Aducanumab: New proof that our health care system is built upon the bricks of Mask-Logic.
“Truth is subjective, Matt. It can be manipulated to meet your purposes. The ingenuity is in picking the truth that works best for you, and then presenting it in a way that removes all doubt about its legitimacy. There are no facts, Matt. Just truths. And we own the truths.”
-The Doctor speaking to Matt in Three Brothers from Virginia
For a year now, despite both compelling evidence to the contrary and the reality of what was transpiring around us, we were told that we must wear masks, that they absolutely save lives, even though that was an utter lie. Dr. Fauci led the charge, Democrats of every stripe followed his lead like sheep, and prestigious university doctors backed him up with unassailable “data.” They turned their backs on genuine scientific studies demonstrating the opposite conclusion, and when COVID-19 cases surged even as more people wore masks they simply asked us all to wear two of them. This was COVID science at its peak, and not only did it reek of a deception and horror that should never be associated with the name of science, but it also led to hundreds of thousands of deaths by convincing us to rely on a containment strategy that did not work.
Welcome to the world of American health care! Masks clutter the landscape of our health care system. Doctors regularly sell us simple solutions to complex problems like the snake oil salesmen of an era gone by. This is the story we describe in our healthcare book, Two Men from Hopkins, and it is what I have been fighting my entire professional career. As the doctor says to Matt in the quote above, explain how the South could position itself as the good guys in the impending Civil War, truth is subjective and can be used to prove anything. But when scientists mangle reality to fit their narrative, and when those scientists are doctors, the results are—as we saw with COVID, and which we describe succinctly in our book Understanding COVID-19 Risks—catastrophic.
This is why in the past twenty years our nation’s annual health care budget has exploded from $800 million to $4 trillion as life expectancy and the overall health of Americans has declined. When we use Mask-science to sell people false cures, we not only deceive them and potentially harm them with our potions, at a huge financial cost to society, but we dissuade them from taking actions that may help their condition, like diet or exercise. It’s far easier to take a medicine that promises us the moon, or open that blocked heart artery, or wear a mask, then to do the hard work of getting healthier!
Mask science relies on something called surrogate markers to prove something works. For masks, we knew from dozens of studies, both prior to COVID and during it, that masks neither protect the wearer nor prevent the spread of infection. The fact that half our nation’s deaths occurred in long term care facilities in which everyone wore masks and shields and body armor from the very beginning of the crisis, the fact that so many health care workers contracted COVID despite being similarly “protected” by their masks and PPE, should have frankly been enough to convince anyone with open eyes how absurd compulsory mask laws were. But then big named doctors do what they always do. They turned their back on reality and built models out of surrogate markers.
A surrogate is simply something you can measure easily that stands in for a real outcome. Let’s look at cholesterol. Many drugs claim to prevent heart disease because they lower cholesterol. The FDA does not force a drug company go through all the trouble of proving that its new drug saves lives or stops heart attacks, just that it does a good job on lowering cholesterol, since cholesterol is seen as a surrogate marker for heart attacks. Hence, our doctors prescribe $5 billion of a drug called Zetia every year which does a fine job of lowering cholesterol but doesn’t prevent a single person from dying. And thus do our cardiologists prescribe $2 billion of drugs like Repatha, which cost between $5-10 thousand a year and dramatically drops cholesterol without saving a single life. Doctors are so sold on surrogates that they flood our market with drugs and procedures that fix these numbers while either not helping or sometimes injuring the patients who they bamboozle. And what patient does not want something so easy to do to fix so difficult a problem?
With masks, the surrogates are COVID particles. Masks block some particles, that is true, even if most particles go through and around masks. So, the brilliant COVID doctors and scientists constructed models from particle data. They proclaimed: Let’s assume that if masks block 30% of particles, then they will prevent the spread of COVID to a certain number of people, and thus less people will die. The word ASSUME is used in any model-building experiment. Then, they make calculations like this: If 30% of particles are blocked, that may decrease 10% of people from getting COVID, which will decrease death by 2%, and thus, with mask use, we will save 200,000 lives. Such logic became the mantra of our COVID doctors and was proclaimed as fact by doctors and CNN commentators and many of our political leaders, who forced us to wear masks because the data was so compelling.
Except, while masks may block some particles, studies looking at real outcomes showed, without a shadow of a doubt, that masks were not preventing any COVID deaths.
Hence, surrogate-built models trumped reality. This is a common story in health care!
Let’s look at dementia, since a new drug called Aducanumab—which is a novel dementia drug approved by the FDA this month and which costs $10,000 a year to use—has generated a great deal of controversy. Like so many drugs and procedures in our health care system that are poured upon unsuspecting patients by their thorough doctors, this drug was approved based on surrogate data, on two sets of surrogate data actually, and is thus just another mask that is polluting our medical landscape.
