
Drugmakers undermine medical journals and skew medical research - gruseom
http://www.theamericanscholar.org/flacking-for-big-pharma/
======
michaelpinto
There's been a great deal of talk about the need for open medical journals —
it's s small movement but I hope it really takes off. Not only would you be
able to get much more info, but it could be free — which can open that info up
to wider and even non-professional audience.

~~~
marciovm123
This is something I'm actively working on.

There's a lot of entrenched interests blocking this kind of innovation, but
several disruptive forces at work (like massive iPad adoption amongst
physicians) are enabling interesting approaches.

~~~
michaelpinto
I think if there was grant money or funding it would help things a great deal.

------
TheBiv
Remember, this is mainly pushed by those living by the profit in the public
markets and not by individual scientists.

I don't believe that this group needs this caveat, but having worked in two
research labs, I know that some people do have the belief that it is "liberal
scientists" deliberately misleading the public.

~~~
fleitz
Accidental misleading is somehow better?

There's a lot of funding from the public trough and a lot of funding from the
private trough, to say that one corrupts less is to misunderstand economics.

The private companies have pens, trinkets and buffets, the public companies
have the school system, the army, the justice system, FDA, IRS, CIA, FBI, DEA,
ATF and the police. If I wanted to mislead and force my will upon doctors I'd
certainly take the latter over the former.

~~~
gruseom
_The private companies have pens, trinkets and buffets_

They have far more than that, which is the whole point of the article.

~~~
anamax
> They have far more than that, which is the whole point of the article.

Anyone who thinks that money is the only, or even most influential, source of
corruption doesn't know much about people.

People will commit the most horrendous atrocities in the name of "doing good",
and that's not the only thing that is far more effective than money.

~~~
leot
This can be compared to the basic distinction between precision and bias.
While noisy and variegated individual biases pitted against each other in
good-faith debate can have low "precision", the more pernicious problem is
bias, which is what emerges where there is a consistent organizing influence
pushing people in a particular direction.

Indeed, it's amazing that the same people who tout most strongly the power of
the invisible hand immediately believe that there are other things "far more
effective" when the hand's unchecked subtle and consistent influence has
negative consequences.

Lastly, the stories of horrendous atrocities caused by misguided-do-gooders
are the exceptions that prove the rule -- throughout history, truly horrendous
has been the cascade of constant repeated atrocities big and small perpetrated
worldwide by people acting in their own (perhaps shortsighted) self-interest
at others' expense.

~~~
anamax
> Lastly, the stories of horrendous atrocities caused by misguided-do-gooders
> are the exceptions that prove the rule

Not at all. Almost every genocide has been initiated by do-gooders.

> the cascade of constant repeated atrocities

Yes, folks tend to go along, but that's true of everything, good and bad.

~~~
leot
Surely you're joking. This has to be the most odious of the objectivists'
canards. Just because "doing good" was used as a pretense or excuse doesn't
mean it was the perpetrator's actual motive.

I suppose you also believe that most violent criminals were individuals that
had only the best of intentions for their victims. Or that Nazis and
Stalinists had little interest in power and influence, which were but side-
effects of their selfless altruism. That Pearl Harbor was an act of charity,
and that the Gulf Oil Spill was caused by attention to detail and an
overabundance of interest in the common good.

~~~
anamax
> Just because "doing good" was used as a pretense or excuse doesn't mean it
> was the perpetrator's actual motive.

And you know that they were lying because you read their minds....

> I suppose you also believe that most violent criminals were individuals that
> had only the best of intentions for their victims.

Nope. But they don't kill all that many people.

> Or that Nazis and Stalinists had little interest in power and influence,

Surely you don't believe that people who want to do good have no interest in
power and influence.

You seem to think that killing lots of people is inconsistent with a desire to
do good. You clearly haven't had much experience with fanatics, or even do-
gooders. It's easy to convince the latter that the world would be better off
if the "right" people were dead.

~~~
leot
> And you know that they were lying because you read their minds....

No, I infer it from their actions.

> Surely you don't believe that people who want to do good have no interest in
> power and influence.

This is a straw man. I'm disputing your original claim that
money(/power/influence) was not the "most influential" source of corruption,
and that the impulse to "do good" was "far more effective than money".

