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“Pharmaceutical companies now control most of the medical research agenda, and their primary goal is not to improve Americans’ health but to maximize their own profits, which they do masterfully… they control the design, conduct, and analysis of most clinical research; and they largely control the delivery of the results of that research across the entire spectrum, from the most respected peer-reviewed medical journals to all those annoying drug ads on TV.”

  • John Abramson, former family physician, clinical faculty of Harvard Medical School teaching public health policy, and expert in litigation involving fraudulent science in the pharmaceutical industry.

If you watch the evening news anywhere in America, you may be startled to notice that almost all of the adverts are pharma ads.

Like most people, I naïvely believed that the reason for this was because it was a prime-time sport and the pharmaceutical companies wanted to make you go out and hassle your doctor for prescriptions. After all, America – along with New Zealand – is unique in the world for allowing direct-to-consumer advertising of prescription drugs.

Many doctors complain about this. They say patients always come demanding the flashy new wonder drug, As Seen on TV!, when an ordinary generic would do the same job for far cheaper, and may even be safer. Patients think the doctor is being stingy if they refuse to bill their insurance for what they believe they are entitled to in exchange for paying their premiums, and doctors don’t have time to argue all day with patients who think they know best. So, we know for a fact that direct-to-consumer advertising does lead to an uptake in the purchase of drugs at least some of the time. But that isn’t the primary reason for it.

The real reason why pharmaceutical companies are advertising during the news is to buy favorable coverage. It’s shocking, but when you look at how the incentives line up it makes perfect sense. Approved drugs are withdrawn from the market at an alarming rate, but this rarely make headlines. In fact, there are enough drug withdrawal events that an outcry could be drummed up virtually any day of the week if someone decided to seize upon it and make it big news. But why the media alienate all their best-paying advertisers by reporting them to the public? That’s why there is surprisingly little criticism of mainstream medicine in the news.

There’s nothing wrong with advertising as such. For most companies it’s the only way they have of establishing an initial market before gaining the benefit of customer testimonials and reviews from the press. However, there are not enough checks-and-balances in place to allow people to make educated decisions regarding drugs which alter their physiology in ways they don’t understand and can even be irreversible. Without knowing it, people are relying on drug manufacturers as their only source of information because the reach of the drug companies is ubiquitous. They are not only the major source of funding for the media, and the medical schools, and Continuing Medical Education – they are also the major source of funding for public health organizations like the CDC, AMA, FDA, NIH and WHO, and even medical journals – which are supposed to serve as a source of scientifically rigorous, impartial information for researchers, doctors and medical experts.

When the FDA regulator, Dr. David Graham, fought against the approval of Vioxx – an anti-inflammatory drug that caused heart attacks and was no more effective than it’s alternatives while far more expensive – his supervisor told him that the FDA’s client was the pharmaceutical industry. Consequently, the FDA approved Vioxx.

When Graham tried to make the scientific community aware of Vioxx’s deadly side effects, he was offered a better position within the agency to stay quiet. Fortunately, he refused to take what he regarded a bribe. He shared his data at scientific meetings, and Merck voluntarily withdrew Vioxx from the market. By the FDA’s own reckoning, about 140,000 heart attacks and 60,000 deaths were attributable to Vioxx, making it the biggest single drug disaster in U.S. history. Given that one out of ten American adults had taken Vioxx in the five years before it was recalled, the number of casualties is probably much higher.

Both the New England Medical Journal and the Journal of the American Medical Association, two of the most trusted and respected medical journals, published information about the comparative safety of Vioxx that was misleading, false and downright fraudulent. It led people to think Vioxx was a lot less dangerous than it was. Even once it became clear that Vioxx caused heart attacks at an alarming rate, the NEMJ refused to update the article, one representative stating: “We can’t be in the business of policing every piece of data we put out.”

This led to incredible harm and loss of life, but The NEJM just kept selling reprints of the misleading article to Merck so they could issue it to doctors to propagandize them into prescribing Vioxx. Nearly a million of them! The journal made over $700,000 from the deal.

When Vioxx was finally pulled off the market in 2004, it was the biggest drug recall in history. 25 million Americans had taken it to relieve aches and pains although it did not do so any more effectively than older, safer, far less expensive anti-inflammatory drugs. Roughly as many of them died as the number of American soldiers who died in Vietnam.

The foxes are guarding the chicken coop.

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