Doctoring Data

By Malcolm Kendrick (Interactive Book Summary)

I recently watched this interview with Dr Malcolm Kendrick.

Well, it wasn’t really an interview, it was Kendrick talking for almost 2 hours virtually uninterrupted about all that is wrong with Modern Medicine.

I enjoyed it far more than I thought I would.

Kendrick reminded me of one of his less well-known books Doctoring Data

Doctoring Data: How to sort out medical advice from medical nonsense: Kendrick, Dr Malcolm

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Modern Cartel Medicine relies on Clinical Trials.

The published data that is produced by these trials is the scaffolding and the very basis of Modern Medical Reality, or The Reality™.

If you can Doctor the Data, you can Doctor reality to create The Reality™.

So, the book could have been aptly titled Doctoring Reality.

Very few have written about just “how” they do it, which is why Kendrick’s book is so important.

Here I have created a Q&A Summary of Doctoring Data.

Doctoring Data By Dr Malcolm Kendrick Unbekoming Interactive Book Summary

207KB ∙ PDF file

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44 Questions & Answers

Question 1: What is the primary reason why medical research is corrupted, according to Kendrick?

According to Kendrick, the single most important reason why medical research is corrupted is money. Money acts like a great tsunami, driving everything before it in favor of the pharmaceutical company, which funds most of the major clinical studies on drugs and other interventions.

Question 2: What is the difference between relative and absolute risk, and why is this distinction important?

Relative risk is a measure of the risk of an event (such as disease or death) in one group compared to the risk in another group. Absolute risk, on the other hand, is the actual risk of an event occurring in a population. The distinction is important because presenting risk in relative terms can make small risks sound terrifying or reductions in risk unbelievably good, while absolute risk provides a more accurate picture of the actual impact of an intervention or exposure.

Unbekoming Note:

This is something that almost no doctor understands. Try it one day if you get the chance and ask them to explain the difference.

Here’s how the trick works.

Imagine two groups, with 100,000 people in them each.

In Group A (the placebo group), let’s say that 3 people had a heart attack within the trial period.

In Group B (the test drug group), let’s assume 2 people had a heart attack.

So, 1 less heart attack per 100,000 people. Doesn’t sound like much, and you would be right. This is Absolute Risk. You have to give this drug to 100,000 people (with all the risks and side effects) but get the benefit of 1 less heart attack.

But reducing 3 down to 2, is a 33% reduction. This is Relative Risk, and this is the number that will go into the abstracts of all the journal papers, in the media releases, and in the full court press “marketing” campaign. It’s what will be taught to the doctors. All doctors, bar the outliers, are too indoctrinated to question these “percentages”.

They used this trick extensively during Covid.

Question 3: Why does Kendrick argue that "lives cannot be saved" in the context of medical interventions?

Kendrick argues that lives cannot be saved because, ultimately, everyone will die. Medical interventions can only delay death, not prevent it entirely. Therefore, Kendrick suggests that it is more accurate to talk about extending life or delaying death rather than "saving lives."

Question 4: What is the "linear model" in relation to blood pressure, and why does Kendrick challenge its validity?

The linear model in relation to blood pressure suggests that the risk of cardiovascular events increases continuously with increasing blood pressure, with no upper or lower threshold. Kendrick challenges the validity of this model, arguing that it is based on flawed data from the Framingham study and that other studies have shown that the relationship between blood pressure and cardiovascular risk is not linear.

Question 5: How do ad-hoc hypotheses contribute to the perpetuation of incorrect ideas in medical research?

Ad-hoc hypotheses are hypotheses that are created to explain away findings that seem to contradict a prevailing theory or belief. In medical research, ad-hoc hypotheses are often used to protect the diet-heart hypothesis or the cholesterol hypothesis when evidence emerges that seems to contradict these ideas. By creating ad-hoc hypotheses, researchers can maintain their belief in a particular theory even when the evidence does not support it.

Question 6: What role do peer review and expert opinion play in maintaining the status quo in medical research?

