Bad Pharma Quotes

The American Academy of Nutrition and Dietetics is sponsored by Coca-Cola.

And if, by the end [of this book], you reckon you might still disagree with me, then I offer you this: you'll still be wrong, but you'll be wrong with a lot more panache and flair than you could possibly manage right now.

Homeopathy pills are, after all, empty little sugar pills which seem to work, and so they embody [..] how we can be misled into thinking that any intervention is more effective than it really is.

Problems in medicine do not mean that homeopathic sugar pills work; just because there are problems with aircraft design, that doesn't mean that magic carpets really fly.

It is clear from the evidence presented in this book that the pharmaceutical industry does a biased job of disseminating evidence - to be surprised by this would be absurd - whether it is through advertising, drug reps, ghostwriting, hiding data, bribing people, or running educational programmes for doctors.

there is essentially no difference between the vitamin industry and the pharmaceutical and biotech industries (that

The American Academy of Pediatrics officially supports breastfeeding, but receives about half a million dollars from Ross, manufacturers of Similac infant formula.

The current regulations -- for companies, doctors and researchers -- create perverse incentives; and we'll have better luck fixing those broken systems than we will ever have trying to rid the world of avarice

natural frequencies are the only sensible way to communicate risk.

Some have estimated that the pharmaceutical industry overall spends about twice as much on marketing and promotion as it does on research and development.

Torture the data, and it will confess to anything,” as

Changing mainstream media will be hard, but you can help create parallel options. More academics should blog, post videos, post audio, post lectures, offer articles, and more. You’ll enjoy it: I’ve had threats and blackmail, abuse, smears and formal complaints with forged documentation. But it’s worth it, for one simple reason: pulling bad science apart is the best teaching gimmick I know for explaining how good science works.

In the past, [medicalization]has been portrayed as something that doctors inflict on a passive and un-suspecting world - an expansion of the Medical Empire. But in reality, it seems that these reductionist bio-medical stories can appeal to us all, because complex problems often have depressingly-complex causes, and the solutions can be taxing, and unsatisfactory.

Most people know what constitutes a healthy diet already. If you want to make money out of it, you have to make a space for yourself in the market, and to do this, you must overcomplicate it, attach your own dubious stamp.

So, if we're to make any sense of the mess that the pharmaceutical industry - and my profession - has made of the academic literature, then we need an amnesty: we need a full and clear declaration of all the distortions, on missing data, ghostwriting, and all the other activity described in this book, to prevent the ongoing harm that they still cause.

Homeopathy pills are, after all, empty little sugar pills that seem to work, and

You cannot reason people out of positions they didn’t reason themselves into.

twenty years ago. First, when you take a static picture of society, people

I hope that you will be asked to participate in a trial at some stage in your disease

If your drug didn’t win overall in your trial, you can chop up the data in lots of different ways, to try and see if it won in a subgroup: maybe it works brilliantly in Chinese men between fifty-six and seventy-one. This is as stupid as playing ‘Best of three … Best of five…’ And yet it is commonplace.

scaremongers—who unquestioningly champion anecdotal data, while meticulously examining every large, carefully conducted study on the same subject for any small chink that would permit them to dismiss it entirely.

[I]t seems to me that a lot of the stranger ideas people have about medicine derive from an emotional struggle with the very notion of a pharmaceutical industry. Whatever our political leanings, we all feel nervous about profit taking any role in the caring professions, but that feeling has nowhere to go. Big pharma is evil; I would agree with that premise. But because people don’t understand exactly how big pharma is evil, their anger gets diverted away from valid criticisms—its role in distorting data, for example, or withholding lifesaving AIDS drugs from the developing world—and channeled into infantile fantasies. “Big pharma is evil,” goes the line of reasoning; “therefore homeopathy works and the MMR vaccine causes autism.” This is probably not helpful.

Doubt has also been cast on the value of McKeith’s certified membership of the American Association of Nutritional Consultants, especially since Guardian journalist Ben Goldacre managed to buy the same membership online for his dead cat for $60.

So what steps can a regulator take when it has established that there is a problem? In very extreme cases it can remove a drug from the market (although in the US, technically drugs usually stay on the market, with the FDA advising against their use). More commonly it will issue a warning to doctors through one of its drug safety updates, a ‘Dear Doctor’ letter, or by changing the ‘label’ (confusingly, in reality, a leaflet) that comes with the drug. Drug-safety updates are sent to most doctors, though it’s not entirely clear whether they are widely read. But, amazingly, when a regulator decides to notify doctors about a side effect, the drug company can contest this, and delay the notice being sent out for months, or even years.

