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Are Medical Tests As Good As We Think They Are? · INSPIRE STORY

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Speaker 1: This episode is going to blow your mind. If you
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thought the benefits and risks to many routine medical procedures
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and common medications were clearcut, then prepare to have your
0:10
world flipped completely upside down. In this episode, doctor Eric Rifkin, PhD,
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author of the Illusion of Certainty and most recently his
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book Interpreting Health Benefits and Risks, takes us on a
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journey explaining how statistics for many commonplace medical procedures and
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treatments do not mean what you think they mean, and
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if you knew the absolute truth, you may very likely
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make a very different choice. Join us as we take
0:37
a clear look at the health risks and benefits of
0:40
cholesterol lowering medications, mammograms, colonoscopies, bone density scans, PSA or
0:48
prostate specific antigen testing, and a daily aspirin in the
0:52
prevention of heart disease and stroke. Welcome to the Inspire
0:56
Health podcast. Your life is about to get a whole
0:59
lot better. Have you ever felt like you tried everything
1:02
and yet still couldn't find the answers or the solutions
1:05
that you were seeking, Whether you're dealing with chronic illness,
1:08
physical or emotional pain, I want you to Know that
1:10
your body is the most sophisticated machine on planet Earth.
1:14
Your body holds unfathomable wisdom. Trust in it and learn
1:19
from it. Know that there are answers and there are
1:22
solutions to your specific health challenges, and we will be
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uncovering all of them here on the Inspire Health Podcast.
1:30
I'm so excited to be a part of your healing journey.
1:33
Your transformation starts now. Welcome back to another episode of
1:40
the Inspire Health Podcast. I have a fascinating guest with
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me today, Eric Rifkin, PhD. He's an environmental scientist and
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an expert in human health risk assessment. He's the author
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of two books, The Illusion of Certainty that came out
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in two thousand and seven and Interpreting Health Benefits and
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Risk in twenty fifteen, both published by Springer. These books
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addressed the need for shared decision making between doctor and patient.
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The books focus on a unique graphic developed by doctor Rifkin,
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which is designed to facilitate doctor patient communication. Doctor Rifkin
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is the author of articles in peer reviewed scientific journals,
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and his broad experience includes the communication of health risks
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and benefits to groups concerned with and interested in this issue.
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Doctor Riftin, thank you so much for joining us, Welcome
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to the show.
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Speaker 2: Well, thank you, Jason. I appreciate it, and I certainly
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hope some of the folks who will be listening to
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this will get some benefit from it.
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Speaker 1: Quite honestly, I think this is going to be this
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is going to blow some people's minds as we go
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through all of this information. I know, in general, when
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I hear the word stats or statistics, usually I get
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a little bit bored and think that it's going to
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be pretty dreary information. But when I read both of
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your books, I literally was be almost gasping out loud
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sometimes at what was coming up that I was reading,
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and my wife would have to look over and ask me,
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what are you reading? What's going on? And so I
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just knew I needed to get in touch with you
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to share it because I really think it is hugely,
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hugely important for the public to understand. So to start
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it off, how did an environmental scientist end up being
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so involved in risk and benefit assessment, especially when it
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comes to the healthcare industry and looking at medical testing
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and procedures.
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Speaker 2: That's a really good question. And had you ask me
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back when I got my PhD in marine biology. I
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would have no way to answer your question at all.
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But what happened was I spent a couple of years,
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maybe four or five or six years as a professor
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at two different institutions, and I became interested in taking
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care of and looking out for the marine environment, and
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I was looking at why things were problematic and why
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people had different thoughts about that. For example, I would
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go to meetings where industry would get up and give
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their perspective and present numbers which sounded pretty good. The
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environmental community would get up and say just the opposite,
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and the government was always someplace in between. But I
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thought it was it was really inappropriate for this to
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have to happen and for people to have to interpret
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what was going on. And that's how it started. And
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then I realized that I wasn't going to be able
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to follow this up, and I was intrigued with it.
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I was intrigued with how information gets communicated to communities
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and to government agencies, and so I started my own
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consulting firm a very long time ago, and we focused
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on this type of issue and these types of problems.
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And initially I stayed with the problems that an environmental
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scientist would I discussed how pollutants and cantaminants in the
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air and the water and on the land needed to
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be addressed to be addressed correctly. But it was very
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difficult because there were a lot of organisms around, and
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you had to look at different species, and you had
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to do a great deal of research, which I knew
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that people without the training would not be able to comprehend.
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So I looked for a more simple example, and I
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thought one organism I would be appropriate, and that would
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be us. And therefore the medical community must really know
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what they're doing, because of course we're more interested in
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people than we are any other living animal. And I
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began to look into how they were making their decisions,
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and all of a sudden it occurred to me that
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there was a major problem, and so I began to
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look into it. And it wasn't something that I came
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up with. The theaters of what I came up with,
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and I'll talk about those momentarily, but there were a
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lot of articles, and those articles said that a certain
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type of statistics were just no good and other types
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were good. And most of the pharmaceutical companies and hospital
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and the number of other groups, we're using the method,
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the statistical method that wasn't any good, and I found
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that hard to believe, but unfortunately that happened to be
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the case. And that's how I got into it. And then,
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as you had mentioned earlier, I wrote a couple of
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books excuse me, and a couple of articles in the
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peer reviewed literature on this. We gave many talks to
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hospitals and to medical schools and to insurance health insurance companies.
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And while what I said, and we'll be going over
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this shortly, I'm sure resonated strongly with them. The process
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that we have here in the United States is so
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unclear and has so many pieces to it that no
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one really knew how to take the next step. Did
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I answer your question?
