“Science is more than a body of knowledge, it’s a way of thinking, a way of skeptically interrogating the universe with a fine understanding of human fallibility. If we are not able to ask skeptical questions to interrogate those who tell us that something is true, to be skeptical of those in authority, then we’re up for grabs for the next charlatan…who comes rambling along.”
-Carl Sagan
Masks are the perfect symbol of what our medical system has become, and what Carl Sagan warns us against. When science is all about having “experts” spit out dogmatic fictions to a fearful and medically uneducated population, these experts are the very charlatans that gives Sagan chills. Often these charlatans, posing as educated and concerned doctors, spread appealing deceptions as a way of enriching themselves or the institutions or companies that pad their wallets. Sometimes they do it because they are trained to follow protocols and algorithms designed by specialty societies and drug companies. But it is rare in our medical universe to find doctors able and willing to tell the truth or to be willing to accept a challenge to their myths, because truth is typically uncomfortable, uncertain, nuanced, and counterintuitive, while myth is far easier to digest. And truth is certainly not profitable! When a white-coated saint with impeccable credentials and an alluring smile offers you salvation through simplistic measures like pills, tests or procedures, if they can allay your fear of being sick or dying, you tend to follow their path and disparage any who question them. Faith is a far more potent elixir than truth.
In fact, in an ironic but unsurprising twist, we who work hard to tell you the truth are labeled anti-science, medical deniers, even nutjobs; I have been called all of those by my highly paid specialist colleagues. That’s because of something called cognitive dissonance, something we speak a lot about in our book, A Return to Healing. Put simply, using the case of masks, we much prefer to hear a message that masks prevent illness, that the reason infection rates (especially COVID) surged was because of non-maskers, that wearing a mask will protect you and those around you. It just makes sense, it gives us hope in the face of fear, and it’s so easy to do so we accept it! Everyone on TV including the great Dr. Fauci have assured us of the importance of masking, and heck, we’re not dead so it must work, even if we did get sick last week but that was because some anti-science nutjob wasn’t wearing a mask. What inherently makes sense and gives us comfort is always what we’ll accept, especially if people we trust tell us it’s so; that feeds our cognitive needs. Think Catholic Church in the Middle Ages. That’s about where we are now in healthcare. Dr. Fauci, Jake Tapper, and the TV doctors don’t have to prove masks work; they just have to say it. If anyone uses evidence to contradict their position, we typically toss that person into the bin of being an anti-science nutjob, because we want masks to work, and hence our faith trumps facts. Just like the Catholic Church did to Galileo, his facts be damned.
Reality is far more troublesome than myths. The fact that we knew before COVID hit our shores that masks won’t and can’t work—decades of studies show that they don’t protect us from flu, which is why we have never worn them before, and since the flu bug is bigger than the COVID bug clearly they couldn’t help prevent COVID either—and that dozens of studies and all of our experience has definitely proven their lack of efficacy has not deterred the belief—mislabeled as science—that they do work. People wear them still, all over the place. Many of the long-term care facilities in which I work mandate them, despite the fact that everyone in those facilities caught COVID/flu/RSV right through those same masks. Reality can’t buck myth. I mean, if masks don’t work, then what do we do? So they must work. Dr. Fauci and all those TV doctors continue to say so. How can we doubt those prestigious and caring experts?
The normalization of myth is the very bedrock of our healthcare industry. And most myths are built with just a few bricks. One brick is that of fear: we scare you and then offer a facile way to alleviate your fear. Another brick is simplicity: we assure that the myth is very simple and makes logical sense. And yet another brick is expert trust: since “expert” doctors and our favorite health reporters all insist the myths are true—even our friends do—no facts are required. We, as Sagan has told us, fall prey to those who manipulate our cognitive dissonance and offer us something that seems truthful and effective, so we don’t ask any questions. Even if we search for answers, google will land us on sites constructed by drug companies and specialty doctor associations, or by media paid by those same organizations. Not only is the truth troubling and in opposition to our cognitive needs, but it’s also less appealing than the myths themselves.