At this time we should take a brife moment to mention quacks: alternative therapists who sell vitamins and homeopathy sugar pills [the latter of which, by definition, contain no active ingredients], which perform no better than placebo in fair tests, and who use even cruder marketing tricks than the ones described in this book. In these people profit at all from the justified anger that people feel towards the pharmaceutical industry, then it comes at the expense of genuinely constructive activity. Selling ineffective sugar pills is not a meaningful policy response to the regulatory failure we have seen in this book

there is an almost linear relationship between the methodological quality of a homeopathy trial and the result it gives. The worse the study—which is to say, the less it is a “fair test”—the more likely it is to find that homeopathy is better than placebo.

Today, scientists and doctors find themselves outnumbered and outgunned by vast armies of individuals who feel entitled to pass judgment on matters of evidence—an admirable aspiration—without troubling themselves to obtain a basic understanding of the issues.

In medicine, brand identities are irrelevant, and there’s a factual, objective answer to whether one drug is the most likely to improve a patient’s pain, suffering and longevity. Marketing, therefore, one might argue, exists for no reason other than to pervert evidence-based decision-making in medicine.

we hope that this will help reduce the chances of real-world outcomes, like heart attack and death, both of which occur at a higher rate in people with

Pulling bad science apart is the best teaching gimmick I know for explaining how good science really works.

in 2008, shortly after being elected President, Barack Obama demonstrated to many academics and doctors that he had a clear understanding of the deep problems in health care, by committing to spend $1 billion on head-to-head trials of commonly used treatments, in order to find out which is best. In return he was derided by right-wing critics as ‘anti-industry’.

Doctors are generally nice people, and eager to please. They will get bounced into giving people what they want, and a lot of patients have been persuaded, through whatever social processes are at play in the world, that pills fix things. I'll rephrase that for something that's coming later in this chapter: a lot of people have been convinced that they're patients.

a review of trials of acupuncture for back pain showed that the studies that were properly blinded showed a tiny benefit for acupuncture, which was not “statistically significant” (we’ll come back to what that means later). Meanwhile, the trials that were not blinded—the ones in which the patients knew whether they were in the treatment group or not—showed a massive, statistically significant benefit for acupuncture.

Aside from all this, for several of the most important and enduring problems in medicine, we have no idea what the best treatment is, because it’s not in anyone’s financial interest to conduct any trials at all.

The detox phenomenon is interesting because it represents one of the most grandiose innovations of marketers, lifestyle gurus, and alternative therapists: the invention of a whole new physiological process. In terms of basic human biochemistry, detox is a meaningless concept. It doesn’t cleave nature at the joints. There is nothing on the “detox system” in a medical textbook. That burgers and beer can have negative effects on your body is certainly true, for a number of reasons; but the notion that they leave a specific residue, which can be extruded by a specific process, a physiological system called detox, is a marketing invention.

Classically, cosmetics companies will take highly theoretical, textbookish information about the way that cells work—the components at a molecular level or the behavior of cells in a glass dish—and then pretend it’s the same as the ultimate issue of whether something makes you look nice. “This molecular component,” they say, with a flourish, “is crucial for collagen formation.” And that will be perfectly true (along with many other amino acids which are used by your body to assemble protein in joints, skin, and everywhere else), but there is no reason to believe that anyone is deficient in it or that smearing it on your face will make any difference to your appearance. In general, you don’t absorb things very well through your skin, because its purpose is to be relatively impermeable. When you sit in a bath of baked beans for charity, you do not get fat, nor do you start farting.

Here we will see that pharmaceutical companies spend tens of billions of pounds every year trying to change the treatment decisions of doctors: in fact, they spend twice as much on marketing and advertising as they do on the research and development of new drugs. Since we all want doctors to prescribe medicine based on evidence, and evidence is universal, there is only one possible reason for such huge spends: to distort evidence-based practice.

Amateur critics often like to dismiss anecdotes as ‘unscientific’, but this is wrong: anecdotes are weaker evidence than trials, but they are not without value, and are often the first sign of a problem (or an unexpected benefit).

[...] I’m very grateful to all the many companies and people who, by their optimistically bad behaviour under fire, have given narrative colour to what might otherwise have been some very dry explanations of basic statistical principles.

