Health & Wellness
By now you have probably seen John Oliver's comic take on the pharmaceutical industry's influence on doctors' prescribing habits. Media outlets from Mother Jones to the Wall Street Journal commented admiringly, and even the American Medical Association felt compelled to declare they were "committed to transparency" around drug company payments to doctors.
But satire will do very little to focus on the real problem if we're distracted by the humor inherent in self-important doctors being bought off by a steak. What's not funny is that America is the most medicated nation on earth, with some 70 percent of Americans taking prescription drugs—yet we have worse health outcomes than other industrialized countries. Part of the problem may be the drugs themselves. As Slate's devastating expose on the fraud in clinical drug trials shows us: We don't know much about the drugs we prescribe.
But as physicians, we have very little good information to go on. Even our most prestigious journals publish research based on falsified studies, according to Charles Seife, a journalism professor whose class spent a semester trying to figure out why the data don't get corrected once research fraud comes to light. "As a result," Seife writes, "nobody ever finds out which data is bogus, which experiments are tainted, and which drugs might be on the market under false pretenses."
If no one knows which data is bogus, we obviously have a big problem in conventional medicine. Perhaps we shouldn't be so focused on marketing shenanigans, and more concerned about the original study data before something becomes standard of care. Standard of care, of course, is driven by "research" that is incorporated into academic guidelines and is the basis of customer demand.
Understanding consumer demand takes very little study—just turn on the TV. Every year pharmaceutical companies spend over $3 billion on direct-to-consumer ads. These ads work: a patient who requests a specific drug will get it most of the time. (We are, by the way, the only country besides New Zealand that allows this.) But the question of how something becomes part of a recommended guideline is less obvious—and has a lot to do with pharmaceutical money paid to academic physicians in research and consulting fees.
Many of these physicians "leaders" then get to influence prescribing practices—since researchers and consultants are, well, experts. Consider the 2004 Cholesterol guidelines that resulted in an explosion in the use of statin drugs—eight out of nine of the doctors who wrote those guidelines were in receipt of money from statin manufacturers. The Harvard psychiatrist credited with hyping the use of stimulant drugs for ADHD—that has resulted in nearly 15 percent of our youth being medicated—received $1.6 million from producers of stimulant drugs. Prestigious medical journals—the ones that often define medical guidelines—allow physicians consulting for pharmaceutical companies or paid medical writers to extol the virtues of the drugs they are selling.
I hate to ruin the fun, but practicing physicians are influenced far more by guidelines, esteemed academic physicians, and opinion pieces in prestigious journals than we are by a deli platter and a smiling drug rep. We look to the world of academic medicine because, well, where else can we turn? Pharmaceutical companies know this and have worked hard to sway the leadership. Now the question comes up if we can trust the data that the leadership relies on. One wonders how deep the deception goes. In fact, the heavy influence of pharmaceutical dollars inspired the former editor-in-chief of the New England Journal of Medicine, Dr. Marcia Angell, to conclude, "It is simply no longer possible to believe much of the clinical research that is published, or to rely on the judgment of trusted physicians or authoritative medical guidelines."
That's why so many practicing physicians and patients alike were relieved that Obamacare would force pharmaceutical companies to come clean about how much money they're throwing at some doctors. Sure, it's fun to ridicule a middle-aged doctor ogling the drug rep's cleavage while stuffing pens in his pocket or wolfing down a falafel sandwich—but this guy isn't really the problem and everybody knows it. While $90 million went to drug-company sponsored meals in 2013, according to the Open Payments database, at least $1.4 Billion went to research. If we can believe that doctors can be bought with a slice of pizza pie, then we cannot underrate the influence of research monies.
And by the way, that $1.4 billion is probably a fraction of what is spent on researchers. Obamacare allows a four-year delay in the reporting of research grants for reasons that really don't make any sense. An explanation from Medscape does little to satisfy: "The thinking is that if there were public transparency, it might stifle companies from getting involved in very early research.... And that's again to specifically protect that research space."
Whether or not the research space needs protecting is a matter of debate. Certainly we have so much research that it's impossible for a working physician to get through it—some 800,000 articles are published annually. In response, the Cochrane Collaboration was formed in the 1990s to perform systematic reviews of the literature. Dr. Peter Gotzsche, the Director of the Nordic Cochrane Center in Copenhagen, has seen enough over the last two decades to sum up his findings in a book whose title says it all: Deadly Medicines and Organised Crime: How Big Pharma has Corrupted Healthcare.
"Much of what the drug industry does fulfills the criteria for organized crime in US law," Dr. Gotzsche said in a recent interview. "And they behave in many ways like the mafia does, they corrupt everyone they can corrupt, they have bought every type of person, even including ministers of health in some countries...The drug industry buys the professors first, then chiefs of departments, then other chief physicians and so on, they don't buy junior doctors."
Gotzsche isn't the only one accusing pharmaceutical companies of wrongdoing beyond the marketing malfeasance they're famous for. In Australia, during the Vioxx class action suit brought against Merck, company emails were released revealing that Merck employees planned to "neutralize" and "discredit" doctors who criticized the drug. "We may need to seek them out and destroy them where they live," a Merck employee wrote, according to The Australian. Apparently, uncooperative physicians were targeted to lose academic appointments and research funding for telling the truth about the negative side effects they observed.
This is troubling—but even more so in light of the fact that it's now widely accepted that prescription drugs can be dangerous and over the years dozens have been recalled. "Our prescription drugs are the third leading cause of death after heart disease and cancer. Our drugs kill around 200,000 people in America every year, and half of these people die while they do what their doctors told them—so they die because of the side-effects," said Dr. Gotzsche in his recent interview. "The other half die because of errors—and it's often the doctors that make the errors because any drug may come with 20, 30 or 40 warnings, contraindications, precautions...and then the patients die."
