Killing For Profit
Enlightening article!
Originally published on www.medium.com
Enlightening article!
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Originally published on www.medium.com
The idea of
Evidence Based Medicine (EBM) is great. The reality, though, not so much. Human
perception is often flawed, so the premise of EBM is to formally study medical
treatments and there have certainly been some successes
Consider the procedure of angioplasty. Doctors
insert a catheter into the blood vessels of the heart and use a balloon like
device to open up the artery and restore blood flow. In acute heart attacks
studies confirm that this is an effective procedure. In chronic heart disease the COURAGE study
and more recently the ORBITA study
showed that angioplasty is largely useless. EBM helped distinguish the best use
of an invasive procedure.
So, why do prominent physicians call EBM mostly
useless? The 2 most prestigious journals of medicine in the world are The
Lancet and The New England Journal of Medicine. Richard Horton, editor in chief of The
Lancet said this in 2015
The case against science is straightforward: much of
the scientific literature, perhaps half, may simply be untrue
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. I take no pleasure in this
conclusion, which I reached slowly and reluctantly over my two decades as an
editor
This has huge implications. Evidence based
medicine is completely worthless if the evidence base is false or
corrupted. It’s like building a wooden house knowing the wood is termite
infested. What caused this sorry state of affairs? Well, Dr. Relman
another former editor in chief of the NEJM said this in 2002
The medical profession is being bought by the
pharmaceutical industry, not only in terms of the practice of medicine, but
also in terms of teaching and research. The academic institutions of this
country are allowing themselves to be the paid agents of the pharmaceutical
industry. I think it’s disgraceful
The people in charge of the system — the editors of the most important medical journals in the world, gradually learn
over a few decades that their life’s work is being slowly and steadily
corrupted. Physicians and universities have allowed themselves to be bribed.
The examples in medicine are everywhere. Research
is almost always paid for by pharmaceutical companies. But studies done by
industry are well known to have positive results far more frequently. Trials run by industry are 70% more likely than government funded
trials to show a positive result. Think about that for a second. If EBM says
that 2+2 = 5 is correct 70% of the time, would you trust this sort of
‘science’?
Selective
Publication — Negative trials (those
that show no benefit for the drugs) are likely to be
suppressed. For example, in the case of antidepressants, 36/37 studies that were favourable to drugs were published. But of the
studies not favorable to drugs, a paltry 3/36 were published. Selective
publication of positive (for the drug company) results means that a review of
the literature would suggest that 94% of studies favor drugs where in truth,
only 51% were actually positive. Suppose you know that your stockbroker
publishes all his winning trades, but suppresses all his losing trades. Would
you trust him with your money? But yet, we trust EBM with our lives, even
though the same thing is happening.
Let’s look at the following graph of the number of
trials completed versus those that were published. In 2008, the company Sanofi
completed 92 studies but only a piddly 14 were published. Who gets to decide
which gets published and which does not? Right. Sanofi. Which ones do you think
will be published? The ones that favor its drugs, or the ones that prove their drugs
do not work? Right. Keep in mind that this is the only rational course of
action for Sanofi, or any other company to pursue. It’s idiotic to publish data
that harms yourself. It’s financial suicide. So this sort of rational behavior
will happen now, and it will not stop in the future. But knowing this, why do
we still believe the evidence based medicine, when the evidence base is
completely biased? An outside observer, only looking at all published data,
will conclude that the drugs are far, far more effective than they are in
reality. Yet, if you point this out in academic circles, people label you a
quack, who does not ‘believe the evidence’.
Rigging of
Outcomes — Or consider the
example of registration of primary outcomes. Prior to year 2000, companies
doing trials did not need to declare what end points they measured. So they
measure many different endpoints and simply
figured out which one looked best and then declared the trial a success. Kind
of like tossing a coin, looking at which one come up more, and saying that they
were backing the winning side. If you measured enough outcomes, something was
bound to come up positive.
In 2000, the government moved to stop these
shenanigans. They required companies to register what they were measuring ahead
of time. Prior to 2000, 57% of trials showed a positive result. After 2000, a
paltry 8% showed good results. More evidence of the evidence base being
completely corrupted by commercial interest, and the academic physicians who
were getting rich on it tacitly allowing corruption because they know that you
don’t bite the hand that feeds you
‘Advertorials’ — Or
this example of a review paper in the NEJM that fracture rates caused by the lucrative bisphosphonate drugs
were “very rare”. Not only did the drug companies pay lots of consulting fees
to the doctors, three of the authors of this review were full time employees!
To allow an advertorial to be published as the best scientific fact is
scandalous. Doctors, trusting the NEJM to publish quality, unbiased advice have
no idea that this review article is pure advertising. Yet, we still consider
the NEJM to be the very pinnacle of evidence based medicine. Instead, as all
the editors of the journals sadly recognize, it has become lucre-based
publishing. Mo money = better results.
Money from
Reprints — The reasons for this problem is obvious to all — it’s insanely
profitable for journals to take money from Big Pharma. Journals want to be
read. So they all try to get a high Impact Factor (IF). To do this, you need to
get cited by other authors. And nothing boosts ratings like a blockbuster produced by Big Pharma. They have the contacts and the sales
force to make any study a landmark. A less obvious benefit is the fees that are
generated by Big Pharma purchasing articles for reprint. If a company publishes
an article in the NEJM, they may order several hundred thousand copies of the
article to be distributed to unsuspecting doctors everywhere. These fees are
not trivial. The NEJM publisher Massachusetts Medical Society gets 23% of its
income from reprints. The Lancet — 41%. The American Medical Association — a gut busting 53%. No wonder these journals are
ready to sell their readers (ordinary physicians) down the river. It pays. Who
needs journalistic ethics when there’s a Mercedes in the driveway? Mo money,
baby. Mo money.
