How to survive in an overmedicated world.
Look up the evidence yourself.

Dutch title:
Hoe overleef ik? Wegwijzer in een overvloed aan medische informatie

By Peter C. G°tzsche

Reviewed by Mira de Vries

Strange. This book was translated into Dutch from English, but at the time of this review (January 2019) the English has not been published so it is available only in Danish and Dutch.* I don't read Danish.

The trouble with translations is you can't trust them. For instance, the English title reflects exactly G°tzsche's two main messages: The world is overmedicated and you should educate yourself about medicine. However the Dutch title, translated to English by me, reads ôHow do I survive? Guide to a proliferation of medical informationö missing both of these points.

G°tzsche posits that most medical literature is unreliable. He espouses searching for the reliable literature on the Internet. Surprisingly, he recommends Wikipedia (I concur) as a good place to start, although it is not always completely right. Another good site is McMaster. Unsurprisingly he expresses a lot of faith in publications of the Cochrane Institute of which he is a co-founder. At the time of this review there is an international scandal regarding G°tzsche and Cochrane.

Suspicious is anything not based on randomized trials according to G°tzsche. He makes a valiant attempt at leading us through the steps on Google to find those. Unfortunately his well-meaning advice isn't much use. We don't need G°tzsche to use Google. His arguments for acceptance or rejection of articles on PubMed seem ad hoc. He almost always rejects them. Following his advice requires fluency in English as exemplified by the translator's leaving a great deal untranslated. G°tzsche recommends that non-English speakers use Google's translate function. It is true that mechanical translation has greatly improved since its early days of sidesplitting gibberish, but it is still not good enough to allow your life to depend on it. Besides, without feeding in the correct terms in English, you won't find the page you need to translate. Today the language of science is English.

In this book G°tzsche repeats his position that screening for breast and prostate cancer is not only useless but harmful. Yet he endorses screening for cervical cancer. Does he mean pap smears? If screening for breast and prostate cancer is more harmful than beneficial, then surely the same applies to screening for cervical cancer, a rare disease? He also endorses screening for colon cancer by colonoscopy. Could this advice have something to do with the detailed story in a different chapter about his personal experience with colon obstruction by a tumor? Surely routine colonoscopy in symptom-free individuals is as harmful as routine mammography?

He also repeats his position that psychiatric drugs should never be used except for acute and serious mental confusion, and even then they should be phased out quickly. He doesn't define acute, serious, mental, confusion, or quickly. He also doesn't quote randomized research comparing the benefit of psychiatric drugs in situations of acute and serious mental confusion, whatever that is, to non-drug interventions such as safe shelter. He warns never to take anti-epileptic drugs unless you have epilepsy. Surely he is not saying that epilepsy immunizes against their toxicity or that the lives of people with epilepsy don't matter? Perhaps he means that regarding epilepsy the benefits outweigh the horrible harms? If so, why does he not point out large-scale randomized double-blinded trials to back it up? I googled the terms anti-epileptics and Cochrane like G°tzsche recommends and found one relevant article. It reveals that about 30% of patients will continue to have seizures in spite of the treatment. But in how many of the other 70% would the seizures have resolved without drugs? He should have added that regardless of one's diagnosis abruptly stopping anti-epileptics, like abruptly stopping psychiatric drugs which in reality belong to the same class, is extremely dangerous. It can cause seizures even in people who have never had them before in addition to a host of other withdrawal phenomena.

A topic G°tzsche did not cover in his earlier books is vaccines. He opposes the HPV vaccine because its safety and efficacy have not been demonstrated. He criticizes a US healthcare facility for firing an employee who refused to take a flu shot even though there is no evidence that flu shots in healthcare workers protect patients. According to G°tzsche the employeeĺs human rights were violated. Yet he does not seem concerned about the human rights of parents who are reluctant to have their children vaccinated. He calls them irrational and untreatable. He calls Andrew Wakefield's research on the connection between the MMR vaccine and autism lies. Maybe it is. Maybe it isn't. Fraud in research is rampant according to G°tzsche himself. On the other hand, whistle-blowing physicians feel the full weight of the pharmaceutical industry pressing upon them, as G°tzsche himself is now experiencing. Although he provides two Wakefield opponents as sources, it's impossible for the reader to judge which side is right. G°tzsche doesn't mention the link that has been suggested between autism and thimerosal, a mercury-based product that used to be used as a preservative in vaccines. This omission is all the more remarkable as elsewhere in the book he complains about the unreliability of modern, electronic fever thermometers. Old-fashioned mercury thermometers always worked perfectly but have been banned because of a theoretical harm from the mercury when the thermometer breaks, not that any such harm has been recorded. If mercury is so dangerous that we are all condemned to substandard thermometers, doesn't it make sense that injecting mercury into little babies is a bad idea? The drug companies have quietly dropped thimerosal but who knows what they will put in the ampules next. In fact, G°tzsche too states that the unreliability of the pharma industry is a valid argument for being suspicious of vaccines.

For the sake of brevity not every subject in the book will be reviewed here, such as G°tzsche's views on diet and alternative medicine. Let's skip to his political recommendations. The first is to modify drug patents. That is not likely to happen in his or my lifetime for reasons he describes in his book Deadly Medicines and Organised Crime. His other proposal is changing the way research and watchdog agencies are funded. He would have this done entirely by the government instead of mostly by the medical industry, but since when is government incorruptible?

In summery, we here at MeTZelf are extremely pleased with most of G°tzsche's messages in this book. We agree that healthcare decisions should be made by the person him/herself though we go much further than G°tzsche in that. We also agree that every citizen should be medically educated. G°tzsche proposes to start learning while one is still young and healthy. Our position is that medical education should be part of the curriculum of all high/middle (whatever it's called in your country) school students. By this we don't mean learning long lists of Latin nomenclature by heart, but rather learning about the body's functioning and what can go wrong with it. There is no reason why adolescents cannot learn this alongside languages, history, sciences, and whatever else they are taught, just as university medical students do. And we wholeheartedly support the abolition of drug patents.

Though it will surely upset the translator, I hope this otherwise fine book will be better edited before it goes to print in English.

*Update: A year later the book is available in English, though apparently only in Kindle, not hardcopy. The author has amended it a bit, for instance, he writes "When I googled hpv vaccine cochrane in February 2019..." At that time the Dutch translation had been available in print for over a year. In the English he also refers to his expulsion from the Cochrane board which transpired after the Dutch translation was published. Basically, however, it is the same book. He is courageous in blowing the whistle on an industry that deals ruthlessly with its critics. Were but all physicians like G°tzsche...

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