Sunday, September 21, 2014
Dr. David Healy has spent decades delving into the dark corners of the pharmaceutical industry, where, for instance, drug companies have tried to hide the worrisome connection between antidepressant drugs and suicide. In the psychiatrist’s best-known previous books, The Antidepressant Era and Let Them Eat Prozac, Healy explored the often vexing history of the mental health field and its troubled relationship with Big Pharma. In his latest book,Pharmageddon, he presents an even bleaker picture of the way industry has co-opted medicine in general — not just mental health. Healthland spoke with Healy about his findings.
What do you mean by ‘pharmageddon’?
At the moment, treatment-induced death is the fourth leading cause of death [overall], and within the mental health field, it’s probably the leading cause of death.
It’s a little bit like climate change. It may feel great to have a car, the convenience you get is a thing we appreciate each time we hop in the car and drive down to the market. But the use of cars is contributing to the bigger picture of climate change. In the same way, quite a few medications we take produce good outcomes. But we’ve [had a] climate change in medicine, which runs the risk of completely destroying medicine as we’ve known it.
And the key tool in all of this is how companies use the scientific evidence. They construct trials to get the outcomes they want; they only publish positive trials. The study often shows the opposite of what the data actually shows.
In the book, you look at how drug companies sell us on reducing risks — like say, high cholesterol — that may not actually do much to keep us healthy because high cholesterol itself is just a marker for cardiovascular disease risk, not an illness itself.
If you [look at] statins to lower cholesterol or drugs for osteoporosis, there’s no obvious benefit like there is from wearing a parachute when you jump out of a plane. You often just don’t feel good and you may feel a good deal worse. There isn’t even a proven benefit at the end. What you’ve got is proof in the sense of demonstrating that over a six-week period, you can show a marginal change that we have agreed to call a change for the ‘better.’ [The point is that the measure doesn’t necessarily mean your health will improve, but rather is just a marker linked with a reduction in risk.]
Trials get used as tool to persuade doctors to persuade you to have treatment. [And making drugs] available on prescription only is a means to persuade you to take things that if you were more naturally cautious, you’d be less inclined to take.
But don’t we need clinical trials to eliminate quack remedies and look systematically at the best treatments?
There’s two [situations] where trials are useful. There’s an area were you don’t need trials at all, where the treatment really works, such as antibiotics for serious infections. And they’re also really useful when they show that something doesn’t work.
What we’ve got is what’s in between, where in actual fact [some] people would say, for example, if you take all the trials of antidepressants, they actually show that the drugs didn’t work.
Yet many people say they experience profound changes after taking the antidepressant drugs like Prozac — some positive and some negative.
That’s not saying that they don’t work — a bunch of people swear that they’re working. The problem is that if we had all the data available [including the data that the drug companies hid], we ought to have said, ‘We’re not impressed by these drugs. We need to go to back to the drawing board and find the people who really benefit.’ There’s a bunch of people on [antidepressants] who clearly do well. But the companies have made whatever billions of dollars [selling them to a lot of people who don’t].
What do you think about the link between antidepressants and suicide? You’ve found some pretty damning evidence that healthy people may become suicidal or aggressive when they take these drugs.
There’s a group of people for whom antidepressants in general work awfully well, but there’s also a group for whom they don’t work well and they can become either violent or suicidal. The problem again comes back to the role of the doctor. If doctors can’t see that drugs may be good and may be bad, that they can be useful and problematic — if they aren’t experts and can’t handle a bit of complexity — they’re going to go out of business. The problem with doctors and antidepressants making people commit suicide is when it first came out about some children being suicidal, the American Psychiatric Association said that it believed that antidepressants save lives.
I’ve been trying to say to doctors, this is a professional suicide note. What they should say is, Psychiatry can save lives. We know that these pills are good for some and not others and it takes expertise to manage this. If don’t take that [perspective], well, there are cheaper people like nurses, and if pills have no risk and work well, there are cheaper people going to be prescribing.
Why do you emphasize the issue of prescribing privileges so much?
