by Steven Hatch
mortality rates for, 78
overdiagnosis of, 75
radiation treatment for, 79, 82
relative and actual mortality reduction for, 77–79
statistics of, 67, 75–76
See also mammography, screening
British Medical Journal, 83
Brody, Howard, 122
Brody, Jane, 117–118
Brown, Timothy Ray, 183, 186–189, 204
see also Berlin Patient
Burgdorfer, Willy, 106
Canadian mammogram trial, 83–84, 88, 249
cancer
correlation/causation problem and, 162–165
Couric’s advocacy for curing, 190–191
determining death from, 79
diagnosing, 15, 34–39, 36 (fig.)
hormone replacement therapy and, 173, 177–178
mortality rates with, 33–34
non-lethal, 37–38
probability with, 7–8
retrospective research on, 154–155, 158–159, 160 (fig.), 162–163
screening for, 65–66, 190–191
survival statistics of, 7–8, 34–37
X-rays and, 71
Cancer, 156–158
cancer treatment
drugs for, 34
harm from, 2, 41
scoring system for, 214
side effects of, 39–40
See also oncologist
cardiovascular disease. See heart disease
case series, 156–159, 160 (fig.)
CAT scans. See CT scans
CBS, 198–199
CCR5 protein, 186–188
CD4 cell, 186–187
Ceccarelli, Leah, 189
Centers for Disease Control and Prevention (CDC)
HIV case series and, 157
on Lyme disease, 105, 111–112
on vaccines, 193, 196, 199, 224
certainty
false sense of, 13
with Lyme treatment, 100
probability compared to, 8
spectrum of, 11–13, 11 (fig.), 100, 162, 193, 221
Cervarix, 191, 195
cervical cancer, 191, 193–194
chocolate, dark, 169–171, 228
cholesterol levels
drugs for lowering, 142–144
guidelines for statins and, 145, 249
mortality rate and, 143–144, 144 (fig.)
chondrosarcoma, 8
chronic fatigue syndrome
diagnosing, 103, 125–126, 256
Lyme disease link to, 100, 105, 124, 256
patient example of, 101–102
chronic myelogenous leukemia (CML), 34, 253
circumcision, 259
clear cell adenocarcinoma
case series on, 156–159, 160 (fig.)
DES and, 158–159, 160 (fig.), 161–163, 165
hysterectomies and, 156
clinical research
bias in, 79–80, 132–133, 167–179
blinding in, 132–134
on blood pressure targets, 94, 217, 250
books on, 242
on breast cancer, 79–80
on chocolate and heart disease, 169–171
on coffee and heart attacks, 166–168
comparison in, 131–132
correlation/causation problem in, 154–155, 166–168, 171, 258
costs of, 134, 248–249, 254
crossover design in, 166
difficulties in, 135, 241
ethnic and nationality differences in, 94, 249–250
Framingham Heart Study in, 170
on herbal remedies, 251–252
on hormone replacement therapy, 173, 175–178
media’s distortion of, 205–206
medical-industrial complex and, 134
modern structure of, 131–133
participant pool size for, 246–248, 253
pilot studies in, 247
placebo controlled comparisons in, 132–133
random allocation in, 133, 245–247
retrospective, 154–155, 158–159, 160 (fig.), 162–163
on screening mammography, 77–78
standardization in, 168, 171
truth and reliability checking of, 257–259
See also drug trials; statistical significance
Clostridium difficile, 6, 116
“clubbing,” physical exam finding of nails, 23–24
CML. See chronic myelogenous leukemia
coffee, 166–169, 258
colonoscopy, 24, 190
communication
of health guidelines, 85–86
ICU family rounds for, 232–235
with physicians, 7, 48, 98, 149, 214–215, 219, 231–233
transparency and trust in, 234–235
about uncertainty, 230–231
comparison
in clinical research, 131–132
in drug trials, 134, 195, 255
placebo controlled, 132–133
confidence, 11–13, 11 (fig.)
