Medical controversies

This learning resource covers medical controversies at all levels including:

disputes over scientific evidence for the safety and efficacy of medical practices
controversy over political and economic influences on the practice of medicine
public perceptions (including vocal minority opinions) of medical controversy, even points of view that are not accepted or considered controversial by the mainstream medical community.

Possible structure

(under construction)

Introduction. Controversy at different levels; within the profession, dealing with other professions (legal, insurance, government regulation), public perceptions.

Controversy within the medical community.

How are controversial issues resolved within medicine?

Are there flaws in the current system for resolving controversies within the medical profession?

Can Cochrane Reviews in controversial areas be biased?

Does science shape medical practice or do market forces and legal constraints?

biases introduced to medical practice by Pharmaceutical marketing
Which provides the best care, free market or Publicly funded medicine?

Public perceptions of medical issues. How does the public perceive controversy that exists within the medical profession? What forces can cause controversy between the medical profession and outside groups even when there is consensus within the medical profession?

Controversy within the medical community

An increasingly important means for resolving controversies within medicine is to rely on Evidence-based medicine and Systematic reviews of evidence. Several high-profile cases have called into question the efficiency of the current evidence-based approach to deciding the value of medical practices. For example, after systematic review of the safety and efficacy of some COX-2 inhibitors it was found that some negative data were not included in the analysis^[1]. There may be systematic sources of error that can cause inacuracies in systematic review processes that are used to evaluate medical treatments^[2].

Controversies outside of the medical community

Controversy over medical practice frequently extends beyond the domain of internal debate within the community of medical professionals. Some medical controversies are major social, political and economic issues while others are less well known and primarily of concern to relatively small special interest groups.

Economic and political influences on medical practice

Government regulators have been struggling to balance the need to approve useful medical practices as quickly as possible while avoiding the introduction of treatments with unrecognized or unnecessary side-effects. Some observers of the process have suggested that regulatory decisions are biased by market forces^[3] and political influence^[4]. Some advocates of Emergency contraception have drawn attention to Susan F. Wood, who left her job as head of the Food and Drug Administration's Office of Women's Health in protest saying that, "scientific and clinical evidence, fully evaluated and recommended for approval by professional staff here, has been overruled."^[5] Some birth control advocates have suggested that religion is acting through politicians to control government regulation of medical practices^[4]. The question of which medical professionals can refuse to provide medical care for religious reasons is currently being decided by politicians^[6] and may ultimately involve the courts^[7].

Other controversies

1. The belief we have a medical monopoly.
2. The belief that HIV doesn't exist, let alone cause AIDS
3. The belief AIDS came from a hepatitis B vaccine experiment, Dr Alan Cantwell MD was the first to promote this.

References

^ Echoing Other Cases, NEJM Says Vioxx Safety Data Withheld by Jennifer Couzin in Science (journal) (2005) Volume 310 page 1755.
^ Can Cochrane Reviews in controversial areas be biased? A sensitivity analysis based on the protocol of a Systematic Cochrane Review on low-level laser therapy in osteoarthritis by J. M. Bjordal, B. Bogen, R. A. Lopes-Martins and A. Klovning in Photomedicine and Laser Surgery (2005) Volume 23 pages 453-458.
^ COX-2 inhibitors: a story of greed, deception and death by G. M. Halpern (2005) in Inflammopharmacology Volume 13 pages 419-425.
^ Actonel (Proctor and Gamble) incident at Sheffield University in the UK. Report in Slate Blog of one involved scientist Many links here Description in AAAS
^ Template:Note label Religion interferes with FDA ruling by Cynthia Martens (November 21, 2005) in The Badger Herald.
^ FDA Official Quits Over Delay on Plan B: Women's Health Chief Says Commissioner's Decision on Contraceptive Was Political by Marc Kaufman (September 1, 2005) in The Washington Post.
^ Romney scraps emergency contraception out for Catholic hospitals by Glen Johnson for the Associated Press (December 8, 2005).
^ Legal fight brewing after pharmacist disciplined on state birth-control rule: Cites conflict with Illinois Right of Conscience Act by Jim Suhr for the The Associated Press (December 18, 2005).