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"...public opinion deserves to be respected as well as despised" G.W.F. Hegel, 'Philosophy of Right'

drugs, doctors, disease « Previous | |Next »
January 5, 2009

In Drug Companies & Doctors: A Story of Corruption in the New York Review of Books Marcia Angell, a former editor of the New England Journal of Medicine, highlights a disturbing trend in modern medicine. She says:

No one knows the total amount provided by drug companies to physicians, but I estimate from the annual reports of the top nine US drug companies that it comes to tens of billions of dollars a year. By such means, the pharmaceutical industry has gained enormous control over how doctors evaluate and use its own products. Its extensive ties to physicians, particularly senior faculty at prestigious medical schools, affect the results of research, the way medicine is practiced, and even the definition of what constitutes a disease.

The conflicts of interest in medicine are deep and pervasive given the dependence of the medical profession on the pharmaceutical industry.

The redefining of disease refers to the way that drug companies have perfected a new and highly effective method to expand their markets. Instead of promoting drugs to treat diseases, they have begun to promote diseases to fit their blockbuster drugs. The strategy is to convince as many people as possible (along with their doctors, of course) that they have medical conditions that require long-term drug treatment.

Some of the biggest blockbusters are psychoactive drugs. The theory that psychiatric conditions stem from a biochemical imbalance is used as a justification for their widespread use, even though the theory has yet to be proved. Children are particularly vulnerable targets. What parents dare say "No" when a physician says their difficult child is sick and recommends drug treatment? The consequences is that:

physicians learn to practice a very drug-intensive style of medicine. Even when changes in lifestyle would be more effective, doctors and their patients often believe that for every ailment and discontent there is a drug. Physicians are also led to believe that the newest, most expensive brand-name drugs are superior to older drugs or generics, even though there is seldom any evidence to that effect because sponsors do not usually compare their drugs with older drugs at equivalent doses. In addition, physicians, swayed by prestigious medical school faculty, learn to prescribe drugs for off-label uses without good evidence of effectiveness.

Angell says that breaking the dependence of the medical profession on the pharmaceutical industry will take a sharp break from an extremely lucrative pattern of behavior. But if the medical profession does not put an end to this corruption voluntarily, it will lose the confidence of the public, and the government will step in and impose regulation.

| Posted by Gary Sauer-Thompson at 7:28 AM | | Comments (4)


I was placed on a new drug some time ago and when I was filling the prescription casually asked the chemist about possible side effects.
She went off and came back with a thick book and we looked at all the medical research results for that particular drug.
What amazed me, and perhaps this particular drug research is atypical, was the small number of case studies and participants, barely more than a few dozen. I had expected long term studies, many years at least perhaps decades, involving hundreds or thousands of human guinea pigs.
Not so. At least for this commonly prescribed drug.
I wonder if this is unusual.

And the side effects?
Too many to list.

Maybe not. Marcia Angell in the above link says the following. In the US:

Drugs are approved only for a specified use—for example, to treat lung cancer—and it is illegal for companies to promote them for any other use.But physicians may prescribe approved drugs "off label"—i.e., without regard to the specified use—and perhaps as many as half of all prescriptions are written for off-label purposes. After drugs are on the market, companies continue to sponsor clinical trials, sometimes to get FDA approval for additional uses, sometimes to demonstrate an advantage over competitors, and often just as an excuse to get physicians to prescribe such drugs for patients. (Such trials are aptly called "seeding" studies.)

She goes on to say that today company employees or their agents often design the studies, perform the analysis, write the papers, and decide whether and in what form to publish the results.

Sometimes the medical faculty who serve as investigators are little more than hired hands, supplying patients and collecting data according to instructions from the company.

"even the definition of what constitutes a disease."

... and the terminology used to describe a physiological state.

See "The Role of Medical Language in Changing Public Perceptions of Illness" (doi:10.1371/journal.pone.0003875) and my potted summary/opinion in "Medical terminology for fun and profit"

The other related issue is that funding research into new therapeutic effects of non-patentable drugs (like aspirin), even though initial studies and meta-analyses show great promise, is carried out all too rarely.

One of the big problems is that studies funded by Big Pharma that do not support the efficacy of their product, or highlight risks, are buried. There is a push to make ALL trials registered as they start, and force publication to stop this practice designed to mislead.

thanks. The study you referred to states:

This study demonstrates that the use of medical language in communication can induce bias in perception; a simple switch in terminology results in a disease being perceived as more serious, more likely to be a disease, and more likely to be a rare condition. These findings regarding the conceptualization of disease have implications for many areas, including medical communication with the public, advertising, and public policy.

As you point out the traditional biomedical realm is being extended. It reaches its limit with the idea of wellness and lifestyle illness.