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Speaker 1: Yeah? Absolutely, And from going over your books, A big
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part of what feels like one of the main focuses
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as to why you're doing this work is the important
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a shared decision making between patients and physicians. How did
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how did you end up with such a focus in
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that area and that becoming such an important piece to
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work with.
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Speaker 2: It's about shared decision making. Shared decision making is a
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wonderful concept, and it's a concept that everybody I would
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like to buy into it sort of has a great
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deal of motherhood associated with it. And it's appropriate for
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doctors and patients to talk about what the problem is
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and for patients to understand, and in my view that
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patients should make the final decision, because determining whether you
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move ahead or not is a basis of whether you
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are risk averse or not. There are pros and const
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to everything you do. This isn't in the end of
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medical decision, but the doctors can help you understand what
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the issues are well. Unfortunately, shared decision making is still
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a slogan and no one pays a great deal of
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attention to it. And they've done a number of studies
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where they asked patients, would you like to be involved
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in shared decision making and make the decisions with your doctors.
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The answers are invariable unvariably yes. However, when it comes
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down to evaluating the studies, only about fifteen percent of
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those patients really want to make the decision in the end,
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and so they leave it to the doctor. And given
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the situation, doctors are under a number of constraints and
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have to follow a number of pathways and patients are different,
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so you find people doing things they might not want
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to do and therefore don't do. So that's that's my
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sense of where shared decision making is and where it
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should be.
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Speaker 1: And I know in your book you talk about a
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bit of a personal example at the beginning of the
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book that you had gone through where you first I
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think it was with your with your son early on,
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where you made some choices around what the doctor had
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said and then what you just to do.
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Speaker 2: Could you, I apologize, I might something went wrong with
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the hearing it, so go.
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Speaker 1: Ahead, okay. In your first book, in the Illusion of Certainty,
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I think there was a story you had too about
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with your son where you took him to the doctor
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early on. Yes, can you share that story just so
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people get an idea.
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Speaker 2: Yeah, my son was about twelve years old, as I recall,
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and he came in and there was a big bump
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on the back of his leg and we didn't know
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what it was, and so we called the hospital and
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we found someone who could deal with young people's problems
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at that point, and asked the doctor what he thought,
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and he looked at it and he said, I'm not
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entirely sure, but that can be something that needs to
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be removed. It could be a cancer. The only problem
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is that we can't guarantee you that your son is
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going to be okay, because there are a great number
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of nerves where his bump is, and we may cut
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one inadvertently and he may have a limp or something
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to that effect for the rest of his life. And
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we really wanted you to be aware of that. So
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I thanked him very much, and I had a further
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discussion with him, and I finally looked him right in
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the eye and I said, and what would you do
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if it was your son? And he hesitated, and I said,
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that's all I need. You obviously are not quite as
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sure as you were a few minutes ago, and I'm
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going to be leaving. The doctor told me that that
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really wasn't my option, that he wanted to and felt
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the absolute need to do this surgery, and that I
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would be held responsible for anything that happened if I
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walked out of the doctor's office. I said, I understand
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all of that, and watch me get up right now,
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because I'm walking out of your arm. So I don't
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remember the exact dates, but it was like two to
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three months later, my son without playing ball with a
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friend of him and they were wrestling, and I heard
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a yell from him and I went out and this
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benign cyst had broken, and I said, thank goodness, it's over.
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And I said to my wife, I'm going to go
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back and talk to our friend in the hospital about this.
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She said, why don't you leave it alone? I said, well,
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I'm just not built that way. So I went back,
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explained the situation to him and said, don't you think
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there's some value in what I was saying in terms?
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I didn't think the risks were that high that we
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should move ahead. I didn't have any quantitative information, but
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the way you've described it, he said, regardless of the outcome,
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I would have done the same thing again. So I
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thanked him for his time and that was the end
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of that story. But that story stayed with me for
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a long time because there were a lot of messages
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in that story that I've run into frequently well.
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Speaker 1: And it sounds like that then led you on the
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road of what started to really look at risks and benefits,
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And it sounds like, I mean, what was the biggest
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eye opener for me when I was reading the book?
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When you were breaking down risks and benefits is just
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how risks and benefits are portrayed to the average person
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in the media, in scientific papers even and it brought
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you broke down the difference between relative risk and absolute risk,
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and I feel like this is a real cornerstone to
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this discussion, so people get it. Can you break down
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for us what relative risk is, what absolute risk is,
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how they're different, and sort of an example that gives
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the viewers a real visceral idea of what this means,
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because it is really important.
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Speaker 2: Okay, I'm going to try to do that, and I
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want you to know you are very perceptive because this
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is the key, and this is the key that has
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made this such a problem. There are a number of
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different types of risks, and if you look at statistics,
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they go on and on. But in terms of medical issues,
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in terms of how you determine whether something is good
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or it's bad, there are two major kinds of risks. One,
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as you said, our relative risks, and the other are
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absolute risks. It's very difficult to understand where those names
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came from, and frankly, I'm not sure anybody really knows,
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because I've read about four or five different reasons. But
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let me use an example, and then I'll maybe use
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another example later on to demonstrate the differences. Because when
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you look at the literature and you really want to know,
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I don't think most people are any for their ahead
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when they finish reading the definitions of these things. And
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so the example would be, let's say you you picked
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up the New York Times and you saw a headline
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that said a wonder drug reduces death from heart attacks
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by fifty percent. Now I always start a number of
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my talks with fifty percent of what is the title
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for my presentation? And so when I give them this
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title and people listen to it, I generally then say,
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what do you think of that? A fifty reduction in
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heart attacks if you take this wonder drug? What do
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you all think? Raise your hand if you think it's
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a good thing. Basically, the whole audience raises their hand.