Peer review and expert opinion play a significant role in maintaining the status quo in medical research. Kendrick argues that peer reviewers and experts are often invested in particular ideas or hypotheses and may reject or dismiss research that challenges these ideas. This can make it difficult for new or controversial ideas to gain traction, even when they are supported by evidence.

Question 7: How does the pharmaceutical industry influence the design and interpretation of clinical trials?

The pharmaceutical industry can influence the design and interpretation of clinical trials in several ways, including:

• Funding studies that are more likely to produce favorable results

• Designing studies with endpoints or comparators that are more likely to show their drug in a positive light

• Selectively publishing positive results while suppressing negative results

• Influencing the interpretation and presentation of study results to emphasize benefits and downplay risks

Question 8: What is the "Deadly quartet," and how does it contribute to the adoption of potentially harmful medical practices?

The "Deadly quartet" refers to four factors that can contribute to the adoption of potentially harmful medical practices:

1. The need to do something/anything

2. Grabbing the simple/easy hypothesis too early

3. Being so certain your hypothesis is correct you don't do any study to prove that it is beneficial -- you just get on with it

4. Running completely contradictory stories at the same time

These factors can lead to the rapid adoption of medical practices that have not been thoroughly tested or proven to be safe and effective.

Question 9: Why does Kendrick argue that the radical mastectomy is an example of a harmful medical intervention that persisted for many years?

Because it was based on a simple, intuitive hypothesis (that removing as much tissue as possible would prevent the spread of cancer) and was not subjected to rigorous testing. Despite the lack of evidence for its effectiveness and the significant harm caused to women, the practice persisted for decades before being abandoned.

Question 10: How does Kendrick challenge the validity of the "diet-heart hypothesis" and its relationship to the French paradox?

Kendrick challenges the validity of the diet-heart hypothesis (the idea that saturated fat and cholesterol in the diet cause heart disease) by pointing to the French paradox - the observation that the French have a low rate of heart disease despite consuming a diet high in saturated fat. Kendrick argues that if the diet-heart hypothesis were true, the French should have a high rate of heart disease, and the fact that they do not suggests that the hypothesis is flawed.

Question 11: What is the "Cholesterol hypothesis," and why does Kendrick believe it is incorrect?

It is the idea that high blood cholesterol levels cause heart disease and that lowering cholesterol levels will reduce the risk of heart disease. Kendrick believes this hypothesis is incorrect because:

• Many studies have shown that people with high cholesterol levels live longer than those with low levels

• The evidence supporting the use of cholesterol-lowering drugs (statins) is weak and based on flawed studies

• The focus on cholesterol has led to the neglect of other important risk factors for heart disease

Question 12: How does the concept of "surrogate endpoints" contribute to the approval of potentially ineffective or harmful medications?

Surrogate endpoints are measures that are used in clinical trials as a substitute for actual clinical outcomes (such as heart attacks or death). For example, a drug may be approved based on its ability to lower blood pressure or cholesterol levels, rather than its ability to reduce the risk of heart attacks or death. The use of surrogate endpoints can lead to the approval of potentially ineffective or harmful medications because:

• The surrogate endpoint may not be a reliable predictor of the actual clinical outcome

• The drug may have other effects that are not captured by the surrogate endpoint

• The drug may have long-term side effects that are not detected in short-term trials

Question 13: What is polypharmacy, and why does Kendrick argue that it may be harmful to elderly patients?

Polypharmacy refers to the use of multiple medications by a single patient, often an elderly person. Kendrick argues that polypharmacy may be harmful to elderly patients because:

• The more medications a person takes, the greater the risk of adverse drug reactions and interactions

• Many medications have not been thoroughly studied in elderly populations and may have different effects in older people

• Polypharmacy can lead to a prescribing cascade, where additional medications are prescribed to treat the side effects of other medications

Question 14: Why does Kendrick question the effectiveness and safety of statin medications, particularly in relation to overall mortality?

Kendrick questions the effectiveness and safety of statin medications, particularly in relation to overall mortality, because:

• Many statin trials have not shown a significant reduction in overall mortality, only a reduction in cardiovascular events

• Some studies have suggested that statins may increase the risk of other causes of death, such as cancer or suicide

• The benefits of statins may be overstated due to the use of relative risk reduction rather than absolute risk reduction

• Statins can have significant side effects, such as muscle pain and weakness, that may negatively impact quality of life

Question 15: How do conflicts of interest among key opinion leaders and researchers influence the development of clinical guidelines?

