“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
- Gøtzsche PC. Deadly medicines and organised crime: How big pharma has corrupted health care. London: Radcliffe Publishing, 2013.
- Makary MA, Daniel M. Medical error – the third leading cause of death in the US. BMJ 353 (2016): i2139.
- Gøtzsche PC. Survival in an overmedicated world: look up the evidence yourself. Copenhagen: People’s Press, 2019.
- 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.
- World Health Organization. The World Medicines Situation. Available here. (Accessed 6 February 2013).
- Gøtzsche PC. Deadly psychiatry and organised denial. Copenhagen: People’s Press, 2015.
”Trust me, I’m a doctor”