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The people who know I'm going to come back with
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something else don't, but they all think that way. And
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so the next question is fifty percent of what could
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any of you out there tell me what that means? Anyone?
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No one has ever been able to do that. Most
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of them don't try. No one's gotten it right, and
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that's where we are in this well, I say this
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country in the United States. Don't know where you are
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in Canada, but this is where we are in the
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United States. And so this is the situation. Let's say
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that out of a thousand people, and you, by the way,
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interrupt me at any point of I'm not being clear.
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Speaker 1: Okay, No, it's very clear so far.
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Speaker 2: Okay, Let's say they came up with this number because
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they did a study. They had a group of a
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thousand who did not take the drug, and they had
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a group of a thousand who took the drug. In
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the group of a thousand who didn't take the drug,
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there were two deaths, and in the case of the
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group of a thousand, there was one death. Is that clear?
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Speaker 1: Yeah, two deaths in a group of a thousand that
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didn't take the drug. One death out of a thousand.
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Speaker 2: Okay, so the drug there was a benefit from taking
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this drug. However, if you do the absolute drugs, then
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all you do is subtract the two in a thousand
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from one in a thousand to get the difference, and
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the benefit is one in a thousand. It's very clear.
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You have right. So let me tell you where the
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fifty percent comes in. And this is before I do.
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This is the way all pharmaceutical companies present the benefit
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of their drugs. It's the way all newspapers do it.
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The New York Times hypothetically did this didn't happen in
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that newspaper. But because people are going to be interested
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in it. If you said there's a drug out there
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that's one percent, it benefits one percent of the population
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in this case is one tenth of one percent, no
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one will read the article. Okay, so where the hell
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do the one? Where the hell is the fifty percent
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come from? This is where it came from. They subtracted,
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or I'm sorry, they divided. Forgive me the two from
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the one, and that's fifty percent. In other words, if
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it's two minus one, it's half. It's one half. Half
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of the people survive. And whenever you see a drug
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using everything, you see a company using percents, it's usually
17:28
a relative value. And so it's it goes from one
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in one thousand to fifty percent. They don't tell you
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what it's fifty percent of. That's where it is. So
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it's so amazing and interesting. It goes from fifty percent
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to one in one thousand. Now, absolute risks are the
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way to go. That's not because I'm saying that, it's
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because you really need a population to be able to
17:55
evaluate whether you're willing to take the risk or not. However,
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when you go using relative when you use relative risks,
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you don't have access to that and you never will.
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And everybody who writes articles, and if you google this
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will say the same thing I'm saying. It'll be a
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little more vague only because they just assume you might
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know that. But no one is doing anything practical, no
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one is doing anything meaningful, And so that's my frustration.
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That's what I've been all about. And you're absolutely right.
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Can you imagine the difference between these two numbers in
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deciding whether you're going to take a pill or not?
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The fifty boom, well, one in a thousand. Never the
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fifty percent is meaningless in this it's used for it's
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used for complicated epidemiological studies, and it works there because
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people understand what those numbers mean. But if you're a
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patient looking to see whether you should take the risk
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or not, it's just not there. Now, this takes a
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little bit of time, It took me more than a
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little bit of time. But it's it's extremely important and
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it's something that uh, if government agencies, I know, in Canada,
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for example, you have a centralized system. If if the
19:18
system we're willing to buy into this, then patients on
19:22
their own would not need to go continually to a doctor.
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They would say, ah, it isn't worth it because now
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we're just talking about the benefits. But there are there
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are the other side, even using absolute risks, which are
19:35
higher than the the benefits. So and I know this
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is a little I think I was trying to do
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the best I can. I'm not sure I would I
19:43
did a sufficient job here, but I can give you
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a couple of other examples.
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Speaker 1: Yeah, give give a couple other examples. I think the
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key thing is basically saying what a lot of the
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say a pharmaceutical company does when they have stats, is
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they use relative risks because it makes numbers look really exceptional.
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So saying something that has a fifty percent reduction is
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makes everybody want to go and get a certain drug
20:09
or a procedu you're done, because it sounds like it's
20:10
a big deal. But when you actually look at the
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amount of people that we are involved in the study,
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and you start to break down what was the absolute difference.
20:22
It can be the difference of fifty percent of a
20:24
relative risk. But the reality is that you're really only
20:28
decreasing your risk by maybe zero point one percent. And
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unless you actually understand the absolute risk involved, you really can't.
20:38
You really don't have enough information to make an informed decision.
20:43
And so the idea of shared decision making really isn't
20:47
possible unless the patient has all of the information in
20:51
a way that they can understand it and it makes
20:53
sense to them.
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Speaker 2: Yes, I agree with everything you've said, and you're spot on.
20:58
The only thing I would add to it is the
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doctors need to know it too.
21:02
Speaker 1: Absolutely.
21:02
Speaker 2: Doctors need to understand because I won't go through the
21:05
statistics with you because I don't have them right here,
21:07
and I'll get something wrong, which would be a bad
21:10
thing to do. Uh. But I think there's only there
21:12
was only about ten percent. This is in the US
21:16
of doctors. Study was done by Jama who really understand
21:21
the difference between these these two numbers, and understanding these
21:24
two numbers is night and day. But people say, well,
21:29
it's it's a it's a it's a statistic, it's it's
21:32
a metric. We just used one or we use the other.
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And I've been in conferences where people said, let's just
21:38
use them both, see which one works better. It's not.
21:41
It doesn't work that way. Okay, maybe I'm going on
21:45
too long, but no, you're.
21:46
Speaker 1: Gonna You're going to give a couple of other examples there,
21:49
and then we will go through some of the main
21:50
ones in a little bit, but share whichever, whichever other
21:54
examples to help illustrate that point.