In several ways:

• Researchers with financial ties to pharmaceutical companies may be more likely to recommend medications or interventions that benefit those companies

• Key opinion leaders may be paid by industry to promote certain treatments or guidelines

• Guidelines may be based on studies that are funded by industry and may be biased in favor of industry interests

• Dissenting opinions or evidence that contradicts the prevailing view may be suppressed or dismissed

Question 16: What is the "Number Needed to Treat" (NNT), and why does Kendrick argue that it can be misleading?

The Number Needed to Treat (NNT) is a measure of the effectiveness of a medical intervention. It represents the number of people who need to be treated in order to prevent one additional bad outcome (such as a heart attack or death). Kendrick argues that the NNT can be misleading because:

• It does not take into account the duration of treatment required to achieve the benefit

• It does not account for the potential harms of the intervention

• It can be manipulated by combining different endpoints or extending the duration of follow-up

• It is often presented without the context of the absolute risk reduction, which can make the benefit seem larger than it actually is

Question 17: How does Kendrick challenge the validity of the "five portions of fruit and vegetables a day" recommendation?

By pointing out that:

• The recommendation was not based on any scientific evidence, but was instead the result of a consensus meeting of fruit and vegetable companies in California in 1991

• There is no clear definition of what constitutes a "portion" of fruit or vegetables

• The recommendation does not take into account the differences in nutritional value between different types of fruits and vegetables

• Observational studies suggesting a benefit from fruit and vegetable consumption are subject to confounding factors, such as other healthy lifestyle behaviors

Question 18: Why does Kendrick argue that the benefits of cancer screening, particularly breast and prostate cancer screening, may be overstated?

Because:

• Many cancers detected by screening may never progress to cause symptoms or death (overdiagnosis)

• Screening can lead to unnecessary treatment and side effects for cancers that would not have caused harm (overtreatment)

• The reduction in cancer-specific mortality may not translate to a reduction in overall mortality

• The harms of screening, such as false positives and complications from biopsies or treatment, may outweigh the benefits

Question 19: How do medical experts and authorities respond to challenges to the status quo, according to Kendrick?

According to Kendrick, medical experts and authorities often respond to challenges to the status quo by:

• Dismissing or ignoring evidence that contradicts the prevailing view

• Attacking the credibility or motives of those who question the status quo

• Suppressing dissenting opinions or research

• Invoking the authority of expert consensus or guidelines to shut down debate

• Suggesting that questioning the status quo is irresponsible or dangerous

Question 20: What is the "great cholesterol con," and why does Kendrick believe it persists despite evidence to the contrary?

The "great cholesterol con" refers to the idea that high cholesterol levels cause heart disease and that lowering cholesterol levels will reduce the risk of heart disease. Kendrick believes this idea persists despite evidence to the contrary because:

• It is a simple, intuitive hypothesis that is easy for people to understand and believe

• It is heavily promoted by the pharmaceutical industry, which benefits from the sale of cholesterol-lowering drugs

• Challenging the hypothesis is seen as heresy and is met with strong resistance from the medical establishment

• Ad-hoc hypotheses are created to explain away evidence that contradicts the hypothesis

• The focus on cholesterol has become so entrenched that it is difficult for people to let go of the idea

Question 21: How does Kendrick argue that the "five portions of fruit and vegetables a day" recommendation was established without proper scientific evidence?

The recommendation was created at a meeting of fruit and vegetable companies in California in 1991, without any prior studies to support the specific number or serving size. Kendrick points out that despite the lack of scientific basis, the recommendation has been widely promoted and accepted as a public health message.

Question 22: Why does Kendrick question the validity of the body mass index (BMI) as a measure of healthy weight?