So, what to do? Like the mask, many of our medial truths crumble when exposed to rigorous studies or real-world experience. Just like masking should not be controversial—masks without any doubt do not impact the spread of viral respiratory infections or protect the wearer, that’s established science—so too should some of the other normalized medical myths I will mention below be demasked to reveal the deceptions they are. In our book we flush this out and provide hundreds of references, and I will provide a few examples. What’s evident from many of these myths is that they pad the wallets of doctors and medical industries. They also create a halo of faith in doctors who promise they are using science and caring to heal you. Simple solutions almost never work and they obscure nuance and adverse effects, but they are so very appealing! That’s why this list may appear shocking. It bucks what has been normalized and challenges our cognitive beliefs, including the belief that our faith in doctors has saved our lives. But, let it be known, it is reality, just like the earth goes around the sun, something that the Church refused to accept for millennia when its experts also claimed to own the truth.
• Unless you are having a heart attack or having unstable heart pains, opening blocked heart arteries does not prevent heart attacks or help us live longer. On the contrary, these stents or bypass procedures subject us to increased risk without providing any benefit. That stent you had for your 90% blockage that saved your life just in the nick of time, it was more likely to harm you than help you. It did help the doctors and device manufacturers who helped you to believe you were better, but it didn’t help you.
• By inference, having a stress test—another lucrative myth pushed by heart doctors in contradiction to scientific reality—will not help you. The only thing a stress test (and even worse, an EKG) does is to find a blockage, and since fixing blockages doesn’t help you, how will a stress test help you? It won’t. In fact, these tests are burdened by false positives (an abnormal test that is fallacious), usually leading to a catheter which itself has a 1% risk of giving you a stroke and a far larger risk of causing bleeding and clots, but pays very well. Or a false negative, where you are told you have no blockages but in fact you are at risk. You can be cluttered with heart disease and have a normal stress test; most plaque that could cause a heart attack would not be detected by a stress test.
• What about getting to the hospital right away after a stroke so you can get clot busting medicine? Every study of this has shown just the opposite; that these medicines don’t lead to long-term benefit and can cause major bleeds and death.
• Of course, if you have atrial fibrillation (afib) you are at high risk of stroke, and taking a blood thinner like Eliqus will save you from that fate, right? Nope. When you count only stokes that you notice—not the tiny blips found on a CT scan that drug-company studies count as strokes—there is a low risk of stroke in afib,and that risk is reduced by about a half percent in those who take Eliquis. But too, Eliquis increases bleeds, including bleeds in the brain which are a devastating form of stroke. Studies show that while blood thinners decrease strokes by half percent, they increase the risk of symptomatic brain bleeding by a half to one percent, increase your chance of dying by about the same, and increase the risk of a devastating internal bleed by almost 20% every single year you are on them!
• Lowering cholesterol is felt to be crucial to preventing heart attacks and strokes, but too that is false. Measuring cholesterol is useless; just as many people with low as high cholesterol are prone to heart attacks. And thus, lowering cholesterol—especially below the magical threshold cardiologists tout through their drug-company designed calculators—has no value at all. That’s a hard fact, even though one calculator-touting cardiologist called me a nutjob for stating it. And yes, when we fix the number with drugs, all we have done is expose you to drug side effects, even if we have created the illusion of efficacy.
• In diabetics, lowering A1C below 7—which is what most endocrinologists and drug-company ads promote—actually is dangerous, not helpful. Studies clearly show that pushing the A1C below 7 is just as harmful as letting it go above 9. Why do all the commercials and ads say otherwise? Well, the lower you push it, the more drugs can be sold, and the more endocrinologists convince you that they are being aggressive and helpful. In the elderly, low A1C’s lead to confusion, falls, and weakness. But they also lead to profit and faith and a false feeling of being healthier.
• This is also true of blood pressure. Many elders need high pressure, and pushing pressures below 120 is frankly dangerous.
