Sunday, September 30, 2012

a grain of salt

For years I trusted my doctors completely. I figured if a drug was doctor-prescribed, it had to be OK, since it would be FDA-approved only after years of exhaustive testing for safety and effectiveness by the drug companies, a transparent and above-board process by legal necessity.

Then I was prescribed the statin drug Vytorin™ by a doctor in Palm Springs, but a couple months later the Food and Drug Administration ordered the drug pulled off the market, announcing bluntly that it was unsafe.

This happened because a) the prescribing MD was a pill pusher, getting kickbacks from pharma reps for prescribing certain drugs; b) the testing process is a farce, and the Food and Drug Administration is owned by the pharmaceuticals companies.

Now a doctor in England has written a book detailing the extent to which we've been taken in by big pharma's deceptions. Ben Goldacre writes:

Drugs are tested by the people who manufacture them, in poorly designed trials, on hopelessly small numbers of weird, unrepresentative patients, and analysed using techniques that are flawed by design, in such a way that they exaggerate the benefits of treatments. Unsurprisingly, these trials tend to produce results that favour the manufacturer. When trials throw up results that companies don't like, they are perfectly entitled to hide them from doctors and patients, so we only ever see a distorted picture of any drug's true effects. Regulators see most of the trial data, but only from early on in a drug's life, and even then they don't give this data to doctors or patients, or even to other parts of government. This distorted evidence is then communicated and applied in a distorted fashion.

In their 40 years of practice after leaving medical school, doctors hear about what works ad hoc, from sales reps, colleagues and journals. But those colleagues can be in the pay of drug companies – often undisclosed – and the journals are, too. And so are the patient groups. And finally, academic papers, which everyone thinks of as objective, are often covertly planned and written by people who work directly for the companies, without disclosure. Sometimes whole academic journals are owned outright by one drug company. 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 Guardian newspaper (UK) published a long and detailed excerpt from Goldacre's book, "Bad Pharma," yesterday, and you can read it here. You'll be doing yourself and your loved ones a favor by taking a half hour or so to read this.

Because of my experiences with statins and other mis-prescribed drugs over the years, I already had an aversion to taking any "new and exciting" pharmaceuticals, and now try to stick with drugs that have been around for ten years or more, and talk to people who are taking "X" to find out what their experience of it is. This is just one more instance of the principle that only fools and babies trust capitalist sales pitches.

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