Because the cut-off points for overweight and obesity were largely arbitrary. Kendrick cites a World Health Organization report stating that the method used to define BMI cut-off points was "largely arbitrary." Additionally, Kendrick notes that the cut-off points have been set at round numbers (e.g., 25, 30), suggesting a lack of precision or scientific basis.

Question 23: How does Kendrick challenge the idea that saturated fat consumption is a major cause of heart disease?

By pointing to the French paradox – the observation that the French have a low rate of heart disease despite consuming a diet high in saturated fat. Kendrick also discusses the lack of evidence supporting the diet-heart hypothesis and the role of ad-hoc hypotheses in maintaining the belief that saturated fat causes heart disease.

Question 24: What role do observational studies play in the development of incorrect or misleading health recommendations?

They play a significant role as these studies can show associations between various factors and health outcomes, but they cannot prove causation. Kendrick argues that many health recommendations, such as the advice to eat five portions of fruit and vegetables a day or to avoid saturated fat, are based on observational studies that are subject to confounding factors and do not provide strong evidence for causality.

Question 25: Why does Kendrick argue that the benefits of hormone replacement therapy (HRT) for menopausal women were overstated?

Because the observational studies suggesting a benefit were subject to healthy user bias. Women who chose to take HRT were more likely to be health-conscious, educated, and from higher socioeconomic backgrounds, which could explain their lower risk of heart disease. When randomized controlled trials were conducted, they found that HRT actually increased the risk of heart disease and stroke.

Question 26: How does Kendrick challenge the effectiveness of antidepressant medications, particularly in relation to publication bias?

By discussing the case of the drug paroxetine (Paxil). Kendrick cites an internal document from GlaxoSmithKline (GSK) that advised staff to withhold clinical trial findings showing that paroxetine had no beneficial effect in treating adolescents. Kendrick argues that this is an example of how publication bias, where negative studies are suppressed, can lead to an overestimation of the effectiveness of antidepressants.

Question 27: What is the "time-lag hypothesis," and how does it relate to the French paradox and the diet-heart hypothesis?

The "time-lag hypothesis" is an ad-hoc hypothesis created to explain the French paradox in the context of the diet-heart hypothesis. According to this hypothesis, the French have a low rate of heart disease despite their high saturated fat consumption because they have not been eating a high-fat diet for long enough. The hypothesis suggests that there is a time lag between the adoption of a high-fat diet and the development of heart disease and that the French will eventually see an increase in heart disease rates. However, Kendrick notes that this hypothesis has been disproven, as the French continue to maintain a low rate of heart disease over time.

Question 28: Why does Kendrick argue that the benefits of the Mediterranean diet may be overstated or based on flawed research?

One reason for this is the reliance on observational studies, which are subject to confounding factors. For example, people who follow a Mediterranean diet may also have other healthy lifestyle behaviors that contribute to their lower risk of heart disease. Additionally, Kendrick discusses the influence of the olive oil industry in promoting the Mediterranean diet and the potential for bias in research funded by this industry.

Question 29: How does the concept of "disease mongering" contribute to the overdiagnosis and overtreatment of various conditions?

"Disease mongering" refers to the practice of expanding the definition of a disease or creating new diseases in order to increase the market for treatments. This can contribute to the overdiagnosis and overtreatment of various conditions by:

• Lowering the threshold for diagnosis, so that more people are labeled as having a disease

• Promoting the idea that mild or asymptomatic conditions require treatment

• Encouraging the use of medications for "pre-diseases" or risk factors, rather than actual diseases

• Creating new diseases or exaggerating the prevalence and severity of existing conditions to generate demand for treatments

Question 30: What is the "Framingham study," and how has it influenced our understanding of cardiovascular disease risk factors?

The Framingham study is a long-term, ongoing cardiovascular study on residents of Framingham, Massachusetts. It began in 1948 with 5,209 adult subjects and is now on its third generation of participants. The study has been instrumental in identifying major cardiovascular disease risk factors, such as high blood pressure, high cholesterol, smoking, obesity, and diabetes. However, Kendrick argues that the Framingham study has also contributed to the development of the linear model of blood pressure and the idea that there is no lower threshold for cardiovascular risk, which he believes is incorrect.