Stigma takes many forms, comes from all directions, is sometimes blatantly overt, but can also be remarkably subtle. It is the cruel comment, the unkind smirk, the extrusion from the group, the lost job opportunity, the rejected marriage proposal, the ineligibility for life insurance, the inability to adopt a child or pilot a plane. But it is also the reduced expectation, the helping hand when none is needed or wanted, the solicitous sympathy that one cannot really be expected to measure up. And the secondary psychological and practical harms of having a mental disorder come only partly from how others see you. A great deal of the trouble comes from the change in how you see yourself: the sense of being damaged goods, feeling not normal or worthy, not a full fledged member of the group. It is bad enough that stigma is so often associated with having a mental disorder, but the stigma that comes from being mislabeled with a fake diagnosis is a dead loss with absolutely no redeeming features.

The idea that depression is caused by low serotonin levels in the brain is now deeply embedded in popular folklore, and people with no neuroscience background at all will routinely incorporate phrases about it into everyday discussion of their mood, just to keep their serotonin levels up. Many people also don't know that this is how antidepressant drugs work: depression is caused by low serotonin, so you need drugs which raise the serotonin levels in your brain, like SSRI antidepressants, which are 'selective serotonin reuptake inhibitors'. But this theory is wrong. The 'serotonin hypothesis' for depression, as it is known, was always shaky, and the evidence now is hugely contradictory ... But in popular culture the depression-serotonin theory is proven and absolute, because it has been marketed so effectively.

The most notorious story is the Trovan antibiotic study conducted by Pfizer in Kano, Nigeria, during a meningitis epidemic. An experimental new antibiotic was compared, in a randomised trial, with a low dose of a competing antibiotic that was known to be effective. Eleven children died, roughly the same number from each group. Crucially, the participants were apparently not informed about the experimental nature of the treatments, and moreover, they were not informed that a treatment known to be effective was available, immediately, from Médecins sans Frontières next door at the very same facility. Pfizer argued in court – successfully – that there was no international norm requiring it to get informed consent for a trial involving experimental drugs in Africa, so the cases relating to the trial should be heard in Nigeria only. That’s a chilling thing to hear a company claim about experimental drug trials, and it was knocked back in 2006 when the Nigerian Ministry of Health released its report on the trial. This stated that Pfizer had violated Nigerian law, the UN Convention on the Rights of the Child and the Declaration of Helsinki.

different subject. The story of the serotonin hypothesis for depression, and its enthusiastic promotion by drug companies, is part of a wider process that has been called ‘disease-mongering’ or ‘medicalisation’, where diagnostic categories are widened, whole new diagnoses are invented, and normal variants of human experience are pathologised, so they can be treated with pills. One simple illustration of this is the recent spread of ‘checklists’ enabling the public to diagnose, or help diagnose, various medical conditions. In 2010, for example, the popular website WebMD launched a new test: ‘Rate your risk for depression: could you be depressed?’ It was funded by Eli Lilly, manufacturers of the antidepressant duloxetine, and this was duly declared on the page, though that doesn’t reduce the absurdity of what followed. The test consisted of ten questions, such as: ‘I feel sad or down most of the time’; ‘I feel tired almost every day’; ‘I have trouble concentrating’; ‘I feel worthless or hopeless’; ‘I find myself thinking a lot about dying’; and so on. If you answered ‘no’ to every single one of these questions – every single one – and then pressed ‘Submit’, the response was clear: ‘You may be at risk for major depression’.

So should patients born under Libra and Gemini be deprived of treatment? You would say no, of course, and that would make you wiser than many in the medical profession: the CCSG trial found that aspirin was effective at preventing stroke and death in men, but not in women;30 as a result, women were undertreated for a decade, until further trials and overviews showed a benefit. That is just one of many subgroup analyses that have misled us in medicine, often incorrectly identifying subgroups of people who wouldn’t benefit from a treatment that was usually effective. So, for example, we thought the hormone-blocking drug tamoxifen was no good for treating breast cancer in women if they were younger than fifty (we were wrong). We thought clotbusting drugs were ineffective, or even harmful, when treating heart attacks in people who’d already had a heart attack (we were wrong). We thought drugs called ‘ACE inhibitors’ stopped reducing the death rate in heart failure patients if they were also on aspirin (we were wrong). Unusually, none of these findings was driven by financial avarice: they were driven by ambition, perhaps; excitement at new findings, certainly; ignorance of the risks of subgroup analysis; and, of course, chance.

