug for a time, plus a batch of specially tailored doses of supplements and a restrictive healing diet of fresh, unrefined food. A month after I’d started, my dry cleaner asked me if I’d had a face lift.
However good these initial results, I soon realized that getting better wasn’t going to be an overnight affair. For a year healing became, in effect, my career. Fortunately I had teamed up with an extraordinary doctor, and we worked together as a partnership in recovering my health, and with it, my sense of control. That year was heady and instructive, with plenty of opportunities to meditate on the science and art of healing, as well as the nature of the doctor-patient relationship. It seemed to me that patients were more likely to get better, so long as they were in charge of the decision-making about their care. True healing could only begin if there existed a dialogue between doctor and patient, a democracy of shared responsibility. I also experienced first-hand that people can get well without drugs and surgery, just by altering what they eat and how they live. Healing isn’t simply a matter of finding the right drug or right operation, but a complex process of accepting responsibility for your own life.
This personal experience stirred up dormant memories that had affected me deeply early in my career. As a young journalist in New York, I had headed the editorial department of the Chicago Tribune – New York News Syndicate. There I’d met the late Dr Robert Mendelsohn and helped to launch his column ‘The People’s Doctor’ in the mid-seventies. As former medical director of a national programme for underprivileged children, and chairman of a state licensing committee for doctors, Mendelsohn had been entrenched in the very heart of the American medical establishment. Nevertheless, here was this kindly, mild-mannered man, your prototypical Jewish grandfather, blowing the whistle on all his peers by denouncing medicine as excessive and unproven. Every week his column would savage yet another medical sacred cow. Most famously, it was Bob who likened medicine to the new religion. ‘Medicine’, he wrote, ‘is not based on science – it’s based on faith.’
Bob sent tremors through the very foundation of my belief system. I had been a product of the post-war American baby boom, the Kennedy New Frontier, brought up to regard American science and technology as the saviours of mankind. As a teenager I had believed in the principles of Lyndon Johnson’s American dream. Most of the big problems of mankind – racism, poverty, illness – could be eliminated by social engineering and science, there in the best country in the world.
In my own journalism, when I began examining some of the social ‘goods’ that medical science engages in – such as ‘breakthroughs’ like the Pill – I came to realize that at times they amounted to a great deal of dangerous meddling. But it wasn’t until I began to investigate my own health problems that the prescience of Mendelsohn’s views really came home.
Once I got better (which took, all told, a year), I became drawn in my freelance work to medicine. I began studying the professional literature in medical libraries and learned how to read medical studies. I followed around exhausted junior doctors working a standard 84-hour shift in a special baby unit, to get a taste for the extreme conditions which young doctors had to endure (and the kind of questionable care their patients would receive under these conditions).
In time I began to feel I’d walked through the looking glass. Nothing in my university training prepared me for the peculiar, often tortured logic of medical studies. Treatments had been adopted with little or no scientific basis in fact. Studies which cast doubt on a drug’s effectiveness were nevertheless applauded as evidence of success. Many of the gravest, sloppy mistakes in study design had been overlooked. Studies clearly showed that certain drugs cause cancer, yet here were top scientists dancing all around the numbers to avoid acknowledging the obvious. Medicine’s own scientific literature offered overwhelming evidence that some of it not only didn’t work, but was highly dangerous. This was not a ‘science’. This was a belief system so fixed, so inherent, that any truth to the contrary was dismissed as virtual blasphemy.
Fired by the missionary zeal of the newly converted, at some point I became extremely boring on the subject. Probably out of desperation, my then new partner (now my husband), Bryan, suggested that I start a newsletter about the true risks of medical practices – so I didn’t have to tell him anymore, but could tell the world.
At the time, we didn’t expect that this newsletter, which we planned to call What Doctors Don’t Tell You, would be much more than a hobby. I was pregnant by that time, and we thought it might be a way for me to stay home with our child and make a modest living.
From the outset, after our launch at the 1989 Here’s Health show, people showed keen interest in subscribing. By then I had assembled an advisory panel of 25 top doctors, chosen because they themselves had blown the whistle on unproven medical practice or pioneered less invasive medical procedures. Although we rarely advertised during the first year, the newsletter seemed propelled forward by its own steam and the zealous faith of our initial subscribers; by the end of that first year we had somehow managed to accumulate 1,000 readers, and now we have many thousands of loyal subscribers in Britain, the United States, and all over the world.
Outrage is now the passion that powers the newsletter – as well as this book. I am livid every time I open my post. Each morning I wade through piles of letters containing heart-rending stories of personal catastrophe – children who have been killed, or husbands and wives mutilated or incapacitated through medicine. Whenever we study their cases we usually discover that the dangers of the treatments given to them were well known. Their doctors just hadn’t bothered communicating this vital information to them.
The problem is, by the time they write to us, it is too late.
I have written this book because I don’t want you to be another statistic in my morning post. I do not promise you a comfortable read. Many of the facts in this book are likely to unsettle you. You may learn that much of what your doctor tells you isn’t true. But that is my intention. I want to help you to become a more informed medical consumer by determining when you actually need your doctor and when his advice is best ignored. I want to save you from unnecessary treatments and dangerous cures, from ‘preventive just-in-case medicine’ that will leave you damaged even before you’ve actually become ill. Besides being alerted to the hazards of many accepted practices, you’ll also find many proven, safe alternatives for diagnosing, preventing or treating many illnesses. I want to help you to learn not to be a ‘good’ patient. Good patients, the kind who blindly follow orders instead of demanding answers, sometimes die.
The following pages will open up to you the trade secrets of what has been largely a closed shop. You’ll have a chance to listen to the private conversation that medicine conducts with itself. And, once you discover just how much hokum resides in your doctor’s medicine cupboard, just how much medicine relies on blind faith, received wisdom and selective facts, not reason, science or common sense, you can grab the power away from this false shaman and begin to take back control of your health.
PART I MEDICINE’S FALSE SCIENCE
1 The Un-science of Modern Medicine
It’s comforting in life to have certainties. One of the cosiest of certainties we’ve grown up with is that modern medicine works miracles and doctors cure diseases. In the stories we tell ourselves, Dr Kildare, Marcus Welby, Dr Finlay, clad in symbolically pure white, engage in the business, all day, every day, of saving lives. And even though more people die in our modern-day equivalents like ER and Casualty, those doctors in the emergency room still have gadgets capable of raising the dead.