Question 31: How does Kendrick challenge the idea that lowering blood pressure always leads to better health outcomes?

By arguing that:

• Blood pressure is not a disease in itself, but rather a symptom of an underlying condition

• Treating blood pressure with medication does not address the root cause of the problem

• The benefits of blood pressure lowering medication may be overstated due to the use of relative risk reduction and surrogate endpoints

• The harms of blood pressure medication, such as side effects and adverse events, may outweigh the benefits, particularly in people with mild hypertension

• Some studies have shown that people with treated hypertension have worse outcomes than those with untreated hypertension, suggesting that the medications themselves may be harmful

Question 32: How do financial incentives and conflicts of interest influence the development and promotion of new medications and medical devices?

In several ways:

• Pharmaceutical and medical device companies fund most of the research on their products, which can lead to bias in study design, interpretation, and reporting

• Researchers and physicians who have financial ties to industry may be more likely to promote or prescribe products from those companies

• Industry-sponsored studies are more likely to report favorable results than independent studies

• Negative studies or adverse events may be suppressed or downplayed to protect industry interests

• Marketing and promotion of new products may exaggerate benefits and downplay risks

Question 33: What is the "placebo effect," and how does it complicate the interpretation of clinical trial results?

The placebo effect refers to the phenomenon where a person experiences a benefit from a treatment that has no active therapeutic properties, such as a sugar pill. The placebo effect can complicate the interpretation of clinical trial results because:

• It can lead to an overestimation of the effectiveness of a treatment, if the placebo group also shows improvement

• It can mask the true effect of a treatment, if the placebo group experiences a large improvement

• It can vary depending on factors such as the type of treatment, the route of administration, and the patient's expectations

• It can be difficult to distinguish from the natural course of a disease or regression to the mean

To account for the placebo effect, clinical trials typically compare an active treatment to a placebo, rather than to no treatment at all. However, even with a placebo control, the placebo effect can still influence the results and make it difficult to determine the true efficacy of a treatment.

Question 34: Why does Kendrick argue that the benefits of the PSA (prostate-specific antigen) test for prostate cancer screening may be overstated?

Because:

• Many prostate cancers detected by PSA screening may never progress to cause symptoms or death (overdiagnosis)

• PSA screening can lead to unnecessary biopsies, treatments, and side effects for cancers that would not have caused harm (overtreatment)

• The reduction in prostate cancer mortality from PSA screening is small and may not outweigh the harms of screening

• The studies supporting PSA screening may be biased or flawed, as they often compare screened to unscreened populations, rather than randomizing individuals to screening or no screening

Question 35: How does Kendrick challenge the idea that obesity is a major cause of increased mortality risk?

By:

• Citing studies showing that overweight people (BMI 25-30) have the lowest mortality risk, and that even mild obesity (BMI 30-35) is not associated with increased mortality

• Arguing that the cut-off points for defining overweight and obesity (BMI 25 and 30) are arbitrary and not based on solid scientific evidence

• Suggesting that the focus on obesity as a major health problem is driven more by social and cultural factors than by objective evidence of harm

• Pointing out that the association between obesity and mortality is often confounded by other factors, such as physical activity, diet quality, and socioeconomic status

Question 36: What is the "healthy user bias," and how does it influence the interpretation of observational studies?

The healthy user bias refers to the tendency for people who engage in one healthy behavior (such as taking a medication or supplement) to also engage in other healthy behaviors (such as exercising, eating a healthy diet, and not smoking). This can lead to an overestimation of the benefits of the specific behavior being studied, as the apparent benefits may be due to the other healthy behaviors, rather than the behavior itself.

In observational studies, the healthy user bias can make it appear that a particular behavior or exposure is protective against disease, when in reality, the association is due to the fact that people who engage in that behavior are generally healthier and more health-conscious than those who do not. This bias can lead to incorrect conclusions about the effectiveness of interventions and the causes of disease.

Question 37: How does the concept of "overdiagnosis" contribute to the overtreatment of various conditions, particularly in cancer screening?

