The drug business
Posted by Henry Bauer on 2011/04/25
Here are quotes from a book by a British doctor and medical historian:
The trials . . . compared these new compounds [to AZT] . . . they were not obviously more effective . . . . Nevertheless, in clinical practice there was a wholesale switch from older to newer agents despite up to a hundred-fold increase in cost in some cases. . . . The change stemmed from a mixture of wishful thinking and aggressive marketing. By the 1990s, pharmaceutical companies had discovered that patient activist were often the most effective lobbyists for the new treatments and they had allied themselves with some of the most aggressive patient groups . . . . But the changes that patients and clinicians were witnessing were often the consequences of changing from the equivalent of more than 5,000 milligrams . . . per day to a dose . . . equivalent to 300 milligrams . . . per day. There were obvious difficulties for clinicians in accepting that even part of the benefits they were witnessing with the new drugs might stem from the fact that they were not now poisoning their patients to the same extent as previously. These difficulties led to a need for myths to disguise what was happening, and marketing campaigns for the new treatments that used the concept[s of idiopathic CD-4 T-cell lymphopenia and immune restoration syndrome] . . . vigorously provided the required mythologies. . . .
How could such a situation arise? . . . The answer has to be that no company stood to make money out of encouraging clinicians to recognize these clinical features. . . . Did it make a difference that clinicians failed to recognize these features? Almost certainly yes: patients were losing their lives because of that failure. . . .
[T]he majority of trials involved a comparison between new and older drugs without a placebo control. The vast majority of these trials did not show whether any of the drugs tested actually worked. . . .
This was a marketplace where companies hired clinical investigators. Previously researchers had told industry what needed to be done, but now companies did not have to approach investigators to design their trials for them, compile the statistics, or write the papers. . . . A process had begun that led to the analysis of trial results within the company and thereafter to the writing up of the results by company personnel. Senior clinical investigators now might be used as figureheads on papers or for presentations at academic meetings, but the clinical presence was increasingly ornamental rather than substantial. . . .
In the 1980s, a new phenomenon, satellite symposia, became increasingly frequent at national and international meetings. These were company-sponsored symposia. [Over a period of 15 years] there had been an increase from $6 million to $86 million in the amount of money spent by the major companies on these events in the United States. In the 1990s, many senior clinical figures, some of whom were notional principal investigators on company studies, could be seen performing in both satellite and regular symposia at meetings, sometimes with a frequency that meant leaving one symposium before it ended to participate in another or in a press briefing.
The proceedings of satellite symposia were published in journal supplements. These were rarely peer-reviewed. Medical communication and public relations agencies sprang up, out-sourced from pharmaceutical companies. The writers in these agencies commonly wrote the drafts of articles that appeared in the journals, as well as producing the slides for speakers. In some cases, the contributions appearing under distinguished names were never even read by their notional authors.
(FOOTNOTE: All of the material in the first part of this paragraph is based on practices I [the author of the cited book] have not only witnessed but engaged in.) . . .
By the mid-1990s [HIV/AIDS meetings] . . . had reached mega-meeting status. In addition to bringing clinicians to these meetings, companies regularly brought journalists and [activists and] held press briefings. What had once been forums for extraordinary intellectual debates had by the 1990s been transformed into little more than trade fairs. . . .
Clinical trials could be designed to demonstrate the proportions of patients who are likely to find a particular therapy both beneficial and acceptable. But no such trials have been undertaken. If science means collecting a full set of data on any phenomenon, then despite its rhetoric, modern [HIV/AIDS practice] . . . would seem to be anything but scientific.
Alert readers will already have noted that all my editorial insertions in  refer specifically to HIV/AIDS whereas none of the rest of the text does. That’s because the book deals with drugs used in psychiatric practice. The analogy with HIV/AIDS struck me particularly concerning lowered morbidity when switching drug regimes: mortality improved under HAART because it is less toxic than the earlier monotherapy.
Other points reflect the general state of contemporary drug-centered medical practice. The prevalence of dangerous, injurious conflicts of interest have been widely described, for example in a series of articles by David Willman in the Los Angeles Times of 7 December 2003, about the connections between high-ranking personnel in the National Institutes of Health and pharmaceutical companies. The corrupting stranglehold that industry exerts has been described by insiders in a number of such articles as “Drug companies and doctors: a story of corruption” by Marcia Angell (New York Review of Books, 56 #1, 15 January 2009) and such books from leading publishing houses as:
John Abramson, Overdosed America: The Broken Promise of American Medicine,
Marcia Angell, The Truth About the Drug Companies: How They Deceive Us
and What To Do About It, Random House 2004
Jerry Avorn, Powerful Medicines: The Benefits, Risks, and Costs of Prescription Drugs,
Peter Breggin, Medication Madness: A Psychiatrist Exposes the Dangers
of Mood-Altering Medications, St. Martin’s Press 2008
Shannon Brownlee, Overtreated: Why Too Much Medicine Is Making Us Sicker
and Poorer, Bloomsbury 2007
Merrill Goozner, The $800 Million Pill: The Truth behind the Cost of New Drugs,
University of California Press 2004
Jeremy Greene, Prescribing by Numbers: Drugs and the Definition of Disease,
Johns Hopkins University Press 2007
Gary Greenberg, Manufacturing Depression: The Secret History of a Modern Disease,
Simon & Schuster 2010
David Healy, The Creation of Psychopharmacology, Harvard University Press 2002
Jerome Kassirer, On The Take: How Medicine’s Complicity with Big Business
Can Endanger Your Health, Oxford University Press 2004
Irving Kirsch, The Emperor’s New Drugs: Exploding the Anti-depressant Myth,
Basic Books 2010
Joanna Moncrieff, The Myth of the Chemical Cure: A Critique of Psychiatric Drug
Treatment, Palgrave Macmillan 2009 (revised ed.)
Ray Moynihan & Alan Cassels, Selling Sickness, Nation Books 2005
Roger J. Porter & Thomas E. Malone, Biomedical Research: Collaboration and
Conflict of Interest, Johns Hopkins University Press 1992
Marc A. Rodwin, Medicine, Money and Morals: Physicians’ Conflicts of Interest,
Oxford University Press 1993
Robert Whitaker, Mad in America: Bad Science, Bad Medicine, and
the Enduring Mistreatment of the Mentally Ill, Basic Books 2010 (2nd ed.)
———- Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America, Crown 2010
Edward Yoxen, The Gene Business, Harper & Row 1983
The more I learn about the history of medicine (American medicine in particular), the more I realize that the flaws in HIV/AIDS “science” and practice are far from unique, indeed they reflect deficiencies in modern medical “science” and practice overall, most especially of course the recourse to drugs and the associated stranglehold that pharmaceutical industry holds not only over treatment aspects of medicine but also over public policies more widely, given that the drug business contributes disproportionately to campaign contributions of politicians and the employment of lobbyists.
This entry was posted on 2011/04/25 at 11:25 am and is filed under antiretroviral drugs, clinical trials, experts. Tagged: corrupt drug-centered medicine, selling drugs. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.