Our greatest certainty about medicine is that it is a lofty and reputable science, arrived at by scientists in laboratories by exhaustive testing and review. We proudly point to the fact that science has progressed and triumphed over chaos and darkness, over the time when doctors didn’t even know that they had to wash their hands.
Since the Second World War, and the discovery of the two great miracle drugs of this century – penicillin and cortisone – medicine has indeed worked miracles. People who would have died from hormone-related deficiencies such as Addison’s disease, and life-threatening infections such as pneumonia or meningitis, can now recover easily and return to normal lives. Most of the great medical discoveries – painless surgery, antiseptic hospital environments, x-rays – only discovered in the last century, have given us in the West the best emergency medicine in the world. If you have an unforeseen heart attack, an operable brain tumour, a near fatal car accident, an emergency in childbirth, then Western medicine, with its array of space-age gadgetry, is without parallel for sorting you out. If a building ever falls on me, I’d like all the very latest in Western gee-whizz technology to put me back together. Indeed, if it hadn’t been for 20th-century drugs, my mother would have died in her early twenties and I never would have been born.
It was also these discoveries during the Second World War, ending abruptly with the ultimate scientific discovery, the atomic bomb, which left us with a great expectancy about science. The aftermath of victory was also the dawning of the scientific age of medicine. Science had helped us to conquer our human enemies. Now it would do battle with our microscopic ones. We were beginning to conquer space; it wouldn’t be very long, as Life magazine promised my generation in America, before we conquered disease.
Doctors and medical authorities contribute to this view of infallible medical science. Whenever discussing its own track record, especially against that of alternative treatments, medicine stakes out the moral high ground, flying the territorial flag of established scientific fact. In mounting an attack on alternative medicine, a British Medical Journal editorial self-congratulatingly trumpeted medicine’s ‘record of objective evaluation of claims.’1
By the same token, orthodox medicine denounces alternative medicine as not following suit. The Royal College of Physicians and the Royal College of Pathologists once denounced alternative treatments for allergies as unscientific, warning that ‘until the methods have been evaluated by reputable, randomized, double-blind, placebo-controlled trials they cannot be accepted into routine clinical practice.’2
Our faith in medical science is so ingrained that it has become woven into the warp and woof of our daily routine. In any average day in Britain, a family may place its entire future in the hands of medical advance. For a pregnant mother, the result of prenatal tests may determine whether she carries her pregnancy to term. Her child may be given his vaccine and her husband his blood-pressure lowering drugs on the premise that this medicine will prevent them from getting future disease. Medical tests determine whether we can have children, continue working, have operations, are eligible for insurance, require caesareans, or, as with an HIV test that comes back positive, are shunned as pariahs. It is doctors with their miracle treatments, we believe, who will deliver us from evil, which, these days, is not temptation so much as the frightening randomness of disease.
But much as we cling to the notion of science as a force of redemption, our faith is misplaced. The truth of it is that medical science actually isn’t working too well. The United States and Britain are losing the ‘War on Cancer’.3 Despite state-of-the-art mammogram screening equipment and surgical techniques, breast cancer mortality rates stubbornly refuse to fall. Despite millions of people following low-fat diets, heart disease is still the biggest killer in the West. With all the fancy chemicals and computerized testing equipment we have to hand, asthma, arthritis, diabetes, cancer – virtually all the chronic degenerative diseases known to mankind – are thriving, and medicine hasn’t affected their incidence one tiny bit.
One glance at the statistics shows that, except in the case of getting run over or needing an emergency caesarean, orthodox Western medicine not only won’t cure you but may leave you worse off than you were before. In fact, these days, scientific medicine itself is responsible for a good percentage of disease. If you’re in hospital, there’s a one in six chance that you landed there because of some modern medical treatment gone wrong.4 Once you get there, your chances are one in six of dying in hospital or suffering some injury while you’re there. Since half this risk is caused by a doctor’s or hospital’s error, you’ve got an 8 per cent chance of being killed or injured by the staff.5 At last count, about 1.17 million Britons end up in hospital each year because of doctor error or a bad reaction to a drug. In the United States, if we extrapolate the results of a 1984 study, over one million Americans are being injured in hospital every year, and 180,000 die as a result.6 Recently, the Journal of the American Medical Association, the official organ of the primary organization representing physicians in America, recently admitted that doctor-induced disease is the third leading cause of death in America, responsible for a quarter of a million deaths per year.7 Dr Allen Roses, the only worldwide vice-president of genetics at GlaxoSmithKline (GSK), shocked the world by recently admitting that 90 per cent of his company’s – or any other drug company’s products – don’t work on the majority of patients.8 In Britain, the latest statistics are that 10,000 Britons die every year from a reaction to a drug, and one in every 16 patients is put in hospital because of an adverse reaction to everyday drugs – even aspirin. To put the magnitude of the problem in perspective, the entire population of a city the size of Birmingham is put in a hospital bed every year by medical error. If you live in the US, where about 40,000 people are shot dead every year, you are nevertheless three times more likely to be killed by a doctor than by a gun.9
This appalling track record has nothing to do with incompetence or lack of dedication. Most doctors are extremely well-intended, and probably a majority are highly competent in what they’ve been taught.
The problem isn’t the carpenter, but his tools. The fact is that medicine is not a science, or even an art. Many of your doctor’s arsenal of treatments don’t work – indeed, have never been proven to work, let alone to be safe. It is a false science, built upon conjuring tricks, supposition and blind preconception, whose so-called scientific method is a vast amount of stumbling in the dark.
Many of the treatments we take for granted – for breast cancer or heart surgery, even treatments for chronic conditions such as arthritis or asthma – have been adopted and widely used without one single valid study demonstrating that they are effective or safe.The so-called ‘gold standard’ respected by medical scientists as the only scientific proof of the true worth of a drug or treatment is the randomized, double-blind, placebo-controlled trial – that is, a study in which patients are randomly assigned to receive either a drug or a sugar pill, with neither researchers nor participants aware of who is getting what. Nevertheless, despite the fact that thousands of studies are conducted every year, very few of the treatments considered to be at the very cornerstone of modern medicine have been put to this most basic of tests – or, indeed, to any test at all.
