The prescribing doctor does not go to the doctor: “An 85-year-old patient should not go to the ICU”
A prestigious surgeon alerts in a provocative book against the unstoppable medicalization of our society
Dr. Antonio Sitges-Serra (Barcelona, 1951) has exercised 40 years in public health , between surgery, research and consultation. Know the system and its diseases as well as the bodies of the thousands of patients who have passed through their hands. But Sitges-Serra is not a normal doctor: in his book, ‘If you can, don’t go to the doctor’ , published by Debate and Libros del Zorzal, and extended by the philosopher Manuel Cruz , he faces the pharmaceutical industry and diagnoses the worst disease of the 21st century: medical technoutopism.
QUESTION. Recently, Amancio Ortega gave some machines to hospitals.
REPLY. High precision scanners, yes.
P. Some said that Amancio is a philanthropist and others that wash his face, but reading his book, I realized something that nobody raised: that perhaps having these machines is worse than not having them.
A. No one raised it because technology is the dominant ideology. Few of us discuss this utopia, but machines often give more problems to hospitals than they solve. High precision scanners can be harmful to the health of citizens.
Q. But everyone wants more and better machines in their hospital.
A. And new drugs, progress without limits. It is a mechanism of self-defense, we want to continue in it, more, more, more, as if we were going to defeat death. But I think it’s a bad road. For now, it has led us to overdiagnosis.
Q. What is overdiagnosis?
A. With the most advanced detection technology, there are diseases that are not really such. There are no symptoms, the patient is fine, he goes to a simple review and, with the new super-scanner of last generation, they find a cancer of two millimeters in the thyroid. The doctor tells you: “We have seen a cancer of two millimeters.” And you think you are a cancer patient, and they treat you as such, although nothing really happens to you.
Q. Can a cancer be harmless?
A. Yes. He may never show his face. But once you’re overdiagnosed, you fall into a vicious circle of reviews that will make you dependent on the hospital, in addition to stress, fear and anxiety. And that, in case the doctor on duty does not want to give you chemo or even operate, always with the best intention, unleashing an unnecessary carnage. Well, that carnage was not caused by your cancer but its diagnosis. This is how early detection technology becomes a serious problem for your health.
Early detection technology has become a serious problem for your health
Q. Are there many people out there with harmless cancers that nobody has seen?
R. Very much, of course. When someone dies from any cause, from old age, for example, it is very common to find thyroid cancer in the body. 20% of patients who die of anything have it. If you buy this machine so fantastic that it detects tumors of less than two millimeters, you can end up removing the thyroid to 20% of the population for nothing. In South Korea, an absolutely slave country of technology, it’s just what happened. It was a massacre. Thousands of thyroids removed by harmless cancers that would never have appeared.
Q. That is to say that if they detect a cancer of two millimeters, do I not have cancer?
R. Exactly. Diagnostics increase with ultramodern machines, but not mortality. Why? Because they detect cancers that do not kill or give symptoms or anything. Another example: 80% of men have prostate cancer at death. He has died of something else, for example, from a heart attack, but he had that cancer since when it was known, without anyone seeing it and without giving symptoms. For the patient’s life, it is best not to be detected.
Q. You say many things that defy intuition.
Q. I know. There is also another problem in hospitals with the most modern machines: that of interpretation. Radiographic reading of a mammogram or anything else requires experience. If you don’t have it, you will raise false positives. Machines always need trained professionals, and constant innovation plays at the expense of the doctors’ learning curve, and therefore against the patient.
Q. When did things get complicated?
A. The twentieth century has been very powerful in the technological progress of medicine, but now the benefits of the novelties are very small and the cost is enormous. For example, many surgical interventions have tripled their duration compared to those of the 1990s, to be robotized. Therefore, the number of operating rooms needed increases. The robot makes the surgery much more complicated, much more expensive, much longer, and the results are no better than without a robot. But industrialists want to sell their inventions, and politicians and citizens are dazzled. That’s the techoutopism.
Now, the benefits of medical news are very small and the cost is huge
Q. What does the economy of a hospital mean, for example, a robot to operate prostate?
A. An initial expense of one and a half million, and annual maintenance of more than 100,000 euros. Plus the cost of teaching doctors how to use it. The big problem of health is the increase in costs: the cost increases every year, largely because unnecessary, but glamorous, products are bought. Health is between 20 and 25% of GDP, and it grows every year. Last year, 6%, while GDP grew by only 2%. If it weren’t for technoplaism, the costs would be greatly reduced. More GDP money could be dedicated to Justice or dependency. And besides, there are plenty of doctors.
Q. How? The opposite is always said, that doctors are missing.
A: Yes, but this is because we have created a hypermedicalized and hypochondriacal society. Look: when they asked Oriol Bohigas, the great city planner, how he would solve the traffic problem in Barcelona, he said: “Well, very easy, making the streets narrower.” This paradox can also be applied to medicine. If you are generating needs, you will always have more demand. If you widen the roads, you will have more cars.