confirmation bias, 31–32
contraindication, 151
control, 60–61, 64
control group
function of, 131, 154
placebo in, 132–133
statistical significance and, 245, 248, 257
VAERS lack of, 195
controversy
experts and medical, 88, 98–99
HPV vaccine, 191–193, 197–198
Lyme disease, 102–103, 105, 119, 123–124
media’s creation of, 189–192
over screening mammography, 10–11, 51, 54, 59–60, 85–86, 88, 99
over vaccines, 22, 190
public view of, 90
Coronaviruses, 201, 202
correlation/causation problem
in biostatistics, 155, 256
with chocolate and heart disease, 170–171
clinical research and, 154–155, 166–168, 171, 258
in coffee and heart attack study, 166–168
for common diseases, 165–166, 168–169
with DES use and cancer, 162–165
with HIV and AIDS, 164–165
hormone replacement therapy and, 179
with HPV vaccine, 196–197
with smoking and lung cancer, 154–155, 256
COSMOS, 254
Couric, Katie
cancer cure advocacy of, 190–191
criticism of, 198–199
HPV vaccine show by, 191–193, 197–200, 204–205
CT scans, 24
cancer and, 260
chest X-ray compared to, 259–260
diagnosis rates with, 37
evolution of, 45
overdiagnosis with, 45, 259–260
for PE diagnosis, 45–47, 46 (fig.)
profit in, 49
data and evidence
health coverage and, 81–82
interpretation of, 6, 107, 111–112, 137, 179–180, 250–251
media’s lack of, 228–229
on screening mammography, 61–62, 64–67, 82–83
from VAERS, 193–196, 199
deaths
from AIDS, 186
from breast cancer, 36 (fig.), 37, 77–79
from cancer, 33–37, 36 (fig.), 38, 42, 79
cholesterol levels and, 143–144, 144 (fig.)
diagnosis compared to, 34–37, 36 (fig.), 38–40, 40 (fig.)
drug trials and, 136–137, 141–143
from heart disease, 203
with hip fracture, 97
from influenza, 202–203
from lung cancer, 34
on ProMED, 200–201
reduction in “all-cause,” 96, 141–142
Department of Health and Human Services, 59, 63
depression, 251
diagnosis of, 146–147, 148–149, 255
drug trials for, 147–148, 255–256
drugs for, 17, 138–139, 148–149, 255–256
DES. See diethyl stilbestrol
diabetes
>
blood pressure targets for, 90–91, 91 (table), 216
diet and exercise for, 15, 95
drugs for, 12, 150, 255
diagnosis
bias in, 31–32, 113–114, 133, 197
of breast cancer, 10, 36 (fig.), 37, 58, 65–66, 74
of cancer, 15, 34, 35–39, 36 (fig.)
challenges with, 15–16
with chronic fatigue syndrome, 103, 125–126, 256
with CT scans, 37, 45–47, 46 (fig.), 259–260
deaths compared to, 35–37, 36 (fig.), 38–40, 40 (fig.)
of depression, 146–149, 255
emphasis on, 23
false-negative and false-positive errors in, 29, 32, 41, 68, 73, 83
handoff in ER, 48
human evolution and errors in, 32–33
Lyme disease, 112–114
pulmonary embolism (PE), 42–43, 44, 45–47, 46 (fig.)
of prostate cancer, 36–37, 36 (fig.), 38, 39–40, 40 (fig.)