21:57
Speaker 2: What had happened when I wrote my first book with
22:00
a colleague from Johns Hopkins University. We had finished the
22:04
book and we said, let's take it back and see
22:06
if we're really going to be able to convey this
22:09
information to the public. And at the same time, we
22:13
both said, I don't know what we were thinking of.
22:15
We know what's going on, but they don't. So let's
22:19
try to think of something. And so I spent two
22:24
and a half months trying to think of something. If
22:27
I were a patient, if I were someone without a background,
22:31
I was frightened. I was coming into an office for
22:34
advice and guidance. I was looking to someone. What would
22:37
I need to get the courage to say, you know,
22:41
I think I want to participate in this. So I
22:43
kept waking up every third night and tapping my wife
22:47
on the shoulder and saying, you know, I think I
22:49
got it, and she would finally tell me, if you
22:52
get it, write it down, but don't wake me up again.
22:55
I'm going to get out of this house. So I
22:59
did find something, and what I found was something that
23:04
was familiar and recognizable to almost everybody, and I decided
23:11
that we would give it a shot. And it's a
23:14
theater grouping of a thousand people. And if you can,
23:17
one of the difficulties about doing a podcast like this
23:20
is it's not it's not up there so but it's
23:25
it's simply well you've seen it. It's simply a graphic
23:28
with a thousand seats, and as you fill in those
23:32
seats or darken them or don't darken them, you can
23:36
tell people exactly what the risks are, so that if
23:40
you only darken a seat or two, that's two in
23:43
a thousand, or point one or point two in one hundred,
23:47
most people would probably say, I don't really know if
23:51
I wanted this vacation that I don't think although there
23:54
are people who said this, I got this little notice
23:58
here about a low system uses you.
24:02
Speaker 1: Can you hear me, okay, I can hear you. Okay,
24:04
but you were starting to get a bit scratchy there.
24:06
Speaker 2: Oh, I don't know what to do.
24:08
Speaker 1: It's okay, it sounds okay right now.
24:11
Speaker 2: Okay, okay. And so most of the numbers are very low,
24:17
believe it or not, the benefits of drugs, the benefits
24:20
of surgery, all those types of things, mostly drugs screening
24:24
tests and numbers are low, but you can see them.
24:27
Some people will say, I don't care if it's one
24:28
in a million, I want this test. They're perfectly welcome
24:31
to do whatever they want. I'm not suggesting for a
24:33
moment that I'm telling people anything to do. But what
24:36
I'm doing is saying, have information that you can interpret
24:40
and understand and appreciate and then decide whether your risk
24:43
averse or not and move ahead. So I can start.
24:49
Then if that answered your question to move.
24:52
Speaker 1: On, yeah, Well, what I want to do now is
24:55
I want to take some of the really big ones
24:57
that were really eye openers for me. Some stuff I
25:02
was aware of to a point, but not to the
25:05
degree that it came up when I read your book.
25:08
So let's break down the benefits and risk for some
25:11
of the really big topics that will be I think
25:13
pretty surprising for people to hear. So the first one
25:16
I wanted to talk about was cholesterol. Everybody knows that
25:20
cholesterols related to heart disease, or at least that's what
25:23
we're told over and over again. And I'd like to
25:25
know what you found when you start to really look
25:28
at the numbers and the difference between the relative and
25:30
the absolute risk.
25:31
Speaker 2: What came up? Okay, I'd be happy to do that.
25:34
Let me just say that we could go on from
25:38
months talking about cholesterol. So what I've tried to do
25:40
is pick out some of the really big ones which
25:43
are going to be sort of hard to agree to.
25:47
But all of our information comes from Cochrane and related
25:51
groups that are independent and objective, and we're not doing
25:56
any of this data gather. All we're doing is communicating
25:59
it using these theaters. And it's a big difference. So
26:04
in the case of cholesterol, if you take normal blood
26:08
serum cholesterol and you you consider and most people consider that,
26:13
now this is fluctuating over the years of when I
26:15
did this, This these are the numbers that about eight
26:18
hundred and two excuse me, two hundred and eighty mg
26:21
is usually significantly elevated, and about one ten to two
26:27
ten mg not so much. And so we've found that
26:31
the difference if you have one thousand people with elevated
26:35
cholesterol and a thousand people with lowest low cholesterol. If
26:41
you just look at cholesterol levels, only one person in
26:44
a thousand, one person in more in a thousand who
26:48
has a high cholesterol will die. That's zero point one
26:51
person in one hundred. So if you saw these numbers
26:55
and trust me on them, they're not my numbers. They
26:57
are numbers that were put out by yeah, people who
26:59
do the for a living. You think that some people
27:02
might say, I'm not sure cholesterol is really the cause
27:06
of heart disease. And today there are numerous articles and
27:09
books that come up with the same conclusion. What they
27:12
haven't done is set out this information so clear and
27:17
so easy to understand. And so if I'm using myself
27:21
as an example here, which is probably not a good idea,
27:25
but if I see anything that's one in a thousand,
27:29
I would take the risk. To me, that's a non risk. Now, people,
27:33
I've talked to, including my wife and kids, and others
27:36
feel exactly the same way. Friends are not friends feel
27:39
exactly now. They always is a person out there who says, well,
27:44
I don't care if it's one in a million, I
27:46
want the drugs, but the drugs aren't necessarily a great
27:48
thing for you. But in this case, it's it's the
27:51
presence of blood serum cholesterol levels. Amazing number, isn't not? Okay?
27:57
So I think that's amazing cholesterol. The next thing you
27:59
really want to talk about is status.
28:02
Speaker 1: Well, so, yeah, so the first the first thing with cholesterol. Basically,
28:06
what the numbers show is that possibly one out of
28:11
every thousand person that keeps their cholesterol under what we
28:14
recognize as being an elevated cholesterol may prevent themselves from
28:18
a cardiovascular incident.
