Blog | Tuesday, July 17, 2012

The Medical Skeptic


I've become a big fan of the "Medical Skeptic" genre.

The idea is that while modern medicine provides many marvels, sometimes we do too much, and that can be counterproductive.

Case in point: Screening for (and sometimes even treating) prostate cancer.

In a nutshell, though it seems counterintuitive, it's a bad idea to invasively look for or treat a cancer that won't cause suffering or death. The side effects (erectile dysfunction, urinary incontinence) are far worse than living with the condition. (The difficulty is that of course there are exceptions to this. Some people do die from prostate cancer. It's just that the science of knowing whom hasn't developed to where we'd like.)

Excellent books in this genre that I'd recommend include Overdiagnosed, by Gilbert Welch, et al., and How We Do Harm, by Otis Brawley & Paul Goldberg.

Due to my interest, I search the web for this kind of information. As I've also become more active on Twitter, I've started locating tips on good reading material there.

In particular, I've started following the tweets of a particular tweeter (Twitter-er?) who calls himself "Medical Skeptic" (@Medskep).

I've noticed that he's prolific-he tweets dozens of times a day. It's impossible to keep up with the flurry of information. But to me, his tweets are almost always educational. His method is to look at a problem of medical over-use, and search for high-powered evidence of its harm (though he will tout benefits when they are there. Gotta call 'em as he sees 'em).

If there's a common theme, it's this: Eating the right food, exercising, and getting enough sleep are the three most important behaviors for maintaining health. Regardless of whether you're healthy to begin with or suffer from a chronic condition, the same advice applies. All the other medical interventions we provide would be relatively unnecessary if we could abide by these three principles.

In a given week, @Medskep might tackle the physiologic underpinnings of coronary disease–and he'll link to writings that show that if we lived by healthier standards, we'd almost entirely obviate the need for stents or bypass surgeries. Another day he'll explore the validity of using SSRIs (Prozac, Paxil, Zoloft, etc.) for depression, and demonstrate that their overuse is a triumph of marketing and politics over sound science.

Heavy stuff.

I went to his blog and didn't find anything about him (it hadn't been updated in years, like a fallow field). So I direct-messaged him on Twitter, and we struck up a phone conversation.

I asked him if he'd heard of the blog "Science Based Medicine," whose writers are doctors and scientists with an agenda of debunking spurious claims about alternative medicine. It seemed to me that he was engaged in a similar pursuit.

He'd heard of them, but for many reasons (chief among them that he considers himself an informed lay-person rather than a scientist or practitioner), he's chosen not to go that route.

Of course, the biggest difference is that @Medskep turns his spotlights on "conventional" medicine, something the folks at SBM do less regularly.

@Medskep is a man of protean interests. He's held many jobs in different fields, and demonstrated that you're never too old (in contrast to last week's post) to gain deep new knowledge. In sum, I'd say he's a man driven to find truth, for the love of pure knowledge and no financial gain.

If you're interested in learning more, I'd encourage you to sign up for Twitter (it's free) and follow @Medskep and @GlassHospital.

This post by John H. Schumann, MD, FACP, originally appeared at GlassHospital. Dr. Schumann is a general internist. His blog, GlassHospital, seeks to bring transparency to medical practice and to improve the patient experience.