For all the science-speak in medicine about risk-factors and painstakingly controlled data, the stringent government regulation, the meticulous peer review in professional literature – for all the attempts to cloak medicine in the weighty mantle of science – a good deal of what we regard as standard medical practice today amounts to little more than 21st-century voodoo.
In their own literature, medical authorities openly acknowledge this fact. New Scientist once announced on the cover of one issue that 80 per cent of medical procedures used today have never been properly tested.10
Medicine as it is practised today is largely a conspiracy of faith. Probably because of the miracle of drugs such as antibiotics, doctors have come to believe that their little black bag ought to be filled, in effect, with magic. The late medical critic Dr Robert Mendelsohn was one of the first to liken modern medicine to a church, with doctors its high priests following the teachings with blind faith: ‘Modern Medicine is neither an art nor a science. It’s a religion,’ he wrote in his book, Confessions of a Medical Heretic (Contemporary Books), ‘just ask why? enough times and sooner or later you’ll reach the Chasm of Faith. Your doctor will retreat into the fact that you have no way of knowing or understanding all the wonders he has at his command. Just trust me.’11
Doctors believe so fervently in the power of their tools that they are willing to suspend all reasonable scepticism about current and new medical treatments – so long as these treatments fit in with orthodox medical practice. Most doctors and researchers operate on the assumption of a priori benefit, whether or not a given remedy has actually been proven: we know what we’re doing is right. Enthusiasm for statins, the current favourite for high cholesterol, is so great, for instance, that doctors are willing to ignore the grossest of scientific lapses in safety testing in order to promote what is looked upon prima facie as a good thing. We know what we’re doing is right.
Even if studies have been done demonstrating that a treatment is ineffective or even downright dangerous, so powerful is this faith that these results often get ignored. Virtually every good study of foetal monitoring – devices employing ultrasound testing supposedly to measure the condition of the foetus during labour and birth – all show that this procedure produces a worse outcome for mother and child.12 This information appears well known to many senior obstetricians – the former head of the Oxford Perinatal Unit repeatedly has written widely about this fact – yet foetal monitors continue to be employed in every delivery room in the land. We know what we’re doing is right.
This is probably why doctors make such rotten logicians. Many in medicine get tied into logical knots, attempting to justify apparent contradictions with the most arcane Alice-in-Wonderland reasoning. Robert Mendelsohn used to say that his favourite line spouted by doctors was: ‘Breastfeeding is best, but bottlefeeding is just as good.’
‘High serum cholesterol levels are an important risk factor for coronary disease,’ once wrote noted heart researcher Dr Meir J. Stampfer of the Harvard School of Public Health, repeating the prevailing view. In the next breath, however, he added, parenthetically: ‘but most patients with [heart attacks] have normal cholesterol levels’ (my italics).13
The faith in the infallibility of their tools allows doctors to adopt as the ‘gold standard’ what are usually little more than experimental treatments, and employ these on millions before their effects are fully understood or the procedure has stood the test of time. The favourite line of doctors, when steam-rolling ahead without proof, is that if they had always waited until they had proper evidence, goodness knows how many advances in medicine would have been held up (and how many millions of people would have died). That argument does not, of course, take into account the vast number of people who have died taking unproven treatments later found to be dangerous. The new Cox 2 arthritis drug Vioxx, one of the biggest money spinners of all drugs, was withdrawn by its manufacturers Merck after it was discovered that it doubled the risk of heart attacks. Still others, such as amalgam in dental silver fillings and the radical mastectomy, are treatments devised a century ago and never properly tested or reviewed to determine whether they are as safe or effective as has always been presumed.
Medicine as it is now practised relies entirely on numbers. When judging the worth of any treatment, researchers must weigh the risks of the drugs or treatments (and all treatments in orthodox medicine carry some risks) against their likely benefits and against the risk of the illness being treated. A drug known to be effective but with serious side-effects might be worth taking if you have a life-threatening illness, but not if your medical problem is a hangnail.
Medical science is, in the main, a triumph of statistics over common sense. When bumping up against unpalatable truths in the study, medical scientists, who again always assume a medical treatment to be beneficial, are inclined to put the best face on the whole exercise, or cut and paste, refine and edit, to fit the premise or explain away an undesirable result.
Some years ago, a large study from the Netherlands Cancer Institute showed that all women taking the Pill, no matter what their age, had an increased risk of breast cancer. Most worryingly, 97 per cent of women under aged 36 who contracted breast cancer had taken the Pill, for any length of time.14 For more than 30 years, doctors have been touting the Pill as the safest drug ever developed. The Dutch study, now the fifth and possibly most damning to show a link between the Pill and cancer, was a colossal embarrassment to an entire industry devoted to contraception at all costs.
However, once they trumpeted the negative findings in the beginning of their article, the Dutch researchers began back-pedalling, by qualifying the overall implications of their findings. They emphasized that the increased risk mainly occurred among certain subgroups. Because the numbers supposedly showed no increased risk of breast cancer after long-term use among women in their latter thirties, their study was, in effect, good news: ‘Our findings accord with the mass of evidence that [oral contraceptive use] by women in the middle of their fertile years [25–39 years] has no adverse effect on breast cancer risk’ (my italics).
Doctors can often minimize the risks of drugs by magnifying the risk of not using them. Most studies have been able to justify that the Pill is safe by turning pregnancy into a dangerous disease. This risk-benefit equation only works if you believe it is better to risk breast cancer, cervical cancer, a stroke or thrombosis – all known risks associated with the Pill – than to have an unwanted baby or to use a condom instead.
A spokeswoman from the British Family Planning Association, which has probably handed out its fair share of Pills to teenagers, dismissed any breast cancer risk out of hand, arguing that this theoretical risk had to be weighed against the ‘evidence that the Pill protects against endometrial and ovarian cancer’.15 This is a typical example of medical reasoning. This drug is beneficial because it may ‘protect’ you against one kind of fatal cancer (a highly questionable conclusion, in any event), even though it may give you another potentially fatal cancer.