Bribery of
Journal Editors — A recent study by Liu et al in the BMJ shed more light on the problem of crooked journals. Crooked
journal editors. Editors play a crucial role in determining the scientific
dialogue by deciding which manuscripts are published. They determine who the
peer reviewers are. Using the Open Payments database, they looked at how much
money the editors of the most influential journals in the world were taking
from industry sources. This includes ‘research’ payments, which are largely
unregulated. As mention previously, much ‘research’ consists of going to
meetings in exotic locale. It funny how many conferences are held in beautiful
European cities like Barcelona, and how few are done in brutally cold Quebec
City.
Of all journal editors that could be assessed,
50.6% were on the take. The average payment in 2014 was $27,564. Each. This
does not include an average $37, 330 given for ‘research’ payments. Other
particularly corrupt journals include:
This is slightly horrifying. Each editor of the
Journal of the American College of Cardiology received, on average $475 072
personally and another $119 407 for ‘research’. With 35 editors, that’s about
$15 million in bribes to doctors. No wonder the JACC loves drugs and devices.
It pays the private school bills. Mo money = we’ll publish your crooked studies
for you. Mo money, baby, mo money.
Publication
Bias — The evidence base that
EBM depends upon is completely biased. Some people
think I’m really anti-Pharma, but this is not really true. Big Pharma companies
have a duty to their shareholders to make money. They have no duty to patients.
On the other hand, doctors have a duty to patients. Universities have a duty to
remain unbiased.
It is the failure of doctors and universities to
keep their greedy paws out of the corrupting influence of Big Pharma money that
is the problem. If Big Pharma is allowed to spend lots of $$$ paying off
doctors and universities and professors, then it should do so to maximize
profits. That is their mission statement. Doctors love to blame Big Pharma
companies because it takes peoples gaze off the real problem — lots of doctors taking
$$$ from anybody who will pay. The pharma industry is not the problem. Bribery of university doctors is the problem — one that is easily
fixed if the political will exists.
Consider this study. Looking at studies in the field of neurodegenerative disease,
researchers looked at all the studies that were started but never finished or
never published. Approximately 28% of studies never made it to the finish line.
That’s a problem. If all the studies that don’t look promising for drug candidates
are not published, then it appears that the drugs are way way more effective
than they really are. But the published ‘evidence base’ would falsely support
the drug. Indeed, Pharma sponsored trials were 5 times more likely to
be unpublished.
Imagine you have a coin flipping contest. Suppose a
player call ‘Big Pharma” chooses heads, and also pays the coin flipper. Every
time the coin flipper pulls up tails, the results don’t count. Every time it
comes up heads, it counts. This happens 28% of the time. Now, instead of a
50/50 split of heads and tails, it’s more like a 66/34 split of heads/tails. So
the ‘evidence based medicine’ lover claims that heads is far more likely to
come up than tails, and castigates people who don’t believe the results as ‘anti-science’.
Evidence based medicine depends entirely upon
having a reliable base of evidence (studies). If the evidence base is tampered
with, and paid for, then EBM as a science is completely useless. Indeed, the
very editors whose entire careers have been EBM have now discovered it to be
worthless. Does the CEO of Phillip Morris (maker of Marlboro cigarettes) smoke?
That tells you all you need to know about the health risks. Do the editors of
the NEJM and the Lancet believe EBM anymore? Not at all. So neither should we.
We can’t believe evidence based medicine until the evidence has been cleaned up
from the corrupting influence of commercial interests.
Financial conflicts of interest (COI), also known
as gifts to doctors, is a well accepted practice. A national survey in
the New England Journal of Medicine in 2007 shows that 94% of physicians had ties to the pharmaceutical
industry. This gravy train only rides in one direction. From Big Pharma to the
wallets of doctors. Sure Big Pharma can simply pay doctors directly, and it
does plenty of that. It’s no surprise that medical students with more exposure to pharmaceutical reps
develop a more positive attitude towards them. Many
medical schools have limited exposure of medical students in response, but
declined to get off the gravy train themselves. There is a simple relationship
between how prominent a physician is (more articles published — almost always academic
doctors and professors) and how much money they take from Big Pharma. Mo
prominent = mo money. Further, there is a ‘clear and strong link’ between taking industry money and
minimizing the risk of side effects of medications. What, you thought people teach at prestigious institutions like
universities for the good of mankind? Maybe that’s why they went there, but
that’s not why they stay. They came for the science. They stayed for the money.
So here’s a damning list of all the problems of EBM
- Selective Publication
- Rigged outcomes
- Advertorials
- Reprint Revenues
- Bribery of Journal Editors
- Publication Bias
- Financial Conflicts of Interests
When the evidence base of medicine is bought and
paid for, people die. That is how doctors have created this opioid crisis that
kills thousands of people. Pharmaceutical companies want to pay off
doctors, just as drug lord want to pay off judges and police officers. Doctors,
being human, should put safeguards against this temptation. Unfortunately,
doctors and universities have been willing participants in this game of killing for profit. We need to end it now. End the corruption of the universities. Stop
the bribery of doctors.
Nephrologist. Special interest in type 2 diabetes
reversal and intermittent fasting. Founder of Intensive Dietary Management
Program.
Disclaimer: This article is not intended to
provide medical advice, diagnosis or treatment. Views expressed here do not
necessarily reflect those of GreenMedInfo or its staff.
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