A Remedy for Corruption

By Anne Peticolas. Originally published at Health Care Renewal

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 Dose vividly 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.

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  1. Robert Hahl

    So true: “people are very keen to use evidence when it supports what they already want to do.” As a medicinal chemist and patent lawyer, I have seen that evidence-based medicine enthusiasts are supported to attack low-cost innovations, the ultimate goal being to clear the field for the next round of patent medicines. Why, for example, is there no single dose, reversible, male contraceptive on the market. One was developed in India thirty years ago. No side effects, works fine but….still needs more testing.

    1. Jeremy Grimm

      I believe the male contraceptive you are referring to is called Gossypol. It’s a substance found in unrefined [or poorly refined] cottonseed oil. There are numerous references to it on the web.

      1. Synoia

        Personally I found 4 or 5 pints of beer stunningly effective as a male contraceptive, but at the time of drinking and for many hours afterwards.

    1. Wukchumni

      I spent a fair amount of time in Aussie and a lot more time in EnZed, and the accents are so different, the easy way to differentiate is to ask an Antipodean what’s the number between 9 and 11 called?

      Oz = ‘ten’

      NZ = ‘tin’

      We were watching NZ news on the telly there, and the lead story was on feral cats in Christchurch, and how the de-sexing* van was out and about looking for feline swingers on the make. And to our ears it sounded like this: ‘Di-Sixing Ven’ we were rolling on the floor laughing.

      *Kiwi words can be very direct, if you get into a car crash and need to get your car fixed, you don’t go to an auto-body shop, you go to the panel beaters.

      1. Meher Baba Fan

        Australians say panel beaters also. Its not the accent, Australians DO have issues with enunciation and diction as a rule however. It makes it harder.
        US films are funny, maybe not more recently.- but they used to use a Kiwi accent for Australian characters. See the final scene in the original Point Break with Patrick Swayze for a classic example. It’s supposedly set in Bells Beach, Victoria. The local policeman has the most outrageous kiwi accent!

        1. Wukchumni

          There’s a film from 1981 I watched awhile back called Race for Yankee Zephyr, shot in NZ. It was so undeveloped back then the country. Queenstown was a sleepy place that would resemble how Lake Tahoe must’ve looked in 1938.

          If you want to see how it looked back then in terms of big cities, you have to go way down south to Invercargill, where it still looks the same, with single retail buildings that have fancy awnings & balconies often. Very quaint.

          A street view:


      2. ebbflows

        In coaching actors to speak different accents Australian is the hardest. The Oz accent comes from the back of the tongue, further back than others.

        1. The Rev Kev

          A very long time ago I met a bloke who had earned money in Japan teaching Japanese how to speak English properly. They needed the practice with a native English-speaker which is fair enough. However, a lot of backpackers were earning money this way who were from many different English speaking countries.
          The result was Japanese who wear speaking English with a Scottish Glaswegian accent or an Irish brogue or, god forbid, with hard Aussie accents. The results must have been hilarious sometimes when they went to put their English to use. This was an era when Japanese tourists with cameras use to be a standard fixture on the streets of the world.

          1. ebbflows

            Yes I have knowlage of such things, mate works in China teaching English a Uni.

            Although I would be exceedingly amusing to have a fair dinkum ocker accent being spread around.

            Aussiest. Interview. Ever. What a legend!


            I hear Google home is experiencing some technical difficulties with the accent and language.

            1. bassmule

              I used to know a currency trader in NYC, born in Stockholm, learned English from two guys from the East New York section of Brooklyn. Imagine Arnold Schwarzenegger crossed with Tony Soprano.

    2. Joel

      I was taken aback by that statement.

      Unnecessary in itself, and weird.

      I have never in my life had trouble understanding an Australian speaking.

      1. Joel

        Also, a little life rule: never compliment someone on their everyday speech, especially if it’s a backhanded compliment that says that other people from where they’re from (i.e., their family, friends, community leaders) speak badly.

        If you’re an American and you meet Americans from different regions (unless you’re from Seattle or Arizona or some place that sprung up yesterday), you invariably get that “compliment” from some people who need to get out more. And don’t get me started on all the backhanded “compliments” you get from some Europeans.


        1. Jeremy Grimm

          Your umbrage at this post’s “compliment [to] Moynihan on his excellent diction” seems odd. How is it a backhanded compliment to say Moynihan has crafted his podcast voice to make it easy to understand and listen to? For that matter — as an American traveling abroad I have been complimented on my clear accent and diction. I was pleased with the compliment since I was speaking with Koreans in English and deliberately spoke slowly and as clearly as I could, while very deliberately avoiding peculiar idioms and slang — though with mixed success in that. An older Korean who lived through the times of Japanese occupation and the hard times during and after the Korean war found the expression “I am full” most amusing as a way to say I was done eating.