• PSA screening (prostate cancer) is among the worst tests available. The inventor of the PSA stated that its being misused as a screening test and the US Preventive Services Task Force gave it an F—causes more harm than good—before being pressured by the Urological Society to change it to a C—likely to cause harm. Every study shows that men who have PSA screening fare worse than those who don’t, even those who find a prostate cancer, especially since we know based on copious research that treating prostate cancer does not improve survival, it only causes new problems. Yes, we can lower a PSA and make you think your life has been saved, but you are much worse off than had you never tested.
• Bone density testing similarly can lead us down dangerous roads, since density does not correlate to bone health. Treating low density can briefly help a very few people avoid a fracture, but prolonged treatment—even as it increases density—leads to more fractures. People who are very flexible and nimble often have low density but very low fracture risks. The calculators doctors use to correlate density to fracture—the FRAX score—are derived by largely debunked pharmaceutical company studies.
The list goes on and on. Even much worshiped tests like mammograms have far lower impact than the myth makers would have us realize; people who have lifetime mammograms have 1/1000 fewer breast cancer deaths than those who never get a mammogram, and after age 75 mammograms actually cause more harm than good even if they do find indolent cancers that are best left alone. This is true of skin cancer screening too, which has never been shown to reduce death even if it will find a lot of benign cancers that, when removed, cause more harm than the cancers themselves. And while cardiologists will toss tons of medicines at you for congestive heart failure and coronary artery disease, there is no evidence that these medicines in combination have any positive effect; in fact, they may well cause serious harm. The fact that so much is not studied—including multiple vaccines at once in elders—should make us skeptical of their value, even if the good doctor simply doesn’t care much about evidence and will sell you the myths.
When people see this list they are dubious if not outright hostile; it falls in the face of normalized truths embedded in the medical liturgy. Many people believe their lives were saved by tests/drugs/procedures that in fact save no lives and are likely to cause harm. It is infuriating to even consider such heresy! Due to our cognitive needs and based on the truths spit out by so many doctors, we often would rather accept myths and write off the truth as non-scientific misinformation spread by nutjobs.
But as we and so many others have shown, facts are facts, and so much of what doctors claim as truth is derived from profit-driven attempts to steer you into a blind complacency. As Sagan has said, it’s easy to be deceived when you trust the deceiver and when you don’t know the truth. And that’s what’s going on in healthcare today behind the mask; we are spending more than ever and living shorter lives, are sicker, and have more chronic illnesses. In fact, if we eliminated the bogus tests and treatments inscribed into medical mythmaking, or if at the very least we stopped paying so much for them, people would likely live longer without so much chronic disease, and the cost of care could be slashed by as much as $2 trillion a year! However, since that extra $2 trillion lands in the pockets of those spreading the myths, and since the myths are comforting to people who seek simplistic solace from their doctors, we have been unable to exorcise these myths from the prevailing norms.
What can we do? It is important to be very skeptical of everything doctors say. This becomes more important when seeing specialists or being thrust in a hospital, since in those settings the overconsumption of ineffective and harmful medical interventions will enrich the very people telling you that you must follow their orders or else! Fear-mongering and absolutism (one right answer thinking) are signs that the person telling you about an intervention is selling you snake oils. As Osler said, uncertainly is the rule in medicine because medical interventions cause harm as well as good; there is no one right answer solution, no mana from heaven. There is only nuance. And when doctors sell you myths that seem too good to be true, or that satisfy your fears in a simple absolutist way, you should be very hesitant to pursue that course of care. Because they are usually just myths.
One day perhaps doctors will be paid to have discussions with you, to tell you the truth, to warn you about the dangers of too much testing, drugging, and fixing. One day perhaps our system will pay more for doctors to think than to deceive. But currently that is not the case; doctors who convince you to travel down often dangerous roads are the ones who reek the largest rewards. So for now, it’s up to you. And the best advice I have is that less is more, treating numbers does not treat people, and doctors who get paid more when you follow their advice are not to be believed. Myths are comforting but dangerous and deceptive. Use your common sense and always be skeptical. As Cal Sagan says, that’s our only defense in a world cluttered by charlatans posing as scientists. We must demask healthcare if we are ever going to get this right.
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