Colonoscopies, cholesterol, and diagnostic deception

0:00I think I remember Garth Davis about four years, four or five years ago at a conference saying that absolutely we should get colonoscopies and that they clearly save lives. He's a smart guy and he's good intentions. I'm wondering why you think his conclusion was so different than yours. That's not the only conclusion he has that's different from mine. He doesn't know. It was wrong when he said that and the data proved him wrong. I could have proved him wrong at that time. I try not to be obnoxious in public settings and beat people up. I don't like to do that, but I was there when that happened and I was quiet and didn't say anything. But he also is very enthusiastic about the childhood vaccine schedule too, just to put it in perspective. Got it. OK. Stephen, can I add just a little bit to what I said? You can both add anytime. Just because I know quite a bit about colonoscopies as a chapter in this book, you actually Gilbert Well to wrote the forward to my book on screen.

1:00And I like you even more. I've known Gilbert for many years and he's taught me a lot, but also it's a good time to introduce the concept of surrogate marker. And a surrogate marker is something like your level of cholesterol. It might be something as simple as a polyp. So if they, now I can talk about why they don't do colonoscopy screenings where I live, but if they go into your colon, even a healthy colon, they may find, they often find polyps, little tags of skin that hang down. And they have tools that they can last suit them and and remove them. There's a theory that if you go in, you find polyps and you remove them, they knew you're going to reduce the person's risk of cancer, which, Pam, correct me if I'm wrong, is complete bullshit. That's not true at all, though it causes a heck of a lot of repeat visits. If you've got, if you've had one trip into the, for colonoscopy and they've removed a pallet, you are going to be a lifelong colonoscopy customer.

2:03And it's a surrogate marker. It's something that they can see they can remove. It's not going to help you live longer or better. That's the bottom line and I agree with your assessment of that. And where I live, they don't routinely offer colonoscopies. Why is because like Pam says, the evidence isn't there. They do offer something called a fit test. It's a fecal test where they can detect signs of blood or whatever in your stool. I'm not sure how, and I have not up to the date on the literature on that, but it's certainly less invasive. And yes, there is some risk of a lot of people getting colon cancer. And a simple stool test seems to be the first route to go here in British Columbia anyways. You do not see people routinely getting colonoscopies here. Yeah, you're in the States. They developed this product called Colaguard. It's a $600 test and it's being advertised on television a lot.

3:06I don't really watch much television. So if I see three ads for it tonight, it's heavily advertised right. So but anyway, this is a home now they mail it to your home. It costs $600 and insurance pays for part of it. But the funny thing about it is that if you look at what the data shows, if it's negative, you should get a colonoscopy to confirm that. And if it's positive, you should get a colonoscopy to confirm that one doctor was even quoted as saying to the media, this is the best tool we have for encouraging people to get a colonoscopy. Well, yeah, you're saying whatever the result is we want you to go get that. And again, what's missing from the discussion is colon cancer is a largely preventable cancer with diet. High fiber diets and low animal food diets are great for reducing the risk of colon cancer. And that's what we should really be talking to people about because I think one of the responses people have when you and I start talking about this is that feeling of helplessness like, oh my gosh, I thought the early detection thing was going to be how I stay alive. So if that doesn't work, what am I going to do?

4:08You know, what do you say to people? I say what I say to people is you better take care of yourself because we don't have a lot of tools for finding it early and saving your life that way. So let's back up and have the diet and lifestyle discussion. Thank you. Alan, you mentioned the Cochrane collaboration as a source of high quality evidence. How accessible and understandable is this resource for the average person? Not very. Yeah. So just a little background. That's the book that I wrote. The Cochrane collaboration. Medicine skip. Best kept seabird. I spent two years going to Cochrane meetings interviewing a lot of the really hard hitting researchers there. People like Tom Jefferson or Peter Gautier and others who really were able to look at, you know, if you're, you know, answer a question such as, is the flu vaccine effective? Simple question. You can say, well, this study says it is.