This is a hard pill for any of us to swallow. We should be able to trust our doctors, who should in turn be able to trust "the science." As amusing as Oliver's "epic takedown" of doctors was, the trouble isn't physicians prescribing a new drug because a drug rep brings us a platter of tacos, the problem is whether the drugs we have to choose from are truly safe and effective in the first place.
Of course pharmaceutical companies are here to stay—and on the whole that's a good thing. But to prevent a power dynamic that may deny us fully accurate drug data, physicians, and patients need more transparency—not just about the money, but about the drugs we are putting in our bodies.
Reader Comments
@Hugh Mann:
Exactly.
The author of this piece, Daniela Drake, displays a typically stunning naivete about the scope and depth of the problem of massive industrial cartels ('companies' in her words), controlling all aspects of life today.
Her last paragraph is just like the bleating of a sheep, who mistakenly seems to find security in a pen, though the only gate that opens and closes is to a catwalk leading directly to the slaughter house. I guess she thinks if the slats in the barriers are widened slightly ('transparency'), so the sheep can 'see out' better, this should be enough to satisfy and correct the issues confronting and disturbing the enlightened sheep (progressive and mindful people) of today.
I find this same thought process, this same naivete all over the internet on the more widely read and popular (by volume) sites. Of course, these are the same sites that practice the most strict censorship and control of content, via administrative, centralized technological means.
Essentially, almost all of this naivete stems from the people's long standing devout cultish worship of technology, as though it were the Great Almighty. This of course is, mental programming and mind control by the secretive elite segment of darkest humanity, those who favor continual war and violence on an international planetary scale to serve their own selfish and demonic interests.
ned
@Hugh Mann:
What's most important for the general public to understand is that big pharma is a component of conventional medicine and that the entire business is a mafia as had been pointed out twenty years ago (read "The Medical Mafia" by Ghislaine Lanctôt).
Anywhere you look closely you will find fraud and corruption at play with the traditional medical business. The war on cancer is just one such an example where this business enterprise has been denying and dismissing the serious harms from orthodox cancer treatments and has been suppressing and omitting critical information on cancer from the public and resorting to deceptive cancer statistics to educate them that their way of treatment is actually successful (read the epilogue of this article: google/bing "A Mammogram Letter The British Medical Journal Censored" or visit [Link] ). Yet the real facts show that the war on cancer has been a near entire failure.
It also needs to be recognized that this medical cartel encompasses many other fraudulent players and allies such as the mass media, the cancer "charities," "science-based" medical spokespeople and hacks, the "federal" authorities, etc.
@nedlud:
Another sign of Drake's naivete is that because pharma drugs are a leading cause of death it is wrong for the author to claim that "on the whole that’s a good thing" that "pharmaceutical companies are here to stay." This shows how difficult it is for a brainwashed public to follow the actual facts truthfully. Denial is their most closest companion.
The Psychology, Psychiatry, Psychoanalysis Nexus: “Mental Disorders” Drives Big Pharma Profit and Social Control
.....The proclivity for the psychiatric field to pathologize humans through exponentially increasing mental disorders can be the speculated result reflecting a deepening level of scientific knowledge, empirical evidence of society’s worsening mental health condition and/or the increasing linkage between psychiatry and Big Pharma’s greedy thirst for record-setting profits. The latter explanation takes into full account the unholy marriage between psychiatry and the ever-powerful pharmaceutical industry. Invention of new diseases leads to more Big Pharma profit.......continued
I have been utterly dismayed that even many of my seeming intelligent, educated friends (so-called "progressives" mostly) have bought into the "vaccines are safe and effective" mythology. "You need to get your kids vaccinated for the common good." (i.e. the herd). Some folks I know on Facebook have even gone on rants threatening to unfriend anyone who even dares to post anything questioning vaccines.
I had a gut feeling it was a flawed paradigm based partly on negative outcomes for one of our kids when they were vaccinated years ago so I ordered four books including Dr. Humpries' excellent Dissolving Illusions and have read every scientific paper I could get my hands on. It's been an eye opener but, unfortunately, most folks are stuck in System 1 thinking. Their emotional hot buttons have been pushed, their minds made up, and they don't even want to think about the issue. The whole measles hysteria feels engineered to me. One of many interesting things I learned from Humphries' book is that vaccine coercion goes back 200 years with disastrous consequences for the vaccinated. The human species is so f*cked.
"Part of the problem may be the drugs themselves". Yes the drugs are killing people but it is no longer just the sheep; with mandatory vaccination requirements the drugs are going to kill even those who have been fighting against the drugging of society.
Your body is no longer your own unless you are willing to give up all of the creature comforts this society appears to offer you and go live in Waziristan or illegally on crown or state land. Militia, anyone?
25 Facts About the Pharmaceutical Industry, Vaccines and “Anti-Vaxers”
During the recent measles outbreak, the mainstream media blamed the epidemic solely on non vaccinated children, even though people who were vaccinated caught the disease and some vaccines have proven to be inefficient in the past. Without the slightest nuance, the mainstream media constantly portrays people reluctant to accept just any vaccine as “anti-vaxers”, irresponsible and misinformed people, relying on irrational fears and the one and only “fraudulent” Andrew Wakefield study linking autism to vaccines. (Watch Lina B. Moreco’s documentary Shots in the Dark, which features Dr. Wakefield and thankful parents of his young patients with autism.)
New Mafia? No. They've been around for quite a while. They didn't become this drug cartel overnight.