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What Doctors Don't Know, Don't Tell You, and
How Truth Can Repair the Patient-Doctor Breach

Hippocrates' Shadow

by
David H. Newman, M.D.
2008

Reviewed by Mira de Vries

Modern-day physicians often cringe or shake their heads when they hear descriptions of Hippocrates' diagnostic methods; laypeople, however, have quite a different response—they wonder aloud how nice it would be to have Hippocrates as their doctor.
According to the author, it is "decidedly un-Hippocratic" that a modern doctor has learned in medical school to never say:
  • I don't know
  • I was wrong
As doctors often don't know and often are wrong, a professional secret is created that has to be guarded, driving the interests of physicians and patients apart.

What doctors are often wrong about is the efficacy and safety of treatments and screening. Statistics on the Numbers of patients Needed to Treat (NNT) consistently illustrate that most procedures do more harm than good. When it comes to complaints such as back pain, migraines, and panic attacks, physicians haven't a clue as to the causes, and no treatments work.

However Newman's main theme, and the one which is fairly unique to him considering the hundreds of books on this subject that have been published these past decades, is the value of placebos. Placebos regularly outperform "real" treatments, whether drugs or surgeries. This could be explained by the absence of dangerous side effects.

But how can placebos outperform no treatment as well? The author posits that the mere expectation that a treatment will benefit triggers recovery. He explains the mechanism as "internal pain-relief substances that are released by the brain called endorphins, and they were discovered largely because experiments with placebos demonstrated that they must exist." This statement is an outrageous aberration from the rest of the book's message, which disparages assumptions drawn from no actual evidence.

Endorphins have never been shown to exist in humans, and even if they do, their interaction with mental stimuli is unproven and unprovable. If Newman had identified his claim as theory and conjecture, fine, but he presents it as fact. "[D]opamine output in the brain, and endorphins, are not subjective." So what are they, objective? How would he know? Anyway, there being no accurate means of assessing pain skews the placebo debate. Patients might be reluctant to disappoint their doctors by admitting there is no improvement.

Yet this unfounded endorphin assumption is crucial to the main message of his book. He posits that healing is more likely brought about by a kind and caring physician than one employing an arsenal of technological instruments and procedures; or worse, one employing "subtle semantics" that blame "patients for treatment failure, or conditions that couldn't be diagnosed or understood." A good doctor-patient relationship gets those endorphins going. It's what Hippocrates had and what doctors today should acquire too, according to Newman.

Then he slips in another contradiction. In a table listing the benefits of various procedures, he omits placebos. But he does list "Prayer, for curing or alleviating illness" as having no benefit. It surely will not benefit anyone who doesn't believe in it. Neither will placebos. Endorphins or not, if you tell the patient that he is taking fake medicine there will be no benefit. Newman observes that "science as a religion, has come between patients and physicians.... Modern culture has devalued the patient-doctor bond and medical truth, and encouraged the secrecy and separation needed to maintain this false religion." If the false religion, that of medical technology, doesn't stimulate endorphins, then prayer should get them going great, at least for believers, especially if doctor and patient share the same belief. My intention is not to endorse prayer as an alternative to medical treatment, but rather to point out the inconsistency in Newman's writing.

Nevertheless, MeTZelf wholeheartedly endorses the conclusion reached early in the book:  "This reality [that there is no high potential for cure, nor do physicians possess a detailed understanding of the pathways of the ailment] only highlights the importance of patient opinions, views, and desires ...  the  values of the patient—the one ostensibly being benefited—should be driving decisions."

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