Antonio Sitges-Serra has written a book that is as revealing and documented as it is controversial. And with a rather provocative title: “If you can, do not go to the doctor.” The recommendation comes close.
Sitges-Serra (Barcelona, 1951) is Professor of Surgery at the Autonomous University of Barcelona, he was head of the Department of Surgery at Hospital del Mar and has published more than 400 scientific articles.
In his controversial book, he denounces how in today’s society – a society that worships science and panics over death and aging – medicine has become a colossal business, almost always at the expense of the patient.
Here we present Dr.Sitges-Serra analysis interview:
If one is well, if it can be avoided, there is no reason to go to the doctor. The concept that the doctor has to monitor our health seems a bit archaic. The doctor is there to help when one has problems, but if you feel well and your life is developing correctly, if you do not have any discomfort, the doctor does not help prevent the disease.
Rather, it is we who should help ourselves to prevent disease. The basic message of the book is reassuring against social hypochondria, against the abuse of medicine and in favor of self-healing, personal responsibility and avoiding over-medication.
Speaking of social hypochondria … In the book it is revealed that between 15 and 20% of patients who go to the doctor have no reason to do so. Where does this hypochondria that we suffer from come from?
It is a multifactorial issue. To begin with, health has become an obsession for many citizens.
Second, the media insist a lot on how to take care of yourself, that you have to be very careful if you notice a lump here and there. Without a doubt, that contributes to generating that hypochondria.
Perhaps science also abuses its power a bit, making citizens believe that even if they are healthy they are all potentially sick. And to that is added our own anguish and anxiety, because ours is a fairly anxious society.
In the end, one believes that health is the most important thing and that going to the doctor and using the health system will allow living much longer, something quite doubtful.
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Is there a risk that when you are healthy and you go to the doctor he will try to find something for you?
Clear. This is what is known as overdiagnosis. You go to the doctor, the doctor asks for tests, if he is not convinced he asks for more tests. When you do many tests it is possible that there are some that do not go well, then the doctor insists.
We can thus enter a spiral that can end with an unnecessary operation, biopsy or medication that will have adverse effects.
And why is there this excess of overdiagnoses?
The doctor does not want to make a mistake and will therefore do everything possible to reach a diagnosis. The patient, if he has a complaint, wants to be treated. And if you abuse medical visits you run the risk of being over-medicated and over-diagnosed.
And that overdiagnosis cannot also respond to strictly economic reasons, to a certain commodification of healthcare?
I remember that a few years ago in Italy they arrested a doctor who was engaged in absolutely unnecessary operations just to charge them … Clear.
Obviously, in private medicine the risk of a patient being over-medicated, over-treated and over-operated is higher, because there are medical fees at stake that they want to charge and there may be the temptation to overindicate surgeries. In fact, there is a study that says that relatives of doctors have much less surgery than those who are not related. A very revealing fact…
And what happens in the public health system?
A bit the same, but the doctors of the public system are not so pressured for commercial reasons, but for other reasons: academics, those of prestige, that their center does the best whatever it is, collusion with the industry. Both commercialization and certain forms of promotion put the patient at risk of being subjected to tests and surgeries that he does not need.
Have we become guinea pigs for pharmaceutical laboratories?
I wouldn’t say it in such aggressive terms. The pharmaceutical industry and the industry of medical devices have been fundamental for the development of medicine, which today has an impressive therapeutic, diagnostic and monitoring arsenal, which is a capital aid.
But, of course, the pharmaceutical industry has essentially commercial interests, because they are companies whose ultimate goal is to do business, increase their value on the stock market and improve their economic performance every year.
It’s a bit of a paradox: it is as if the healthcare industry were a television or car industry. Also, if we are healthier, if we live longer, to a certain extent we should receive fewer treatments than we do. But the pharmaceutical industry, like any other industry, wants to grow. And in this growing it uses dishonest practices. This must be stated.
What dishonest practices does the pharmaceutical industry resort to?
Practices of bribery, to take out publications that are not correct, to over-finance continuing training, training biased in favor of the industry … All of this is due to the fact that the medical industry in general is a capitalist industry like any other. The shareholders press, we must increase sales … And then we enter into over-medication and the promotion of diseases.
For example, news stories are beginning to appear in many newspapers talking not about impotence but about sexual dysfunction, which has a much broader spectrum than impotence, and this can help increase sales of Viagra.
Could all this also be the result of the fact that we have deified technology, science?
Anything that comes with the label ‘science’ we buy it without hesitation….Clear. I think that in general the population, the citizenry, have a very dogmatic concept of science.
It is paradoxical: we have rejected religious dogmas to accept others. And especially when science is very controversial. What science defends today may not be defended tomorrow. The very nature of science is to be critical, to continually review what it says.
