That’s the title of a new book by Melvin H. Kirschner, M.D. When I first saw the title, I expected a polemic against conventional medicine. The first line of the Preface reassured me: “Everything we do has a risk-benefit ratio.” Dr. Kirschner took the title from his first pharmacology lecture in medical school. The professor said “I am here to teach you how to poison people.” After a pause, he added, “without killing them, of course.”
He meant that any medicine that has effects has side effects, that the poison is in the dose, and that we must weigh the benefits of any treatment against the risks. Dr. Kirschner has no beef with scientific medicine. He does have a lot of other beefs, mainly with the health insurance industry, the pharmaceutical industry, and alternative medicine.
He explains the FDA, the standard drug approval process (phase I through III studies), fast-tracking, classification of drugs (Schedule I through V), black box warnings, drug recalls, off-label prescribing, the scientific method, package inserts, expiration dates, drug interactions, side effects, the role of sanitation in disease prevention, informed consent, developing resistance to antibiotics, placebos, immunizations, ethical issues, conflicts of interest, drug advertising, copycat drugs, why drugs cost so much, why “natural” doesn’t mean “harmless,” how dietary supplements can kill, how alternative medicine is not based on scientific evidence, chelation, DSHEA, NCCAM, the infiltration of CAM into medical schools and why we need a new Flexner report, what’s wrong with the American medical system (“What’s broken is the coverage system, not the care delivery system.”), and why “poison, cut and burn” is sometimes the only rational option. He does not like insurance companies, and he explains why. He ends by saying Lincoln’s characterization of our government as “Of the people, by the people, for the people” is now better described as
Of the people, Buy the lawmakers, For the corporations.
I liked his comments on the natural herb that has caused more human grief than any other in history: tobacco. I liked his assertion that it would be redundant to label family practitioners as “holistic.” I didn’t like his discussion of automated lab tests because he missed the opportunity to explain how ordering panels of tests to screen patients can do more harm than good by finding false positives.
I particularly liked his essay on “Doing Nothing.” Treatment is not always necessary and sometimes the decision to do nothing is actually doing something. It ties in with what I wrote about “Not Treating – A Neglected Option.”
In my opinion, CAM is often neither complementary, alternative, nor medicine.
But his criticism of alternative medicine is weak. He falsely conflates chiropractic with massage. Instead of excoriating the idiocy of therapeutic touch he merely calls it a “treatment that sometime works but is actually doing nothing.” In criticizing CAM his approach is more like that of Caspar Milquetoast than like the respectfully insolent snarkiness of our esteemed colleague Orac.
The book is derived from his previous writings over the last 60 years, everything from lectures to letters to the editor. It shows. It is fragmented, with short chapters on a variety of unconnected subjects. He has a lot of solid information and clinical wisdom to share, but his material is not well organized and suffers from an awkward, stilted style of writing. Some of the examples he uses are ill-chosen.
That said, the book might appeal to laymen and it might serve to get some very important points across to the public. The catchy title might persuade people to read it who would not otherwise be exposed to these ideas.
*This blog post was originally published at Science-Based Medicine*