Criticisms of medicine
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Despite the tremendous progress of medical science in raising general health levels and increasing life expectancy, there have been criticisms of various aspects of medical research and practice. The critical study of medicine is multidisciplinary, using methods from history, sociology, anthropology, psychology, and quantitative science.[1][2]
The claimed failures of modern medicine include lack of time and effort devoted to the patient-doctor relationship, methodological flaws in published research, inadequate access to health care among the poor, and scandals involving malpractice or scientific fraud. Certain problems, such as excessive cost of treatment and over-prescription of opioids and other pharmaceuticals, are particularly acute in the United States. The history of medicine has been characterized by patterns of discrimination and abuse against women and minorities; and despite improvements, the job of providing healthcare equitably without bias is still a work in progress. Some criticism of modern medicine has been proven to be unfounded, such as with criticism of vaccinations.
Lack of access[edit]
In developing countries and in wealthy countries such as the United States that have no universal health insurance, the less affluent sections of the population often have inadequate access to modern medicine.[3][4] Some developing countries, such as Cuba, have had success in providing universal healthcare,[5] although in the case of Cuba hospitals have been plagued by shortages caused by the U.S. embargo.[6]
The access problem in the United States[edit]
In the U.S., a country without universal health insurance, the access problem is aggravated by spiraling costs.[7] Costs of a hospital procedure often vary wildly from one region of the U.S. to another, and even among hospitals in the same region.[8] The pharmaceutical industry, in particular, has been accused of price-gouging.[9]
Inadequate therapeutic relationships with patients[edit]
In a paper published in 2010, Edzard Ernst, a leading authority on "complementary and alternative medicine" (CAM), discusses the appeal of CAM:
[CAM] is popular. An analysis of the reasons why this is so points towards the therapeutic relationship as a key factor. Providers of CAM tend to build better therapeutic relationships than mainstream healthcare professionals. In turn, this implies that much of the popularity of CAM is a poignant criticism of the failure of mainstream healthcare. We should consider it seriously with a view of improving our service to patients.[10]
Similarly, journalist David H. Freedman writing in The Atlantic has said that an explanation for the appeal and commercial success of CAM in the United States is "its adherence to a 'healing' model of patient care"—a model that is too time-consuming and inefficient for most physicians working under the constraints of the standard American health care system.[11]
Conflict of interest and faulty methodology[edit]
Stanford University School of Medicine Professor John Ioannidis has sharply criticized the quality of published medical research, claiming that most published findings are false.[12] Marcia Angell of the Harvard Medical School has written:[13]
...Similar conflicts of interest and biases exist in virtually every field of medicine, particularly those that rely heavily on drugs or devices. It is simply no longer possible to believe much of the clinical research that is published, or to rely on the judgment of trusted physicians or authoritative medical guidelines. I take no pleasure in this conclusion, which I reached slowly and reluctantly over my two decades as an editor of The New England Journal of Medicine.
In a two-part article in The New York Review of Books,[14][15] Angell was sharply critical of the pharmaceutical industry, medical researchers, and psychiatrists for promoting the over-use of psychotropic drugs in the U.S. She wrote that unfavorable studies on the use of such drugs had been suppressed and only the more favorable studies had been made available to the public and to regulators. She further wrote that there is evidence that some psychotropic pharmaceuticals can cause brain damage, especially in children.[16]
Some writers have criticized Ioannidis' own methodology and maintained that his conclusions are greatly exaggerated.[17][18] In this debate about the prevalence of faulty methodology in medical research, the objective of both sides is to improve the reliability of science-based medicine, not to support alternatives to it; Marcia Angell, for example, is an outspoken opponent of CAM.[19]
Harm resulting from treatment[edit]
Some have criticized the medical profession for a tendency to use treatments without adequate consideration of likely adverse effects (often called iatrogenic effects, although that word has a broader meaning). Examples include surgery that leads to complications or questionable outcomes; over-prescription of psychotropics, opioids, and antibiotics; extreme end-of-life treatments that diminish quality of life; and medicalization of normal human conditions, such as hyperactivity in children and menopause.[20][21][22]
Over-prescription of opioids[edit]
The U.S. and Canada are experiencing what some call an opioid epidemic, and opioid overdose is a significant cause of death in many American cities.[23] This crisis has been caused both by over-prescription of opioids and by illegal traffic in the drugs.[24]
Scandals[edit]
