After reading a post by Carl Elliott on this website in which Elliott discussed his upcoming presentation to an audience at a Pharmed-Out conference, I went to the Pharmed-Out Web site and ordered the tapes of their annual conference. Pharmed-Out is an organization at Georgetown Medical School of professors and students who are demanding that the training that future doctors receive reflect valid conclusions based on research untainted by the self-interest of purveyors of devices and pharmaceutical companies.
In the present climate, the truth proves elusive. Almost all clinical studies of various drugs are designed and funded by the pharmaceutical companies. Only the studies which support efficacy of a drug are published while the more numerous negative studies are rarely acknowledged. While companies are supposed to register the studies they are conducting so that planned timing of study endpoints are public knowledge, these requirements are often ignored.
Thus, when drug efficacy is lacking at the planned evaluation time point, companies scan the data for a time point when the drug seems efficacious. Then the company capitalizes on chance variation and publishes the positive finding. Drug companies pay “Key Opinion Leaders” to put their names on such questionable reports, and to provide continuing medical education for the practicing physicians.
The end result is that even when physicians want to provide the best of care, they are limited by corruption of the sources from which they derive their information. This point is effectively documented by Ben Goldacre. In a Ted Talk, Goldacre related his attempt to garner accurate information about a particular antidepressant and his later realization that he had been duped.
Marcia Angell, editor of the New England Journal of Medicine for twenty years, and her husband, Arnold Relman, have written extensively about the unhealthy relationship between pharmaceutical companies, purveyors of devises, medical education and the FDA. Of late, the story of corruption in medicine is receiving more focused attention. Recently, articles on the influence of the pharmaceutical companies on how doctors are informed appeared in the Washington Post (see Peter Worisky, November 24, 2012) and Scientific American (Charles Seife December 2012,).
The 2012 documentary, Escape Fire, also talks about bad medicine (this can be documented for statins--see books by Stephen Sinatra and Duane Graveline) and Democracy Now’s U-tube interview with Steven Nissan on Escape Fire, focused on over-treatment. Several recent books (Overdiagnosed by researcher and physician H. Gilbert Welch et al. and Seeking Sickness by Alan Cassels M.D.) have questioned the value of screening for various diseases which ends up doing very little to effect end points, results in sometimes harmful treatments, and costs lots of money.
Otis Brawley, the chief medical director of the American Cancer Society, in his 2012 book How We Do Harm: A Doctor Breaks Rank about Being Sick In America, discusses the widespread use of a medication that was supposed to reduce fatigue in patients undergoing cancer treatment. Although there was evidence that the drug increased red blood cell production, fatigue reduction had not been established. Despite the lack of evidence for reducing fatigue, the drug was widely used.
Later evidence emerged that the drug promoted tumor growth. In addition to stories about bad drugs and overtreatment, some have articulated the mechanisms enabling the current state of affairs. For an inside look at the power structure in medical schools, Doug Bremner, an Emory Psychiatrist, in The Goose that Laid the Golden Egg, discusses the pressure coming from the Emory medical school in response to his study documenting the suicidal-ideation-inducing effect of Accutane, a drug used to treat acne.
In the coming weeks, congress will be focused on reducing the national debt. There is a lot of talk about cutting entitlements, which include Medicare and Medicaid. We do have the world’s most expensive health care system, although we are not even close to being a nation with the best health. With the recognition that medications taken as directed are a leading cause of death (see 2000 JAMA by Barbara Starfield), one would think that someone would be asking the obvious questions.
To his credit, Republican Senator Charles Grassley has been a strong advocate for reducing pharmaceutical company influence at the FDA, for investigating ghost writing of articles in medical journals, and eliminating the use of strong medications for foster children.
Perhaps corruption in medicine can be one of the few issues on which Republicans and Democrats can agree. But, just as Dick Durbin said about the banks’ influence over congress, perhaps the pharmaceutical companies own the place. So, demanding integrity from the system will require a sea-change. Will the people demand it? Only if they know they are being mistreated by segments of the medical community they’ve always trusted.