She don’t lie, she don’t lie, Cochrane

What started me investigating propaganda and related topics, around nine years ago now, was the strange phenomenon of how public attitudes on sexuality had (ostensibly) been dramatically reversed in just a decade or so, as if by magic. Another decade has shown up many of the mechanisms, such as institutional capture, mass formation and so on. But it still remains strange how it is far easier to sell lies than truth to ordinary people.

A new case in point. A close family member of roughly my own age, in generally robust health, decides to visit the doctor for “a checkup,” which mainly seems to mean getting his blood pressure checked (high, lent sphygmomanometer to check it at home, where it of course varies as much as his activity), and requesting prostate screening (sent for the obligatory PSA, with no cost-benefit discussion).

And that’s not news, in that such checks have been advocated by a succession of governments, though they are much less frequently advertised by GP surgeries now that the system is designed to keep people away. But in this case, the patient has been exposed over many years to my own professional evidence-based disillusion with screening. We’ve always been in frequent contact, and he will remember (because I crowed about it so much) back in 2001 how I organised an interdisciplinary meeting in the town I practised in, to resolve the discrepancy between private urologists advertising prostate screening “for peace of mind,” and the local NHS policy, which was that asymptomatic screening was not recommended.

I’ve mentioned before how in researching this I unwittingly entered into correspondence with Sir Muir Gray, founder and at that time Director of the UK Screening Service, and was schooled in the epidemiological mysteries of lead-time bias, length-time bias, and so on. Together these demonstrated that, in the state of knowledge at that time, we could not be sure that screening would not cause more harm than good. And if in doubt, don’t.

Furthermore, throughout the COVID scam I was reporting in personal communications, as well as on this blog, how evidence was being contradicted by policy in practically every prevention situation. And recently I commented on how I had received an NHS bowel-cancer screening letter, despite a comprehensive 2019 BMJ review showing that blanket screening up to 79 years doesn’t meet the 3% risk threshold that counterbalances injuries, false positives, false negatives and stress from investigation. I mentioned in passing how that aligns with my doubts about PSA screening, now confirmed by the evidence… but that did not affect his decision to go and ask for the latter anyway.

Indeed the situation with prostate screening was confirmed, when the studies awaited by Sir Muir Gray back in 2001 were collated in an authoritative Cochrane review in 2014. That the benefits of asymptomatic prostate screening are almost nil, and outweighed by the risks, is now proven beyond reasonable doubt. And yet the screening goes on, and I have several friends who have suffered possibly unnecessary surgery, and resulting complications, as a result.

The same is true for mild hypertension. Cochrane has done several reports on this, largely because the evidence base of studies is surprisingly poor for such a common intervention. The most recent was in 2021, and it concluded that overall mortality and a list of specific fatal outcomes was not improved by treatment, whilst side effects were sufficient to cause problems that made people stop medication. At very least this shows that doctors cannot be sure they are doing any good by putting people on lifelong medication, and yet it’s pretty true to say that if your GP finds your blood pressure moderately raised, you’ll be started on pills, whatever the best quality evidence shows. Why is that?

Now, some of you of medical background, or interested in the whole COVID phenomenon, may be aware that there has been controversy over Cochrane‘s last two reports on the use of masks to prevent viral transmission. Both of these found that there was zero good quality evidence that masks limit transmission, but the highly experienced authors, Tom Jefferson and Carl Heneghan, found themselves publicly bad-mouthed for the findings not only by fellow professionals, but even by the Chairwoman of the Cochrane organisation itself, bowing to pressure from outside. After much process and an indecent interval, the threat of changes to the later review were quietly shelved, thus tacitly admitting that its findings are robust – masks don’t work. But that doesn’t stop some NHS facilities, even now, from insisting on them against government policy. At least, it’s government policy until the next lab leak.

