CrossFit | ”Trust me, I’m a doctor”

”Trust me, I’m a doctor”

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ByProf. Peter C. GøtzscheJune 16, 2019

“Trust me, I’m a doctor” — One of my colleagues once turned up at a scientific meeting with a badge she had produced with this message. We were a group of people championing the new movement of evidence-based medicine where we make decisions about health care based on the most reliable scientific evidence we have, in contrast to eminence-based medicine where you trust your doctor blindly. We had a big laugh. The irony was that you should always ask critical questions of your doctor to protect yourself against drug harms.

Most people let their doctor make the decisions for them, but the evidence tells us that we should be cautious. Doctors make many errors of judgment, and they get much of their information from the drug industry. They therefore use far too many drugs, often because they do not know better. We live in a world that is so overdiagnosed and overtreated that in high-income countries, our medications are the third leading cause of death after heart disease and cancer. This has been demonstrated by several independent studies in Europe and North America (1). It has also been shown that medical errors, including incidents apart from drug-related errors, are the third leading cause of death even when only counting hospital patients’ deaths (2).

Most of these deaths are preventable (1), but no one really does anything. The deaths continue to pile up year after year, and the shocking result is that family doctors kill one of their patients every year, on average, in good faith (3). But don’t skip your family doctor and consult a specialist right away, as this is even more dangerous for you. Where the proportion of specialists increased, the relative position of the U.S. on health indicators among OECD countries worsened (4).

The waste in the U.S. is gigantic: In 2000, the spending per capita on drugs was 2.7 times higher than in European countries, and yet — or perhaps because of this — the outcome is much worse (5). The health disadvantage of Americans is not only because of extreme income inequalities and widespread poverty. It is also seen among those with health insurance, a college education, higher incomes, and healthy behaviors.

So, what can you do? Avoid taking drugs unless they are absolutely necessary, which they rarely are (1, 3, 6). Ask if there are other options and whether you’ll be better without treatment; remember that very few patients benefit from the drugs they take.

Above all, avoid the biggest killers — e.g., NSAIDs (pain-relieving agents such as ibuprofen)(1) and drugs for mental health issues (3, 6). The causes of almost all these drug-related deaths are invisible to doctors, which means the doctors don’t learn anything from their mistakes. When a patient dies due to an NSAID, the drug may have caused a stomach ulcer or heart attack, but that might have happened without medical treatment anyway. Frequent causes of death due to depression pills and other brain-active drugs are balance issues. When older patients fall and break a hip, about one in five will die within a year. Their doctors do not think these deaths may be due to their drugs, because so many old people not taking medication fall and break hips, but in fact, most drugs in common use are likely to affect the brain and may lead to falls. In the elderly, drugs against increased blood pressure, for example, should be used with caution.

Very few drugs are indispensable. Therefore, you might try now and then to taper off slowly one drug at a time and see how it goes — e.g., whether your blood pressure, cholesterol, or blood sugar remains reasonably OK without a drug. Such taper attempts are best done in collaboration with your doctor. Many people who have tried this have discovered that a life without drugs is possible and their tiredness, muscle pain, memory problems, or impotence disappeared, having been unrelated to their advanced age, which people tend to think when drugs give them side effects.

Disclaimer: Although I am a specialist in internal medicine, I don’t take drugs regularly; only when I am very ill, which usually means when I have a life-threatening infection. I exercise a lot and enjoy life, and my motto is: “Don’t worry, be happy.” As we shall all die, we should not be afraid of dying.


Professor Peter C. Gøtzsche, MD, co-founded the Cochrane Collaboration. He has published more than 70 papers in the top five general medical journals and six books, most recently, Death of a Whistleblower and Cochrane’s Moral Collapse. He recently launched the new Institute for Scientific Freedom with the goal of preserving honesty and integrity in science.


References

  1. Gøtzsche PC. Deadly medicines and organised crime: How big pharma has corrupted health care. London: Radcliffe Publishing, 2013.
  2. Makary MA, Daniel M. Medical error – the third leading cause of death in the US. BMJ 353 (2016): i2139.
  3. Gøtzsche PC. Survival in an overmedicated world: look up the evidence yourself. Copenhagen: People’s Press, 2019.
  4. Starfield B, Shi L, Grover A, et al. The effects of specialist supply on populations’ health: assessing the evidence. Health Aff (Millwood). 2001 March 15.
  5. World Health Organization. The World Medicines Situation. Available here. (Accessed 6 February 2013).
  6. Gøtzsche PC. Deadly psychiatry and organised denial. Copenhagen: People’s Press, 2015.