Major malpractice or scientific fraud scandals can also undermine public confidence in mainstream medicine. For example, in the early 1990s the Imanishi-Kari case and the Luk van Parijs case of research misconduct led to the resignation of Nobel Prize-winner David Baltimore as President of Rockefeller University[25][26] and as President of the California Institute of Technology,[27] respectively. In 2016 at the world-renowned Karolinska Institute, the Paolo Macchiarini affair, involving multiple deaths from malpractice, led to the resignation of the Secretary of the Nobel Committee for Physiology or Medicine,[28] the resignation of the Vice-Chancellor of the Karolinska Institute,[29] and the dismissal of the entire board of the Institute.[30]
In 1998 the British medical researcher Andrew Wakefield wrote a paper, published in The Lancet, in which he claimed that he had established a link between autism and measles, mumps and rubella (MMR) vaccine. His widely publicized paper gave encouragement to the anti-vaccine movement, but it turned out to be fraudulent. The length of time the fraud went undetected was seen as highlighting problems with the peer-review process.[31]
Historical discrimination against women and minorities[edit]
In the U.S., one consequence of the professionalization of medicine early in the 20th century—culminating in the Flexner report[32] in 1910—was the decreasing role of midwives. Although the main purpose of the Flexner reforms was to standardize and improve medical training, some historians have written that another purpose was to combat the "irregulars," such as homeopaths and midwives.[33][34] This not only reduced the opportunities for women and minorities as health care providers,[33] but also sometimes resulted in setbacks for women's health. In 1936 the prominent gynecologist-obstetrician Frederick J. Taussig wrote that the "therapeutic" (legal) abortions performed by doctors at the time were more dangerous—more likely to result in often fatal perforations—than the (illegal) abortions that had been performed in earlier decades by midwives.[35]:223
The clinical trials leading to approval of the early birth-control pills have been criticized as inadequate and for greatly underestimating the serious side-effects,[36][37][38] and the disastrous consequences of the heavily-marketed Dalkon Shield[39] caused further questioning of the medical establishment's commitment to women's health and safety.
A related criticism is that for a long time, and occasionally even in the 21st century, clinical studies have routinely excluded women, and medical researchers have made the unfounded assumption that conclusions from those studies relating to safety, effectiveness, and appropriate dosages would apply in exactly the same way to women as to men.[40][41]
Historians of medicine have written that in the U.S. some of the founders of the field of gynecology in the 19th century used African American and poor immigrant women as guinea pigs for experimental surgery;[34] and that African American men were also abused by medical researchers, for example, in the notorious Tuskegee syphilis experiment conducted between 1932 and 1972.[42]
References[edit]
- ↑ Albrecht, Gary L.; Fitzpatrick, Ray; Scrimshaw, Susan C. (2000). The Handbook of Social Studies in Health and Medicine. Sage. ISBN 9780761942726. Search this book on
- ↑ Weitz, Rose (2016). The Sociology of Health, Illness, and Health Care: A Critical Approach, 7th Edition. Cengage Learning. ISBN 978-1305583702. Search this book on
- ↑ "New report shows that 400 million do not have access to essential health services". Retrieved 26 April 2018.
- ↑ "National Healthcare Disparities Report, 2011". Retrieved 26 April 2018.
- ↑ "How Cubans live as long as Americans at a tenth of the cost". Retrieved 26 April 2018.
- ↑ Barry, Michele (2000), "Effect of the U.S. embargo and economic decline on health in Cuba", Annals of Internal Medicine, 132 (2): 151–154, PMID 10644277
- ↑ "Technology and rising health care costs". Retrieved 26 April 2018.
- ↑ "One hospital charges $8,000 — another, $38,000". Retrieved 27 April 2018.
- ↑ "Big pharma accused of price gouging life-saving drugs". Retrieved 27 April 2018.
- ↑ Ernst, E. (2010). "The public's enthusiasm for complementary and alternative medicine amounts to a critique of mainstream medicine". International Journal of Clinical Practice. 64 (11): 1472–4. doi:10.1111/j.1742-1241.2010.02425.x. PMID 20846193.
- ↑ Freedman, David H. (2011), "The triumph of new-age medicine", The Atlantic, 308 (1): 90–100, ISSN 1072-7825, retrieved 2018-05-29
- ↑ Freedman, David H. (2010). "Lies, damned lies, and medical science". The Atlantic. 306 (4): 76–84. ISSN 1072-7825.
- ↑ Angell, Marcia (2009), "Drug companies & doctors: A story of corruption", The New York Review of Books, 56 (1), retrieved 26 April 2018
- ↑ Angell, Marcia (2011), "The epidemic of mental illness: Why?", The New York Review of Books, 58 (11), retrieved 26 April 2018
- ↑ Angell, Marcia (2011), "The illusions of psychiatry", The New York Review of Books, 58 (12), retrieved 26 April 2018
- ↑ Whitaker, Robert (2010). Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America. Broadway Books. ISBN 9780307452429. Search this book on
- ↑ Goodman, Steven; Greenland, Sander (2007), Assessing the unreliability of the medical literature: A response to 'Why most published research findings are false', retrieved 27 April 2018
- ↑ Leek, Jeffrey T.; Jager, Leah R. (7 March 2017). "Is most published research really false?". Annual Review of Statistics and Its Application. 4 (1): 109–122. doi:10.1146/annurev-statistics-060116-054104.
