That sounds good in theory, but it only works if that evidence can be trusted; if the evidence at hand has been generated independently, without bias and with the sole desire to find the best treatments--pharmaceutical or otherwise. This model fails to work if the underlying motive is profit. In a recent report in the Journal of the American Medical Association French scientists reviewed over studies published in the top medical journals during an entire year, and analyzed in detail 72 of those they considered to be of the highest quality.
In their analysis they only included studies with the most respected and reliable design--the randomized controlled trial. The authors of this report did not just read the abstracts and conclusions of the studies they reviewed, but independently analyzed the raw data. Their findings call into question the reliability of the very scientific papers that doctors use to make decisions regarding treatment and that the press counts on to communicate the latest medical findings.
They found that 40 percent of the articles misrepresented the data in the abstract or in the main text of the study. Furthermore they uncovered that in cases where studies had negative outcomes--in other words, the treatment studied DID NOT work--the scientists authoring the studies created a "spin" on the data that showed the treatments DID work.
Here is their conclusion:. In plain language, 40 percent of the studies we count on to make medical decisions are authored by scientists who act as "spin doctors" distorting medical research to suit personal needs or corporate economic interests.
If the conclusions in 40 percent of the papers published in medical journals are being spun toward independent interests, how can we consider the medicine we are practicing "evidence based? Consider the example of the recent large and widely quoted JUPITER trial "proving" that Crestor a statin or cholesterol-lowering drug could prevent heart attacks in people with normal or low cholesterol.
In this trial researchers twisted the data to suit the commercial sponsor of the study. Marcia Angell, former editor-in-chief of the New England Journal of Medicine recently wrote a scathing analysis of the infiltration of Big Pharma into medical research, education and drug policy. Thought leaders from academic medical centers are provided grants to do research "contracted for" by Pharma, and the research is often designed, executed and ghostwritten by the funders.
The conflict of interest statements of authors on research articles now often runs several pages long. These authors not only receive grants but sit on corporate advisory boards, receive large speaking fees and enter into patent and royalty agreements with Pharma.
Experts like these are also relied upon to create practice guidelines. These guidelines help physicians determine what medications to use and how to keep up with "best practices. For example, in a survey of expert panels, one-third of the panelists had a financial interest in the drugs they evaluated. This led to guidelines that expanded the number of Americans who "should" take statin drugs from 13 million to 36 million. There was only one problem.
Eight of the nine panel members who established these new guidelines had industry ties. An independent group of over 30 scientists in a letter to the National Institutes of Health publicly opposed these recommendations. Even more recently, 95 of the psychiatrists and contributors to the new manual for psychiatric illnesses DSM-V were found to have financial ties to companies that make psychiatric drugs. Studies have also shown that practice guidelines from independent groups such as the American College of Cardiology are based on inadequate or questionable science.
A new model of research may help us sort out this messy collusion between science, government and Big Pharma. Comparative effectiveness research takes existing treatments and compares them to determine which are the most effective.
Unfortunately, fear mongering and lobbying by the pharmaceutical industry for "rationed care" convinced the Senate to leave a critical provision for funding comparative effectiveness research on the cutting room floor. Apparently, independent comparisons of medical therapies, including a comparison of new expensive drugs to older, proven, cheaper drugs, was considered bad for business.
This is all the more tragic given recent findings using this model of research. A large independent comparative effectiveness study conducted in July found older high blood pressure drugs such as water pills or diuretics to be more effective in reducing heart attacks and strokes at dramatically lower cost than "new and improved" blood pressure medication.
Unfortunately, in our health care system, business trumps science every time. Such confusion is not accidental but intentional. The more confusion about medication, the more Big Pharma sells. Propagating doubt is big business.
These are the same kinds of techniques Big Tobacco used to great profit, claiming that scientific links between smoking and cancer were "not proven. Take the recent Avandia debacle. For 10 years Glaxo Smith Kline, based on their internal research, knew their blockbuster diabetes drug increased the risk of heart disease.
But they hid the data. Even though it was legally required, they did not submit the data to the FDA or post it on their website. After legal action forced them to publish the data on a public website, independent scientists analyzed the data, showed it to be harmful and reported their findings.
From to , it is estimated there were over 47, unnecessary deaths from Avandia. Glaxo Smith Kline was fined a few billion dollars for their deception--a fraction of their profit from the drug--and a small penalty to pay for the mass murder of almost 50, people. The Europeans have removed it from the market, but the FDA avoided clear action until this month. Would you want to take it? Would you want your mother or father to take it?
Hiding evidence is only one tactic Pharma uses to illegally promote and profit from medication. Another is illegal marketing practices. They were illegally marketing their drugs to doctors. Drugs can only be marketed for the conditions for which they were approved. If a medication, such as Trileptal one of six illegally marketed Novaritis drugs is approved for seizures, it cannot be marketed for chronic pain. This is exactly what Novaritis and others do.
This is not an oversight, a mistake or unintentional criminal activity on the part of drug companies, but a deliberate and focused strategy that feeds profits. Perhaps, they think of these criminal "fines" as part of their marketing budget. They should be fined the entire amount they earned from the illegal marketing of those drugs.
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