This is a book review of the new volume by Peter C. Gøtzsche, Deadly Medicines and Organized Crime: How Big Pharma Has Corrupted Healthcare (New York: Radcliffe Publishing, 2013). It presents the evidence for an aspect of the pharmaceutical industry that almost never gets discussed, but that you should be aware of.
Deadly Medicines: Over the Top or Overdue Wake-up Call?
Ethics, Medicine, and Pharma
The book features Forewords by two heavy hitters, Richard Smith, former editor of BMJ, and Drummond Rennie, long-time deputy editor of JAMA. If you read between the lines, the two editors both convey more or less the same message-this guy comes across as a raving lunatic, but it would be a shame if you were put off by that tone, because he actually has something important to say.
By way of the lunacy quotient, I append a representative list of quotes:
‘In the United States and Europe, drugs are the third leading cause of death after heart disease and cancer.”(1)
‘The main reason we take so many drugs is that drug companies don’t sell drugs, they sell lies about drugs. Blatant lies that-in all the cases I have studied-have continued after the statements were proven wrong.”(2)
‘The book addresses a general system failure caused by widespread crime, corruption and impotent drug regulation in need of radical reforms. Some readers will find my book one-sided and polemic, but there is little point in describing what goes well in a system that is out of control. If a criminologist undertakes a study of muggers, no one expects a ‘balanced’ account mentioning that many muggers are good family men.”(2)
‘I dedicate this book to the many honest people working in the drug industry who are equally appalled as I am about the repetitive criminal actions of their superiors and their harmful consequences for the patients and our national economies. Some of these insiders have told me they would wish their top bosses were sent to jail, as the threat of this is the only thing that might deter them from continuing committing crimes.”(3)
‘[Industry] clinical trials are rarely research in the true sense of the word…it is marketing disguised as research. The trials are often flawed by design, additional flaws are introduced during data analysis, and the misleading results are spun to make sure that whatever an honest trial might have shown, the trial concludes something that is useful for boosting sales.”(87)
‘We should ask our politicians to forbid marketing of drugs, as it is harmful, just like marketing of tobacco is, which is why we have prohibited tobacco advertisements…. There is no need for drug marketing, as the products should speak for themselves.”(94, 275)
‘Anyone of us will need to consider the pros and cons of taking a drug, and our doctor isn’t always the best person to ask, as most doctors have been brainwashed and many have been bribed by the drug industry.”(129)
‘We cannot trust industry trials at all and the reason is simple. We don’t trust a person who has lied to us repeatedly, even though that person may tell the truth sometimes.”(265)
Throughout the book, Gøtzsche uses the organized crime motif to characterize the drug industry. This is quite deliberate and measured. He argues that something counts as organized crime when:
They kill people
They lie about what they do
They routinely break the law as a part of their business practices
They use their ill-gotten gains to corrupt the government regulatory apparatus so as to be allowed to continue to operate
Gøtzsche is a physician, epidemiologist and research methodologist, and has achieved prominence as head of the Nordic Cochrane Center, a part of the Cochrane Collaboration which is generally recognized as the most reliable and independent assessor of medical data-a sort of gold standard if you want to know: how good is the evidence that any treatment works for any disease? So this guy is not one to fly off the handle and make charges that he cannot document with solid evidence. (I give him some credit for solid evidence since he several times cites HOOKED.) I have not always agreed with Gøtzsche in the past-he’s co-author of a widely cited meta-analysis in the New England Journal (2001) purporting to show that the placebo effect, one of my own pet research interests, probably doesn’t exist. But while some of the evidence he brings forward in this volume is new to me, and much is worth reading simply to get the European perspective on the issue, very little of ! what he says would be of any real surprise to anyone who has read HOOKED and/or kept up with this blog.
In a minor way, the evolution of this blog parallels what Gøtzsche is up to. If you take the trouble to go back and look (I don’t advise it), check out how long it took me to use the actual words bribery and corruption in describing Pharma behavior. I now use those words unabashedly because I am quite secure in knowing that the behavior is accurately described by such terms, and there is no point in pussyfooting around the real and serious problem the behavior poses. If we get overly obsessive about not appearing intemperate, we pay the price of failing to endorse the really basic and drastic reforms that are needed to clean up the current mess.