I’d like to introduce you to someone who calls himself a “skeptical surgeon,” Ian Harris, M.D., Ph.D. He is an academic orthopedic surgeon in Sydney, Australia. Dr. Harris has a point of view I thought you would find interesting and provocative.
What are you skeptical of and how did you develop this philosophy?
Dr. Harris: I am skeptical of the degree to which medicine benefits society. It is my position that the benefits from medicine are overestimated and the harms are underestimated.
The more objectively you explore many of the claims that arise from modern medicine, the more you realize that this is the case. There are so many examples of interventions that, on the surface, sound good, but when put to the (scientific) test, turn out to be a net harm, or barely beneficial. Either that, or you find that they have never been properly tested in the first place.
The public and the medical community therefore see medicine through rose-colored glasses, which results in an over-diagnosed, over-treated society.
Conditions that are part of normal life are being medicalized (sadness, grief, social anxiety, low grades, backache, obesity, childbirth, sex, menopause, aging) and “real” diseases are being over-medicalized (high blood pressure, arthritis, cardiovascular disease, and some types of cancer). In fact, those examples show you how difficult it is to define disease.
I went into medicine straight from college, and then into surgical training soon after that. I had some exposure to surgery in Europe and in the United States. and then started as a specialist orthopedic surgeon.
I was always interested in the scientific basis for medical practice, rather than just doing what everyone else did, which is how most medicine is practiced.
While I remain a practicing surgeon, I now have higher training in clinical epidemiology and statistics, and remain a student of the scientific method. I perform research and teach evidence-based medicine.
Since I have started challenging the conventional wisdom of medicine, I have found that much of it does not stand up to scrutiny. Repeatedly, I find that what appeared effective was either naive or deliberately calculated to show an effect. The biases that drive our perception of the net benefit of medicine are numerous and all point in the same direction.
What do you see as the biggest, broadest issues patients are facing these days?
Dr. Harris: Much of our zeal over new studies, and our biases in conducting and reporting those studies, are the result of a lack of scientific rigor.
Patients face a problem because they are entrusting their doctor to be the judge of all this science and they do not realize that the doctor may be just as biased as is the general public.
Consequently, the average patient is more likely to be screened unnecessarily, put on medication that might not work, and undergo surgery with questionable benefit/risk ratios. Simply saying something is scientific is no longer enough.
Something happened to our culture over the last 50 years or so that has made us believe just about everything can be tested and most everything can be treated. How did this happen and how can this approach be dangerous to our health?
Dr. Harris: The reason we believe in medicine is because that is what we want to believe. Who wouldn’t? In fact, there is no negative feedback on this belief.
The health industry (doctors, nurses, hospital administrators and owners, universities, pharmaceutical companies, and device inventors and manufacturers) want medicine to work in order to help people, make a profit, keep their jobs, or whatever.
Patients want medicine to work to validate their suffering, take responsibility, solve their problems, etc. There is very little that that opposes this strong medicalizing force.
We have been overestimating the benefits and underestimating the harms for a long time. It is only recently that the problem is being addressed, partly because we are being more scientific and partly because those harms are becoming so large that they are getting hard to ignore.