• The people’s briefing note on prescription drugs
2012 is behind us, thank goodness. And what a year it’s been. I have anointed it “The Year of Prevention Propaganda.” Wikipedia tells us propaganda is “a form of communication that is aimed at influencing the attitude of a community toward some cause or position by presenting only one side of an argument.” The problem is, when it comes to preventing illness, propaganda doesn’t work. It’s like polluted water laden with parasites, bacteria and viruses that can make you very sick.
In 2012, we saw a lot of propaganda designed to influence our attitudes around preventive medicine, much of it awash in language hard to defy because it sounds so authoritative and wholesome. After all, why wouldn’t you want to prevent disease instead of treating it?
Two impressive victories in the prevention propaganda war concerned widely promoted forms of medical screening, which promise to save us from the scourge of cancer. These victories reveal the large gaps between what many specialists say – about getting a mammogram or a PSA test – and the evidence gleaned from high-quality screening research. The year’s biggest triumph came when Danish researcher Peter C. Gøtzsche published an editorial in the Canadian Medical Association Journal noting, “The best method we have to reduce the risk of breast cancer is to stop the screening program.” He threw down the gauntlet by asking readers – mostly Canadian doctors – one simple question: “Which country will be first to stop mammography screening?”
Remember, mammography screening is looking for disease in otherwise healthy women.
Also in 2012, the PSA test – to evaluate a man’s level of ‘prostate specific antigen,’ a potential sign of prostate cancer – was deemed to cause more harm than good when the major independent screening group in the US – the United States Preventive Services Task force (USPSTF) – concluded it shouldn’t be offered to otherwise healthy, asymptomatic men. There is a great danger that men might be harmed through unnecessary treatment, which can often result in incontinence, impotence or both.
Remember, PSA screening is looking for disease in otherwise healthy men.
Essentially, the cleanest, most reliable, research around breast and prostate cancer screening programs showed they are probably harmful for most people being screened. We learned that the tests being promoted often find “pseudodisease” – things in your blood or body that would never have gone on to hurt you. Overly aggressive screening often leads to unnecessary breast and prostate cancer biopsies, surgeries, chemotherapies and drugs.
There is still a lot of enthusiasm for screening and much polluted information around its alleged benefits. Cancer is not unique and whenever anyone is recommending a screening test for things like Alzheimer’s, ADHD, pre-diabetes, osteoporosis and many other conditions, remember that all forms of screening involve harm.
Should we still try to eat well, exercise and reduce stress in our lives? Of course. We know those things provide our best means of staying well. Should we be vigilant about signs of disease? Certainly. If you have any worrisome symptoms whatsoever or think you are at ‘high risk’ due to a unique family history, you should ask your doctor about that risk and what you can do to lower it. If you are feeling perfectly healthy, should you blindly accept the advice that a preventive screening test will “save your life?” Absolutely not.
In 2012, we also saw prevention propaganda emanating from the vaccine world. This propaganda is characterized by oceans of information that appear very authoritative, but is often acutely unhelpful. Preventive propaganda has some characteristic signs: it is information that makes the dangers of the disease seem as horrible as possible. The benefits (of the vaccine) sound too good to be true. The controversies are skirted and harms are either downplayed or dismissed. Once you are aware the information is potentially polluted, you might be less likely to swallow a lot of it.
Vaccines are a huge and growing industry. Recent vaccine marketing reports say the global vaccine market is currently worth about $34 billion per year and will rise to over $40 billion in the next few years.
We also saw advertisements asking older people to get vaccinated for shingles, a painful and sometimes debilitating viral disease. While shingles can make you very miserable, complications from it are fairly rare and the vaccine is barely effective (five in 1,000 might benefit annually). And yet there are reports of people getting the shot and still getting shingles, as well as reports of people being injured by the vaccine.
Remember, these are otherwise healthy, older people.
In 2012, we saw waves of professional endorsements of the HPV vaccine from those who say girls need it to avoid the virus associated with the development of cervical cancer. One website supported by the Society of Obstetricians and Gynecologists of Canada (hpvinfo.ca) tells us “Vaccines have been developed to prevent you from contracting the HPV virus and could dramatically help reduce the incidence of HPV-related complications such as genital and anal warts and cervical cancer.”
A search of the site delivers little more than dramatically murky propaganda with no reference to the many unanswered questions about the effectiveness and safety of the two HPV vaccines. It also doesn’t say that there hasn’t been one trial that showed any difference in cervical cancer rates due to the vaccine and that many groups are demanding better research around the vaccine’s safety. According to the National Vaccine Information Center (www.Nvic.org), in the US, as of August 2012, “There have been a total of 26,304 reports made to the federal Vaccine Adverse Events Reporting System (VAERS)” associated with HPV vaccines, including 118 deaths.
Remember, these are healthy, young girls being asked to take this vaccine.
In 2012, we saw public health authorities praising the value of the annual flu shot and in some instances implementing flu polices in very heavy-handed ways. Admittedly, this vaccine is designed to prevent infection by a very slippery, constantly changing virus; the flu itself is mostly bothersome and rarely fatal.
When the authorities fail to come clean about the uncertainty or safety of a vaccine, it smells an awful lot like propaganda. In 2012, the American actor Andy Griffith died. While that might not be important to you, he is probably the most famous person to have ever come down with Guillain Barré syndrome (GBS), which he suffered in the 1980s and was left paralyzed for many months. In the last three years, there has been an increase in the number of reports of GBS in people who had taken the H1N1 “swine flu” vaccine and the 2010/11 seasonal flu shot containing the pandemic H1N1 strains. The rates of GBS in current flu vaccines are said to be “extremely rare.” We hope so.
Remember, these are otherwise healthy people of all ages.
I leave you with this last word on prevention propaganda: it might not make you sick, but it is the very opposite of proper, informed consent. Propaganda is like polluted water and citizens who want to make informed decisions about their own preventive healthcare need access to clean, clear facts as urgently as we need clean, clear water to live.
Let’s make a pledge in 2013: let’s pledge to resist the pervasive pull of preventive propaganda. Let’s avoid information that is polluted. Do you still want to be “proactive” about your health? Then remember that any ‘preventive’ treatment offered to already healthy people must come with crystal-clear information that provides unequivocal evidence of effectiveness and safety.
Let’s brand 2013 as the year of living cleanly, without preventive propaganda.
Alan Cassels is the author of Seeking Sickness: Medical Screening and the Misguided Hunt for Disease. Follow him on Twitter @AKECassels or www.alancassels.com