Comments on ”Trust me, I’m a doctor”

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Julian Donovan
August 15th, 2019 at 10:28 pm
Commented on: ”Trust me, I’m a doctor”

If you are going to make these large statements then please provide primary sources rather than the author referencing their own books - this seems quite the conflict of interest and lack of peer review, especially on an article that has such traction and audience.


The claim that 1/3 of deaths in the US are caused be medication errors is speculative based on extrapolations of death certificate data, and in no way verifiable.


"Most people let their doctor make decisions for them" - quite the statement but no citation. Maybe you haven't heard of shared-decision making.


Many medicines are taken by risk:benefit decision, and its not as simple as saying they are 'unnecessary'. Sure, an anticoagulant is 'unnecessary', but only if you accept a significant increased risk of stroke if you suffer from AF. Not to mention we have risk scores that balance risk of stroke versus bleeding, which are discussed WITH the patient, not AWAY from the patient.


I am *seriously* on board the train to reduce medications, drive lifestyle promotion, and keep people the hell out of the medical system for as long as humanely possible, but this is sloppy sensationalist writing.

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Robert Labutta
June 21st, 2019 at 5:29 pm
Commented on: ”Trust me, I’m a doctor”

Yes, be a skeptic, learn about your condition, make lifestyle interventions, etc....and if you don't trust your doctor, find a different doctor. Trust is a crucial element of the patient-physician therapeutic relationship.

Robert Labutta, MD

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Grace Patenaude
June 19th, 2019 at 5:49 pm
Commented on: ”Trust me, I’m a doctor”

Thank you; great article!

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Matthew Martin
June 17th, 2019 at 2:54 pm
Commented on: ”Trust me, I’m a doctor”

Great read, keep this up- Thanks!

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Arianna Sisto
June 17th, 2019 at 12:01 pm
Commented on: ”Trust me, I’m a doctor”

This content was very interesting and useful, thank you

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Katina Thornton
June 17th, 2019 at 5:13 am
Commented on: ”Trust me, I’m a doctor”

"For every action, there is an equal and opposite reaction."

While in his third law Newton was not describing medications, he may as well have been. How can we believe that a medication will only have one desired effect with no other system perturbations? The benefit must outweigh the risks. This is why we must always have a healthy degree of skepticism, but not so much that we forego all treatment.

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Dan Palenchar
June 25th, 2019 at 10:51 pm

Katina, you make a great point. Almost all treatments have some side effect and it's not always the case that the benefits are justified by the potential risks. Do you think medicating has become such a norm, that people readily accept it without a healthy degree of skepticism? Furthermore, are there other unintended consequences of the current medical paradigm? For example, the anti-vax movement is the extreme response that takes skepticism from healthy to deadly.

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Clarke Read
June 17th, 2019 at 2:46 am
Commented on: ”Trust me, I’m a doctor”

Gotzsche's 6th paragraph (Above all, avoid the biggest killers...) has particularly damning implications with regard to our ability to accurately assess the net impact of our medications on overall health. We have a reasonable sense of how a drug affects its targeted condition - i.e., how a heart disease drug affects heart disease morbidity / mortality. But it seems hard to believe we could understand the various incremental ways a drug, or a combination of drugs, could affect morbidity & mortality (and other, softer outcomes like quality of life) related to a variety of other conditions. We can capture some of this in clinical trials, of course, but this may fail to capture negative effects felt by a subset of the treated population, or negative effects that are not obviously connected to the drug and so are minimized or dismissed.


Of course, some of the reliance on drugs likely stems from an often-fatalistic attitude toward lifestyle interventions - egregiously illustrated by the growing chorus of recommendations to push for bariatric surgery as the first line of treatment for morbid obesity. If we can show lifestyle interventions can be MORE effective, and consistently so, then the perceived NEED for drugs decreases dramatically. And that would be an improvement by almost any standard.

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Emma Shopia
June 18th, 2019 at 12:10 pm


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