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Manipulating causality: Medical journals and the pharmaceutical industry fraud

22 May

“Medical journals are an extension of the marketing arm of pharmaceutical companies”

Richard Smith

This is a safe life

We are never far from captivating headlines telling us how our path to eventual death may be even closer should we consider squatting below 90, consuming a double espresso, eating bacon and eggs, or god forbid, challenging state health authority recommendations for diet and exercise. For most, avoiding doing anything remotely controversial when it comes to lifestyle changes is a scary option. And people do not like to get scared. People prefer to stay inside the wheel like a mouse, going nowhere in particular, eating birdseed, and wondering if what you did yesterday was what you will do tomorrow, and the day after. But of course being content that even if you never get around to doing something, you´ll not face fear. Society tells us a lot about fear, let´s just exist.

But some seek to understand their shortcomings, and move beyond page 3 of the tabloid newspapers whilst subliminally wondering what life on the road with Shakira would be like (this is the alter ego speaking, they confused image with reality). Some seek the science behind the myth, the clinical evidence that makes us convinced cholesterol is bad, fat loss is a genetic thing, and 60% carbohydrate intake is optimal for health performance. We go to the journals.

I´ve always liked journals, not so much for their up-to-dateness, but for the constant variation and stimulation provided on a regular basis, and the thought provoking material that one can either add to the pile in the office shelf or keep open and develop further knowledge. Much like relationships to a woman or a dip bar, journals can be a challenge, and thoroughly rewarding if approached methodically at the correct time in a focussed way, but can provide confusing feedback that may require extended periods of self-reflection. If I appear slightly Freudian, I can explain. And I love the dip bar.

Richard Smith was editor in chief of the British Medical Journal and CEO of the BMJ Publishing Group for 13 years between 1991-2004. His article “Medical Journals Are an Extension of the Marketing Arm of Pharmaceutical Companies” is based on a lecture at the Medical Society of London in October 2004 when receiving the HealthWatch Award. The article overlaps to a small extent with an article published in the BMJ in 2003. He later published a book in 2006 entitled “The Trouble with Medical Journals” which further expands upon this topic. Now what struck me as interesting, was the levels of collusion that must be systematically inherent in the medical journal industry that allows for randomised controlled clinal trials to be the basis of cause and effect “evidence” that ends up as published papers, which are force fed to the medical industry, state health authorities and eventually to all the mice on treadmills living the life of existence in the uncivilized and brainwashed modern society. Sorry about the long sentence, I´ve been reading too many medical journals and drinking coffee, so that MUST be the effect.

The pharmaceutical industry is big. The biggest company Pfizer had global revenues in 2008 of USD$68billion, so sponsoring journals and clinical trials and no doubt unethical medical practitioners/peer reviewers to promote its drugs is well worth it. The World Health Organization (WHO) recently issued a fact sheet warning about the corrupt and unethical practices that are endemic to every step of the pharmaceuticals business. This is probably not so new to many, as is usually the case with multi-billion dollar industries, corruption and malpractice is the norm rather than the exception; “Join the ride and keep your trap shut, or stand up against it, quit the industry and take up life as a poor, but morally sound social scientist instead” type gig. An extract:

  • Corruption in the pharmaceutical sector occurs throughout all stages of the medicine chain, from research and development to dispensing and promotion,” the fact sheet reads.The medicine chain refers to each step involved in getting drugs into the hands of patients, including drug creation, regulation, management and consumption. The WHO notes that corruption is so widespread in part because medicines pass through a large number of intermediaries before they reach the patients who need them. Each extra step provides an opportunity for corruption to take place, ultimately driving up the cost of the medicine or diverting it toward the wrong recipients.

So we see the journals being published by professional societies (e.g. British Medical Association), the pharmaceutical companies that provide the funds for gaining the results they want and the academics/medical professionals who provide the writing, reviewing, and promotion of the results to the students/patients/media. Talk about symbiosis. Reading through PubMed to gain some knowledge about type II diabetes, hormone regulation, fat metabolism etc is like a discovering a fetish for handbags, and sitting down with a decade´s supply of Woman´s Weekly magazines to work out what has been in fashion. Take cholesterol research for example.

You got it Homer!

Statins (lipoprotein reducing medicine) are the best selling medicines in the history of modern pharmaceuticals. It is a billion dollar drug range, and these companies will do anything to keep up the myth of cholesterol being bad for us and linking it to disease. But recent research, often coming from the internet/blog driven independent health research field, is telling us that this is little more than a scam on a massive scale. Still, one cannot help but feel sorry for the confusing advice that not only is “bad” cholesterol actually “bad”, because “new insights” tell us so, but some “good” cholesterol is actually “bad”, or can go “bad”. Even statins that reduce “bad” cholesterol, also reduce the risk of certain cancer. And again here. Or we could just relax, eat well, rest well and not worry about it at all. What methods to these companies adopt to get the results from clinical trials they look for?. Back to Dr. Smith´s article (2005)

  • Conduct a trial of your drug against a treatment known to be inferior.
  • Trial your drugs against too low a dose of a competitor drug.
  • Conduct a trial of your drug against too high a dose of a competitor drug (making your drug seem less toxic).
  • Conduct trials that are too small to show differences from competitor drugs.
  • Use multiple endpoints in the trial and select for publication those that give favourable results.
  • Do multicentre trials and select for publication results from centres that are favourable.
  • Conduct subgroup analyses and select for publication those that are favourable.
  • Present results that are most likely to impress—for example, reduction in relative rather than absolute risk.
The problem seems inextricably bound up in economics. As long as drug companies continue to fund research and be complicit in directing every step along the way, then the public will not get the preventative treatment that could be developed if, for example, state funding agencies began to sponsor trials based upon the types of broad-ranging interdisciplinary research that are beginning to uncover so many of the myths of modern medicine. It seems a long way off however. I cannot see even the state providing funding for a decade-long study looking at the effects of a lower carbohydrate/sugar intake on mental and physical health, without having to admit the fallacy of their advice over the past decades to consume a low-fat, high carbohydrate diet. Another suggestion would be to regulate the medical journal industry, making them somehow independent of the drug companies, and adopting a critical approach to existing research, instead of continuing to publish results from clinical trials that quite obviously seek to prove an effect from a pre-framed cause. This too, seems a long way off.
In the meantime, we can continue to discuss informally some of the benefits that a social science orientated methodological approach can provide to some of the natural sciences that seem steeped in a reductionist-type methodological orientation. We need to look closely at ideas taken from biocultural anthropology and evolutionary psychology and merge the holistic understandings about human physiological development to forge a new health paradigm for the current millennium that is not a slave to corrupt commercial interests, but actually has the wellbeing of humanity at its core.
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