Now, as far as the rejection of my own professional expertise by my relly is concerned, I guess “No prophet is accepted in his home town.” During COVID, he also rubbished my opinions on the basis that I am retired (much as Antony Flew’s conversion to theism, or Professors’ emeritus’ rejection of climate alarmism, are attributed by the powerful to dementia). But how does an entire learned profession consistently ignore the best learning of that profession? Where does the counter-narrative come from?

One answer must be the power of the Big Pharma lobby and its loaded research. You can be sure that Merck’s RCT on its patented antihypertensive Squashitol will show 10% less mortality for every point of BP above that of a teenage girl. And yet, and yet – surely one would expect that the message has spread abroad about the doubtful quality of commercially-funded research, since John Ioannidis ‘s 2005 paper on it is the most cited work in science. As a matter of policy, it seems, doctors work on the basis of research they know to be biased and flawed, whilst ignoring the gold-standard, evidence-based findings of Cochrane.

As for the punters, it’s not simply that they are following the lead of their health advisors. Rather it’s the reverse: a lot of my frustration regarding prostate screening came from patients turning up to insist on screening, and my diligently having to spend twenty or thirty minutes trying to impart the basics of epidemiology to enable informed consent. It’s far easier just to sign the form and tick the referral boxes if it comes back positive… the incontinence and impotence from probably unnecessary radical surgery are distant prospects.

I’ve no doubt that part of the issue is the failure to understand how “a simple test” could be anything but beneficial, an attitude shared by urology consultants as well as the general public. The critical thinking doesn’t go far ahead: my own Mrs G., hearing me say I would skip the faecal occult blood testing this time, said that, in her case, she wouldn’t do anything about it if it came back positive, but that a negative result is reassuring. Rubbish, of course – only the most fanatical Mary Baker Eddy devotee would do nothing about a positive cancer test. But most people have no concept of the dangers of a false negative, of the real risk of bowel perforation from sigmoidoscopy, and so on.

I rather think that behind the whole phenomenon is, ultimately, man’s hubristic belief that we can control the world. When it comes to screening, or masks, or MRNA vaccines, is it not a case of “Something must be done. This is something. Therefore it must be done”? So your father dies of aggressive prostate cancer, and you ask the doctor how you can prevent the same fate yourself. How do you react if, truthfully, he replies, “You can’t. 40% of males of a certain age have foci of prostate cancer, and most will die with it, not of it. Currently only God can predict whose cancer will begin to motor”? Not good enough – give me the test.

Even more commonly, of course, is the case of the relative dropping dead suddenly in the prime of life (I’m not talking about mRNA-induced sudden adult death, here – just the common or gardening cardiac arrest). No doctor dares say: “It may happen to you too, but it may not. There’s probably a God. Now stop worrying, enjoy the life he gives.” No, if your BP is a few points up, taking the pills gives you a feeling of control, even if the evidence shows that it makes no difference to your chances. Nobody, of course, will tell you that over a thousand people like you will have to be on pills for life to prevent just one death.

And if the alternative to masks is “masterly inactivity” as one negotiates the virus soup, we’d better wear the mask “just in case.”

And so the patient wants to believe that a simple test will give them control over what, in fact, is in the hands of God. And the doctors want to believe that they can intervene to make a difference even if there is evidence that they can’t. Quite possibly, the pharmaceutical companies also want to believe they can make effective molecules so much that it biases the research – though to be fair, it’s a lot more likely they hear the tinkling of cash registers. Governments certainly want their people to believe that salvation comes from them, so will promote screening until all the money runs out or the doctors drop dead from overwork (for which there is no screening programme).

As for me, whilst not being complacent should I develop chest pain, or persistent headaches, or constant diarrhoea, or any of those other marvellous warning systems with which my body is so thoughtfully provided, I am trying to cultivate Isaiah’s advice from God:

“In repentance and rest is your salvation, in quietness and trust is your strength…”

(Isaiah 30:15)

Sadly, though, the Lord ends his sentence by observing of the majority:

“…but you would have none of it.”

Eric Clapton endorses Cochrane… or maybe I misheard.