Overdiagnosis refers to the detection of abnormalities or conditions that would never have caused symptoms or harm if left undetected. In cancer screening, overdiagnosis can occur when screening tests detect slow-growing, non-aggressive, or even non-progressive cancers that would not have caused problems during the person's lifetime.

Overdiagnosis contributes to overtreatment by:

• Labeling people as "cancer patients" and subjecting them to the psychological and physical harms of cancer diagnosis and treatment, even though their condition may never have progressed or caused harm

• Leading to unnecessary surgeries, chemotherapy, radiation, and other treatments that can have serious side effects and complications

• Diverting resources and attention away from the treatment of more aggressive or symptomatic cancers

• Creating a false sense of the benefits of screening, as the detection and treatment of overdiagnosed cancers can make it appear that screening is saving lives, when in fact, it may be causing more harm than good

Question 38: What is the "number needed to harm" (NNH), and why does Kendrick argue that it is often overlooked in discussions of medical interventions?

The "number needed to harm" (NNH) is a measure of the safety of a medical intervention. It represents the number of people who need to be treated for one additional person to experience a harmful outcome, such as a side effect or complication. The NNH is the inverse of the "number needed to treat" (NNT), which measures the effectiveness of an intervention.

Kendrick argues that the NNH is often overlooked in discussions of medical interventions because:

• There is a bias towards reporting and emphasizing the benefits of interventions, rather than their harms

• Harms may be underreported or not captured in clinical trials, particularly if they are rare or occur after the trial has ended

• The NNH is often not reported alongside the NNT, making it difficult for patients and physicians to weigh the benefits and risks of an intervention

• The harms of an intervention may be seen as less important or less newsworthy than the potential benefits

By neglecting the NNH, discussions of medical interventions can create a false sense of their safety and lead to an underestimation of the potential harms to patients.

Question 39: How does Kendrick challenge the idea that high cholesterol levels are a major cause of heart disease?

By:

• Citing studies showing that people with high cholesterol levels live longer than those with low levels, particularly in the elderly

• Arguing that the benefits of cholesterol-lowering drugs (statins) have been overstated and that the evidence supporting their use is weak and based on flawed studies

• Suggesting that the focus on cholesterol has led to the neglect of other important risk factors for heart disease, such as inflammation, stress, and diet quality

• Questioning the validity of the diet-heart hypothesis, which proposes that saturated fat and cholesterol in the diet cause heart disease, by pointing to evidence that contradicts this hypothesis, such as the French paradox

Kendrick believes that the cholesterol hypothesis has been perpetuated by the pharmaceutical industry, which benefits from the sale of cholesterol-lowering drugs, and by a medical establishment that is resistant to changing its long-held beliefs, even in the face of contradictory evidence.

Question 40: How do medical journals and the media contribute to the promotion of potentially ineffective or harmful medical interventions?

In several ways:

• Medical journals may be biased towards publishing positive or exciting results, while rejecting or downplaying negative or null results

• Journals may have financial conflicts of interest, such as advertising revenue from pharmaceutical companies or industry-sponsored supplements

• Media coverage of medical research often focuses on dramatic or promising findings, while ignoring the limitations or potential harms of the research

• Press releases and media reports may exaggerate the benefits or downplay the risks of interventions, creating a false impression of their effectiveness or safety

• Sensationalized or oversimplified media coverage can create public demand for unproven or inappropriate interventions

• Experts quoted in media reports may have financial or professional conflicts of interest that are not disclosed or adequately considered

By uncritically promoting or hyping medical interventions, medical journals and the media can contribute to the overuse or misuse of treatments that may not be effective or safe for all patients.

Question 41: What is the "file drawer effect," and how does it contribute to publication bias in medical research?

The "file drawer effect" refers to the tendency for studies with negative or null results to be less likely to be published than studies with positive results. This can happen because:

• Researchers may not bother to write up or submit negative studies, assuming that they will not be accepted for publication

• Journals may be less interested in publishing negative studies, as they are seen as less exciting or newsworthy than positive studies

• Funding sources, such as pharmaceutical companies, may not want negative studies of their products to be published and may suppress or discourage their submission

The file drawer effect contributes to publication bias by creating a skewed picture of the evidence base, where positive results are overrepresented and negative results are underrepresented. This can lead to an overestimation of the effectiveness or safety of interventions and an underestimation of their harms or limitations.