28:20
Speaker 2: Correct.
28:21
Speaker 1: That's basically it one out of a thousand, so zero
28:24
point one percent.
28:25
Speaker 2: Correct, And you have to decide what you have to decide,
28:30
as does everybody else. But we felt that this is
28:33
the other thing about this graphic. If you would put
28:35
this information in a rectangle or a box, it wouldn't resonate.
28:40
But when you look at this theater, they see themselves
28:43
in it. They see the seats around them, and people
28:46
can can grab onto it. We've gotten I hate to
28:49
say this because it's a little embarrassing, but we've gotten
28:51
a lot of Wow, that's a that's a good that's
28:54
you're right, this makes a lot of sense. So not
28:57
that it's moving anywhere in the States, but okay, that's okay.
28:59
So so you use Everybody knows that in order to
29:04
reduce cholesterol that you take statins, and statins, as you
29:10
probably know, block a liver enzyme responsible for cholesterol production,
29:15
and statins really do significantly reduce cholesterol. But when I
29:19
come back to that first graphic, you really wonder if
29:24
statins and if they do any good. That's also happening
29:27
here too, but that reducing cholesterol may not be a
29:30
wonderful thing, and which i'll tell you in a minute.
29:36
That's what people are saying about the statins. But they're
29:40
also now beginning to say they're not sure that statins
29:45
are worth the negative impacts associated with them. And I
29:48
read an article recently and I copy part of it
29:51
here for this talk. They focus on something called statistical deception,
29:58
exactly what I was talking about. They just called it
30:00
up and that's why statins are being used. So so
30:05
they so there was an analysis of data and the
30:10
statin trials which led them to conclude that statin advocates
30:13
used statistical deception to create the illusion that statins are
30:18
wonder drugs when the reality is that their modest benefits
30:23
are more than offset by their adverse effects. Well, now,
30:26
how could that be that everybody everybody knows statins are
30:30
good for you. Well, there's a study that proves it.
30:33
And they'll also go back to my idea of absolute
30:38
and relative. So there's a study called the ASCA the
30:40
ascot L a study a number of years ago where
30:46
the individuals were broken into two groups. One group was
30:52
a placebo group which which was not treated at all,
30:56
and h three percent of that group of heart attacks.
31:01
The other group, they had one point nine percent of
31:05
the group who are taking liperatoire liberatory you knows is
31:09
a form of the status. So the difference is from
31:12
three percent to one point nine percent. If one we're
31:15
using absolute risks would be about one point one percent, right,
31:20
that's the difference.
31:20
Speaker 1: One point.
31:23
Speaker 2: Reduction in if you take the three and you compare
31:28
it to the two, the one point nine, then the uh,
31:31
the effect is thirty six percent reduction in heart attacks
31:36
from taking lipatory. So it goes from one point one percent,
31:40
which everybody would say, why bother acronym, but it's not
31:45
very nice. But if you say thirty six percent, if
31:50
I heard's thirty six percent, I put everybody on it.
31:54
And so this is an exactly this is a real
31:56
life situation which follows step by step my little hypothetical
32:02
situation of the of the heart, uh, the heart drugs.
32:06
So the final thing that these guys said, by the way,
32:09
I called them recently because I just got into this
32:12
interesting but uh, they said, I'm quoting them, increased rates
32:15
of cancer, cataracts, diabetes, cognitive impairments, and muscular skeletal disorders
32:22
more often offset offset. This is from this is from
32:26
lipatour the modest cardiovacular cardiovascular benefits of statin treatment. Now,
32:31
these guys are PhDs and m ds, and there's there's professor's.
32:37
I don't have their permission, but this was in an
32:39
expert review of clinological climate hip, sorry, of clinical pharmacology.
32:44
So you know when you hear all this, you have
32:47
to say, this can't he's making this up. It can't
32:51
be true. But this what I just gave you, But
32:55
I thought it would be good to give you things
32:56
that I did not look like I was coming up with. Now,
33:00
when you look at statins, it is true that if
33:03
you give people statins who have never had a heart attack,
33:08
they call it primary prevention, then about three out of
33:13
a thousand benefit when compared to people who did not.
33:18
And then when you compare these, when you compare these
33:20
people who had previous heart attacks, it's about six, so
33:24
that the difference is three and a thousand people benefit
33:29
if they didn't have a heart attack or if they
33:32
did have a heart attack. So those are you know,
33:35
I might say three in a thousands, but it's between
33:37
three and one hundred. It's not a big number. So
33:40
I would predict if I would live this long, and
33:43
it isn't going to happen, but if I did, I
33:45
will predict that statins will soon absolutely be worthless. And
33:51
not only worthless, but if you start doing these theaters,
33:53
which we haven't, on these different endpoints which I just
33:56
gave you, then you'll see that people will go, oh
33:59
my goodness, oh my goodness, and so and you know
34:02
there are there are problems with the liver because that's
34:04
where it goes, and that's where it goes to get
34:06
rid of the enzyme.
34:07
Speaker 1: And I think that's a that's an important point though,
34:11
because it's the thing is that a lot of people
34:15
will decide to accept the side effects because they think
34:20
that the benefits are so profound. So when you hear
34:24
like close to forty percent reduction in a cardiovascular problem
34:29
if you are taking a statin, then you might be
34:33
okay with the slight the chances of having certain side
34:36
effects and muscle problems and even maybe liver damage if
34:39
the percentage don't look that high. But when you actually think, well,
34:43
I'm actually only really reducing my risk by point three
34:48
or maximumly point six, you might start to think twice
34:53
about whether or not point three risk reduction really makes
34:58
sense verst on all of the from problems that could
35:00
potentially happen from it, because it's so negligible.
