Scalpels, Drugs, and the Continued Barbarism of Modern Medicine
Weekly Wisdom
Episode 48
In 1949, psychosurgeon Egas Moniz received the Nobel Prize for pioneering the prefrontal leucotomy, known colloquially as the frontal lobotomy, a medical breakthrough in treating schizophrenia and severe anxiety. Yasser Arafat, leader of the PLO, a known terrorist organization, also received the Nobel Peace Prize. As did Henry Kissinger, despite his role in a bombing war that killed many civilians. So much for awards.
At first, the frontal lobotomy did not take off. Not until psychiatrist Walter Jackson Freeman II popularized the transorbital lobotomy. This was the McDonald’s of lobotomies, easily taught and completed in as little as ten minutes. With this technique, any doctor with a bit of training could perform lobotomies at their convenience. Freeman himself performed thousands in his lifetime. He enjoyed his job so much that he once performed two hundred twenty-eight lobotomies in just twelve days. Throughout the course of his career, he boasted an eighty-five percent patient survival rate. Not bad for a quick ten-minute procedure that involved poking an icepick-like tool through a patient’s eye socket and into their brain.
Sorry, did I just breeze over the fact that fifteen percent of his thousands of patients did not survive the procedure? And yet, the procedure remained popular until it was replaced by the rise of pharmaceutical interventions. Lobotomies were not outlawed in Canada until 1978. The last lobotomy was performed in France in 1986.
Today’s psychiatrists are armed with an array of pharmaceutical options considered less barbaric than practices such as frontal lobotomies, electroconvulsive therapy, or psychiatric institutions. These drugs come with a host of side effects, which makes compliance a challenge. Different patients tolerate the side effects differently.
I chose this example of how well-intentioned medical interventions can go wrong not only because it is graphic and seems obvious to us now, but because it is personal. Mental illness runs in my family. And the available interventions have not proven effective. This is not only an issue in mental health.
The Danger of Medical Consensus
Unfortunately, just as lobotomies seemed de rigueur in their day, so do many medical interventions that we take for granted today. It is easy to judge in hindsight, but much more difficult to cast a critical eye on current practices. In a decade or two, we will look back in horror at procedures we currently consider normal.
Relative Risk vs. Absolute Risk
Recently, a loved one with elevated LDL cholesterol received a statin recommendation. Now, I’m not that intelligent, so I relied on some artificial intelligence to explain to me the difference between absolute versus relative risk. Here’s what it said:
Absolute risk is the actual chance that something will happen.
Example:
Out of 100 people, 2 get a disease.
The absolute risk is 2 out of 100, or 2%.
Relative risk compares one group's risk to another group's risk.
Example:
Group A: 2 out of 100 people get a disease.
Group B: 1 out of 100 people get the disease.
Group A has twice the risk of Group B.
That means the relative risk is 100% higher (or 2 times greater).
Why This Matters
Relative risk can sound dramatic.
Imagine a headline:
"Eating Pickles Doubles Your Risk!"
That sounds scary.
But if your risk only went from 1 in 10,000 to 2 in 10,000, then:
Relative risk = 100% increase
Absolute risk = 1 extra case per 10,000 people
Same numbers. Very different impression.
This becomes a critical distinction when making personal health decisions because an intervention that decreases relative risk at the population level may make little meaningful difference in your personal risk (2 in 10,000).
Here are some of the actual possible side effects of statins (just the real ones, not the unsubstantiated, overblown threats unsupported by evidence):
1. Muscle Pain and Weakness
2. Increased Risk of Type 2 Diabetes
3. Reduced Exercise Performance (In Some People)
4. Rare but Serious Muscle Breakdown (Rhabdomyolysis)
5. Liver Enzyme Elevation
6. Cognitive Complaints
7. Reduced CoQ10 Levels
Statins are a classic example of why it's important to look at both relative and absolute risk.
A simplified example:
Imagine 100 people similar to you who are at risk of having a heart attack over the next 10 years.
Without statins: 10 people have a heart attack.
With statins: 7 people have a heart attack.
Relative Risk Reduction
The risk went from 10 to 7.
That's a reduction of 3 out of 10.
So the relative risk reduction is:
3 ÷ 10 = 30%
A headline might say:
"Statins reduce heart attack risk by 30%!"
That's true.
Absolute Risk Reduction
The actual difference is:
10% risk without statins
7% risk with statins
That's an absolute risk reduction of 3 percentage points.
In other words:
Out of 100 people taking statins for 10 years, about 3 heart attacks are prevented. Did you catch that? Only 3 people in a cohort of 100 receive the heart-protective benefits of statin drugs.
Here’s the conundrum my high-cholesterol loved one faces:
Elevated LDL is a known risk factor for heart disease. But she also struggles with high blood sugar, and diabetes runs in her family. Statins increase the risk of developing type 2 diabetes.
Well, it just so happens that Type 2 diabetes is one of the strongest risk factors for cardiovascular disease.
If two otherwise similar people are compared, the person with Type 2 diabetes is typically about 2 to 4 times more likely to develop heart disease or have a stroke.
So this means that the statins that my loved one's doctor is recommending to ward off possible heart disease also increase her risk of developing type 2 diabetes, which in turn increases her risk of heart disease.
Meanwhile, somehow during the statin conversation, the doctor made no mention of exercise or nutritional interventions.
Didn’t even mention beta-glucans.
Did you know that beta-glucans are one of the few dietary interventions that consistently produce a measurable reduction in LDL cholesterol? They are not a miracle cure, but they are supported by a solid body of evidence.
What Are Beta-Glucans?
Beta-glucans are a type of soluble fibre found in:
Oats
Barley
Certain mushrooms
Yeast
How They Work
When beta-glucans reach the intestine, they form a thick gel.
That gel:
Traps bile acids.
Causes more bile acids to be excreted.
Forces the liver to make new bile acids.
The liver pulls LDL cholesterol out of the bloodstream to do that.
It's conceptually similar to how some cholesterol-lowering medications work.
How Much Do They Lower LDL?
Most studies find:
3 g/day of oat beta-glucan lowers LDL by roughly 5-10%.
Higher intakes sometimes produce slightly larger effects.
For someone with an LDL of 150 mg/dL (3.9 mmol/L), a 5-10% reduction might lower it to roughly 135-142 mg/dL (3.5-3.7 mmol/L).
The problem with statins, just like lobotomies, is not that they don’t work. Sometimes they do. For 3 in 100 people, in fact. Lobotomies, despite a 15% mortality rate, actually reported a success rate of 30-40%. Though, like statins, they did not come without their share of side effects.
Is it unfair to lump statins in with lobotomies? Probably. After all, you cannot undo the effects of a lobotomy. The point, however, is that culturally we continue to do a poor job of evaluating our medical practices and move too quickly to medical intervention before exploring potentially helpful, low-risk, side-effect free, lifestyle modifications. It was true in the past. It remains true today. And not only in the field of mental health. Yes, there may be elements of media misinformation and political/profit agendas, but often I think that the road to hell continues to be paved by people with the best of intentions.
Why, in this modern age, is there continued barbarism? Why do we continue to reach for scalpels and drugs to address issues that might be mitigated or resolved through exercise and nutrition? Why do we continue to inflict these horrifying practices on ourselves and our loved ones? Let’s stop the insanity. But please God, not with a scalpel.
