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The year is 1950. Your doctor lights a cigarette and tells you smoking is fine. He read it in a study. He is telling the truth about having read it. He does not know, or is not saying, that the study was funded by the tobacco industry.
The year is 1958. Your doctor tells you to eat less fat. The evidence is contested. The contestation is not in the public messaging. The food industry has been helpful in clarifying which findings deserve attention. Some researchers who published contradictory data have been quietly defunded. Ancel Keys is on the cover of Time magazine.
The year is 1962. Your doctor prescribes thalidomide to your pregnant wife for morning sickness. It has been approved. The FDA gave it the green light in Europe. Twelve thousand children will be born with severe limb malformations before anyone in an official capacity acknowledges the problem. The families are told the drug was safe. The drug was approved. Both of these things remain true.
The year is 1972. Your doctor prescribes Valium. Britain is in the grip of a benzodiazepine wave that will last two decades. The dependency risk is known internally. It is not shared. Your doctor is not lying to you. He was not told either.
The year is 1999. Your doctor prescribes Vioxx for your arthritis. It is newer than ibuprofen, well-tolerated, and Merck has a study showing it works. Merck also has internal data suggesting it roughly doubles the risk of heart attack. This data will not reach your doctor for four more years. Fifty thousand people are estimated to have died in the interim. Merck eventually settles for 4.85 billion dollars. No criminal charges are brought.
The year is 2002. Your doctor prescribes OxyContin. Purdue Pharma trained its sales representatives to tell doctors the addiction risk was less than one percent. That figure came from a letter, not a study. The letter was about patients with terminal cancer on short-term doses in hospital settings. Your doctor is a GP with a patient who has a bad back. Nobody draws a distinction. Nobody is required to.
The year is 2008. Your doctor checks your cholesterol. Your LDL is elevated. You are prescribed a statin. Nobody mentions that the number needed to treat for primary prevention is approximately 250. Nobody mentions that the muscle deterioration you'll notice over the next two years is listed as a rare side effect rather than a documented pattern affecting a meaningful percentage of patients. The trial that informed the prescription was funded by the manufacturer.
Now it is today.
Your doctor has new guidelines. New studies. New consensus.
He is confident.
He has always been confident.
The confidence has never been the problem.
The confidence is, in fact, precisely the problem.
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