Of course, there is solid, acquired knowledge that nobody disputes. But be careful with having faith in science because that leads us to pervert its meaning. Science is wrong many times or, at least in it, there are very different opinions.
We have seen it for example with the Coronavirus pandemic … That almost every country, every epidemiologist, every health regime, has acted differently. Scientific evidence is, by nature, questionable; in some respects things are clearer, but in many others not. There are those who defend the use of the mask and those who do not, those who defend confinement and those who do not, those who defend one thing for the sick and another for the healthy. I believe that the public at this time should be a little more skeptical about what science represents, because in this Pandemic it has proven to be very insufficient.
We also live in a period dominated by hedonism, the fear of disease, and the fear of death. There are even doctors who say that we are going to conquer death, that in a few years we will be immortal… Is all this related to the capitalist concept of health? Of course.
Google, for example, is spending hundreds of millions of dollars to fight aging and search for the key to perpetual life. There are large corporations that are already freezing very sick people with the promise of unfreezing them when science and technology allow it.
There is a whole transhumanist movement, which is strongly supported by the industry, and which seeks to convince the public that it is within our power to eliminate death or, at least, delay it for many years.
And do you think that is possible?
I believe that it is a great lie and, in addition, it seems to me that this idea is dishonest with respect to the generations that follow us. There must be a certain intergenerational solidarity, giving way to the people of the next generations. The world is not ours, we have it on loan and we have to go through it. No one can own it forever.
Apart from strictly ideological or technological issues, in living forever or many more years there is a philosophical and ethical aspect that makes me very critical. What is being done today is to make many incurable diseases, chronic, which causes those who suffer from these diseases to often have a terrible and even agonizing quality of life … And so much. I am in favor of prolonging life, but not prolonging death.
Because – as Ivan Illich, one of the forerunners in the cultural criticism of medicine, already said – medicine generates a lot of pathology. It also cures things, but it generates many sick people, often chronically ill. I think it would be wise to invest less in end-stage medicine and invest more in prevention or, for example, in other social measures.
I imagine that the quality of life of some of these people would have to be analyzed, right?
Yes. The quality of life, visits to the doctor, complementary tests, new visits to the doctor, chemotherapy treatments that often have no therapeutic purpose. And apart from the fact that the quality of life of the patient is often compromised, the patient is totally dependent on the health system. All of this is enormously expensive, both in terms of quality of life for the patient and for the public purse.
In recent years, and despite hypermedicalization, in the most developed countries life expectancy has not only stagnated but is also falling …
Yes. There is news from France, the United States, Spain, which suggests that there may be a stagnation in the growth of life expectancy. In fact, for years the curve has been flattening out.
And it has its logic: we are approaching what many of us believe to be the biological limits. Due to biological issues and the deterioration of the organism itself, I think it is inadvisable to try to extend life extremely. And in doing so, we are paying a price: for example, Alzheimer’s disease, which is a terrible disease, has already reached almost epidemic proportions.
The lengthening of life has a B side: the appearance of more cancers, more incurable neurological diseases and more deterioration of the cardiac and vascular system.
If to this is added that obesity is becoming widespread, addictions are gaining ground and that diseases related to climate change (re) appear, it is logical that life expectancy does not grow and even regress.
And all these problems, how are they cured?
A little with the empowerment of the sick. It will be difficult, today we see no signs of the system taking steps to change itself, despite the warnings coming everywhere.
I do not rule out that there is an involution and a change of route in some of the fundamental issues that we are discussing. But each of us must be aware of all this.
The patient who has cancer may have to see that they cannot have two years dying little by little, maybe they have to wonder how their doctor is really helping them or they are doing a clinical trial behind their back or testing a drug to see if life extends a month, at the expense of the public system spending 50,000 euros more on that patient.
I think there must be more self-responsibility and a certain acceptance of natural death. Before, our grandparents were said to die a natural death. Now death is supermedicalized, it is very artificial.
How has your book been received by your medical colleagues?
Perhaps no one writes to the author to tell him that he has done it wrong, because I have received a lot of emails telling me that it was time for someone to put what many of us thought in black on white. I think this book has crystallized what has been floating in the environment for a long time.
Now, I have exposed – and perhaps they have bothered – those who believe that medicine is a basic science. Oncology and psychiatry are the target of my book and some professionals will have felt singled out.
For example, I make a rather harsh criticism of social psychiatrization that turns what are physiological states into mental illness and abuses medication. Today around 15% of men and almost 30% of women receive some type of neuroleptic medication.
In general, the book has been well received and I believe that the public has received a liberating message. Plus, it’s documented, full of numbers, facts, data. And opinions can be criticized, but the facts and data are there.