35:04
Speaker 2: Absolutely, it makes a big difference.
35:06
Speaker 1: Yeah, all right, next one on the list, let's talk
35:09
about mammograms.
35:11
Speaker 2: Okay, mammograms are are interesting. They the number is and
35:22
this has been demonstrated by a number of very well
35:25
known research groups as approximately that if you have a
35:29
thousand people who don't take mammograms over a lifetime, and
35:34
a thousand women a thousand women who do take mamograms
35:37
over a lifetime, those who do take it will have
35:41
one less death than the other. So it's one out
35:44
of a thousand point one out of one hundred. And
35:47
the problem is that mammograms aren't peachy. Mammograms cause a
35:53
lot of problems. So you keep that point one and
35:57
one hundred versus you know, one in a one thousand
36:00
in the back of your mind, and then you look
36:02
a little bit into, for example, the frequency of false
36:06
positives in abnormal mammograms, and you find out that there
36:12
are about, let me say, find this an additional sixty
36:16
four women represented by which would be these blackened seats
36:20
who require a biopsy for what proves to be a
36:23
benign vision, compared to one thousand who are not screening.
36:27
So I know a woman, and my wife knows a
36:30
woman who had a real problem with that and they
36:35
hit they hit a an artery and she had actually
36:41
she died after that. This is nothing to do with it,
36:42
but it was a very serious problem. So so if
36:47
anybody were given this number in a theater, the previous
36:51
number in a theater, and then there's one here which
36:55
I won't go into, but unnecessary treatment as a result
36:58
of mammograms that also can lead to serious problems. And
37:06
so to me, when my wife asks me, and she
37:09
does because she knows these things, you really think I
37:11
should get a mammogram. Now we're in an age where
37:13
no one's supposed to get anything. But when she was younger,
37:17
I said, don't do it. And from my point of
37:19
view here, but I want to show you these theaters
37:22
and I show them to her and she said, why
37:24
would anybody do that? Can I give you one more anecdote?
37:28
Speaker 1: Yes, absolutely.
37:29
Speaker 2: We gave a talk at Johns Hopkins University at the
37:34
medical school, and we showed these theaters on mammogram. The
37:37
woman stood up in the back. She said, I don't
37:39
mean to interrupt you. She's a doctor. She said, are
37:41
you telling me about the one? Is that accurate? I said, yeah,
37:44
you have the same information that we do. You have
37:47
the same medical journals. Look it up. And she looked
37:51
out just in the blue and said, why the hell
37:54
would I want to do this again? And I didn't
37:56
answer her, of course, but I said, well, at least
37:58
you're thinking about it again. And I'm not I'm not
38:01
sure that you won't stay with the same view that
38:03
you have. And so this is even even the doctors
38:07
at the best places. Yeah, I haven't done this. Now.
38:11
My partner who went to Brown University in the States,
38:16
he graduated Magnekum loud and he said, they never learned this.
38:21
They never learned this all through medical school and all
38:24
the groups we talked to. I asked them, do you
38:26
know the difference bet student? Now? Now we really don't.
38:30
I don't know if that's important.
38:31
Speaker 1: Okay, So well, in what you're saying with the mammograms,
38:37
I got the numbers on your work here too, and
38:39
it was over five hundred out of every thousand women screamed,
38:43
we're also having abnormalities on their mammogram. They were, So
38:47
they are like for false positives, about half out of
38:50
every thousand often have false positives, which then means that
38:54
increases your stress. You have to get retesting. Then a
38:57
certain percentage of that ends up being bopsies. And I
39:01
think you even found a small personage about two point
39:03
four out of every thousand ended up actually having treatment
39:06
with either radiation chemo surgery that were never even required.
39:11
Speaker 2: Yes, and I didn't go through that because I'm not
39:13
sure how much time you have, but yes, that's exactly cool.
39:16
Speaker 1: I just think that was really amazing. So it's when
39:19
you think about it that way, two point four out
39:22
of every thousand could end up having treatment for something
39:25
that they didn't need treatment for, versus one out of
39:29
every thousand that might actually avert death from breast cancer.
39:33
Speaker 2: Yep, it's remarkable though.
39:36
Speaker 1: Yeah, yeah, all right, next one on the list. Colonoscopy.
39:41
Speaker 2: All right. Colonoscopies are are tough because one of the
39:48
things that isn't included in these graphics. I try to
39:53
be as upfront as I can. It's a technique of mind.
39:56
I feel it's better doing life that way. Actually, most
40:00
people who don't have a family history of it will
40:08
probably shouldn't be shouldn't be scanned in the first place,
40:10
but they have a lesser risk to begin with. But
40:13
let's assume that everything is done the way it's supposed
40:16
to be done here, and as you can see, there
40:18
are about two point five people which would be represented
40:22
by these black seats who will have major complications such
40:27
as bowel perforation and with a surgery if if something
40:32
went a rear. Now, as it turns out, I think
40:36
it's about the same number of people it is that
40:41
would prevent the death from from not having UH, from
40:47
having from having a from not having a colonoscopy. So
40:53
so if you if you don't have it, about two
40:56
and a half people extra people in a die over
40:59
over a lifetime, and if you do have it, about
41:01
two and a half people are going to be seriously
41:03
hurt if you do. And there are some other little
41:07
things in here, but I'm those are the main issues.
41:10
And you can see one more thing. There's a theme here.
41:13
The numbers were. Picking out a thousand was not just random.
41:17
There are very few actual effects from either screening tests
41:24
or drugs or other types of things, and we just
41:27
wanted to make that known to people because when you
41:29
hear about it, it comes out exactly the opposite. It
41:33
comes out in big numbers.
