How well do drugs work ?

The common practice amongst the medical profession is to quote relative risk improvement rather than absolute risk improvement. Why?, because if they quoted the more realistic and honest absolute risk improvement of drugs many patients simply would not bother or ate last give them up when the side effects kick in. Dr Michael Greger sums this up in his latest post which is shown below. You can follow more of his messages at nutritionfacts.org

"One of the reasons people may undervalue diet and lifestyle changes is an overconfidence in the ability of pills and procedures to prevent disease. For example, people tend to wildly overestimate the power of things like mammograms and colonoscopies to prevent deaths from breast and bowel cancer, or the power of drugs like Fosamax to prevent hip fractures, or the power of cholesterol drugs to prevent fatal heart attacks. Patients believe statin drugs like Lipitor are about 100 times more effective than they actually are in preventing heart attacks. Studies show most people wouldn’t take multiple blood pressure medications if they knew the truth.

For most people, the chance of benefit is normally less than 5 percent over five years for cholesterol, blood pressure, and blood thinning drugs. Patients don’t want to take drugs unless they have at least a one in five chance—even those who just had a heart attack. It’s no wonder, then, that doctors seldom share these figures. Informing patients of the percentage chance of benefit from preventive drug strategies would likely substantially reduce the likelihood that patients would agree to take the drugs every day for the rest of their lives.

For the individual, not being informed of the low percentage chance of benefit from these preventive drug strategies is unlikely to be detrimental; after all, there’s a 95 percent chance it won’t do anything for them. But for the population at large, being informed would make a difference; so, doctors and drug companies oversell the benefits by conveniently not mentioning how tiny they actually are, knowing most patients wouldn’t take them if doctors divulged the truth. To practice non-lifestyle medicine is to practice deceptive medicine.

The best that cholesterol-lowering statin drugs appear to do is an absolute risk reduction of 3.1 percent over six years. If Dr. Esselstyn’s work can be replicated in a randomized, controlled trial, then a whole foods plant-based diet will have been shown to work twenty times better, an absolute risk reduction of 60 percent after less than four years. In Esselstyn’s study, 99.4 percent of high-risk patients that stuck with the diet avoided major cardiac events, such as death from heart attack.

When we have to decide whether we want to go diet versus drugs, we’re not making a choice between eating healthy to prevent a heart attack or taking a pill to prevent a heart attack. Because in 97 percent of cases in the near-term, pills don’t do anything. We’re risking side effects for nothing, whereas if we treat the underlying root cause of the disease by eating a healthy, cholesterol-free diet, we may even reverse the progression of the disease, as seen in my video The Actual Benefit of Diet vs. Drugs.

If we stop eating an artery-clogging diet, our bodies can start dissolving that plaque away, opening up arteries in some cases without drugs or surgery. A healthy whole food plant-based diet by itself may work 20 times better than drugs to combat our #1 killer.

Now, that’s something doctors may want to tell their patients.

Yes, an ounce of prevention is worth a pound of cure, but a pound isn’t that heavy—why change our diet and lifestyle when we can just wait and let modern medicine fix us up? Turns out we overestimate the efficacy of treatment as well, the subject of my video Why Prevention is Worth a Ton of Cure.

Sometimes, preventive medicine procedures can even be harmful. See Cancer Risk From CT Scan Radiation and Do Dental X-Rays Cause Brain Tumors?

I’ve previously noted how an honest physician-patient interaction might go in Fully Consensual Heart Disease Treatment, Optimal Diet: Just Give it To Me Straight, Doc and Disclosing Conflicts of Interest in Medical Research. What should we be saying? See: What Diet Should Physician’s Recommend?

So why don’t more doctors do it? See Barriers to Heart Disease Prevention and Find Out If Your Doctor Takes Drug Company Money.

More on Dr. Esselstyn’s heart disease reversal study in: Evidence-Based Medicine or Evidence-Biased?

Of course, then there’s just the brute force method: Kempner Rice Diet: Whipping Us Into Shape.

In health,

Michael Greger, M.D.

3 Replies

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  • Most reports I read use a lot of "weasel" words - like, could or should or may. This article above says this "if we treat the underlying root cause of the disease by eating a healthy, cholesterol-free diet ..... ,". Elsewhere, I read that cholesterol in the diet is now considered to be not the problem it once was considered to be - and that most people's "excessive" cholesterol levels come from their livers and not from their diet. I further read that the low fat ( moreso low saturated fat) diets espoused over the past few decades are wrong - and have lead to a great increase in obesity and related heart diseases.

  • Yes BUT there are studies showing low fat no oil vegan diets can work wonders ( Ornish) but also, oddly, LCHF diets too

  • Agreed

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