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TIL 236 | How to Approach New Medical Research (feat. Dr. Dan Gannon)

Dale Johnson: This week on the podcast I am joined by Dan Gannon. Dan is a medical doctor who is retired from orthopedic surgery and is also a biblical counselor. He is a member at Grace Bible Church in Bozeman, Montana. I’m so delighted that you’re here with me to talk about this subject of medical research. Medical research is one of the things that is a huge hindrance for many people to even contemplate the ideas of biblical counseling. So many people see the field of medical research as limiting what we think in the biblical counseling world. I couldn’t think of a better topic for us to address to squelch our fears about what is happening in the medical world. It’s something that we can be excited about and we don’t have to fear in biblical counseling. We don’t have to see a pitting of faith against science if it’s true, legitimate science. To begin our conversation, is medical research a bad thing?

Dan Gannon: Medical research is critical, and I embrace it as something that we need in this world. We need to make advances in medications that can be used for illnesses. We need to bring new therapies and new surgeries to relieve suffering. We need it to weed out present errors. There are some mainstream medical errors that we think are true, but future research will say are not good. It’s critical that we have research. But as commanded in 1 Thessalonians 5:21, we need to examine everything carefully and hold fast to that which is good. That is very true for medical research because some of it is not good. We have to take it with a grain of salt and be discerning. Matthew describes us as sheep amongst wolves in this world and we have to be wise as serpents, and yet gentle as doves.

Dale Johnson: As we see medical research coming out, we have this tendency, especially in our culture, to think that anything that’s published in a medical journal has to be more than simple theory. We tend to think that theory equals fact in medical research. We have to be, as you’re cautioning, very sensitive and discerning in how we approach research, how we adopt things as being scientifically true, especially when they might have a different view of anthropology than what the Bible presents. We have to be cautious. This is not something that is unusual, particularly when we look at some things that we believed to be true medically 200 years ago and today would say, “Wow, we didn’t see the sum total of that at that time.” What are some examples of that from history that were believed to be true medically speaking at one time, but we now look back and see we made some mistake in our understanding of research?

Dan Gannon: One example is the use of Thalidomide, which was a drug to treat morning sickness of early pregnancy. Later on, it was found to cause tremendous birth defects in babies. Through research, it was found to be a bad thing. It was thought that estrogen supplementation was a good thing while going through menopause, but then they found out there’s a lot of problems with estrogen supplementation. In fact, the side effects probably outweigh the benefits. In my own world of orthopedics, there’s trouble with metal on metal implants. Artificial hips were thought to be the greatest thing in Europe and Australia, so we adopted that in the United States. With time we found out the troubles with metal on metal implants. Medicine makes advances, but sometimes we make mistakes.

Dale Johnson: That’s an honest, open assessment of how we approach medical research. It’s always helpful to keep in mind that even the people who are doing this type of research are flawed. They don’t see all the variables or the totality of the implications. I don’t say all that, nor do you, to demonize medicine. We praise the Lord for medical advancements and it is a common grace from the Lord. Thank you, Lord, that we don’t have to go through surgery without anesthesia. That’s a good thing. But especially in our capitalistic, hungry, greedy culture, we do see medical research being utilized, even weaponized in such a way that marketing takes over in medical research. What are some cautions when we talk about biases in medical research?

Dan Gannon: Marketing far outpaces science and research. In our society, we are bombarded all the time with the benefits of, for instance, medical marijuana, of CBD oils and alternative medications, or even of stem cell therapy. They do have tremendous uses but it’s been tremendously marketed for financial gain by clinics popping up all over without research to back them up, and they are very winsome in their arguments. They have speakers that are very influential and they will get people to sign up for this treatment that’s $14,000, insurance doesn’t cover, and the FDA hasn’t approved it. A lot of marketing is claiming, “One product will cure a whole variety of ailments.” That’s a common error that’s out there.

Dale Johnson: As we think about the marketing aspect, how do you think marketing plays into biasing some of the research that’s out there?

Dan Gannon: There was an article about transgender therapy and who decides to do it, and the article concluded that there was a significant social contagion for those choosing transgender therapy. In other words, some girls were influencing their friends to go through transgender treatment, transgender surgery, and that was discovered in this paper. The paper was to be published, but there was a great uproar by a certain community saying, “We don’t want this to be suggested to be a social contagion because we think that it is a biological, ethical problem.” So that paper did not get published because of the great uproar before it could even be submitted, before the editor decided to print it or not.

