A new book by Thomas Schneider, MD, offers A Physician’s Apology. The subtitle asks, “Are WE making you sick?” I was eager to read it, because I could think of many things doctors might be apologizing for: overdiagnosis, overtreatment, ordering unnecessary tests, pathologizing the vicissitudes of everyday life, offering misleading low-fat diet advice, misrepresenting inadequately tested treatments, not putting enough emphasis on prevention, prescribing medication before giving lifestyle changes a chance, etc. I was disappointed: his basic apology was “Truth is extremely hard to find in medicine and science, and I’m sorry,” which is true but is hardly his fault. Then he promises to “tell you a number of medical and scientific facts that are different from what many have always been told.” He blames commercials, creative marketing, and clueless doctors. Then he offers his own “truths” and his personal recipe for wellness. Some of these “truths” are questionable, and some are frankly wrong.
The author’s personal story
As a fighter pilot in Viet Nam, he was shot down and “landed in Agent Orange” which he believes causes all sorts of metabolic and physiologic abnormalities. (It does, or rather the dioxin contaminant does, but the effects are dose-related, and some veterans with minimal exposure have blamed it for everything from birth defects to diabetes. According to the American Diabetes Association, the evidence for a link with diabetes is modest. Schneider doesn’t provide any information that would help us assess his degree of exposure.) After his military service he went to medical school; but instead of implementing what he learned there about a healthy lifestyle, he smoked, drank, ate too much, didn’t get adequate sleep, and led a stressful life. He developed a number of health issues and eventually started a “wellness” program. He stopped smoking and drinking, ran triathlons, and dropped his weight from 294 to 180 pounds. It didn’t keep him well: he developed diabetes, coronary artery disease requiring bypass surgery, went on dialysis when medications destroyed his kidney function, developed joint pain for which he took medication that perforated his intestine and put him in the ICU for 3 months, developed cancer that was surgically removed, and continued to experience a series of other medical disasters including gout, hypertension, impotence, and a worsening of his diabetes requiring insulin treatment.
He concluded that his “wellness” program was not working. (My conclusion is that it couldn’t very well work to reverse all the damage that was already done.) In frustration, he collaborated with other doctors to develop a program to evaluate patients holistically and encourage a healthy lifestyle. He says much of this new medical path has not been published yet, that most physicians don’t know about it, but that it is the truth. He claims that
…the information we are given is often just plain wrong (or, at best, is unsupported by scientific evidence.
He offers the truth, but many of his truths commit the very sin he accuses mainstream doctors of: they are unsupported by scientific evidence. He doesn’t even give us any reason to believe his own health has objectively improved from (belatedly) following his own advice.
Good advice
He provides a lot of good advice for a healthy lifestyle: nutritious diet, exercise, smoking cessation, weight control, adequate sleep, stress avoidance, limiting alcohol intake. No one can argue with any of that, but it’s nothing new; it’s what mainstream doctors have always recommended.
Questionable advice
Much of what he says is not supported by any published studies showing credible evidence of clinical benefit and it contradicts consensus recommendations like those of the US Preventive Services Task Force (USPSTF). Here are a few examples:
- If you don’t get adequate sleep, you won’t be able to lose weight. Take melatonin or magnesium for restful sleep. Magnesium is pretty much good for everything and everyone.
- Drink 8 glasses of water a day. (This is a medical myth that even Snopes.com has declared is FALSE.)
- Cholesterol should be managed without statins. You shouldn’t take statins if your doctor can’t guarantee that they won’t hurt you and will prolong your life. (There are no guarantees, but statins have been shown to decrease all-cause mortality.)
- A wellness evaluation should include measurement of your neurotransmitters (serotonin, GABA, dopamine, glutamate), a free T3 level, a free testosterone level, hemoglobin A1C, insulin level, homocysteine, hsCRP, arachidonic-to-EPA ratio. He even recommends routine carotid ultrasound testing. (These are simply not indicated as routine screening tests. I wonder if he is related to the doctor I wrote about recently who ordered $3,700 worth of unnecessary lab tests on a healthy 21-year-old.)
- These supplements have been “clearly related” to increased brain function: omega-3, CoQ10, multivitamins, melatonin, arginine, acetyl L-carnitine, carnosine, d-ribose, nitric oxide, chromium, and water. Low cholesterol impairs brain function.
- Hormones should be “balanced” by measuring their levels and prescribing testosterone, thyroid (both T4 and T3), and bio-identical female hormones. No one should be taking Premarin because it is not “natural” but is made from pregnant horse urine. (Not true. The company website says it “contains a mixture of conjugated estrogens obtained exclusively from natural sources, occurring as the sodium salts of water-soluble estrogen sulfates blended to represent the average composition of material derived from pregnant mares’ urine.” Anyway, one could argue that horse urine is a “natural” substance.)
It’s unfortunate that he mixes a wealth of excellent science-based health advice with non-evidence-based opinions. As in the case of Dr. Oz, this misleads laymen who can’t tell them apart. It even confuses doctors who wonder, “Why does he say that?” and waste time trying to find his (nonexistent) sources in the literature.
Non-recommended sources
He recommends functional medicine (criticized here and elsewhere on SBM) and anti-aging websites like A4M, which has received a Silver Fleece Award for quackery. He recommends books like Mark Hyman’s The UltraMind Solution: Fix Your Broken Brain by Healing Your Body First (listed as nonrecommended by Quackwatch).
Conclusion
Dr. Schneider’s book is misleading. Offering an “apology” is a clever ploy to engage readers and make them more receptive to his impassioned approach to wellness, much of which is simply not supported by credible evidence.
In my opinion, that’s what he should be apologizing for!
This article was originally published in the Science-Based Medicine Blog.