When you come to me for treatment, in sense you’re my hostage. If I ask you if something is wrong [in terms of side effects, you say], ‘No, things are fine.’ You may be having strange thoughts, you may be getting aches and pains you didn’t have before, but the problem is that you either want to keep me happy and so you don’t mention it, [or you say nothing] because I’ve told you that you have to be on these pills because otherwise you will have a heart attack or stroke. You may not even know that the problem is caused by the pill. As a doctor, I’m not trained to pick up that these things may be going on.
The other I’m thing not trained in is that when things are available by prescription only, it’s me, the doctor that ‘consumes’ the pill. I’m the consumer in the sense that companies market these drugs [to me] — in the case of pharma, they’re spending more on marketing than Apple spends or Microsoft or GM. [While those companies] market to all of us, the amount of dollars per head is small. But pharma markets to doctors. Direct-to-consumer ads are only a small part of budget and they’re designed not [just] to get you to believe in the pill, but get you to bring pressure to bear on doctors.
Wouldn’t a big part of the problem be solved simply by requiring drug companies to release all their data?
There should be a law requiring them to reveal all the data. I think that’s a key thing: there should be access to all of the data from the clinical trials. We take risks with new pills on an understanding that the data is going to be made available to experts to sift through and let us all know what the true profiles of these pills are.
If people entering into trials were asked to sign form saying, ‘Do you agree to have pharmaceutical companies sequester the data from this trial?’ they wouldn’t have signed it. Most assumed that because it appears to be science, that the scientific community will get to scrutinize the trials.
You’re personally working on a project to help bring more of the risks to light.
What we’re trying to do with our colleagues is to open up patient adverse event reporting. It’s called rxrisk.org, which will be a website where both people on pills and their doctors can go to report adverse events that may be happening. The idea is to give you a tool so that if things are going wrong, you can get an expert report from us about what is known about the links between the problem and the pills you’re on and by asking a few questions, try to pinpoint whether the pill actually causing the problem. That will give you a report to take to your doctor to make it easier to overcome the kind of hostage problem most people have when they go to the doctor and want to keep him or her happy. The idea is ultimately to create teamwork between doctors and patients and let them know in real time how many other people have reported this problem also.
We’re trying to put patients and doctors in the kind of position where, if they know that thousands of others have had this problem and then the pharmaceutical company says there’s no linkage, people won’t believe it and will say, This isn’t right. It’s in beta at moment.
So what else can be done?
There are ways to play with the system to get the outcomes we want. At the moment, we have a system that works well for the health of pharmaceutical companies but not so well for our health. I’m just trying to raise these issues. How best we solve them is a different matter, but we can’t begin to try to solve them if we don’t raise them. I’m not hugely hopeful but not entirely pessimistic either.
Wednesday, September 10, 2014
Doctors in the US suck more than most people can even comprehend. Get educated about these greedy thieving butchers! They don't give a shit about you or your health. All they care about is money and prestige.
Big Pharma and Greedy Doctor$
June 28, 2013
By Evan Levine, M.D.
The Combination Is a Prescription for Fraud and Abuse
How does one explain an internist who wrote over 900 prescriptions for the controversial and very expensive drug Lovaza, a drug approved to lower triglycerides, or a geriatric doctor who is the top prescriber of a very expensive heart medication known as Ranexa, or a cardiologist who neglects the less costly and generic statins, and presribes mostly Crestor, a very effective but also very costly drug, or just about any top prescriber of Tarka, an expensive blood pressure medication that combines two generic medications that can be purchased for pennies, into a brand drug that costs around $4.50 a pill (something I discussed in a previous article “Drug Dealing For Big Pharma“)?
The answer is simple and unsurprising — greed. It’s all about putting more money in the pockets of doctors and the coffers of the big Pharmaceutical companies, but it is finally being exposed. Probublica, “an independent, non-profit newsroom that produces investigative journalism in the public interest”, petitioned under the Freedom of Information Act and obtained records for Medicare’s popular prescription-drug plan Part D. ProPublica has now made public on their website the names of prescribers and the drugs they chose to prescribe to their patients.