And because they live and breathe medicine by numbers, and believe in the infallibility of their tools, doctors are willing to hand out dangerous medication on the confident assumption that new tests will pick up any side-effects that they cause, and yet other drugs will be able to treat these new problems. Hence the reason why family planning enthusiasts will usually patiently explain that, even though the Pill may cause cervical cancer, cervical smears should pick up early changes, at which stage things are mainly treatable. Like many in medicine, they make the fatal error of requiring medicine to be infallible. This reasoning works if a test that can be wrong more than half the time picks up the cancer early, and if medicine can always cure cancer, which thus far it has singularly failed to do.
This kind of tortuous logic was once used to minimize evidence showing a link between vasectomy and the development of prostate cancer. The two studies, which examined over 74,000 men who had had vasectomies, showed that vasectomy increases the prostate cancer risk by 56 to 66 per cent.16 Those patients who’d had their operation done 20 years ago faced a whopping increase in risk of between 85 and 89 per cent. In other words, having a vasectomy 20 years ago nearly doubles your risk of getting cancer.
Pretty damning evidence, one would have thought. Nevertheless, after it was published, some professional magazines encouraged doctors to tell their patients that the risk of prostate cancer following a vasectomy was minimal. The article attempted to claim that, compared to other methods of birth control (the condom? natural family planning?), vasectomy is ‘still one of the safest’. A Family Planning Association spokesperson concurred: ‘These studies do not tell us that vasectomy causes prostate cancer’ (again, my italics).
A similar situation has occurred with HRT. Although two major studies were stopped when it was found that women on HRT are more likely to have heart attacks, cancer and stroke, the British medical establishment refused to recant or admit that this might not be the treatment of choice for women going through the menopause.
Doctors and medical researchers have been known to hype up the risks of a disease compared with the risks of the drug used to treat it. Dangerous drugs look good if you turn an ordinarily benign problem into a killer disease. In 1992, the UK Department of Health (DoH) announced the hasty withdrawal of two of the three brands of the combined measles, mumps and rubella (MMR) vaccines. The official line circulated to the press about why these drugs were withdrawn, after having been jabbed into millions of 15-month-olds, were allegedly the results of a study showing that the two withdrawn brands had a ‘negligible’ (1 in 11,000) risk of causing a ‘transient’ and ‘mild’ (all DoH words, these) case of meningitis. The third brand, made from a different strain of the mumps virus, supposedly did not pose this risk.
In 1989, when I first interviewed Dr Norman Begg of the UK’s Public Health Laboratory Service, which recommended the vaccine in Britain, he assured me that mumps on its own was a very mild illness in children. Mumps, he said, ‘very rarely’ leads to long-term permanent complications such as orchitis (where the disease hits the testicles of adult males, very occasionally causing sterility). The mumps component had only been added, he said, to give ‘extra value’ to the jab.17
By 1992, however, when the two versions of the MMR were withdrawn, the British government painted a very different picture, announcing that mumps leads to meningitis in 1 in 400 cases. Hence, even though the old vaccine was dangerous (and it must have been pretty dangerous to get hauled off the market virtually overnight), it was not as dangerous as catching mumps.
But of course, two-thirds of medical practices don’t have any proof at all. There is no such regulatory agency like the Food and Drug Administration or the Committee on Safety in Medicines to monitor surgery, screening or diagnostic tests – nothing but peer review through national medical associations. Run by doctors for doctors, these organizations tend to rule by consensus, and by a peculiarly circular logic: if a practice is universally employed, it must be safe, even when many studies point otherwise.
In the case of surgery, most treatments get the nod without any kind of clinical trial (partly because it is very difficult to have either a randomized or double-blind trial or to reverse an operation with an unfavourable result). Consequently, some new techniques get adopted with very little in the way of proof to show they are doing any good or at least not doing drastic harm.
Medicine as it is currently practised is a private conversation by doctors, for doctors. There’s no doubt that medicine maintains a double standard. Doctors often privately voice their doubts, disappointments and fears about particular treatments in their own literature, yet fail to disclose this in any discussion with patients or the press. For instance, some years ago an especially alarming piece of information came to light about vaccines. The US Centers for Disease Control and Prevention in Atlanta, Georgia, discovered that children receiving the triple jabs for diphtheria/tetanus/whooping cough or for measles/mumps/rubella were three times more likely to suffer seizures. Nevertheless, this information was only announced to nine scientists and was never otherwise publicized.
Another prime example of this double standard surrounded the issue of treatment for breast cancer. An editorial in The Lancet published a scathing attack on the failure of mammography as a technology to halt the rising breast cancer death rates, and organized a conference to talk over new solutions18 – at the same time that various government bodies were calling for increasing the frequency of mammograms.
The greatest reason that medical research is tainted is that the majority of it is funded by the very companies who stand to gain by certain results. These drug companies not only pay the salaries of researchers, but they can often decide where – indeed, whether – they get published. It’s wise to keep in mind that this industry, in a sense, has a vested interest in ill health: if drug companies found cures, rather than lifelong ‘maintenance’ therapies, they’d soon be out of business.
The constant exposure of medicine to the pharmaceutical industry, and the reliance of future medical research on these companies, has bred a climate in which much of mainstream medicine refuses to consider any other treatment options besides drugs and surgery, even when copious scientific evidence exists to support those options. Many conventional doctors are especially vituperative in their dismissal of important work by innovators, while uncritically embracing many surgical or drug-based solutions that are little more than modern-day snake oil. This has bred a climate into which healers are polarized into ‘alternative’ and ‘orthodox’ camps, rather than into one common group approving of anything that has a solid basis in science or clinical practice. Dr Peter Duesberg, a leading University of California professor in molecular biology, was one of many publicly vilified for suggesting, with a well-reasoned argument backed up by a 75-page published paper, that HIV is not the cause of AIDS.
To give you some idea how medicine handles heretics, witness how it still reacts to scientific evidence supporting alternative medicine. A study conducted scientifically, with all the usual gold-standard double-blind, placebo-controlled checks and balances that medicine prides itself on, showed that homoeopathy for asthma actually works. Scientists now had some proof: homoeopathy works. In fact it was the third study carried out by the same man since 1985 to show exactly the same result.
