
Drug Companies and Doctors: A Story of Corruption (2009) - quickfox
http://www.nybooks.com/articles/2009/01/15/drug-companies-doctorsa-story-of-corruption/
======
quickfox
An older article, but interesting in light of the replicability crisis that
has come out since. FTA:

"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 _The New
England Journal of Medicine_."

~~~
shovingitall
Physician here (intensive care, about 10 years of practice).

> It is simply no longer possible to believe much of the clinical research
> that is published

Absolutely agree. I've tried arguing this with colleagues—that we should be
more careful about the clinical conclusions we draw from single studies—but
I'm just met with resistance. We just added a new drug to the standard
treatment of heart failure, based on a shady Novartis-funded study that
decided, in a post-hoc analysis, to exclude something like 50% of the patients
after-the-fact (and oh look! now we can show a mortality benefit!). It spits
in the face of everything I've learned about the scientific method and
clinical research. This is the PARADIGM-HF study and the drug is ENTRESTO in
case anyone wants to look into it more. Caveat: it might be a beneficial drug
for many patients.

> It is simply no longer possible...to rely on the judgment of trusted
> physicians or authoritative medical guidelines

I'm going to disagree with the author on this one. It is possible to trust and
rely on your physician, and in many cases you have no choice. Guidelines are
just that: guidelines. Not a replacement for careful thought. And I actually
like the direction that many guidelines are adopting: one that brings more
continual minor updates rather than infrequent major changes. This is a
complicated discussion, and depends on what illness you have that leads to
your interaction with our health care system, but my advice is to seek out
doctors that seem to communicate well with you.

~~~
epmaybe
Can you provide a source for the 50% post-hoc exclusion? Here is the NEJM
paper:
[http://www.nejm.org/doi/full/10.1056/NEJMoa1409077#t=article](http://www.nejm.org/doi/full/10.1056/NEJMoa1409077#t=article)

~~~
shovingitall
Ahhh!! I mixed up my studies, that didn't happen in the PARADIGM-HF study. It
has other limitations, but I was thinking of TOPCAT.

~~~
epmaybe
From briefly reading the paper and the post-hoc analysis, it seems that they
were very clear about their post-hoc analysis and its limitations. In this
situation, whoever are reading into it more than they should (could be
novartis and their marketing, could also be the physician colleagues of yours)
are the ones that should be criticized, not the authors themselves.

Edit: here are some quotes from the author of the post-hoc analysis

"Referring to the fact that these observations came from a post hoc analysis,
Pfeffer said: 'I normally draw a line here, and I wouldn't cross this line if
we had things to do for these patients.'

But he added: 'This is a growing part of the heart-failure syndrome. And if we
have something that can help these 40% to 50% of people with symptomatic heart
failure and an impaired prognosis—if we can improve their prognosis and take
care of the safety measures—then I will go below this line by stating that our
observations in the Americas—that spironolactone was associated with reduced
CV deaths and hospitalizations for CHF—should be taken into account.'"

------
techthroway443
This is the saddest part to me:

 _children as young as two years old are now being diagnosed with bipolar
disorder and treated with a cocktail of powerful drugs, many of which were not
approved by the Food and Drug Administration (FDA)_

Why are we giving psychiatric drugs to people whose brains aren't fully
developed, especially when there is still so much we don't understand about
how the brain works?

~~~
batter
Who said you should blindly trust doctors? Pretty often you'll feel like Don
Quixote when dealing with US healthcare.

~~~
techthroway443
Why consult a health professional if you're not going to trust what they have
to say?

When a doctor tells a parent that their two year old is suffering from bipolar
disorder and the way to treat that is to take a cocktail of meds then it's not
the parents fault when they follow that advice.

~~~
phil21
Why treat doctors as infallible? Do you bring your car to the mechanic and
blindly trust what they have to say?

Doctors are no better or worse than any other profession out there. 80% of
doctors are pretty bad, and the other 20% make the rest look decent. Just like
any profession that has ever existed.

You should be double-checking absolutely every single thing a doctor is
telling you - especially important things like giving a two year old
psychiatric meds that are not approved by the FDA.

I do agree with your point that it's not the parents "fault" \- but I also
would be pretty upset with my parents if they blindly followed whatever advice
some guy with a piece of paper told them.

~~~
techthroway443
Trusting a professional's recommendation is not treating them as infallible,
it's called "using the advice you paid for". No I don't blindly trust my
mechanic, you shouldn't blindly trust anyone but generally when you seek out a
professional's opinion on something it's because you value their expertise.

> You should be double-checking absolutely every single thing a doctor is
> telling you

Right, because the average person who knows next to nothing on mental health
is going to make a better judgement call on which medication to prescribe
their child than their doctor.

Guess what, if that were the case we wouldn't have a story here.

~~~
icebraining
_Right, because the average person who knows next to nothing on mental health
is going to make a better judgement call on which medication to prescribe
their child than their doctor._

Often, yes, the person who cares about the child more than about themselves
will make a better decision than a doctor who has 300 more random kids to
check that week.

Now, it depends on how that double-checking is done. The simplest way is to
get a second (and third, and fourth) opinion, and then judging based on them
all.

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tcj_phx
I think whole field of medicine is confused.

On the one hand, we have some very good pharmaceuticals. They work very well
for their purpose. For example, Naloxone [1] is very good for reviving people
who overdose on opiates Some of the modern formulations reflect profiteering
[1], but this drug and its cousin (Naltrexone) are very useful.

[1]
[https://news.ycombinator.com/item?id=14782221](https://news.ycombinator.com/item?id=14782221)

Two more useful generic drugs are the thyroid medications Synthroid and
Cytomel.

On the other hand, most commonly drugs can at best be considered 'palliative'
rather than 'curative'. This article talks about the drug industry's efforts
to convince people that they'll need to take maintenance drugs for the rest of
their lives.

It would be helpful for Medicine to undergo a "back to basics" scrap & re-
write of the med schools' curriculum. This will probably take 25 years...

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brooklyntribe
And these MDs just shame the whole industry. Bring the status of all
hardworking MDs down a notch. No conscience here at all.

What people will do for the all mighty buck.

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telot1
For a punk rock perspective on this issue, I'd encourage you to checkout
OxyMoronic by the legendary NOFX.

[https://www.youtube.com/watch?v=ohguwyFECHI](https://www.youtube.com/watch?v=ohguwyFECHI)

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danielam
Reminds me of how "advisory", pay-to-play rackets like Gartner work. It's
dishonest and smarmy and all the more more repulsive when the medical field
engages in such practices.

