Professor Michael Baum, Professor Emeritus of surgery at University College London and architect of one of the United Kingdom’s first breast screening centers, plays a game each year with senior postgraduate oncology students at a Royal College of Surgeons of England course. He tells them two screening tools exist for prostate cancer. The first reduces the chance of dying from the disease by 20 to 30 percent. The second saves one life for every 10,000 person-years of screening. He asks which they would adopt. They vote unanimously for the first. The two programs are identical. One figure is relative risk reduction; the other is absolute. Dr. Malcolm Kendrick’s Doctoring Data: How to Sort Out Medical Advice from Medical Nonsense, published in 2014, documents how this inversion operates across cardiology, cancer screening, blood pressure management, and preventive care as a structural feature of modern medicine’s commercial model.
Dr. Malcolm Kendrick graduated from Aberdeen Medical School in 1981 and trained as a general practitioner in Scotland. He now works in Cheshire across general practice, intermediate care, and out-of-hours medicine, with 30 years of clinical experience behind him. His institutional record places him inside the apparatus he dissects. Kendrick set up the online educational system for the European Society of Cardiology in collaboration with the European Commission, and built the first website for the National Institute for Clinical Excellence in the United Kingdom. He is an original member of the Centre for Evidence Based Medicine at Oxford and of The International Network of Cholesterol Skeptics, a group of clinicians and researchers who reject the diet-cholesterol-heart disease hypothesis. Publications in the British Medical Journal, Medical Hypotheses, Pulse, and PharmacoEconomics followed, along with election to Who’s Who in 2009. His earlier book The Great Cholesterol Con established him internationally as a critic of statin pharmacotherapy. The man dissecting the apparatus helped build it.
By 2014, the pharmaceutical capture of evidence-based medicine was no longer a contested proposition in serious research literature. John Ioannidis’s 2005 paper “Why Most Published Research Findings Are False” had become one of the most-downloaded papers in medical science. Merck had paid $4.85 billion in 2007 to settle Vioxx litigation after documents showed the company had known about cardiovascular risks for years. GlaxoSmithKline paid $3 billion in 2012 for fraud, including the suppression of unfavorable data on Avandia and Paxil. The Cochrane Collaboration had been fighting Roche since 2009 for the full clinical study reports on Tamiflu, a drug on which governments had spent billions stockpiling for pandemic preparedness, only to discover the trial data had been systematically withheld. In clinical practice, cholesterol thresholds had fallen from 7.5 mmol/L at Kendrick’s graduation in 1981 to 5.0 mmol/L, bringing over 85 percent of the Western adult population above the drug-treatment line. Blood pressure thresholds had moved from 160/110 to 140/90, with “pre-hypertension” now beginning at 115/75. The Quality and Outcomes Framework incentivized British general practitioners to meet numerical targets on blood pressure, cholesterol, and blood sugar, converting the consultation room into a surrogate-endpoint delivery system. Six million Britons were on statins. Another six million were slated to begin.
Doctoring Data belongs on the shelf with Marcia Angell’s The Truth About the Drug Companies, Peter Gøtzsche’s Deadly Medicines and Organised Crime, Ben Goldacre’s Bad Pharma, and Uffe Ravnskov’s work on cholesterol. Kendrick’s contribution is methodological. He teaches the reader how to read a trial. The JUPITER study, which produced the headline that rosuvastatin cut all-cause mortality by 20 percent and triggered a vast expansion of statin eligibility, dissolves under Professor Michel De Lorgeril’s reanalysis: cardiovascular deaths were 12 in the placebo arm and 12 in the statin arm. A 1995 United States study of women and breast cancer screening found they overestimated their 10-year probability of dying from the disease by a factor of 20 and overestimated the benefit of screening by a factor of 100, a combined risk-benefit error of 2,000 before any treatment decision was made. “Five-year survival” rates for cancer, universally cited as cure rates, capture lead time: diagnose a slow-growing cancer five years earlier and five-year survival approaches 100 percent even if the disease kills on precisely the same date it would have anyway. The Norwegian analysis Kendrick cites found that by age 50, applying European Society of Cardiology guidelines, 95 percent of the population of one of the healthiest nations on earth would qualify for lifelong drug treatment on cholesterol, blood pressure, or both.
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