In a recent interview, Tim Harford, the Underground Economist, said,

That’s what makes medicine such an effective academic discipline.

By “that” he meant certain methodologies, especially randomized experiments. I disagree with this assessment. My opinion is that health care is in a state of profound stagnation, unable to make much progress on major problems.

Here are six signs of the stagnation in health care (by which I mean everything related to health):

1. The irrelevance of Nobel Prizes. Year after year, the Nobel Prize in medicine is usually given for research that is so far useless (e.g., teleomere research) or irrelevant to major health problems.

2. The obesity epidemic. Starting in 1980, obesity rates climbed fast. Thirty years later, doctors seem to know no more about how to cure obesity than in 1980. Low-fat diets, popular in the 1980s, are still popular! Low-carb diets are ancient — the Banting diet became popular in the 1860s.

3. Ancient treatments for depression still popular. SSRIs were introduced in 1988. Cognitive-behavioral therapy began in the 1980s, combining earlier ideas. Neither works terribly well — and notice how different they are.

4. The high cost of ineffective care. Americans pay much more for health care than people in other rich countries, yet American health is no better. All that new technology that Americans are paying for isn’t helping. In an article complaining about our education system, Joel Klein, the former head of New York City schools, wrote, “unlike in health care . . . in education, despite massive increases in expenditure, we don’t see improved results.” Actually, that’s exactly what we see in health care when we compare America to other countries. Tyler Cowan makes this point in The Great Stagnation.

5. Statins. A defender of modern medicine would claim that statins were an important innovation. They are heavily prescribed, yes. Yet in recent tests they have been stunningly ineffective — so much so that the earlier favorable evidence has been questioned.

6. The stagnation has become invisible — the normal state of affairs. Allowing Harford to make that comment. Harford, like Dr. Ben “Bad Science” Goldacre (whom Harford praises), believes you judge science by whether it follows certain rules. By making various rules (e.g., the need for placebo controls) and then following them, medical researchers have drawn attention — at least Harford’s and Goldacre’s — away from lack of progress. They’re making progress, they say, because they’re following self-imposed rules. Well, what if the rules make things worse? (For example, placing high value on placebo controls may draw attention away from non-pill treatments.) Better to judge by results.

What do you think are the clearest signs of health-care stagnation — if you agree with me about this?

The notion that high cholesterol (more specifically, high “bad” — LDL — cholesterol) causes heart disease may be as widely accepted as the notion that humans have caused dangerous global warming. It is much easier to test, however. An excellent study published in 2006 compared two groups of people at risk for heart disease: those given a high dose of statins and those given a low dose. The high dose reducd LDL cholesterol levels; as it was meant to; the low dose did not. But there was no effect on coronary heart disease progression. After a year of statins, persons in both groups had increased their coronary artery calcification score by the same amount — about 25%. Totally contradicting the cholesterol hypothesis.

Regular readers of this blog may remember that after a year of eating butter (half a stick per day), my coronary artery calcification score decreased 24%. Because increases of about 25% are the norm, my score was about 50% less than expected. Decreases are very rare, I was told.

Thanks to Hyperlipid. Statin side effects.