Nevertheless, in his published report the leader of the trial distanced himself from his results, pointing out in his conclusion that tests such as these just might end up producing false-positive, or wrong, results.19 Despite the scientific design of the trial, an editorial in The Lancet flatly refused to accept the results: ‘What could be more absurd than the notion that a substance is therapeutically active in dilutions so great that the patient is unlikely to receive a single molecule of it?…Yes, the dilution principle of homeopathy is absurd; so the reason for any therapeutic effect presumably lies elsewhere.’20 In other words, the scientific method works only when it applies to things we have faith in, but not, it seems, with anything we don’t understand or agree with.
The problem with this dogmatic adherence to preconception and dismissal of dissension or doubt, as far as you and I are concerned, is that it covers up the fact that much of standard medical practice may not work very well. It makes dangerous drugs look safe and effective. It makes it seem like people who don’t need drugs should take them. It justifies a lot of useless surgery that may very well kill you, and certainly isn’t going to make you better. It explains away many promising treatments that don’t require dangerous drugs or surgery. Despite the very best of intentions, it sometimes causes untold pain and suffering, rather than contributing to your health. In fact, you are in grave danger from the moment you walk into your doctor’s surgery, particularly at the point when he tells you he’d like to take a few tests.
PART II DIAGNOSIS
2 Diagnostic Excess
Your modern-day doctor has at his disposal an array of high-tech gadgetry that allows him to monitor and measure virtually every nook and cranny of your body. He and his fellow doctors are now completely reliant upon these tests to diagnose disease. As patients, we trust tests so implicitly to provide us with a definitive view of our state of health, even to predict when we’re going to get ill at some distant point in the future, that most of our children begin having tests as soon as they’ve been conceived.
At last count, there were more than 1,400 of these, ranging from the simple blood-pressure cuff to the most sophisticated computerized nuclear magnetic imaging devices. Back in the relatively dark ages of 1987, some 19 billion tests were performed on Americans that year alone, which works out to be 80 tests for each man, woman and child.1
Despite the kind of gadgetry that would put NASA to shame, the problem is that the technology doesn’t really work very well. Most tests are grossly unreliable, giving wrong readings a good deal of the time. A false-positive test sets in motion the juggernaut of aggressive treatments at your doctor’s disposal, with all their attendant risks. But the tests themselves can be as risky as some of the most dangerous drugs and surgery, risks that are magnified because so many of these tests are patently unnecessary. In many cases (more so in the United States), doctors protect themselves against potential lawsuits by ordering every test they can. In fact, in the US, many orders for tests are motivated by a doctor’s own self-interest, since so many physicians either own or have substantial shareholdings in the facilities to which they refer their own patients.
Another problem is that, these days, technology has replaced the fine art of diagnostics – of examining a patient’s clinical history and having a good look at his eyes and the state of his tongue. The problem often comes down to trainee doctors, who often order tests under the mistaken notion that their consultant superiors desire such ‘just-in-case’ medicine. But in many cases senior doctors do flog their juniors if they fail to request particular tests, engendering the view that more is better and that massive test-taking is what constitutes good doctoring.2
Tests also make the fundamental error of assuming not only that all people are alike, but that people (and their measurements) always stay the same.
The other problem is that, unless your doctor has a particular feeling for taking apart computers in his spare time, he can get a bit muddled by this gee-whizz technology. One study found that virtually all doctors and nurses don’t know how to work a pulse oximeter, a monitoring system which is vital for monitoring patients recovering from anaesthesia and recording potential life-threatening situations.3 Consequently, they make serious errors in evaluating readings. The medics reported not being ‘particularly worried’ when patients had levels indicating that they were seriously deprived of oxygen and needed immediate attention if they were to live.4
BLOOD-PRESSURE READINGS
Your problems can start even when your doctor brandishes his blood-pressure cuff to record your blood pressure. Professor William White, chief of Hypertension and Vascular Diseases at the University of Connecticut, refers to this gizmo, known in medicalese as the ‘sphygmomanometer’, as ‘medicine’s crudest investigation’. Blood pressure, he says, can vary tremendously – as much as 30 mm Hg over the course of any day.5 In fact, the time it’s most likely to rise is in your doctor’s surgery, when you’re waiting to have the test – a phenomenon known as ‘white-coat hypertension’. A recent study comparing blood-pressure readings taken at home, at work and at the doctor’s surgery found that the most inaccurate were those performed in the doctor’s surgery.6 Such an artificially high test reading at the doctor’s surgery can launch a patient onto a lifetime of blood-pressure medication.7 The latest studies into blood pressure and hypertension have concluded that true high blood pressure is more related to average levels over 24 hours and also the degree of fluctuation between day and night than any particular or casually-made blood-pressure readings.8
These days, your doctor is more likely to give you a home-monitoring device or even to strap you up with a portable electronic device, which will measure your blood pressure at pre-set intervals over 24 hours. This is now thought to be the more accurate way of assessing your average blood pressure, although there is still a great deal of evidence that this system, called ‘ambulatory monitoring’, likewise doesn’t provide accurate enough information for doctors to decide whether a patient needs treatment for high blood pressure.9
Even the World Health Organization recommends that ambulatory monitoring is best conducted with multiple readings over six months. But because no one has yet bothered to do proper large-scale scientific studies, no one can agree over how long you should go on doing the ambulatory monitoring before making a diagnosis, or what actually constitutes high blood pressure over this period, or even how much blood pressure should be lowered by to make it ‘normal’.10
The values used today are still hypothetical, gleaned from studies of populations with normal blood pressure.11 With home-monitoring systems, accuracy also remains a large problem. Only about a fifth of self-recording devices evaluated in recent studies have met acceptable criteria.12
In the US, the Food and Drug Administration mandates that any hypertension medication must be shown to lower blood pressure over 24 hours through ambulatory monitoring. Nevertheless, neither doctors nor drug companies really understand which reading – morning average, evening average, ambulatory reading, difference between day and night, degree of variation – shows that things are finally under control. Furthermore, many patients have different degrees of variability, depending on the nature of the stress they confront on the job.13 Older patients also have more exaggerated differences in day and night readings – the significance of which is anyone’s guess.14
A task force of participants at the 1999 Consensus Conference on ABP monitoring, sponsored by the International Society of Hypertension, recommended against using ambulatory monitoring for routine screening purposes.15 The latest recommendations are that patients use ambulatory monitoring for initial diagnoses of hypertension, and self-monitoring for long-term follow-up.16
Even the variation between the arms influences a blood-pressure reading. One doctor from City General Hospital in Staffordshire, England discovered a variation of more than 8 mm Hg in systolic blood pressure between the two arms of nearly a quarter of his patients. In one case, the difference was 20 mm Hg.17
Things are just as confusing for pregnant women and children. Doctors and health-care workers can’t even agree over how to record the second beat of blood pressure (called the diastole), which measures when blood fills up the heart,18 or whether certain sounds accurately reflect diastolic pressure. This was even the subject of a heated debate at a world congress of hypertension in pregnancy in Italy, calling for an ‘international consensus’ on how to record blood pressure in pregnant women. In fact, some researchers have claimed that doctors have been using the wrong type of blood-pressure test on pregnant women: obstetricians and midwives prefer the blood-pressure gauge called Korotkoff phase 4, but research shows that phase 5 testing is far more reliable – the reverse of the prevailing view. In one test, virtually nobody agreed on the reading from a K4 test, while everyone was in agreement on the K5 test.19 As for children, the latest recommendations are that they, too, have ambulatory monitoring.20
This potential for different interpretations in readings can cause problems for you if your blood pressure is being monitored by several people who may have had different training in how to read the cuffs.
