The business goals of pharma companies influence the mission of research institutions and the final results. Young doctors are learning that there is a pill for every ill and a surgical correction for every anatomic deviation from the normal
“Who lies for you will lie against you.” - Bosnian Proverb.
The recent disclosures by the The New York Times that more than 47% of the Harvard Medical School faculty is on the regular pay roll of drug companies should give us a wakeup call. All thinkers need to believe what I had been writing for years that most of what doctors learn from textbooks and their teachers is the ‘wisdom’ distilled by the vested interests in pharmaceutical and medical devices industries!
The Harvard revelation is only the tip of the iceberg. In India, where we do not have such audits, the numbers must be prohibitive. Many doctors make a comfortable living thanks to the largesse of the industry. The unholy marriage between the academia and the industry should cease forthwith for the good of humanity.
Intelligence is derived from the roots inter (between) and ligere (to choose). An intelligent doctor, therefore, should be able to choose between the good and the evil for the sake of his/her patients as also to become a person of value and not just a person of success. Albert Einstein wrote that one should “try to be a man of value, rather than a man of success.” An editorial in the New England Journal of Medicine deplores the evil in medical science.
My lamentations about medicine having gone to the market place, riding piggyback on technology, making it almost impossible to believe any of the short case-control studies published even in the “respectable” journals for years, had only fallen on deaf ears. I have become a laughing stock in the higher echelons of the Indian medical academia!
I am told that a group of cardiologists in Mumbai, when asked to assess me for the Fellowship of the Academy of Medical Sciences some years ago, had opined, “He is only a quack and has no idea what cardiology is all about!” I did become Fellow-thanks to a few thinkers still in the organisation.
“The ties between clinical research and industry include not only grant support, but also a host of other financial arrangements. Researchers serve as consultants to companies whose products they are studying, join the advisory boards, and the speakers’ bureaus, enter into patent and royalty arrangements, agree to be listed authors of articles ghost written by interested companies, promote drugs and devices at company sponsored symposia, and allow themselves to be plied with expensive gifts and trips to luxurious settings. Many also have equity interest in companies. Academic medical institutions are themselves growing increasingly beholden to industry. Harvard used to be an exception; but they are also softening their stand,” wrote Marcia Angell.
I could quote some of my bitter experiences, which I had shared with readers from time to time, here to complete the picture. Time was when a symposium on treatment of high blood pressure was held in a five-star hotel in Goa. I was pitted to speak against a star speaker from America. This gentleman is a regular company “employee”, having a very high academic status in addition. The drug in question was a receptor blocker of a particular new variety.
While the American went on to describe the drug as the panacea for all hypertensives and should be the first drug of choice, I had to, per force, take the opposite stand as I was convinced that this drug was not the drug of first choice. This great master ridiculed me and the audience, of course, was with him!
In March 2000, while I was on a lecture tour of some Universities in the US, early morning wake up alarm in my hotel room was blaring out the news item that this very drug, in the first-ever human study, had caused many more heart failures, while it was being touted as the drug to prevent heart failure.
The study has since been stopped and the newscaster was asking nearly a million Americans who are already on the drug to contact their doctors to get the drug changed immediately. I tried in vain to contact the “great” man but to no avail. This happens again and again.
The drug in question was one of the alpha blockers. Any blocker, alpha, beta, ACE or H1—or, for that matter, any other drug that blocks any normal body function, is not conducive to normal body physiology. Recent revelations about metaprolol in the POISE study are a good example. There are others ills, which follow all the above blockers but space does not permit me to go into them in greater details.
No one has so far described science in a way that satisfies everyone. “Science, for example, can not give absolute proofs of the laws of nature because, although we can test an idea repeatedly, we can never be sure that an exception does not exist,” says Michael Cross in the New Scientist 2000 February 19th. Every time something goes wrong and is detected, anyone could take refuge under this clause. This statement of Cross should not be misread to say that science is not good. It only goes to emphasize the fact that scientific methods are but one of the many ways to human wisdom.
One other subtle way of taking the practicing doctor for a ride by the companies is the use of confusing statistical jargon, which, unfortunately, most medical students do not get to study in the medical school. This specially applies to the risk factor correcting efforts using drugs, a real money-spinner.
While there are 17 studies (RCTs) in the area of blood pressure lowering drugs where the collective relative risk reduction (RRR) was only -20% and this is the one sold in the journal articles and company literature. If one were to analyse the absolute risk reduction (ARR) it comes down to -0.8% only! This will translate into a very insignificant survival benefit (SB) of just 0.8%.
To put it differently, if a healthy man with moderately raised blood pressure were to take the drugs religiously for five years to reduce his box blood pressure, despite lots of other inconveniences due to the drug in question, his chance of survival becomes 96.8%, whereas it would still be 96% without any drug at all for five years but with simple change of mode of living!
Almost identical figures arise from all the cholesterol-lowering drugs. That is not all. The number needed to treat (NNT) unnecessarily is another serious matter. To save one young man with mild to moderate hypertension from a possible stroke in the next five years the doctor will have to treat 850 normal people with the same level of BP for a period of five years. The adverse drug reactions of those drugs in five years would be enormous, to say the least, both in morbidity and mortality, leave alone the cost! Practising doctors get to see only the RRR figures that look very impressive. The table below shows it all!
In the next part we will examine why there is such a large nexus between the academia and the “for-profit” industry.
(Professor Dr BM Hegde
, a Padma Bhushan awardee in 2010, is an MD, PhD, FRCP (London, Edinburgh, Glasgow & Dublin), FACC and FAMS. He is also Editor-in-Chief of the Journal of the Science of Healing Outcomes, chairman of the State Health Society's Expert Committee, Govt of Bihar, Patna. He is former Vice Chancellor of Manipal University at Mangalore and former professor for Cardiology of the Middlesex Hospital Medical School, University of London.)