Action in diabetes and vascular disease

Jean Sterne: the first to trial metformin on humans. According to Diabetologia, Sterne was an army medic. ‘Taken prisoner, he escaped to Morocco, where he worked as a musician. He returned to France to assist in the liberation of Toulouse. In 1956, after several years working in a Casablanca hospital, he took a post at Aron Labs in Suresnes.’

Much of what doctors do, writes Dalrymple,

is less than scientifically sound or justified, and some of it is downright harmful.

He cites an item from the back of a recent edition of the British Medical Journal. It comes from a column called ‘Minerva’,€ which supplies very short summaries of papers in other medical journals. It reads:

If patients knew how little the drugs they were taking were likely to benefit them, would they bother to carry on? In type 2 diabetes, tight blood pressure control is probably only of value above a certain threshold of cardiovascular risk, as shown by the ADVANCE trial, among others. But an analysis of the ADVANCE data shows that even if you select the patients at the highest risk, you would need to treat 200 for five years to prevent one adverse event.

What this paragraph is saying, Dalrymple explains,

is that untold thousands, possibly even millions, of people are being treated with drugs with actual or potential side effects, at enormous expense and effort, all to no benefit whatsoever to themselves. They do not know or appreciate this, even if they have been told of the logic and statistics on the basis of which they are being treated: for patients often fail to listen to, understand, or retain the information given them by their doctors. (And some doctors give no information.)

He points out that the actual situation is worse than the paragraph conveys,

for when trials such as the ADVANCE are carried out, the test patients’€™ compliance with their medication — the degree to which they take what they are prescribed€ — is usually much better than in normal conditions.

A half of patients prescribed antihypertensive pills

stop taking them within twelve months; the rest rarely take them precisely as prescribed. And most of the patients given the drugs in the first place will not even fall into the category at highest risk, two hundred of whom have to take the drugs for five years to prevent one stroke or heart attack.

Only one conclusion is possible:

the principal beneficiaries of this medical endeavour are the drug manufacturers, with the doctors a poor second.

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