Q. You advocate setting limits.
A. And for rethinking our relationship with death. The specialist doctor lives with his back to death. He is little compassionate and always pulls forward. There is always another medicine, another instrument, etc.
Q. We always expect that miracle.
A. We hope you invent something, and it is irrational. Technoutopism requires us to live with our backs to death. You talk to oncologists and death does not exist. For them, there is a drug, a CT scan and a tumor. And with that they play until the thing explodes. If we seriously reconciled with death, we could in question this health system. But you cannot say that a patient in his eighties must never enter the ICU, because they call you everything.
Q. Why shouldn’t you log in?
A. Because we know that an 85-year-old patient who spends a week in the ICU has a 70% chance of dying in the hospital, and another 30% of dying during the following year. The cost-effectiveness margin of the treatment is null. But, as the system pays, this is not valued in public medicine. And it should be the guide.
Q. What other examples of technotopism in contemporary medicine?
A. The so-called ‘breast cancer prevention’ is a brutal example. I say that it is better to forget about mammograms and dedicate those resources to putting in more nurseries, so that women can give birth sooner. It influences more that you do not die of breast cancer than advance maternity than 20 mammograms in 20 years. Preventive medicine has to do with changing bad social habits for health, and not with subjecting all women to free scanners from the age of 40.
5% of these thousand women with mammography will suffer an inadmissible masectomy
Q. Do periodic mammograms prevent women from dying of breast cancer?
A. Throughout a woman’s life, between 40 and 90, she has a 10% chance of dying from breast cancer and 90% of dying from anything else. That is, mammography deals with a disease of low prevalence. That to begin with, but, in addition, comparative studies have been done: one thousand mammographed women and one thousand non-mammogram women. Well, in one group four die, and in the other five die. Who does mammograms, then says that he has died 20% less, but this is a trap: a patient of a thousand does not justify that the other 999 women get a mammogram a year. But there is more: of those thousand mammographed women, 200 give the false positive. That is: they have to repeat the mammogram or have a biopsy. Finally, 5% of these thousand women with mammography will suffer an inappropriate masectomy. So it is better for women who do not have mammograms.
Q. Everything is full of ads, however, telling them to make them. And let’s look at cholesterol, and what a joke.
R. A hypochondriacal and overmedicated society. Of course. Social hypochondria has many factors: the press, doctors, industry, scientific societies, and so on. The bombardment of news and announcements about the dangers of falling ill creates anxiety. And it is an anxiety endorsed by the Spanish Society of Cardiology.
Q. Reading your book, I have had the feeling that the debate about vaccines is poisoned, and that the fact that the anti-vaccines are stupid gives white letter to the pharmacists to give us vaccines that we don’t need.
R. That’s right. Vaccines are good for the pharmaceutical industry. The debate revolves around a false dilemma. Vaccines, hygiene, antibiotics and minor surgery are the four main pillars of health in the twentieth century. No doubt. Now, when the pediatric vaccine schedule assumes 45 doses in six years, I say: are you sure? Because maybe we are subjecting the immune system of these kids to a bombardment that we do not know what will end. Because one thing is that you vaccinate diseases such as smallpox, tetanus, whooping cough, diphtheria, polio, etc., and another that we begin to expand the market: that if meningitis, that if pneumococcus, that if papilloma. .. There we are going. There are vaccines that only interest pharmaceutical companies, and they pass them, in part, because the debate is polarized.
There are vaccines that only interest pharmaceutical companies, and they pass them, in part, because the debate is polarized
Q. It is part of the medicalization of society, which you describe.
R. Sure. We do not want to die, nor do we want to have pain or sadness. Then death, pain and sadness are medicalized, and the industry wins, not the people. What happens when they lower the acceptable limit of blood cholesterol? That you have millions of patients who will need millions of doses of medication. Not to mention that other thing they do, which is to invent diseases.
Q. Regarding pharmaceutical companies, you say that many medications are sold before knowing if they are safe.
R. It is something impressive. 40% of drugs that have been proven deadly after starting to sell take two years to be recalled. Why? Because the development of the drug has been expensive, and they try to amortize it in the first years. The industry squeezes a lot because it knows that either the medicine will end up revealing a problem, or it is not as effective as it is sold, or a competitor will come out. How do they get it? With propaganda, and convincing doctors, sometimes with little honest methods. In oncology, this is very normal. Oncology is one of the most corrupt practices of medicine.
Q. That phrase has cloth!
R. Ya, ya. When you scratch the specialty a little inside … The vast majority of oncologists of a certain reputation charge directly from the pharmaceutical industry, or through trials, or in kind, or through congresses. Oncology is one of the specialties with the most investment of all kinds.
Q. Monday was Blue Monday, the saddest day of the year, so we have to go shopping to heal. I think it’s a good synthesis of what your book tells.
R. Ha ha! Yes, it is the medicalization of life, until Monday. They turn into illness (with their corresponding drug) sadness, sex, nutrition, the rule, menopause, ugliness, stupidity … Everything human is susceptible to treatment, and the industry expands its market. As Huxley said, medicine advances so much that we will soon be all sick.