A Story of Corruption

That's the subtitle of an article by Marcia Angell, long-time editor of the New England Journal of Medicine, in the current NY Review of Books. Basically, Angell documents the corruption that has arisen in the relationship of pharmaceutical companies, medical schools and doctors. It is a very sad article in that it documents bribery, an abandonment of ethics and the willing sacrifice of what had come to be accepted standards of practicing medicine.

I've written about the bribery, but Angell claims that the drug manufacturers subsidize "most meetings of professional organizations and most of the continuing medical education needed by doctors to maintain their state licenses". Furthermore, the companies exert a strong influence on the guidelines issued by medical organizations and they are able to get the FDA to approve drugs based on what are essentially rigged tests.

Let me talk a little about drug testing. The FDA's approval is usually based on the success of a relatively few trials; it's possible that the FDA would approve a drug in cases where there was one successful trial and several unsuccessful trials. Tests typically compare new drugs to placebos rather than to older drugs that do essentially the same job. It is not always the case that the comparison between placebos and the new drug is that favorable; one study of the major antidepressant drugs found that placebos were 80% as effective as the new drugs. And, as Angell reports, "the sponsor's drug may be compared with another drug administered at a dose so low that the sponsor's drug looks more powerful. Or a drug that is likely to be used by older people will be tested in young people, so that side effects are less likely to emerge."

And then there is the whole question of "off label" use, i.e., using the drug for something for which it was not approved by the FDA. Such use relies on doctors who have supposedly done some serious testing; reality is a reliance on the word of the drug company or its shills at famous medical schools.

Reporting on tests is even worse. Only good results are printed and, if the results are bad, it is not unheard of to slant the results. Political spin doctors would come in second to drug spin doctors.

Anyone who watches television soon becomes aware that almost any feeling one has can be diagnosed as something that can and should be treated by a drug. A marketer for a drug company is quoted, "Neurontin for pain. Neurontin for monotherapy. Neurontin for bipolar. Neurontin for everything." This for a drug that was approved to treat epilepsy.

The 'everybody needs drugs' syndrome is especially prevalent with regard to mental illness. The medical handbook defining mental illnesses has grown from a few pages in 1952 to 943 pages today. The past fifty years have been unsurpassed in diagnosing new illnesses. And, with a long title, "Diagnostic and Statistical Manual of Mental Disorders", one would assume that this is truly a scholarly, well-researched, sound document. Guess again.

Angell appears to be thoroughly disgusted, "It is simply no longer possible to believe much of the clinical research that is published, or to rely on the judgment of trusted physicians or authoritative medical guidelines. I take no pleasure in this conclusion, which I reached slowly and reluctantly over my two decades as an editor of TheNew England Journal of Medicine."