Dale Johnson: When we think about medical research, it’s always important to applaud those things which are good. Hebrews 5:14 tells us that what it means to be mature is that we learn to discern the difference between good and evil. When we approach medical research, we have to learn to be discerning. In order to do so, what are some warnings we should think about in medical research as we see marketed on our television or on social media?

Dan Gannon: It has to be considered in the framework of analyzing the purpose of the research paper. There’s always a purpose for any research. There’s a motivation and an agenda. “Agenda” sometimes has a negative connotation. Some research purpose is to advance academia truly for knowledge, but sometimes there are desires for fame or fortune. For example, the head chairman of a university might be a little bit competitive with a chairman from a different university, especially if they just got into a verbal spat at a conference and one disagreed with another. Then they go back to the university and say, “I want somebody to do research to show that my technique is correct. I want to become famous.” All too often, they want to release something that’s outrageous and radical. That’s what gets published while the negative studies rarely get published.

The Christian has to look at the motivation of the publisher and for publication bias. The editors can decide whether this article is going to get published or not. We see with antidepressant medications that published articles show that there is a positive result from a particular medication. You also have to look at if it was sponsored by a pharmaceutical company. That’s a dead giveaway. If this is sponsored by a certain pharmaceutical company, there may be bias involved. The positive studies get published at about a 97% rate, but the negative studies (i.e. that show this drug did not help in depression) only get published 3% of the time. When you look at meta-analysis, a compilation of a lot of different papers together so that there’s more statistical power, sometimes meta-analysis is only for published papers. The ones that were published are already pre-selected and have positive results. Other meta-analysis that may be more beneficial would include both published and unpublished papers. Those are some of the things that you have to look at as a Christian. Is there sponsorship of a particular pharmaceutical company? Is it prospective, doing a study looking forward, or is it retrospective, only looking at past experiences? The retrospective studies are typically weaker.

There can be bias, there can be fraud, there can be errors in study design. Study design is difficult and there are statisticians who specialize in trying to design a good study, but we have to look for those errors. Typically there is an agenda, and we see this in articles where they’re talking about evolution, inhabitable planets, gender identity issues, mental disorders, medical marijuana, and CBD. The ones that get published are the positive ones. Another thing for Christians is to look carefully at the wording in the results section. Often, there’s a little caveat that says, “The results of this study suggest that such and such might or may.” They may not actually have definitive data, but they imply something. Then the next research article cites the first one, the first one said it may cause such and such, and the second article says that the research previously showed conclusively. There’s an error in that next generation of research that goes on.

Dale Johnson: Many of these studies have to go through and be approved by the FDA, especially in the United States. What are some issues or points of caution about the process in the FDA and some of the things that we’ve seen that might not be helpful?

Dan Gannon: The Food and Drug Administration is certainly our friend, but it’s far from perfect. For instance, in the supplement industry, if they fall under the category of a food supplement then they do not need FDA approval as long as they do not claim to treat a disease. They can make any claims the want. They can claim to improve memory or diminish memory loss, but they cannot claim to treat Dementia or Alzheimer’s. The same thing goes for a lot of different things in the supplement industry as far as aging. The whole supplement industry does not have to go through the FDA process. The pharmaceutical company does have to go through the FDA approval process because they are treating a disease and they have a product that they patent. The end goal is to have a product that is able to patent to sell and make money for their shareholders, the pharmaceutical companies. Their business is to make money through medications.

Dale Johnson: As a doctor, in personal experience you encountered people trying to promote a drug. They’re doing their job, their desire is not to harm anybody or anything like that. As a doctor, give us perspective on how much that happens, how persuasive that can be, and how it might be disconnected from what this drug was intended to do in a curative or a palliative form for the individual.

Dan Gannon: In my practice, drug representatives would bring in lunch for my employees and they always had a sales pitch, and we allowed that. They were doing their job, selling their products. They were careful, but I took it upon myself that I did not want to be unduly influenced by them. The opioid problem is coming on now with sales of Oxycontin, and I remember them talking about how they can be addictive. Now the big issue is if this company that sold that product withheld that or not. I don’t think that they were ever purposely misleading. However, it’s influenced by name recognition. I know Chevy versus Ford when I see it—there’s a bit of name recognition. That’s the whole way that advertising comes about. Yes, we did have pharmaceutical representatives come into our offices. Was I influenced by them? I probably was, and I wish I was not. I tried to take what they said and then do my own research, but there’s probably times when I gave patients the free samples we were given (patients love free samples) and said, “By the way, here’s a prescription.”