CHOLESTEROL TESTS
Today, a cholesterol test is the most-often sought diagnostic test of all. In a general check-up a doctor will routinely offer you one to determine whether if you are at risk of heart disease. The test measures the amount of cholesterol and triglycerides in the serum (the non-cellular part) of your blood.
A total cholesterol test, which is rarely used these days, will examine all the blood fats, including the overall cholesterol level, the LDL (low-density lipoproteins, or ‘bad’ cholesterol), HDL (high-density lipoproteins, or ‘good’ cholesterol), VLDL (very low-density lipoproteins), chylomicrons (fats that are present right after a meal but ordinarily disappear within two hours) and triglycerides (compounds in the body that shift fatty acids through your blood). However, the typical cholesterol test only examines the LDL cholesterol.
The test requires a relatively straightforward blood test. You are asked to fast for 9–12 hours before the test is taken. A tourniquet is applied to your arm, so that the lower veins will pool with blood, and the blood is drawn from a vein either on the inside of the elbow or the back of the hand.
All fat tests (lipids, as they are known in medicalspeak) are measured in terms of milligrams per deciliter of blood (mg/dL). Medicine rates as acceptable a total cholesterol count of less than 200 mg/dL. The current medical wisdom is that the higher the cholesterol count, the greater the risk of heart disease or atherosclerosis (clogged arteries), and that if your levels are over 240 mg/dL you nearly double your risk of heart disease, compared with someone in the normal range.
The (largely unsubstantiated view) is that high LDL cholesterol levels may be the best predictor of risk of heart disease; if you have no other risk factors, your LDL count should come in at below 160 mg/dL. People with diabetes, heart or vascular disease, other risk factors or a family history of heart disease should try to keep their cholesterol levels even lower, say doctors.
Medicine loves statistics, and nowhere is this more evident than with this test, where a high LDL is thought to be countered by a high HDL, and vice versa. HDL cholesterol levels of 60 mg/dL are thought to counteract other risk factors; HDL levels below 40 mg/dL themselves become a risk factor.
Even if you have low LDL and high HDL cholesterol, high triglyceride levels may put you at risk. For instance, a normal triglyceride level should be less than 150 mg/dL. A vast array of conditions can result in an inaccurate test – liver disease, an underactive or overactive thyroid, kidney problems, liver disease, malabsorption of your food (say from a leaky intestinal tract), pernicious anaemia, infection and diabetes that isn’t under control. Pregnant women and those who have had their ovaries removed also will register high on the test. An array of prescription drugs – beta-blockers, thiazide diuretics, steroids, phenytoin, sulphonamides, the Pill, even vitamin D – can also throw off your test.
The other problem is the inherent inaccuracy of the lab test itself. According to one study, some 70 per cent of samples analysed have evidence of bias in the computation of results21; other research shows the products themselves used to measure blood cholesterol have major drawbacks.22 In one Canadian study of total cholesterol tests, nearly one-quarter were misclassified (as, say high risk), nearly a fifth registered a false-positive (a high cholesterol level when it wasn’t) and among those in the ‘high risk’ category, half had a false-positive reading.23
A few people in medicine are waking up to the fact that LDL levels alone are not an accurate predictor of heart disease. A large British Health Survey for England found that forecasting heart disease was far more accurate when factoring in the HDL levels, too.24
ECG Readings
Besides blood-pressure and cholesterol measurements, your doctor’s next favourite activity is listening to the state of your heartbeat. However, these days, the all-purpose stethoscope (never proved to have any advantages over the naked ear) has been replaced by a number of space-age gadgets, all designed to record the most minute changes in your heart’s ability to do its job.25 The stalwart of any cardiac specialist is the electrocardiogram (ECG), even though studies demonstrate enormous potential for error in recording or interpreting correct results. One study showed that computers, often used to interpret ECG readings, were only right two-thirds of the time, and missed 15 per cent of cases of enlargement of the right ventricle. Nevertheless, human beings didn’t fare much better; even trained heart specialists misinterpreted one out of every four readings.26 This is largely because, as with blood-pressure, readings can be affected as much as 20 per cent by recent activity, time of day, and even factors such as fear of the cardiologist’s findings! The late Dr Robert Mendelsohn wrote of a study in which electrocardiography detected only a quarter of proven cases of heart attack, and another study in which the tests found gross abnormalities in more than half of perfectly healthy people.27 As Stephen Fulder, author of How to Be a Healthy Patient (Hodder & Stoughton), notes, an incorrect ECG has led to ‘vague diagnoses of organic brain disease in healthy but unruly children, turning them into medical cases’.28
More state-of-the-art these days than the ECG is echo-cardiography – a diagnostic test on the heart, often using a mixture of contrast agents and soundwaves. The procedure had been gaining acceptance for its safety and accuracy. However, as with much ‘perfectly safe’ new technology, doctors have only recently realized that it is more dangerous than had been thought, possibly leading to life-and-death complications.