- ↑ Angell M, Kassirer JP (September 1998). "Alternative medicine—the risks of untested and unregulated remedies". N. Engl. J. Med. 339 (12): 839–41. doi:10.1056/NEJM199809173391210. PMID 9738094.
- ↑ Fausto-Sterling, Anne (1992). Myths of Gender: Biological Theories about Women and Men. Basic Books. pp. 90–122. ISBN 978-0465047925. Search this book on
- ↑ Illich, Ivan (1974). Medical Nemesis: The Expropriation of Health. London: Calder & Boyars. ISBN 0-7145-1096-3. Search this book on
- ↑ Dutton, Diana Barbara; Preston, Thomas A.; Pfund, Nancy E. (1988), Worse than the disease: pitfalls of medical progress, Cambridge, UK; New York: Cambridge University Press, doi:10.1017/CBO9780511572951, ISBN 0521340233, OCLC 17234197
- ↑ "Opioid overdose crisis". Retrieved 26 April 2018.
- ↑ "The opioid epidemic: Costs, causes, and efforts to fight it". Retrieved 26 April 2018.
- ↑ Hall SS (December 1991). "David Baltimore's final days". Science. 254 (5038): 1576–9. Bibcode:1991Sci...254.1576H. doi:10.1126/science.1749930. PMID 1749930. or here [1]
- ↑ Natalie Angier, "Embattled Biologist Will Return to M.I.T." (New York Times, 19 May 1992, P. C5)
- ↑ Hotz, Robert Lee (October 4, 2005). "Caltech President Who Raised School's Profile to Step Down". Los Angeles Times. Retrieved 21 May 2015.
- ↑ Cyranoski, David (8 February 2016). "Nobel official resigns over Karolinska surgeon controversy". Nature. doi:10.1038/nature.2016.19332.
- ↑ "Anders Hamsten steps down as Vice-Chancellor of Karolinska Institutet". Karolinska Institute. 2016-02-12.
- ↑ "Sweden fires board of institution handing out medicine Nobel after scandal". Reuters. 2016-09-06.
- ↑ Godlee F, Smith J, Marcovitch H (2011). "Wakefield's article linking MMR vaccine and autism was fraudulent". BMJ. 342: c7452. doi:10.1136/bmj.c7452. PMID 21209060.
- ↑ Flexner, Abraham (1910), Medical Education in the United States and Canada: A Report to the Carnegie Foundation for the Advancement of Teaching (PDF), Bulletin No. 4., New York City: The Carnegie Foundation for the Advancement of Teaching, p. 346, OCLC 9795002, retrieved June 8, 2015
- ↑ 33.0 33.1 Ehrenreich, Barbara; English, Deirdre (1973). Witches, Midwives, and Nurses: A History of Women Healers. Feminist Press. ISBN 9780912670133. Search this book on
- ↑ 34.0 34.1 McGregor, Deborah Kuhn (1998). From Midwives to Medicine: The Birth of American Gynecology. Rutgers University Press. ISBN 9780813525723. Search this book on
- ↑ Taussig, Frederick J. (1936). Abortion, Spontaneous and Induced: Medical and Social Aspects. C. V. Mosby. OCLC 00400798. Search this book on
- ↑ Briggs, Laura (2002). Reproducing Empire: Race, Sex, Science, and U.S. Imperialism in Puerto Rico. University of California Press. ISBN 0520222555. Search this book on
- ↑ Marsh, Margaret; Ronner, Wanda (2008). The Fertility Doctor: John Rock and the Reproductive Revolution. The Johns Hopkins University Press. ISBN 9780801890017. Search this book on
- ↑ Seaman, Barbara (1969). The Doctors' Case Against the Pill. Peter H. Wyden, Inc. OCLC 00030564. Search this book on
- ↑ Hawkins, Mary E. (1997). Unshielded: The Human Cost Of The Dalkon Shield. Toronto: University of Toronto Press. ISBN 9780802078612. Search this book on
- ↑ "Women are being excluded from clinical trials". Retrieved 26 April 2018.
- ↑ "The medical research gender gap: How excluding women from clinical trials is hurting our health". Retrieved 26 April 2018.
- ↑ Reverby, Susan M. (2009). Examining Tuskegee : the infamous syphilis study and its legacy. Chapel Hill: University of North Carolina Press. ISBN 9780807833100. OCLC 496114416. Search this book on
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