First a step back. There are no drugs that help dementia, and yet American doctors—mostly neurologists—prescribe dementia drugs to the tune of $6 billion a year, promising that they do work. The most well-known ones are Aricept and Namenda, with Exelon being a copycat of Aricept. I have read virtually every study of these drugs, and their lack of efficacy is a clear as the sun. But that’s not what the “experts” tell us. In fact, recently a patient of mine asked me if we should put his wife, who has severe dementia, back on Aricept because a new study showed that it does work. Of, course, I looked at the study, which is summarized here, and the author-doctor declared unequivocally that after 5 years the drugs were very effective in helping people think better. What was the data? Well, they relied on a surrogate marker called a mini mental status test, a 30-question test that somehow has the power to determine if someone has more or less dementia. And after 5 years, on this 30-question test, drugs like Aricept improved the score by 0.18 questions compared to people not taking Aricept. Yes, one-fifth of a point was the dramatic improvement, with just as many people getting worse as getting better! And the trial was observational, meaning that it does not control for other variables, and since we know that people who take dementia drugs are more likely to be more educated and wealthier and engage in the things that really do help dementia—like care giver support, exercise, good diet, day care programs—it is very likely that the drugs over time caused people to get worse, not better, which is what other studies have suggested.
But even beyond this fact is one that is more glaring. How is a memory score test used to validate a drug? It is a mask, a surrogate marker, not a real measure of whether a drug helps someone. The most helpful measure to assess these drugs, called caregiver score, determines if a person’s caregiver notices a change in mental capacity or behavior with the drug. Initial studies looked at caregiver scores, and these drugs failed miserably. So, they found a good surrogate marker, fiddled with it, and came up with a couple of studies that showed a tiny improvement on this memory test for a brief period of time, sold that as proof of efficacy to doctors and patients, and $6 billion a year later, people are still viewing their dementia drugs as being necessary and effective, and neurologists prescribe them incessantly without any hesitation in telling their patients that the drugs have been proven to work.
This is the power of surrogates! It worked so well with masks, convincing huge numbers of educated people that a useless piece of cloth would save them and all of society, because it has worked for decades with so many drugs and tests and procedures that are similarly useless, but which patients rely on because their doctors sell them as being vital and effective.
Yea, the Civil War doctor was right. Truth is easy to manipulate! And that comes at a high price.
So now everyone is clamoring about the new dementia drug Aducanumab, which is really expensive and which passed the FDA despite the fact that it does not work. But, hey, how is that any different than the mask-logic we have been using all the time in health care? Aducanumab helps some surrogates, you can’t deny that. It reduces amyloid plaque in the brain, which some doctors—despite no evidence, but who needs evidence, right?—says causes Alzheimer’s Disease. It may even slightly improve some memory test scores. Sure, it doesn’t necessarily help people with dementia in any meaningful way, but since when in our masked medical society do we demand that level of scrutiny before we prescribe a drug? Oh, and it could cause some people to bleed in their brains, but Aricept has horrid side effects, so too do drugs like Eliquis which we think is absolutely necessary; side effects and complications usually don’t’ get in the way of our nation’s doctors prescribing drugs that improve surrogate markers. Like masks, we don’t care about the misery they cause, or the fact that they don’t help us in a meaningful way, we only care that they mitigate some surrogate marker.
That’s why I’m not pissed at the FDA for approving this drug or surprised at all that it was approved. I fully expect our nation’s neurologists to prescribe it and sell it to their patients as being the best thing since masks. Hell, they’re doing it already with drugs we know don’t work, and which cause harm, so why would we expect otherwise? And how can we blame that on the FDA? The FDA doesn’t prescribe drugs. Doctors do. And they’ve been selling masked-drugs for so long that they don’t know what else do to.
Before we single out Aducanumab as the face of evil, we had better look at ourselves in the mirror. Look at how many people we have deceived and killed and maimed by pushing other drugs and interventions whose efficacy is similarly predicated on flimsy surrogate data. Look at how quickly our nation’s doctors pushed the mask myth because, rather than relying on reality or caring about the harm and discomfort they caused, they were persuaded by models constructed out of surrogates. This is why our health care system is a mess. If we are going to assail Aducanumab, let’s point our finger at the entire health care system. And let’s not blame the FDA, but rather try to figure out why our smart, well-trained doctors are choking us with masks based on data that shows no real benefit.
The truth is malleable. But it shouldn’t be. We as a nation should demand more from our doctors.