The first major study into the procedure discovered that it can be life-threatening in one in 210 cases, requiring special treatment or a stay in hospital; two people of the 3,000 studied suffered a heart attack after the procedure had been completed.29
The procedure often employs the use of microbubbles of a contrast agent like octafluoropropane, which are useful in visualizing the tiniest blood vessels of the heart. In laboratory research, rats have developed cardiac arrhythmias after being exposed to echocardiography because the contrast agent interacted with ultrasound, causing the alterations in heart rhythms. Although animal models often don’t apply to humans, this effect on a living being demonstrates that pulsed ultrasound can interact with bubbling contrast agents.30 There’s also evidence that the microbubbles cause destruction of capillaries, leaking red blood cells into skeletal muscle.31 Furthermore, the act of using pulse-sound waves with contrast agents in the brain has been shown to cause tissue damage to vascular walls, causing haemorrhage and tissue death.32
ANGIOGRAPHY
If your doctor suspects that something is awry, he may trot you off for angiography, an x-ray test supposed to examine the state of your arteries via a contrast dye. The doctor will place a catheter into a blood vessel in your arm or leg, guide it towards the heart, and inject what is usually an iodinated dye like isosorbide dinitrate, which then travels into the main pump of the heart. Once all this is in place, the doctor will then snap pictures of your heart from different angles, all the while replenishing the supply of dye.
There’s plenty of evidence that this test also has a poor batting average, wrongfully setting in motion one of a number of potentially lethal heart operations. In one test in Boston, half of the 171 patients recommended to have a coronary angioplasty (the operation where furred-up veins are opened by tiny inflated balloons) on the basis of their angiograph were found not to need the operation. In the end, only 4 per cent of the patients advised to have the angiograph really needed one.33
Angiographs are also especially open to misinterpretation. In another study in which the pathology reports of deceased patients were compared with prior angiographs, two-thirds were found to be wrong.34 A number of critics blame the test itself, which only examines the main coronary arteries, will not show any vessel smaller than a 0.5 mm in diameter and will only highlight, at best, a quarter of all the blood flowing to the heart.
Many patients with an abnormal angiogram are referred for surgery, when, at best, the procedure can locate the site of a block and its severity, but not overall heart function. Angiography, for instance, cannot distinguish between patients with stable and unstable angina.
There’s also a problem with accuracy. In one instance, after the deaths of three patients unsuccessfully treated by angioplasty, pathology reports found that the angiography on which the procedure was recommended had given misleading information about the patients’ conditions.35
Finally, this nasty little test is not without its own dangers. The procedure itself causes death in two of every 1,000 patients or, at very least, can trigger a heart attack, stroke or severe blood loss.
Serious side-effects occur, regardless of the type of dye used,36 and reactions to the dye often appear up to a week later. In one study, nearly half the patients involved complained of delayed reactions – including itchiness, rash and nausea – from one hour to seven days later.37 More than 5 per cent of patients suffer reactions to the dye of moderate intensity, particularly those who have had the test before,38 and one in ten will have a reaction of some sort. Although most are mild, at least 1 in every 2,500 is quite severe.39
If you have to have such a test, the less dangerous option may be magnetic-resonance-imaging angiography, which doesn’t require either x-rays or dyes, but a magnetic field and pulses of radiowave energy to produce pictures of soft body tissues.40 And as it provides pictures in three dimensions and on multiple planes, it shows better differentiation of tissues.
X-RAYS
X-rays are the most common procedure you’re likely to be exposed to at least once in your lifetime. Today they represent approximately 10 per cent of any Western nation’s health expenditure. Ionizing radiation is actually comprised of very high-frequency waves, which pass through living tissue. Depending on how dense the tissues are, the body retains some of this radiation. These absorbed rays are what gets recorded on the film as white or grey; those that pass completely through hit a plate of photographic film and show up as dark grey or black. Besides mammograms, bone x-rays and dental x-rays, the newest kind of x-rays include CAT scans, in which a moving beam of x-rays creates a three-dimensional picture, usually of the brain, and fluoroscopy, which sends the x-ray shadow picture onto a television screen. Occasionally contrast dyes like iopamidol or mediums like barium are used to provide a clearer picture.
Although the newest equipment uses lower and more precisely targeted doses, there is still no such thing as a safe x-ray (that goes for dental x-rays, too). In all of medicine there is virtually no disagreement that ionizing radiation is damaging – and those risks are multiplying as our understanding of the medium grows. ‘Medical irradiation is by far the largest man-made contribution to the radiation burden of the population of developed countries,’ R. Wootton, professor and director of Medical Physics at Hammersmith Hospital in London, wrote in a textbook on the subject. In the UK, he says, x-rays ordered by doctors account for over 90 per cent of the total radiation exposure of our population.41
X-rays harm people in three ways. First, they can damage individual cells (although the harm caused by the lower doses is usually quickly repaired). Rarely (but depending on exposure), this damage can convert the cell to a cancer cell. Although we don’t know exactly how this works, it has been proposed that, since a cell is 75 per cent water, most of the radiation will be absorbed by the water, forming free radicals, which are known to be carcinogenic.42
Second, if a woman is pregnant, it can injure the developing foetus, causing death or malformations.
Finally, x-rays can damage the sperm or ovaries of children or adults, causing abnormalities in future generations. We also know that x-ray exposure is cumulative; the danger of something going wrong may increase every time you get another one.