          You may have no difficulty understanding Australians and should be complimented on you aural acuity. I have difficulty understanding American speech — especially the speech of those younger persons in such a great hurry to spray out their words that many vowels and consonants important to my understanding of their speech get clipped and compressed into aural oblivion. I suppose I am remiss for not giving the compliments due to those fellow Americans who make an effort to speak clearly in a way I can understand without effort and frequent requests for them to “say again”.

          1. Synoia

            You have a cute accent!

            I receive many of those, and my reply is sometimes,

            I don’t have an accent. You do.

            Which can be either delivered as a joke, or not.

  2. Thuto

    In South Africa during the times immediately after the Treatment Action Campaign took the government to court and won, you didn’t need “evidence” to see that the first generation of antiretrovirals were toxic to boot, even a bad pair of eyes were sufficient for the task. You could spot an HIV positive person on ARVs from the proverbial mile away, just by the havoc the “treatment” was wreaking within their bodies. Humps and changing of skin pigmentation were just some of the noticeable side effects, with patients also reporting constant diarrhea, fatigue and brittle bones as some of the more private side effects they dealt with on a more or less permanent basis. The TAC was just a front activist group used to wage war against government’s stance that the toxicity of these drugs needed to determined before mass rollout could be sanctioned. And the prices big pharma was demanding from the public health care system were beyond insane, but not anything that couldn’t be obscured by the propaganda laden campaign the TAC so successfully ran, to the utter detriment of those first generation of patients who still live, those still alive, with the scars (pun intended) of the “treatment” the TAC “won” for them through that “hard fought victory”.

    I suspect the aforementioned patients might find the assertion that the evidence supported “minor side effects” to be more than just a minor irritant, and they have their ravaged bodies to prove it.

  3. JEHR

    I would be interested on a clarification of the quotation, “it’s more the US public, he says, that is insane than Trump.” Sometimes I think that the media is often to blame for Trump’s responses, even the “good” media.

    1. JEHR

      Well, stupid me, all I had to do was listen to Dr. Frances’s explanation linked to in the article above.

      Another thought: What if CNN stopped talking about Trump all the time and instead talked about how single payer could be introduced into the US. It would be wall-to-wall single-payer healthcare for weeks and weeks. The program could start with examinations of other single-payer systems and include lots of conversations with patients, family doctors, specialists, etc. In a year, American interest in single payer would be overwhelming! (But, of course, I know that such a conversation would not be in the interests of the “company.” )

      1. Johnny Spaghetti Stain

        What you describe is called manufacturing (or engineering) consent, a method approved for creating consent for things like wars, invasions, elections, corporate bail outs, tax cuts for the rich, cutting grandma’s Medicare but not, repeat, NOT (ever) to do some good for the American people at large. The corporate guidelines for CNN and the rest of the corporate mouthpieces quoloquially known as media are very clear.

  4. JEHR

    What would happen if all the news media just refused to listen or record what Trump says? I would like that very much.

    1. ambrit

      As I mentioned on another thread, Trump is bypassing the traditional gatekeepers to Power by communicating directly to the people through Twitter. That is, to my mind, political genius. No wonder the traditional elites hate him so much. He has figured out a way to elude their attempts to corral him.

      1. Anon

        Yes, but that makes him no less crazy and dangerous. I think the use of Twitter as a communication tool is what makes the ” it’s the American people who are insane” comment accurate.

        1. redleg

          His use of Twitter has resulted in the most transparency the oval office has seen since the days people could wander through the White House.

          As disgusting as I usually find his tweets, I think that all future presidents should follow his example.

          1. Synoia

            I think that all future presidents should follow his example.

            You might want to qualify that a bit.

            for example: Serial Marriages?

      2. The Rev Kev

        When you think about it, it is nothing new. Roosevelt use to have his fireside chats with the American people over the new medium of radio, Presidents soon took up the use of television as use of that technology exploded in the 50s and 60s. Yeah, Trump could use podcasts or YouTube clips but we have become so used to sound-byte politics that his tweets are only matching what people have become use to. Doesn’t mean that we have to like it and I still can’t be bothered getting a Twitter account myself but there it is.

        1. JEHR

          Trump and Twitter were made for each other. What President other than he could make policy in so few character strokes? His policy matches his message; that is, “the medium is the message” in full bloom.

        2. ambrit

          I concede the transformative nature of radio and televisions’ effects on politics. However, radio and television were and are still mainly large organization ‘coordinated’ venues. Gatekeepers in those venues still enforce conformity to the dictates of the large organizations, whether they be private or governmental in nature. Unless and until Twitter becomes obviously ‘controlled’ by some group or clique, the messages communicated therein will have the cachet of “unfettered freedom,” and thus enjoy popular credence.
          The other ‘virtue’ of Twitter communications is its’ seeming immediacy. I can imagine Tweet ‘storms’ being preplanned and strategized to advance agendas. However, I’d imagine that the more astute Twitter aficionados could recognize such an occurrence and thus discount it.

  5. John Rose

    Hey group, focus on the content, not the bloke’s articulation or accent!
    Maybe a thank you for the fully fleshed reference to an information source that could well we worth our time.

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