Publication bias can also distort meta-analyses and systematic reviews, which rely on published studies to draw conclusions about the overall evidence for an intervention. If negative studies are systematically excluded from these analyses, the conclusions may be biased in favor of the intervention, even if the true effect is smaller or non-existent.

Question 42: How does the concept of "lead-time bias" influence the interpretation of cancer screening studies?

Lead-time bias refers to the overestimation of survival time in cancer screening studies that occurs because screening detects cancers earlier than they would have been detected clinically, but does not necessarily prolong life.

For example, imagine two groups of patients with a particular cancer, one group that undergoes screening and another that does not. The screened group will have their cancers detected earlier, at a point when they are not yet symptomatic. The unscreened group will have their cancers detected later, when they develop symptoms. If both groups die at the same time after the onset of symptoms, the screened group will appear to have a longer survival time, because their survival is measured from an earlier point (the time of screening detection).

However, this apparent increase in survival time does not necessarily mean that screening prolonged life, as the total duration of the disease (from the time the cancer first developed to the time of death) may be the same in both groups. Lead-time bias can create the illusion that screening improves survival, when in fact, it may only shift the diagnosis earlier in time, without changing the ultimate outcome.

To account for lead-time bias, cancer screening studies should measure mortality rates, rather than survival times. If screening truly reduces cancer deaths, then the mortality rate in the screened group should be lower than in the unscreened group, regardless of when the cancers are detected.

Question 43: How do medical device companies influence the adoption of new technologies, even when evidence of their effectiveness may be lacking?

Through various strategies, such as:

• Funding or sponsoring studies that are designed to show their products in a favorable light, while suppressing or downplaying negative results

• Providing financial incentives, such as consulting fees, research grants, or royalties, to key opinion leaders and clinicians who can influence the adoption of their products

• Engaging in aggressive marketing and promotion campaigns that emphasize the potential benefits of their products, while minimizing or ignoring their limitations or risks

• Lobbying regulatory agencies, policymakers, and professional societies to gain approval or endorsement of their products, even when the evidence may be weak or incomplete

• Exploiting loopholes or weaknesses in the regulatory process, such as the 510(k) clearance pathway in the United States, which allows devices to be approved based on similarity to existing devices, rather than evidence of effectiveness or safety

• Encouraging the use of surrogate endpoints or short-term outcomes in studies of their products, which may not reflect their long-term effectiveness or impact on patient health

By creating a perception of innovation, superiority, or inevitability around their products, medical device companies can drive the adoption of new technologies, even when the evidence for their benefits may be lacking or uncertain. This can lead to the overuse or misuse of devices that may not improve patient outcomes or may even cause harm.

Question 44: How does Kendrick suggest that individuals can protect themselves from potentially ineffective or harmful medical interventions?

By:

• Being skeptical of health claims and recommendations, particularly those that are based on observational studies or expert opinion, rather than randomized controlled trials

• Asking for evidence to support the benefits and risks of proposed interventions, and seeking out independent sources of information, such as the Cochrane Collaboration or other systematic reviews

• Considering the potential harms and side effects of interventions, not just their potential benefits, and weighing these factors in light of one's own values and preferences

• Recognizing that many medical interventions, such as screening tests and preventive medications, may have diminishing returns or increasing harms as they are applied to lower-risk populations

• Being aware of financial and professional conflicts of interest that may influence the promotion or prescription of certain interventions, and seeking out unbiased sources of advice and care

• Engaging in shared decision-making with healthcare providers, and being willing to question or refuse interventions that may not be necessary or appropriate for one's individual situation

• Adopting a healthy lifestyle, including regular exercise, a balanced diet, stress management, and avoidance of harmful habits like smoking, which can reduce the risk of chronic diseases and the need for medical interventions

By being an informed and engaged consumer of healthcare, individuals can help to protect themselves from the potential harms of overdiagnosis, overtreatment, and medical reversals, and can make more informed choices about their health and well-being.

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