41:34
Speaker 1: So you're having to use numbers in a thousand because
41:38
they're the overall benefit is not that high, So you're
41:42
having to do it in a group of a thousand.
41:44
You can't even do it in a group of one
41:45
hundred because it's so it's so far off from that.
41:49
Speaker 2: That's correct. Now, a great philosopher his name I don't
41:52
in the US philosopher he said, motives are always suspect
41:57
when it comes to why the pharmaceutical company is keep
42:00
doing this, and why the newspapers keep doing this and
42:03
on and on. That's true technically, but in my not
42:09
so nice brain, I think everybody knows exactly what they're
42:14
doing and what's going on, and they keep doing it
42:17
and no one can figure out. No, the bad part
42:20
about this is no one can figure out see what
42:24
we have in this graphic that we have. If someone says, yeah,
42:27
I got a better one, that's okay too, But the
42:29
fact is no one says this. You're right, we ought
42:35
to use these, And to the life of me right now,
42:38
I can't understand why people don't do it. Don't say, look,
42:42
is this your license? Is this your intellectual property? And
42:44
it is. And it turns out we'll give you this
42:46
because we can if this was ours on and on.
42:49
It's some some blockage. And I'm just being when I
42:55
get when you get to be my age, you'll stop
42:57
being able to just talk and not care that much.
42:59
But that's that's really where it is and where we are.
43:03
Speaker 1: Well, I think you shine a light on something that's
43:08
been going on for years. And I'm sure when when
43:12
the company sort of thought, I mean, from my side,
43:16
how I would see it the same way you are.
43:18
But I'm sure at some level they went, Wow, this
43:21
is a real statistic that we can use. That we're
43:24
going to use it sort of in an inappropriate way,
43:27
but it's still a legitimate statistic. So let's use it
43:30
because it makes things sound so much better than it
43:34
does if we just give really absolute risk values that
43:38
really shows such limited benefits to so many things.
43:43
Speaker 2: Now, my partner, Eddie Lazarus, who is a family doctor
43:46
here in the States, he is all uses and his
43:51
patients just say things to him. I'm using the words,
43:55
but you know they're all older, he's gerontologists. They all
43:59
say to him, well, the hell did your show with
44:01
this earlier? And I we could decide what we want,
44:03
what we don't want, we don't understand the other stuff.
44:06
And it is true. I I don't see doctors frequently
44:11
at all, basically not. But I feel that if I
44:14
had a serious problem, and I've had problems, but if
44:17
I had a serious problem, I wouldn't be able to
44:20
think straight. I wouldn't know what to do. I wouldn't
44:22
know how to do it, and I would want to
44:25
listen to somebody give me answers. However, if the answers
44:30
good answers, that's that's not a good way to go.
44:33
And if we keep working together, one of these days,
44:36
I will tell you about my heart attack four years ago.
44:41
And it's a great story. And actually I wrote, I
44:44
was I wrote the leader. I was the lead author
44:45
with Andy on an article for jama and they published
44:49
the whole thing. So it was it was it was interesting.
44:53
I can that, h all right. Next one on the
44:58
on the list is bone density. Okay, we as you
45:03
can say. I think it's two examples of that here,
45:05
and one of them has to do with They both
45:08
have to do with bispofonates. And and we found out
45:15
that if you a thousand women in a theater who
45:20
use these bisphofonates for over five years, approximately twenty more
45:24
of them will sustain low impact FEMA fractures than those
45:31
who take a placebo. So that's not a good thing
45:34
to see. And even though twenty out of one thousand
45:38
is two out of one hundred, it's still not a
45:40
good thing to see. So if you're taking the drug
45:43
to prevent something that's causing it, you might want to
45:46
think twice. And there was a there was a lot
45:48
done on this. But my feeling is if if the
45:52
medical community, the appropriate doctors and physicians were to use
45:58
this technique would enable them to communicate information more accurately
46:04
and more effectively. Not that they want to do that
46:07
or they want to take the time to do that.
46:09
I can't speak for them, but it just seems like
46:13
that that's where that's where it should be in the future.
46:17
Speaker 1: Yeah, I absolutely agree with you, and I think the
46:20
last one on the list was the p s A
46:22
testing for prostate Oh yes, yes, yes, yes or no
46:26
not last. We had one more after that, but PSA testing.
46:29
Speaker 2: Okay, okay, the p s A testing. P s A
46:37
is you know, prostate serum serum ritigen and UH. Prostate cancer,
46:46
as you well know, can either be indigen and you'll
46:50
die of something else, or it can be aggressive. Pretty
46:55
much in both cases, there's nothing much you can do
46:59
if it's into UH and they tell you it's INTEL,
47:02
even if they don't, if it is, you'll die of
47:04
something else. And if it's at the point where they
47:07
see it happening. It's sort of like pancreatic cancer. That's
47:10
not a great deal you could do. But there was
47:12
a which I don't have with me right now, but
47:16
let me let me use that because it's more it's
47:18
more recent. There was a major study done in Great
47:22
Britain on prustate cancer and PSA and they want to
47:30
know the value of PSA. This study cost a lot
47:33
of money. It was a huge group. Don't remember the
47:36
exact numbers. And they came out that if you had
47:40
PSA testing for the time of your life that you needed,
47:45
three individuals would die from prostate cancer, and if you
47:48
never got PSA testing, three people would die from prostate cancer.
47:53
There's absolutely no difference between the two. So a little,
47:57
a little anecdote, but you I'm sure expected from me.