of pseudodisease, 33–34
in psychiatry, 25–31
uncertainty with, 5, 6, 9, 181
See also overdiagnosis; underdiagnosis
diagnostic technology, 37
cancer detection with, 35–36
overdiagnosis with, 24–25, 46, 50
sensitivity of, 24–25
See also CT scans; mammogram
diagnostic tests, 24
for Lyme, 102–103, 106–112, 126
predictive value and, 55–56, 259
screening compared to, 58, 65–66
diet, 14–15, 184, 203, 225–226
diethyl stilbestrol (DES)
cancer correlation problem with, 162–165
clear cell adenocarcinoma and, 158–159, 160 (fig.), 161–163, 165
fetal risk categorization and, 161–162
digitalis, 128
disease, 8
complexity in studying, 135, 241
correlation/causation problems for common, 165–166, 168–169
rarity and correlation with, 164–165
risk and benefit ratio with severity of, 216–217
See also pseudodisease
disease prevention, 14–15, 95–96, 184, 203, 225–226
DNR (Do Not Resuscitate) order, 218–220
doctors. See physicians
drug industry, 3
FDA marketing regulations for, 174–175
Lyme treatment debate and, 120–121
in overdiagnosis and treatment, 49–50
profit and, 22, 49–50, 121, 172–173, 251
drug trials
comparison in, 134, 195, 255
for depression, 147–148, 255–256
FDA and, 138, 142, 148, 193–194
for Hepatitis C, 253–254
history of, 130–131
for HPV vaccine, 193–195
hypothetical zinc, 250–251
interpretation of data in, 137, 179–180, 250–251
modern structure of, 133–134, 247–248
mortality rate and, 136–137, 141–142, 143
Phase III study in, 193–195
for scurvy, 129–132, 135, 137, 140, 245–247
for statins and heart disease, 140–145, 176, 178
on TB, 247–248
uncertainty with, 17, 136–138, 140–141, 153–154
drugs
for cancer treatment, 34
for cholesterol levels, 142, 143–144
classes of, 17, 138
for diabetes, 12, 150, 255
FDA approval of, 138, 142, 148, 161–162, 174–175, 193–194
for heart disease, 92, 128, 138–139, 149
for high blood pressure, 92, 95, 98, 150, 255
history of, development, 128–129, 139
modern compared to early, 127–128
off-label market for, 174–175
during pregnancy, 157–159, 160 (fig.), 161–163
in psychiatry, 21, 148
risk and benefit of, 151, 177–178
side effects of, 6, 116, 145, 248
uncertainty with prescribing, 149–150, 153
See also antidepressant drugs; statin drugs
ductal carcinoma in situ, 81
Ebola, 201, 202, 228
EBV. See Epstein Barr virus
electrocardiogram (EKG), 2, 43, 44, 45
ELISA, 106
false-positive errors with, 108–110
function of Lyme testing with, 107–108
reliability with, 111, 112, 126
emphysema, 15
environmental risks, 9
epidemiology, 2
Epstein Barr virus (EBV), 125
error management theory, 32–33
erythema migrans, 105–106
estrogen, 158, 172–173
ethnicity, 94, 249–250
exercise
disease prevention with, 14–15, 95–96, 184, 203, 225
media on, 203–204
fainting, 97
false-negative errors, 29, 32, 68, 69 (fig.), 110–111
false-positive errors, 32
antibodies and, 108–109
biopsies and, 68, 81, 260
consequences of, 16, 81, 83
in CT scans, 260
with ELISA, 108–110
in HIV test, 16, 54–56, 58, 67, 68, 108
in Lyme disease testing, 108–109
in mammography, 16, 67–68, 69, 69 (fig.), 75, 221–222
occurrence in radiology, 73
psychological factors in, 81
in Rosenhan experiment, 29
surgeries from, 41, 69 (fig.), 75, 81, 82
Western blot reducing, 109–110
family
in ICU, 6, 218–219, 232–235
patient decisions by, 219–220
physician communication with, 7, 149, 219
uncertainty understanding of, 13, 18
family rounds, in Intensive Care Units, 232–235
FDA. See Food and Drug Administration
fear. See psychological factors
Feld, Ellen, 74
Feminine Forever (Wilson), 172–173
financial interest. See profit