Dale Johnson: The heart behind it is that you want to see patient outcome. You want to see something good and you want to see relief. That’s not in and of itself a negative thing. Let’s talk briefly about the STAR*D trial. Some might not be familiar with it, so introduce it and then give some points of caution as we think about it.

Dan Gannon: The STAR*D trial is Sequenced Treatment Alternatives to Relieve Depression. What’s known is that antidepressant drugs are often marketed by a pharmaceutical company because they would like this product to be sold. They want people to be helped, but they also want it to be sold so they can make money. Often, they are the ones that sponsor these trials and that introduces possible bias. It’s not a guarantee, but it’s possible that the author would then be biased. Those pharmaceutical companies own that study, so if the study showed that their product didn’t work, they would not release it. There was a selective publication release and bias.

The STAR*D trial was designed to avoid that. There’s no pharmaceutical industry involved. It was done by the NIMH, the National Institute of Mental Health, and it was very large—4,000 patients. It was looking at antidepressants and whether they worked. They would do a sequence that started with a particular SSRI, Selective Serotonin Reuptake Inhibitor, and then they would switch if it didn’t work. There was a lot of different levels and tiers to this. It was a magnificent trial in the respect that it was not influenced by industry, it was very large, and it was prospective. They studied patients for a year and even supplied the medications for free, trying to keep people in the study and reduce dropouts. When people drop out of a study, that usually means that they did not do well. The STAR*D trial ended in 2006 and they never published the results. The bottom line is that the antidepressant medications did not do well. In fact, in some cases they did not even meet the placebo rate of improvement. That was a great embarrassment, because they wanted to show the opposite. The STAR*D trial is somewhat buried and it’s very hard to get statistics from it. People are saying, “Why is not in the limelight?” It’s buried because it did not show significant improvement.

Christians have to take into consideration that we are being pushed to believe antidepressants work. You can use the Bible, but if that doesn’t work then just go ahead and take the antidepressants because they work. We are being influenced by physicians who prescribe them. It’s the most pragmatic way to handle somebody in their office that has despair. You can’t spend an hour or two treating them and talking about why they’re in this despair. You can’t go after the real source of their problem.

Dale Johnson: It sounds unloving if you’re withholding something that has been proposed for many years to be helpful. There’s a pressure there as well.

Dan Gannon: Absolutely. People are referred to go see a doctor because they’re depressed. They want to help their mom. They want to help their sister or their daughter because nobody wants to see their loved one going through struggles with depression. The STAR*D trial really did not show that it worked, it was an embarrassment.

The other thing that comes up in the realm of antidepressant drugs is the discontinuation syndrome or withdrawal syndromes. When people take antidepressants for a long time, it’s hard to get off of them. There are real effects on our nervous system that make it difficult to stop them. It doesn’t matter if you wean for one, two, or three weeks because the discontinuation syndrome can go on for months or even years. It was thought that it only happens once in a while, but the more recent research is saying that 30 to 60 percent of people who take antidepressants go through these withdrawal symptoms. It’s not a recurrence of the depression, it’s other manifestations of feeling blasé, agitated, or having nausea or dizziness. There’s a whole plethora of symptoms that are involved, and now people feel badly after they’ve been weaning off the antidepressants. The wrong conclusion is, “Aha, you need the antidepressant medication.” The prescription is refilled and then they feel like they need to be on this for a lifetime. It really is not a need to be on it for a lifetime, rather they are suffering from withdrawal effects from their antidepressant.

Dale Johnson: That was denied for a long time. If you care to hear more about it, the British Medical Journal is producing a plethora of articles related to this very subject, trying to demonstrate how deeply this withdrawal effect has been upon people who have been on anti-depressant medication long-term.

We can’t cover all the topics, but this is a topic that we don’t have to be afraid of. We need to engage in it, but we need to engage in it wisely. We have to approach these issues with our eyes wide open, paying attention to what’s going on and not assuming that anything that comes to us through “medical research” is definitive science. We shouldn’t feel like it’s pitting science and what is real or true against faith. That’s the position we start to get ourselves in. I want to think thoroughly through these issues, and we hope to do so as we continue on in the future. Not everybody’s going to be a medical doctor and be able to sort through these issues, but as a biblical counseling organization, I don’t want us to stick our head in the sand about it. I want us to deal with it and not just accept everything that comes through medical science. I want us to be wise and diligent through the lenses of the passages that you mentioned. Thank you so much for being here and for describing in detail what can be helpful points of caution as we think about good, helpful medical research, and some medical research that we need to be cautious about.

Resources:

Bibliography of Critical Psychology

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