5:08Well, this study says it isn't. So that's not good enough. What you need to do is you have to have a systematic way to go out and collect all of the studies. English language, French language, whatever. You bring them all together and then you assess them as a meta analyses. And that becomes the results of that. If it's done properly and you're using the highest quality randomized trials, you come to better answers. And Cochrane has been very good at doing this. They've been around for now almost 40 years. And they do have plain language summaries that are available on the web. I've always criticized the plain language summaries. They've never been that intelligible. They're very careful in their wording and their scientific statements. You might have heard during COVID that one of them, the most cited Cochrane reviews was the review on masks. This is done by Tom Jefferson and his colleagues. Essentially finding that the effectiveness of masks was essentially non-existent.

6:10They couldn't find any good, high quality trials to show that masks prevented people from developing or transmitting viruses. People were shocked at this. And of course, it caused a certain amount of political backlash within the collaboration. There's been schisms forming and things that have happened within the group. I would say that among the instruments that are out there to inform consumers, the Cochrane plain language summaries is one of them. I wouldn't stop there, though. You would want to refer to say some of Pam's information, for example, and you get a better cross-section. Thank you. Pam, or Dr. Popper, you discussed the issue of disease mongering. Can you provide further examples of conditions that may be over-medicalized? Well, I think I'd start by saying all of them. And this is a major shift that's happened.

7:12I'm going to be 69 years old this year. And so I'm old enough to remember that you visited a doctor when you were sick. And you had symptoms. And the job of the doctor was to figure out what was wrong with you, or maybe send you home with an aspirin or a prescription drug. But someplace along the line, we got the idea that hanging out with doctors and finding disease early was a good idea. And it sometimes things sound good, but they're not. And a lot of medicine is based on sound reasoning, not sound science. Excuse me, my voice is a little bit scratchy. So now we're hanging around with doctors. And we look for more and more and more things. So when I started in this business on this 30 years ago, people would come in with a blood test. It was two pages. Now it comes in a UPS box filled with little marks, little ups and downs, 10th of a, of the 10th of a point here down, 10th of a point there up.

8:14It's all noise. You know what you're looking for is wildly abnormal things. And usually you find those when somebody's symptomatic and bleeding rapidly. Or my, I have psoriasis from my head to my foot. What's going on, right? So then, then you find things. And we should be talking to people about how to solve them, how to eradicate them. But more and more and more tests results in more and more and more and more in consequential noise. And then Alan mentioned a very important thing, which was the changing of the diagnostic parameters. So that almost anybody who's getting tested for thyroid. For a mammography screening. You're going to get diagnosed sooner or later. You will get diagnosed with something. And so you either become part of the worried well. I don't know if I should do it. I see people like this all the time. I don't know what to do. I don't know what to do. I don't want to take drugs. And then you see people by the time they're by age, they're all drugged up. And most of it is completely unnecessary.

9:15And when we get our typical patient comes in because they want out of the medical meal, they're often taking drugs from minor abnormalities and blood pressure. Slightly high cholesterol. They don't really have any real risk, but they're all drugged up. This comes from being drugged up for the not sick, not being sick. That makes any sense, you know. Thank you. Alan, in light of potential publication bias in pharmaceutical research, what safeguards should be in place to ensure a complete and unbiased view of a drug's effectiveness and safety? Yeah, that's a really good question. You know, publication bias is just really one part of the potential for bias. There's many potential for bias. When I say bias meaning, you're not getting a true answer out of the research. And I would probably argue that the systems that we have in place are so slack

10:21as to allow things that would be, would shock most of your audience. To give you an example, a major pharmaceutical company a number of years ago did something like ten trials of its antidepressant. Ten. And these would be probably somewhere between four to eight or ten week trials of their antidepressant. And of those trials, two were published. Two of them, they were positive, they were published. And they went to the FDA. The FDA looked at the published trials. They said, okay, well, these drugs show some level of benefit. But the company didn't tell the FDA that there were eight other trials that were published that were negative. So what you've done, even before the drug gets to the market, you've skewed what we know about. I mean, that's a probably gross example of publication bias. But I mean, this is why you need people doing systematic reviews. Looking at all the evidence, the good, the bad, the ugly, and assessing that.

