Medicine’s House of Cards – What Happens When We’ve Got It All Wrong
I have to admit, the randomized, double-blind, placebo-controlled trial still holds a special place in my heart even after I have spent the past half-decade immersed in the shortcomings of our current data collection model. As I now understand, the role of industry bias in publication of studies, the design limitations of randomized trials in accounting for biochemical individuality, and the many permissible aspects of randomized trials that allow for skewed outcomes (placebo washout, breaking blind with inert placebo, allowance of sedatives, etc.). I now understand that health is about so much more than is factored into these trials. I have observed that patients can seem “just fine” on a basic lab screen and physical exam, and be anything but, if you know how to scratch beneath the surface.
Sometimes, pharmaceutical companies and their doctorly friends collectively make a bold move that shows their hand. Usually, this is in the form of indiscriminately and categorically broadening the eligible candidates for the suddenly lifesaving benefits of a pre-existing product. Recent changes in guidelines put forth by the American Heart Association and the American College of Cardiology aim to expand the recommendations of lipid-modifying statins to include those for whom there is a stated “10-year risk of 7.5 percent or more” of cardiac events, based on a calculator that now eliminates LDL targets.
When I was 3 months postpartum my first child, I thought: when I’m done nursing, I’m going vegetarian. I had the competing impulse to cleanse my diet and to postpone restricting my diet until after I was no longer the sole source of my daughter’s nutrition. I was compelled by the clear and urgent need to treat animals with compassion and respect, I felt sufficiently convinced that I could replicate and supplement (with a high degree of accuracy) the missing nutrients, and I believed that it represented a “cleaner” existence. Simultaneously, I was learning about fatty acids as they applied to mental health, neurology, and conception.
It was early in my actualization as a feminist-minded, righteous post-adolescent that I began to think of birth control as a woman’s right (who was anyone to tell me that I couldn’t assault my hormones with synthetic imposters). It would be years before I would consider the nuanced considerations of tacit permissiveness toward reckless unprotected sex, the wholesale delegation of contraception to the female counterpart, and the fundamental divorce of a woman from the very feedback systems that fire up her reproductive age vitality. These concerns would begin to color my perception of this gift from Pharma, well before I began to learn about functional biochemical concerns surrounding the metabolism of synthetic hormones.
For many women pregnancy is not a time of blissful navel-gazing. Almost 1 in 5 women will experience depression during or after pregnancy1. For some, a history of depression or anxiety and associated treatment has left them with questions and confusion when they are planning a pregnancy or find themselves in a fertile bind. Since we have shed so many of the mood-supporting aspects of our ancestral lifestyle – outdoor activity, food derived from it’s natural chain, community, sleep when it’s dark – it can take a lot of work to be well and avoid biochemical pitfalls. What are some of the options?
“I’ll have the egg white omelet, please.”
Since the 1950’s, we’ve been told that eating fat makes you fat and that avoiding traditional fats (i.e. butter, animal meats, lard, eggs) in lieu of industrialized, man-made fat substitutes is highly recommended. Why did we agree to disavow several millennia of instinctive eating in favor of a high carb and sugar diet, deficient in this staple? It started with a misinterpretation of a manipulated study.