Like many doctors, I was frankly traumatized by some of the experiences I had early on in my career. When you lean over a patient in an emergency room, trying to bring a dead body back to life, you are entirely focused on the job at hand. On the other side of a thin curtain, you can hear that person’s husband or wife howling and wailing, knowing that the person they loved and lived with for fifty years is dying, begging the staff to do all they can, phoning their children, struggling to speak through tears to form the words and communicate the horror, telling them to come, quickly. I have memories from cubicles that I will never be able to deal with, and they upset me even now.

Some have estimated that the pharmaceutical industry overall spends about twice as much on marketing and promotion as it does on research and development. Regardless of how those two figures compare to each other, the fact that they are in the same ballpark gives one pause, and this is worth mulling over in various contexts. For example, when a drug company refuses to let a developing country have affordable access to a new AIDS drug it’s because – the company says – it needs the money from sales to fund research and development on other new AIDS drugs for the future. If R&D is a fraction of the company’s outgoings, and it spends a similar amount on promotion, then this moral and practical argument doesn’t hold water quite so well.

Some have estimated that the pharmaceutical industry overall spends about twice as much on marketing and promotion as it does on research and development. Regardless of how those two figures compare to each other, the fact that they are in the same ballpark gives one pause, and this is worth mulling over in various contexts. For example, when a drug company refuses to let a developing country have affordable access to a new AIDS drug it’s because – the company says – it needs the money from sales to fund research and development on other new AIDS drugs for the future. If R&D is a fraction of the company’s outgoings, and it spends a similar amount on promotion, then this moral and practical argument doesn’t hold water quite so well. The scale of this spend is fascinating in itself, when you put it in the context of what we all expect from evidence-based medicine, which is that people will simply use the best treatment for the patient. Because when you pull away from the industry’s carefully fostered belief that this marketing activity is all completely normal, and stop thinking of drugs as being a consumer product like clothes or cosmetics, you suddenly realise that medicines marketing only exists for one reason. In medicine, brand identities are irrelevant, and there’s a factual, objective answer to whether one drug is the most likely to improve a patient’s pain, suffering and longevity. Marketing, therefore, one might argue, exists for no reason other than to pervert evidence-based decision-making in medicine.

The most widely cited figure for the number of women suffering from Female Sexual Dysfunction comes from 1999: according to this, some 43 per cent of all women have a medical problem around their sex drive.27 This survey was published in the Journal of the American Medical Association (JAMA), one of the most influential journals in the world. It looked at questionnaire data asking about things like lack of desire for sex, poor lubrication, anxiety over sexual performance, and so on. If you answered ‘yes’ to any one of these questions, you were labelled as having Female Sexual Dysfunction. For the avoidance of any doubt about the influence of this paper, it has – as of a sunny evening in March 2012 – been cited 1,691 times. That is a spectacular number of citations. At the time, no financial interest was declared by the study’s authors. Six months later, after criticism in the New York Times, two of the three authors declared consulting and advisory work for Pfizer.28 The company was gearing up to launch Viagra for the female market at this time, and had lots to gain from more women being labelled as having a medical sexual problem.

It would be a mistake to imagine that drug companies are the only people applying pressure for fast approvals. Patients can also feel they are being deprived of access to drugs, especially if they are desperate. In fact, in the 1980s and 1990s the key public drive for faster approvals came from an alliance forged between drug companies and AIDS activists such as ACT UP. At the time, HIV and AIDS had suddenly appeared out of nowhere, and young, previously healthy gay men were falling ill and dying in terrifying numbers, with no treatment available. We don’t care, they explained, if the drugs that are currently being researched for effectiveness might kill us: we want them, because we’re dying anyway. Losing a couple of months of life because a currently unapproved drug turned out to be dangerous was nothing, compared to a shot at a normal lifespan. In an extreme form, the HIV-positive community was exemplifying the very best motivations that drive people to participate in clinical trials: they were prepared to take a risk, in the hope of finding better treatments for themselves or others like them in the future. To achieve this goal they blocked traffic on Wall Street, marched on the FDA headquarters in Rockville, Maryland, and campaigned tirelessly for faster approvals.

People were “guilty,” of thought-crimes like “HIV denialism.” Fauci had made political correctness the new revolutionary language, see? And that meant if you were “bad,” if you didn’t push agenda driven science, everything was taken away from you. And the media cheered. And anybody who didn’t was destroyed, vilified, harassed, fired, in a word, canceled.