48:00
At this point, I no one was paying any attention
48:03
to it. So I wrote to this guy who was
48:05
ahead of a hospital group, and I said, I thought
48:09
your study was absolutely first class, and I can't figure
48:13
out why no one's paying any attention to this. You're
48:16
saying a lot here, and so I said, why don't
48:19
you look at these theaters and see if it makes
48:21
any sense to you? You can demonstrate by using these.
48:24
So I had two theaters of one thousand each with
48:26
three dots in them, you know, and one for one
48:28
and one for the other. He said to me, this
48:32
is an amazing idea. Who's idea with this? I said, oh,
48:34
it's my idea, and thanks for the compliment. But why
48:36
don't you it's yours? Why don't you just attached that
48:40
to you? You get people all over the place are
48:42
going to be saying, oh, that's what you're talking about
48:44
right now. They don't know what you're talking about. They can't.
48:47
If they do, they're afraid to say something because there's
48:49
technical words in there. He said, you know, you're right.
48:51
I'll get back to you. So about three months later
48:54
he got back to me and he said, I'm terribly
48:57
embarrassed to tell you this, but I can't convince these
48:59
people for political reasons to incorporate this. This documents and
49:04
he said, he just said, I wish you nothing but
49:06
the best of luck. This is it said a lot
49:08
of nice things, which it's going to make you make
49:10
it embarrassing for me to say. I said, listen, you're
49:12
calling me and telling me that it's sufficient. Thank you
49:15
very much. If you think you've had delays, you have
49:18
no idea. So so that's that's PSA. And my brother
49:23
recently called me about p s A and I gave
49:25
him this information. He said, damn, Eric, right the hell
49:29
didn't you give me this before? And I'm not going
49:31
in there, So it's it's breaking through, which is my
49:35
problem right now. But I do hope these theaters made
49:40
some sense. I hope they were legible. I hope I was.
49:46
Speaker 1: Oh, I think they're fantastic. And and what we will
49:48
do is we'll, with your permission, if there's even the
49:51
video you sent, if I can use that as a
49:54
link on the show notes, if people are able to
49:56
go and watch the video that you guys presented, because
49:58
you guys did a good job with breaking it down
50:01
and visualizing it really well, and that'll that'll be another
50:03
way for people to really grasp the concept. One last one,
50:08
I don't know if you have the notes for this one,
50:09
but the other one that I found really fascinating was
50:14
aspirin and the prevention of heart disease and stroke.
50:18
Speaker 2: Oh yes, let me let me see if I got
50:21
that here? Mm hmm, sure there weeth me for just
50:31
a second. That's Okay, okay, I got I got it.
50:37
I got it.
50:38
Speaker 1: Because again we're all told that taking an asp in
50:41
a day substantially decreases your like a baby asp for
50:44
in a day or so substantially decreases your risk of
50:47
cardiovascular incident.
50:49
Speaker 2: Okay, So what we found in the literature was if
50:53
you take a thousand healthy men in the theater who
50:55
take aspirin regularly, approximately six will have some reduction and
51:00
adverse cardiac outcomes. Compared to one thousand men who take
51:04
a placebo. I'm sorry, but three will have an increase
51:12
in stroke. So the difference is three. And that's how
51:15
this three came up. But if you hear something like that,
51:18
it's not very reassuring that you're not going to be
51:20
the one that has a stroke, and so that that
51:25
that's where that is pretty much.
51:27
Speaker 1: So six people out of a thousand might decrease cardiovascular outcomes,
51:33
but they would increase three out of one thousand to
51:36
get a stroke. So the wash on it is that
51:38
you might get three out of a thousand benefits to
51:41
being on an aspirin.
51:45
Speaker 2: Added them. Yeah, we had them together because they were
51:48
it was aspiring, But I'm not sure that's kosher. But
51:50
that's that's sort of what we did. So it's another
51:54
another small number. Everything's the small numbers. And again we
51:59
picked a thousand because we knew we could get it
52:02
in and it seemed to have resonate more than if
52:06
we could use one hundred or ten thousands to seem
52:08
like the right way to go. So it's it's neat,
52:13
it's interesting. Glad you like it.
52:16
Speaker 1: Oh, I honestly, I feel like it is. I feel like,
52:20
quite honestly, if people read your books and they took
52:25
that to heart, and medical doctors and physicians prescribing these
52:30
different tests routinely just because that's what everybody is taught,
52:33
and that's the numbers that they're shown are all relative risks.
52:36
So it makes sense they're doing it because they in
52:38
their mind it makes sense.
52:39
Speaker 2: But if they.
52:40
Speaker 1: Actually knew the real truth of it and could then
52:43
relay that information to their patients, I really feel like,
52:49
like millions of people, you would be reducing unnecessary treatments
52:54
and unnecessary suffering. I mean it would be it would
52:57
be a huge impact on people overall well being. So yeah, man,
53:03
of your work, and I really, I really hope that
53:06
this message gets out more and more. Eric, thank you
53:09
so much for your time and your energy and your expertise.
53:13
If people want to learn more about you and the
53:15
work you're doing, where's the best place for them to
53:17
reach you.
53:19
Speaker 2: My email is E Rifkin ri f k I M
53:24
one O two at aol dot com. My phone number
53:28
in the States is four ten three seven one two
53:32
four nine one.
53:34
Speaker 1: Wonderful. I'll make sure that I put your information in
53:36
our show notes so that people can get a hold
53:38
if you have any questions. Been absolute pleasure and I
53:42
appreciate so much the work you guys are doing.
53:45
Speaker 2: Well Jason, it's good and honor. Thank you very much.
53:47
Speaker 1: Okay, you take care and I'll talk to you soon.
53:50
By Eric.
53:51
Speaker 2: Bye.
53:52
Speaker 1: Well that was awesome. Thank you so much for taking
53:56
the time to invest in your health and well being.
53:58
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54:02
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54:07
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