11:22As an individual to try to sort through this, it's really tough. But I think one of the ways to detect sort of publication bias is really following the money. And a lot of the publications and medical journals have been ghostwritten, which is to say the people that whose names are on the trial, they might be big importance, prestigious specialists, cardiologists, and so on. They didn't actually do the work. The work was done by a company that was hired by the pharmaceutical company to basically massage the data and put it in a form that drives the, that leads to what the drug industry calls the drug successful visit. So that information is going to get published. And, you know, I can take a look at a trial published in New England,

12:22the first thing that I'm going to look at were the conflicts of interest disclosures. And if the person is on the payroll of Pfizer, Eli Lilly, Novartis and stuff, I know for a fact that they have been helped along the way by ghost writers and by those who are able to take the information and make it appear the most flattering. And, you know, oftentimes if this is the best that the drug is going to look at, sometimes if you read closely these published trials, you say, really people are going to prescribe that drug on the basis of a 2%, or a 3% difference on this weird biomarker that we're not sure what it means. That's what happens. And so if that's the best of the thing, you can be assured that in the real world, the drug is going to perform a lot worse. Thank you. Dr. Popper, what are your thoughts on the long term use of anti-depressant drugs given the evidence comparing them to placebo?

13:24They're terrible. And I can't think of anybody I dislike enough to prescribe them to. I've thought one and hard about some of the people I dislike and this world, and I wouldn't wish it on them. The first thing is that the whole premise of these anti-depressant, antistachotic, all these psychiatric drugs we can categorize and together is that there's a chemical imbalance in your brain that's causing you to be depressed or anxious or whatever. And then this is going to correct it. But there's no evidence that there is any such thing as this chemical imbalance in the brain. And what these are, problems with living. You know, living being a human is hard. It really is hard. I've had moments when I thought it was pretty hard too. People get married, they get divorced, somebody in the family dies, they lose their job. Bad things happen to people and all through life, the longer you've lived, the more that stuff you've experienced. And the answer is not to drug people. The answer is to help them. And we have very good therapists, particularly cognitive behavioral therapists,

14:26they're super good at helping people sort this type of thing out. And when you drug people, you numb them out so they don't care about anything. I remember a woman who was lived in Columbus at the time. She was coming into Mama's farm a lot. And she made up her mind to get off of these drugs. And by the way, you don't have a chemical imbalance when you start taking them. But by the time you've taken them for a while, you have a chemical imbalance in the brain. And it is harder to withdraw from them, particularly the benzodiazepines. It's harder to get off of them than it is to get off of drugs like heroin and oxycrotic. I'm not kidding, it takes a long time. And so anyway, she decided to get off of the drug and she succeeded in doing it. It took her about 90 to 120 days to lean off. And she said the first thing she did was sit down and cry. And she said, I realized I hadn't cried in five or six years. I hadn't laughed either. I just didn't feel anything. When happy, wasn't sad, I'm just muted out. And so what we've really done is we've pathologized life.

15:28I mean, which is just a horrific thing to do. A former business partner of mine was an expert witness in the case against Eli Lilly. All those cases got consolidated early on. And I remember in a lecture, he gave in Columbus. He said that these drugs are the, the PERSAC, which was the first drug. Lily, Eli Lilly had told the public that 10,000 people were in the trial, only 149 finished. And many of them were taking benzos to calm down their homicidal and suicidal urges. This is horrific. And I could tell you similar stories about all the rest of them. And don't get me started on the drives for ADHD because that's another condition that's problems in life that need to be solved. So this is a horrific, horrific thing that in my opinion is just as vicious and awful as people bringing fentanyl into our country. It's just a different way of hurting people. And I've been opposed to them for a long time. And, but they're super profitable.

16:29And as many as 20% of the country has been drugged with them. All of them collectively. Music