A Remedy for Corruption

Do I really have a remedy for corruption? I wish I did. But, I have lately found an effective balm for the sickening discouragement that it is easy to feel when confronted day after day with another instance of the medical industry’s price-gouging corruption, purposeful distortions, and callous disregard of patient  welfare. That remedy is a new podcast from Australia: Ray Moynihan’s The Recommended Dose. 

If you don’t already recognize Moynihan’s name, he’s an author of Selling Sickness and he’s had a persistent interest in overdiagnosis and medicalization. He describes the podcast as “interviews promoting healthy questioning in medicine” and most, though not all, of the interviewees are medical professionals somehow associated with evidence-based medicine and/or Cochrane. Many interviewees have practiced in unfamiliar countries and settings; hearing about problems and issues there is broadening for a U.S. listener.

So far there are eight episodes, and not a dud in the lot. Moynihan interviews the people as human beings, not just as experts, so you get a real feeling for their lives and motivations, including background, interests, and motivations. He doesn’t hesitate to go a bit afield, as in Episode 7 where he interviews a novelist! His conversation with Sarah Moss covered literature and themes related to medicine very enjoyably.

Other episodes I particularly enjoyed were: 

• Episode 2. Psychiatrist Allen Frances discusses mental health, including his role in the DSM and how he regrets the direction later editions have taken. On another topic, he thinks diagnosing Trump remotely with some psychiatric disorder is unenlightening; it’s more the US public, he says, that is insane than Trump.
• Episode 4. South African Jimmy Volmink recounts how Cochrane was contacted by the government to look into the evidence for using antiretrovirals for prevention of mother-to-newborn HIV transmission; government officials stressed they were particularly interested in harms of these toxic chemicals. A big project resulted, concluding that side effects were comparatively minor, and the treatment tremendously effective. Decision makers (who had clamored for the study) then proceeded to disregard the results. That was an interesting insight into an environment where the pressures were to make treatments look less effective than they are rather than more effective than they are, as is generally the case in the U.S. setting. Volmink comments that people are “very keen to use evidence when it supports what they already want to do.” (Fortunately the study was still of great use when the Treatment Action Campaign took the government to court.)
• Episode 6. Indian psychiatrist Prathap Tharyan discusses being on a team to assist people after a tsunami and what evidence shows people need after disasters (spoiler: it’s not mass debriefing/counselling for everyone). It concludes by a recording of Tharyan’s singing Leonard Cohen’s Alleluia; I feared it would be embarrassing, but it was sublime.
• Episode 8. An optimistic interview with Julian Elliot, who is working on access to evidence including in low-income countries. His reflections on working on HIV treatment in Cambodia were interesting. But the highlight of the episode for me was when Moynihan reflected that there are two elements in science, innovation and evaluation. The public, Moynihan says, appreciates medical innovation, but not evaluation, important though it is. (What a factor that is in the many “medical reversals” Vinay Prasad and Adam Cifu write so eloquently about!) 

I have to compliment Moynihan on his excellent diction. I usually find Australians really hard work to listen to. Although Moynihan’s accent is strong, he speaks so clearly that it’s a pleasure to listen to him and not difficult for this American to understand what he’s saying at all.  Such beautiful clarity is a fantastic asset in making accessible the meat of the podcasts.

The Recommended Dosevividly showcases some of the many people who make medicine and life still wonderful and beautiful (in parts); and who live with intelligence, determination, courage, and humor despite obstacles.  That’s an excellent medicine for the heart and mind, and I recommend it without reservation.