Friday, September 29, 2006

This is what we are up against - The fall of pharmaceutical medicine

The integrity of the scientific literature relating to pharmaceutical products is heading, like the Titanic, towards an iceberg of enormous size [ref, ref]. If you are wondering why, here is a primer. In an astonishing article in the Guardian this week, journalists Boseley and Evans reveal what has been happening at the heart of British government.
burnhamDrug firms' lobby tactics revealed
Evans and Boseley, The Guardian, September 28, 2006

"In May, the health minister Andy Burnham met Peter Dolan, then chief executive of Bristol-Myers Squibb and chairman of the Pharmaceutical Research and Manufacturers of America (PhRMA), the powerful industry body in the US." "Over the eight months from October to May this year, senior executives from 10 drug companies met ministers to press for favourable decisions on their products."

"Documents obtained by the Guardian under Freedom of Information legislation reveal that": The world's biggest drug company, Pfizer, warned ministers that it could take its business elsewhere. "Pfizer ... noted that there is complacency in some quarters of Whitehall regarding their continued investment in the UK," the minutes of the meeting record." That sounds like blackmail to me.

A memo also reports the summing-up of the view of Johnson & Johnson: "NICE should take into account what the companies see as the overwhelming views of patients, carers and clinicians on the efficacy of the drugs." "Pfizer asked for more public support from the government for a robust pharmaceutical industry in the UK."

Bristol-Myers-Squibb director of external affairs stated "companies want to invest in countries with a 'favourable environment.'"

I wonder who pays those those patient groups and those clinicians? I wonder who pays those academics and journals who publish selective or distorted findings? I wonder who funds the whole system of thought in medicine? I wonder who pays those guideline writers and even kids and teachers for that supposedly "overwhelming view"? Pfizer and its friends perhaps?

It stinks. The scientific method, that supposed cornerstone of Western civilization, has been replaced by the political method. This is characterized by a fuzzy relationship with reality, conflicts of interest and outright lies.

The statement, from the preface to C. S. Lewis's "The Screw Tape Letters" could serve as a summary of all that that is wrong:

"The greatest evil is not now done in those sordid 'dens of crime' that Dickens loved to paint. It is not even done in concentration camps and labour camps. In those we see its final result. But it is conceived and ordered (moved, seconded, carried, and minuted) in clean, carpeted, warmed, and well-lighted offices, by quiet men with white collars and cut fingernails and smooth-shaven cheeks who do not need to raise their voices. Hence, naturally enough, my symbol for Hell is something like the bureaucracy of a police state or the offices of a thoroughly nasty business concern."

That is what we are up against. It is not about that overwhelming view of "patients careers and clinicians". It is not about the free market or about innovation. It is not even about honest science, honest Universities, honest government or honest drug regulation. It is about power and the golden rule in a monopolistic and distorted market - he who holds the gold and the ear of government rules.

See also the excellent discussion at Health Care Renewal about the Guardian report.

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Anonymous said...

Yes C.S Lewis

How about C.P. Snow:

"The only ethical principle which has made science possible is that the truth shall be told all the time. If we do not penalise false statements made in error, we open up the way, don't you see, for false statements by intention. And of course a false statement of fact made deliberately, is the most serious crime a scientist can commit." (Snow 1959)

CL Psych said...

Great post. The relentless pursuit of profit in the absence of oversight ends up...

1) Quashing the production of new medicines because it's much easier to just make a me-too medication -- innovation is expensive, copying is cheap. For example, how many SSRI's do we really need on the market?
2) Corrupting academic researchers affiliated with industry -- one can make a lot more $$$ from industry than in academics. The conflicts of interest are becoming lengendary.
3) Blinding the public. Pharma has the cash to run all sorts of advertising and fund so-called patient advocacy groups who present an overly optimistic view of drug treatment
4) Blind doctors. Through the training of "thought leaders," one creates an allegedly objective third-party who proceeds to "educate" their colleagues about the latest wonderful medications. Dissemination of thousands of copies of positve studies while generally suppressing the publication of negative studies is also a great way to make sure your products look safe and effective.

This list could go on for days. Many thanks to this blog for its excellent insights.

Nostrumdammit said...

I quite agree with everything you've written.
The thing that I find sinister is the long view taken by companies
regarding the design of their clinical trials. It's almost as if part of the process of bringing any drug to market now involves the development of an 'evidence base' which works backward from the desired clinical perception, taking great care to oust it's competitors with skewed comparisons en-route.
If you consider the recent change in the guidelines governing
hypertension whereby the faithful old beta-blocker has been cuckoo'd out of the nest and then have a look back at the perindopril series of trials over the past six or so years, I think you'll see some very impressive woolling over several sets of eyes which should have known better. Also - at what stage of R & D did the PPI manufacturers know about
parietal cell proliferation and the difficulty in withdrawing the drug class once healing was achieved???

Anonymous said...

CL Psych - what's wrong with Pharma funded patient advocacy groups? Look at the ways they benefit so many!