- Overkill: When modern medicine goes too far, by Paul Offitt. Scribe. $32.99.
Compared to many countries in Europe and the Americas, Australia has dealt with the coronavirus pandemic extremely well. This is variously put down to the fortune of geography, the absence of political grandstanding and the general compliance of the population. What deserves to be added to that list is our health system and in particular the way that routine ailments can be treated under Medicare.
In countries where all doctor visits are charged, and where medical treatments are advertised like motor cars or cat food, people often make decisions based on their finance rather than their health. One of the strengths of this book is the idea it gives of what happens when market forces are allowed to run medicine.
A number of chapters deal with the proliferation of products that come under the general heading of dietary supplements. The US National Academy of Medicine has produced figures for recommended dietary allowance (RDA) for a number of vitamins. For Vitamin C, for example, it is 60 milligrams. So a person chewing a 1,000 milligram capsule available in health food stores and pharmacies, is taking 16 times the recommended figure, equivalent to eating 14 oranges, something about which our stomachs would likely object.
Advisory boards set up by US federal authorities concluded that 97.5 per cent of the American population receive enough Vitamin D from sunlight and normal processed food.
Yet there is a boom industry around testing for Vitamin D and subsequent consumption of supplements; the author suggests that this has great benefit for the screening/testing industry and the pharmaceutical companies, but little if any benefit for the paying public. He explains the FDA is unable to alert people to the dangers of these products because they are classified as dietary supplements rather than pharmaceutical products. In the end, however well the public may be informed, "advertising dollars trump scientific studies".
The story with supplemental anti-oxidants is even more alarming. There is no evidence that they help to prevent heart disease or protect against cancer, and the author gives a number of instances of research programs - many involving thousands of participants over a number of years - which indicated that these products may in fact increase the risk of heart disease and cancer.
But all of these pale beside the problem with antibiotics and the tendency of patients to demand them - doctors who are reluctant to prescribe are given low ratings on internet sites. Just as difficult is trying to rid the language of the phrase "a course of antibiotics". Research shows that these pills have done their job after a few days, meaning that the often-heard instruction, "finish the course" is merely giving bacteria an opportunity to adapt. And if you wonder how serious this situation is, "the WHO now estimates that antibiotic-resistant bacteria will kill at least 50 million people per year by 2050". More than 100 times the current toll of COVID-19.
The chapter on cancer raises a number of worries. The author gives the case against relying on the PSA test as a trustworthy indicator of prostate cancer, a position taken also by the Australian College of General Practitioners - little better than the toss of a coin, it has been suggested. Thyroid cancer is now much easier to diagnose with the use of ultrasound, but Offitt suggests that surgery is wasteful and possibly dangerous; "the 20-year survival rate for people with thyroid cancers who did or didn't have thyroidectomies is statistically indistinguishable".
Whereas these are largely medical opinions, likely to vary between GPs, the section on breast cancer will raise many an eyebrow, including from those charged with distributing public funds for mammogram tests. These invasive and sometimes painful procedures, the author asserts, basing his view on research in the last 10 years or so, have little value. Based on tests involving hundreds of thousands of women in different countries, he gives the following summary. Imagine 1,000 women screened every two years over a 10-year period. More than half will have had a false-negative in that time; 146 will have an unnecessary biopsy; 19 will have undergone invasive treatment - surgery, chemotherapy, radiation, hormone therapy - for a cancer that would never have killed them; only seven will have prevented a fatal case of breast cancer.
Other topics covered include why taking aspirin or equivalent increases the length of a fever, why using ice on muscle strain slows the healing and why surgery for knee arthritis is rarely helpful. There is useful information on sunscreens and their limited value, and Australia may count itself lucky to have missed out on the marketing of products for men advertised under the benign heading of dealing with low testosterone, a condition, the author maintains, that is just a normal part of ageing which does not need to be treated with drugs that have known harmful side-effects.
Although written by an American doctor, the many examples of research that he quotes come from all over the world, including Australia and New Zealand. The writing is clear, the explanations easily followed and the arguments powerful even if the reader is left with the feeling that this is one man against the world.