To a very complex and confusing discussion.
This is a huge topic, but as a medical professional with a basic science doctorate, I felt I had to weigh in.
I'll try to keep it to a few paragraphs, assuming no one wants to read an Hrunner 10 page treatise.
I respect Dr. Seaman's inquiry and theses, as I respect any honest scientific inquiry. Science historically has often been far too dismissive of good ideas in defense of orthodoxy. Part of this negative reaction is justified because there can be a lot of perhaps well-intended but not well founded scientific work and outright quakery.
I think Dr. Seaman has ideas worth investigating and following up.
Readers, and Chris as well, should understand that biomarkers are surrogates, or 'stand ins' for so-called hard endpoints. Hard endpoints are usually measures of things that we as patients and providers ultimately care about and are hard to disagree that have occurred, things like actual heart attacks, death, progression to diabetes, progression of cancer.
Biomarkers can be very useful, but must be viewed with great caution. They are pointers, but not the final answer. Hard endpoints are the final answer. History is littered with the bodies of promising therapies that had good results based on biomarkers, only to turn out to have statistically no effect when the more difficult but more definitive studies with hard endpoints were done.
I cannot tell you the number of therapies that were put forward based on large amounts of precursor scientific experiments, based on sound logic, and good biomarkers. And completely failed the key test of "do they work in patients".
The problem is simple- the human body and it's response to disease is far more complex than we know.
Your comment about "traditional medicine that understands everything and does everything" is out of line. I don't know a single medical profession out of thousands who has said that or believes that. It sounds to me like you are transposing some anger or belief system onto a profession. Can modern medicine be smug and over confident, even egotistical- yes. I have seen the anecdotal bad behavior. My general experience is much more to the other side of the equation which is humility, frustration over lack of tools, acknowledgement that healers are limited.
But you are entitled to your beliefs, ill-informed or due to lack of experience as they are.
Your comment about U.S. life expectancy is simplistic and also under-informed. Start with the understanding that the WHO is agenda-driven (which is their right, just understand where they are coming from) as an anti-U.S., anti capitalist organization. The life expectancy data you cite are used relentlessly by left-of-center folks to bash "Big Medicine", however the truth is much more complex and less supportive of your belief system. The U.S. has lower life expectancy for several reason, including 1) due to our vast and heterogeneous population (as opposed to Germany's more homogenous population) we tend to deliver a lot more premature and high risk babies that the rest of the world. Since a large subset of these babies die shortly after birth, this dramatically affecting the "life expectancy" data, I am confident WHO are scientifically competent enough to understand this, but refuses to normalize the data- you have to ask them why 2) we have unhealthy lifestyles in the U.S., meaning low exercise, bad diets, high stress, low sleep. I think we would agree on this point. Unfortunately, these are cultural and value issues, and American medicine is often left to pick up the pieces of this wreckage, to me it's a miracle we are not more unhealthy and incapacitated than we already are. However, this is not the fault of U.S. doctors- I promise you all family practice docs I know promote healthy lifestyles, 3) we have a chaotic payment system that rewards activity and not value for dollar, the result of disconnecting the healthcare consumers from the providers. This was a result of the takeover of healthcare by employer insurance and third party payment processors (HMOs, insurers). Unfortunately we, and Germany, are replacing a bad system with a worse system- a disconnected, ineffective, corruption-prone government insurer payer. This situation was lead and is still lead by government left of center progressives, albeit in collaboration with insurers and large corporate interests. Not by doctors by and large. In summary, you should be more circumspect and more balanced in the future before you demigogue American medicine.
We have 100,000 deaths because we treat millions of often very ill people with powerful medicines. Are there improvements to be made and deficiencies- yes and many are being implemented. Will we ever have a risk-free healthcare system with serious diseases being treated with serious medicines and surgeries- no. It is a bit naive and simplistic to think otherwise. You said you wanted to have adult-size conversations, so here is one.
While on the subjects of statistics, obtaining scientific evidence from clinical trials, that is statistically convincing is one of the hardest endeavors on the planet. There are numerous confounders that can cloud results. There is statistical noise, including the placebo effect that Chris mentions. There are stochastic fluxuations that are simply dumb luck that no one can control. There may be several useful therapies that we have likely dismissed because they failed to meet a hard statistical bar in a clinical trial.
That said, these rigorous clinical trials are done with noble intent, and with some success, to weed out what "works" from what "doesn't work". It is an imperfect tool. It is one of the best we have. Without it, we have at best speculative, ineffective therapies and at worst, snake oil salesmen.
All this said, I lean Libertarian. I support every person's right to treat themselves in the best way they are led to. I would vote for more freedom and a less patronizing, nanny-state system than we have currently. Information should be voluminous, available and as highly vetted as possible.
I note that pain areas, such as Dr. Seaman is working in, is notoriously difficult to measure success in, as pain is so subjective and at present, we cannot measure pain with a blood marker or a reliable lab test. We must be extremely careful in relying on results of studies whose primary endpoint is how they subjectively feel.
That said, I'm all for folks trying different approaches, and if it works for you, great. As I think I said in a recent post defending you, it is possible that more than one person is right.
Enjoy your day,
H