Consider this: I am a busy cardiologist and I wrote about 1,500 Medicare scripts in 2010, but a cardiologist practicing in New York City’s Chinatown, wrote 21,000! How is that possible? How can one person write 1,400 % more prescriptions than me? And not by coincidence, he was a top prescriber for one my least favorite drugs, Bystolic, a costly blood pressure medication that competes with generics that cost pennies per pill. Perhaps not by coincidence, he happened to give paid lectures for the company, Forest Labs, that sells Bystolic. Even more troubling is that he was a top prescriber of a drug known as Multaq, a very controversial and also costly drug, used to treat arrhythmias.
I suggest that anyone interested — lay or professional — check out the Prescriber Checkup on the Propublica site. Buried in the data you’ll find a physician, Rohan Wijetlaka, who was arrested last year for essentially selling prescriptions of narcotics, especially oxycodone. It’s easy to see that while his peers, on average, prescribed narcotics to about 4% of their Medicare patients, he prescribed, or as it turns out sold and prescribed, narcotics to 31% of his patients — and he’s a cardiologist. I guess those type of numbers were a big enough red flag to alert the DEA who pounced on him in July of 2012.
And yet there is another physician listed as a cardiologist, a Dr. (initials) V.P., who, according to this site, prescribed narcotics for 36% of her Medicare patients. If the data are correct, you have to wonder if she is being investigated, and if not, why?
For the past two days I have hurried home after work to review this data and found the same outcome – if a doctor wrote a lot of prescriptions for an expensive drug, he was usually a paid speaker for the drug company! Apparently, a simple and disgusting, quid pro quo.
Of course, I anxiously plugged in my name to see if I practiced the way I hoped I did. I found that all my frequently prescribed drugs were generic and that the average cost for each drug was $48 dollars. I compared that with other cardiologists I know and it was, thankfully, among the lowest compared to many doctors, including one that is always on a famous “Top Doctor“ list whose average prescription cost was $86 dollars; don’t be shocked when I tell you he prostitutes himself to Big Pharma.
I looked at physicians whom I knew to be bad docs, as well as bad human beings, and found some of them with an average cost for their prescriptions of almost THREE TIMES the cost of mine. Again, they too were big prescribers of drugs that I would never consider prescribing because they are too expensive and offer no benefit when compared to generics that cost pennies.
While I have been telling people for years that Big Pharma manipulates greedy, cooperative physicians into prescribing their drugs, now anyone can go to ProPublica and see what drugs their physicians prescribe. The list does fall short in identifying some of the king-pins of this Pharma scam, though; in particular, the heads of departments at some of the biggest universities. While these elite may get paid hundreds of thousands of dollars to help sell drugs, they often don’t see patients and prescribe drugs, so you won’t find them on the list.
In one instance I know of, the chief of Medicine at a major New York Medical center accompanied a drug rep bringing lunch to a busy cardiologist’s office. Why? So he might convince doctors there to prescribe the drug Bystolic. But you won’t find his name on the list because he lectures from his bully pulpit and rarely prescribes medications.
So what’s the take-away from all this? Just what I’ve been saying all along: Big Pharma, their “friends” in medicine, and their army of lobbyists, are corrupting the American healthcare system and it’s about time someone put a stop to it. Hello DEA, are you reading this?
Dr. Evan S. Levine is a cardiologist in New York and a Clinical Assistant Professor of Medicine at Montefiore Medical Center – Albert Einstein College of Medicine. He is also the author of the book “What Your Doctor Won’t (or can’t) Tell You”. He lives in Connecticut with his wife and children.
- See more at: http://www.leftistreview.com/2013/06/28/big-pharma-and-greedy-doctors/evanlevine/#sthash.C93DTztf.dpuf
Friday, September 5, 2014
Fatal Dose? Investigators Uncover How Dangerous Drug Propofol May Have Sent Joan Rivers Into A Coma, Source Claims — New Details On How The Health Crisis Unfolded