Would Your Doctor Risk it All to Fight the System

Segment # 039

I have spent a good amount of time over the past few years trying to understand the pressures borne by clinicians in their practice of medicine in the United States. When bringing up the inconsistencies of the scientific data supplied by the FDA and CDC, it made no sense to me that doctors I knew to be good, honest trustworthy people were making decisions for their patients that seemed illogical. Some even said to me John we agree with you on some of the issues you have brought up; however we need to follow the standard of care or risk losing our practice as we are confronted by medical boards.  In essence our doctors are pretty much trapped unless they want to risk it all. This still just made no sense until I read Dr. Abramson’s book, Sickening: How Big Pharma Broke American Health Care and How We Can Repair It. This has been going on for decades and I fully admit to being oblivious. I along with most Americans just assumed that folks in authority would always have our best interest at heart. That’s not the world we live it.

The inside story of how Big Pharma’s relentless pursuit of ever-higher profits corrupts medical knowledge—misleading doctors, misdirecting American health care, and harming our health. The United States spends an excess $1.5 trillion annually on health care compared to other wealthy countries—yet the amount of time that Americans live in good health ranks a lowly 68th in the world. At the heart of the problem is Big Pharma, which funds most clinical trials and therefore controls the research agenda, withholds the real data from those trials as corporate secrets, and shapes most of the information relied upon by health care professionals.

In this no-holds-barred exposé, Dr. John Abramson—one of the foremost experts on the drug industry’s deceptive tactics—combines patient stories with what he learned during many years of serving as an expert in national drug litigation to reveal the tangled web of financial interests at the heart of the dysfunction in our health-care system. For example, one of pharma’s best-kept secrets is that the peer reviewers charged with ensuring the accuracy and completeness of the clinical trial reports published in medical journals do not even have access to complete data and must rely on manufacturer-influenced summaries. Likewise for the experts who write the clinical practice guidelines that define our standards of care.

The result of years of research and privileged access to the inner workings of the U.S. medical-industrial complex, Sickening shines a light on the dark underbelly of American health care—and presents a path toward genuine reform. https://www.harpercollins.com/products/sickening-john-abramson?variant=39935390089250

Excerpts

 "Not everyone was sitting idly by while the integrity of American research was under attack. In September 2001, the editors of twelve of the world’s most influential medical journals (including NEJM, JAMA, and The Lancet) published an unprecedented joint statement warning that the validity of clinical trial reports was threatened by commercial influence, and the use of the studies for marketing was making “a mockery of clinical investigation.” The journal editors did not pull any punches, noting that, as things stood, “investigators may have little or no input into trial design, no access to the raw data, and limited participation in data interpretation. These terms are draconian for self-respecting scientists, but many have accepted them because they know that if they do not, the sponsor will find someone else who will.” The editors concluded that these arrangements were a violation of academic independence that “not only erode the fabric of intellectual inquiry that has fostered so much high-quality clinical research, but also make medical journals party to potential misrepresentation.” But the editors’ clarion call went virtually unnoticed, in part because the integrity of medical knowledge was not the only thing under attack that week. The journal editors’ alarm was completely overshadowed by the tragic events of September 11, 2001. By 2004, the percentage of drug company–funded clinical research"

"More broadly, by their selection and training, doctors are reluctant to contradict authority and don’t want to incur the wrath of peers, oversight organizations, or lawyers poised to sue if quality-of-care standards are not followed and there is a bad outcome. Doctors’ acceptance of commercially influenced evidence published in journals and the recommendations in clinical practice guidelines (or the marketing materials based on them) is not just the path of least resistance; it’s the only path that will allow them to get through their professional day."

 "The most important lesson I learned during my years serving as an expert in litigation was not about the particularities of any specific drug company’s wrongdoing buried in corporate computers, although these were numerous and often of major consequence. Rather, it was how predictably doctors were influenced by the drug companies’ biased presentation of their “scientific evidence” and their marketing campaigns — just as I had been, as a hardworking family practice doctor, especially earlier in my career.

 "Again, this is not to say that none of the information found in medical journals is important or that none of the new therapies provide heretofore unavailable benefit. Rather, it is a warning to doctors that the primary purpose of the knowledge produced by commercially sponsored clinical research is to serve as a private rather than a public good. Why doctors are so willing to ignore this warning, leaving them and their patients vulnerable to the manipulations of the drug industry, is the subject of the next chapter."

"The National Academy of Medicine and the U.S. Agency for Healthcare Research and Quality have made repeated appeals, asking for CPGs that are independent of commercial influence, but those appeals have failed. Doctors are left in the untenable position of having the quality of their practice judged by their adherence to guidelines written by experts who often have financial ties to the drug industry and who rarely, if ever, have access to the underlying data necessary to independently evaluate the evidence from the primarily commercially funded clinical trials. And Americans are left with the highest medical costs in the world but with care that often is not based on the best of medical science."

"Most of what practicing doctors believe they know about optimal care comes directly or indirectly from the medical journal articles that report clinical trial results. As a corollary, they’ve been taught to trust that what they read there has been properly vetted and accurately reflects the relevant raw data hidden below the waterline. Little do they know . . ."
"Sickening…, Abramson, 2022