flavonoids, 169, 171
Food and Drug Administration (FDA)
drug approval and, 138, 142, 148, 161–162, 193–194
drug marketing regulations by, 174–175
HPV vaccines and, 193, 196
4S Study, 143–144
Framingham Heart Study, 170
Gardasil, 190–192, 193–197
gastrointestinal problems, 116
genetic mutations, 24, 187–188, 222
Gleevec, 34, 253
Goldman, William, 18
Goldstein, Steven, 177
government. See national health guidelines; politicians
The Greatest Benefit to Mankind (Porter), 3, 130
Haas, Stephen, 207
Hamilton Depression Rating Scale, 146–147, 255
Hampton, Aubrey, 43
Hampton’s hump, 44, 45
harm
from cancer treatment, 2, 41
with overdiagnosis, 16, 34, 50
with screening mammography, 12, 58, 69 (fig.), 74–76, 83
with treatments, 48–49, 50, 89, 100, 113, 223
health guidelines. See national health guidelines
HealthNewsReview, 206–210, 230
heart disease, 10
chocolate and, 169–171
coffee consumption and, 166–168, 169, 258
deaths from, 203
diet and exercise for, 15, 95–96, 203
drugs for, 92, 128, 138–139, 149
hormone replacement therapy and, 175–178
media on, 204
risk factors for, 170
SHEP trial success with, 92
statin drug trials for, 140–145, 176, 178
Hepatitis B, 224
Hepatitis C, 253–254
herbal remedies
native cultures’ staples and, 252–253
<
br /> research on, 251–252
uncertainty with, 250–253
Herbst, Arthur, 155–159, 160 (fig.), 162–163
HERS Study, 175–176, 177
hip fractures, 97
HIP study, 77–78
Hippocrates, 23–24
history
of drug development, 128–129, 139
of drug trials, 130–131
of modern medicine, 2–4
of vaccines, 223–224
HIV
case series on, 157
false-positive test results for, 16, 54–56, 58, 67, 68, 108
media coverage of “cure” for, 182–185, 189, 204, 227
modern screening for, 56, 68
molecular function of, 186–187
statistics in testing for, 54–56
statistics of infection rate for, 182, 259
See also Berlin patient
Holmes, Oliver Wendell, 127
hormone replacement therapy
cancer and, 173, 177, 178
clinical research on, 173, 175–178
correlation/causation problem and, 179
decline in, 83
drug industry profit and, 172–173
heart disease and, 175–178
media on, 173, 175, 177
in 1980s, 173–174
risks and benefits with, 176–177
hospitals, 3–4, 48, 49
See also intensive care unit
The Hot Zone (Preston), 202
HPV vaccine
controversy about, 191–193, 197–198
correlation/causation problem with, 196–197
drug trials for, 193–195
FDA on, 193, 196
Katie episode on, 191–193, 197–199, 200, 204–205
risk and benefit of, 193, 194
human evolution, 32–33, 50
hypertension. See blood pressure, high
hypothermia protocol, 218–219
hysterectomies, 156, 176, 177
ICU. See intensive care unit
IDSA. See Infectious Diseases Society of America
ILADS. See International Lyme and Associated Diseases Society
In Defense of Food (Pollan), 14
Infectious Diseases Society of America (IDSA)
ILADS compared to, 117–118
legal allegations against, 119–121
Lyme guidelines review of, 122–123
influenza, 202–203
insanity, 25–29
insurance industry, 120–121
intensive care unit (ICU)
environment of, 232
family members in, 6, 218–219, 232–235
uncertainty in, 218–219, 231–233, 235
interferon alpha, 253
International Lyme and Associated Diseases Society (ILADS)
divergence from mainstream of, 104, 105, 113
IDSA compared to, 117–118
prolonged antibiotic use advocacy of, 123, 126, 256
test interpretation debate with, 112
Internet, 130, 166, 199
confusion with, 17
health stories review on, 206–210, 230
Lyme disease controversy and, 102–103, 105, 119, 123, 124
physician’s using, 200
public health knowledge and, 151, 181–182, 185