I naïvely thought the pandemic would not make a big difference in the gap because my thinking was that it’s a global pandemic, so every country is going to take a hit,” said Steven Woolf, Director Emeritus of the Center on Society and Health at Virginia Commonwealth University. “What I didn’t anticipate was how badly the US would handle the pandemic. These are numbers we aren’t at all used to seeing in this research; 0.1 years is something that normally gets attention in the field, so 3.9 years and 3.25 years and even 1.4 years is just horrible,” Woolf continued. “We haven’t had a decrease of that magnitude since World War II.”26

This is how we know that Anthony Fauci was well aware of remdesivir’s toxicity when he orchestrated its approval for COVID patients. NIAID sponsored that project. Dr. Fauci had another NIAID-incubated drug, ZMapp, in the same clinical trial, testing efficacy against Ebola alongside two experimental monoclonal antibody drugs. Researchers planned to administer all four drugs to Ebola patients across Africa over a period of four to eight months.10,11 However, six months into the Ebola study, the trial’s Safety Review Board suddenly pulled both remdesivir and ZMapp from the trial.12 Remdesivir, it turned out, was hideously dangerous. Within 28 days, subjects taking remdesivir had lethal side effects including multiple organ failure, acute kidney failure, septic shock, and hypotension, and 54 percent of the remdesivir group died—the highest mortality rate among the four experimental drugs.13 Anthony Fauci’s drug, ZMapp, ran up the second-highest body count at 44 percent. NIAID was the primary funder of this study, and its researchers published the bad news about remdesivir in the New England Journal of Medicine in December 2019.

What’s good for you isn’t necessarily good for others—and vice versa. Consider this story: In 1985, a discovery by a major U.S. pharma firm led to a significant success in breast cancer treatment in two animal species. The phase I human trials showed no major safety concerns, but the study failed in phase II. The problem was with the cohort that was used. Half the patients had a gene that failed to metabolize the drug and they developed toxicity; the other half had a gene that metabolized the drug so quickly that it had no effect. When this problem was finally discovered in 2010 after gene sequencing of humans and of their tumors became more common, researchers realized that this beneficial drug had not helped the hundreds of thousands it could have since 1985. The point: The Human Genome Project has led to a better understanding of why something can be bad for some but good for others. That has led to scientific progress that is letting us live younger for longer.

That doesn’t mean all chemical antidepressants are bad: some credible scientists argue they give some temporary relief to a minority of users, and that shouldn’t be dismissed. The false story is the claim that depression is caused by a chemical imbalance in the brain and that the primary solution for most people is a chemical antidepressant. That story has made Big Pharma over $100 billion,1 which is one of the crucial reasons why it persists.

Meanwhile,” adds Dr. Brownstein, “we’ve seen lots of really bad vaccine side effects in our patients. We’ve had seven strokes—some ending in severe paralysis. We had three cases of pulmonary embolism, two blood clots, two cases of Graves’ disease, and one death.

My health research is bad for the businesses of healthcare and the pharmaceutical industries.

As we have seen, drugs regulators don't require that new drugs are particularly good, or an improvement on what came before; they don't even require that drugs are particularly effective.

[T]here's room for a small cottage industry, if there are any academics feeling brave enough to pursue the project. Someone somewhere needs to identify all the studies where the main outcomes have been switched, demand access to the raw data, and helpfully, at long last, conduct the correct analyses for the original researchers. If you choose to do this, your published papers will immediately become the definitive reference on these trials, because they will be the only ones to correctly present the pre-specified trial outcomes. The publications from the original researchers will be no more than a tangential and irrelevant distraction. ¶ I'm sure they'll be pleased to help.

About a quarter of the money taken by pharmaceutical companies for the drugs they sell is turned around into promotional activity which has, as we will see, a provable impact on doctors' prescribing. So we pay for products, with a huge uplift in price to cover their marketing budgets, and that money is then spent on distorting evidence-based practice, which in turn makes our decisions unnecessarily expensive, and less effective.

pharmaceutical companies spend tens of billions of pounds every year trying to change the treatment decisions of doctors: in fact, they spend twice as much on marketing and advertising as they do on the research and development of new drugs. Since we all want doctors to prescribe medicine based on evidence, and evidence is universal, there is only one possible reason for such huge spends: to distort evidence-based practice.

The Bias Toward Positive Evidence It is the peculiar and perpetual error of the human understanding to be more moved and excited by affirmatives than negatives. —Francis Bacon

The reason Big Pharma spends so much on small gifts as well as the big ones is well known to marketers, lobbyists, and social psychologists: being given a gift evokes an implicit desire to reciprocate.