We’re still coming to grips with exactly how dangerous x-rays are, however. Unnecessary radiation from x-rays may be responsible for 700 cancer deaths in the UK every year, and perhaps 5,700 cancer deaths per year in the US, according to a recent Oxford University study.43 But these figures may still be conservative. A UK National Academy of Science committee reviewed the usual assumptions that x-rays were responsible for 1 per cent of all leukaemias and 1 to 2 per cent of all other cancers, and concluded that the real risk could be as much as four times higher44 – a conclusion also reached that same year by the International Commission on Radiological Protection.45 Recently, multiple x-rays have even been linked with multiple myeloma – a form of bone cancer now sharply on the rise. Those who’d had the most exposure had a four times increased risk, the National Cancer Institute found.46
As far back as the 1950s, medicine discovered a link between leukaemia and prenatal x-rays. X-raying pregnant woman used to be routine, on the ludicrous notion that x-rays could tell a doctor whether her pelvis was ‘wide enough’ for the foetus to fit through during birth. We now know that if children are exposed to x-rays in utero their risk of all cancers is increased by 40 per cent, of leukaemias by 70 per cent, and of tumours of the nervous system by 50 per cent.47 There also may not be a safe ‘dose threshold’; single babies who’d received five to six times less radiation than twins who’d been x-rayed more frequently had the same incidence of cancer.48 To put these numbers in perspective, for every million babies exposed in the womb to even a single rad of x-rays – the equivalent of a single picture of the stomach and intestines – between 600 and 6,000 could develop leukaemia.49 John Gofman, Professor of Molecular and Cell Biology at the University of California, believes that women who undergo yearly mammograms receive cumulative doses not unlike the Japanese atomic bomb survivors.50
Gofman estimates that women’s breasts receive 0.4 rad of medical x-rays a year for each year of life. If you compare that dosage with the levels suffered by Japanese atomic bomb survivors, he says, 114,000 women, from 62 to 75 per cent of those diagnosed every year with breast cancer, could blame x-rays as the cause. Besides cancer and genetic deformities, x-rays of the brain can lead to abnormal hormonal function, possibly causing underactive thyroid and infertility, or resulting in subtle changes in your adrenal glands.51 The US Food and Drug Administration has also lately received a number of reports of patients suffering skin burns after radiation, so severe in some instances that the skin has died. The problem is complicated by the fact that these injuries don’t show up for weeks after exposure. Your typical dose of fluoroscopy can result in skin injury after less than an hour.52
Even the offspring of those exposed to x-rays suffer. Exposure to x-rays increases a woman’s risk of giving birth to a Down’s syndrome baby.53
Although x-ray risk is cumulative over a lifetime of exposure, even single shots are not innocuous. According to the United States’ Health Research Group, a consumer group which reports on risks in medicine, topping the list are x-rays of the upper intestine, which give an equivalent dose to the entire body of 400–800 millirads; the next highest (apart from the risk associated with x-raying the other organs) is the spine (100–500 millirads); stomach, breast and pelvis (100–200 each); skull or shoulder (25–75); chest (20–60); with whole mouth dental x-rays taking up the rear at 10–30 millirads.54
In case you are feeling complacent about that low dosage from dental x-rays, a single bite-wing dental x-ray is equivalent to smoking half a cigarette every day for a year. The US Academy of Sciences figures that one barium meal shot of the intestines carries the same risk as smoking up to a pack of cigarettes a day for a year. This means that, with x-rays of the lower back, which some 700,000 people undergo in Britain alone every year, 19 people could die each year as a direct result.55
Even if everyone in medicine knows that x-rays are dangerous – possibly dazzled by another of their ‘miracles’, the ability to ‘see’ through living tissue, Superman style – doctors blithely downplay the dangers and make few efforts to minimize exposure when ordering up a set, even on your teeth. Most GPs and orthopaedists have a kneejerk approach to ordering x-rays.
A joint working party established between the UK’s Royal College of Radiologists and National Radiological Protection Board (NRPB) reviewed the existing evidence in 1990 and estimated that up to one fifth of the x-ray exams done in the UK were unnecessary or downright useless.56 In one examination of patients given x-rays of the lower back, more than half were absolutely unnecessary57 In the US, the Food and Drug Administration reckons that a third of all radiation is unnecessary.58
The most common unnecessary x-rays are those of the chest, limbs and joints. This translates into some seven million unnecessary x-ray exams in a single year. The UK’s more modest wastefulness has worrying implications for the rest of the West, since the UK performs only about half the number of x-rays per person as other countries such as France or the US,59 where seven out of every 10 people get subjected to at least one x-ray every year.60 In Canada the figures are even worse: virtually everyone gets an annual x-ray of some sort.61 (It’s also no cause for complacency in the UK, since British doctors order twice the number of certain types of x-rays – barium meal and enema – as their American counterparts.62) The NRPB has recently announced that overall radiation in the UK could be halved without reducing diagnostic effectiveness.
For instance, doctors routinely x-ray for back pain, when it has never been found to do any good at all.63 Skull x-rays have a poor batting average in detecting bleeding in the brain,64 and even the good old chest x-ray, used to detect tuberculosis, is considered a waste of time by the World Health Organization.65 The prestigious medical journal The Lancet admitted that most chest x-rays routinely performed on patients awaiting surgery other than on their heart or lungs were of so little benefit that over a million pounds’ worth of x-rays would have to be done to end up saving a single life.66
The decision of whether you need an x-ray or not also depends on the whim of the individual doctor. An audit of nearly a million day and in-hospital patients has shown that referrals for x-ray varied by 13-fold in general and up to 25-fold for chest x-rays, depending on which consultant was in charge.67
Because the reproductive organs are susceptible to radiation damage, they should always be protected from exposure during x-ray by a lead shield. Nevertheless, in a Consumers’ Association (Which?) report, in 40 per cent of cases the men surveyed had not had their testes shielded, and women were unprotected two-thirds of the time.68 (In a third of cases, no attempt was made to find out if the women were pregnant.) In another study of children, three-quarters of the time the lead shields used to protect the reproductive organs hadn’t been used or placed properly.69
Obviously there are times when x-rays are invaluable – particularly when limbs are first broken (though many doctors insist on constant new shots to check the progress of healing). However, even if your doctor is responsible about ‘dose constraints’ – the new buzzword among radiologists for the least amount of radiation necessary for individual snapshots – you still could be getting more radiation than necessary, largely from ageing equipment. The NRPB has reported that patients in some hospitals receive doses 20 to 30 times higher than necessary for obtaining diagnosis from machines that were, in some cases, 15 years old.70 Just a few years ago Liz Francis, NRPB information officer, said ‘physicists were saying that old x-ray equipment was giving out doses bigger than Chernobyl’.71
Even dental x-rays can subject you to unnecessary risks, since they are often performed by untrained staff who can’t use the equipment properly and who may either need to repeat the exercise or will set the dosage unnecessarily high. Two dentists in the West Midlands escaped suspension by their professional body for using untrained school-leavers to take their x-rays when it became clear that dentists throughout Britain were doing exactly the same thing.
As with most tests, there is a strong likelihood of human error in interpreting the results. One study of Harvard radiologists found they disagreed on the interpretation of chest x-rays half of the time. There were significant errors in 41 per cent of their reports.72
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