> It's easy to convince [do-gooders] that the world would be better off if the
> "right" people were dead.

I'm calling B.S. Evidence? (or did you actually mean the "former"?)

> You seem to think that killing lots of people is inconsistent with a desire
> to do good.

Yes, I do, especially since we're talking about corruption in the U.S., and
not about the rise of Stalinism. At base we're dealing with issues of systemic
bias, not the actions of fanatics. Show me a consistent source of corrupting
bias, one that silently and perniciously organizes the behaviors of millions,
but which _isn't_ money.

~~~
anamax
> > And you know that they were lying because you read their minds....

> No, I infer it from their actions.

There's your mistake. You think that bad outcome implies bad intentions. It
doesn't.

How do you know that they didn't honestly think that killing a lot of people
would result in good?

> > It's easy to convince [do-gooders] that the world would be better off if
> the "right" people were dead.

> I'm calling B.S. Evidence?

It's a conversation that I have as often as possible, in hopes that pointing
out where they end up will convince them that they really should rethink what
they mean by "good".

>> You seem to think that killing lots of people is inconsistent with a desire
to do good.

> Yes, I do, especially since we're talking about corruption in the U.S., and
> not about the rise of Stalinism.

You seem hung up on Stalinism. While it does have the record in shear numbers,
it isn't the winner in percentages. And, there are plenty of other folks who
will go the same route.

For example, it's not hard to find environmentalists who are hoping for a
population crash. Do you really believe that none of them would push things in
that direction?

> Show me a consistent source of corrupting bias, one that silently and
> perniciously organizes the behaviors of millions, but which _isn't_ money.

All of the "I know what's best for you" behaviors qualify.

~~~
leot
Because it bears repeating, at issue is your original claim that
money(/power/influence) was not the "most influential" source of corruption,
and that the impulse to "do good" was "far more effective than money".

> All of the "I know what's best for you" behaviors qualify.

Since behaviors themselves are a result of bias, I'll interpret this to mean
'All of the "I know what's best for you" _sentiments_ or _beliefs_ '.

Pick one, then, and show how it is all of the following:

a) consistent (i.e. remains relatively stable in how it exerts its influence)

b) corrupting (i.e. causes those involved to violate values/ideals to which
they once claimed allegiance)

c) silent (i.e. can exert its influence absent a need for explicit discussion
of implementation)

d) pernicious (i.e. causes, in certain conditions, a net "bad" when aggregated
across the humans affected)

e) organizing (i.e. coordinates the behavior of multiple individuals)

 _For money, we have:_

a) _(yes)_ by definition, the system has been organized to consistently
incentivize (i.e. reward) the accumulation of money

b) _(yes)_ bribery (including, perhaps especially, the tacit "lean to the
green" kind [1]). E.g., claiming that the most important thing is jobs and the
federal debt, but devoting most of one's actual effort trying to lower taxes
for rich people, thereby increasing the deficit and giving money to those
least likely to spend it.

c) _(yes)_ money's influence does not require explicit discussion or
coordination for it to lead to bad behavior, witness the frequent tacit
agreements of "you scratch my back and I'll scratch yours" ([1] also applies
here)

d) _(yes)_ e.g. the _retroactive_ extensions of copyright Congress has
repeatedly passed
(<http://en.wikipedia.org/wiki/Copyright_Term_Extension_Act>)

e) _(yes)_ this is self-evident as it's the entire purpose of currency

 _In the case of "I know what's best for you":_

a) _(no)_ it's rarely consistent in its influence. Individuals are moody, and
groups of individuals seldom maintain the same "best for you" impulse. There
are thousands of causes (from wanting to better educate future generations to
promoting birth control in order to decrease the population), each with tens
or hundreds of methods for accomplishing them, all of which are changing over
time.

b) _(mostly no)_ It _could_ be corrupting (as defined above), but is rarely
so. Bureaucrats and politicians are criticized far more often of being overly
fearful of taking principled risks and instead wanting to keep their comfy
jobs[2]. In general, violating sworn-to ideals in order to promote some hidden
agenda is a great way to get fired or lose an election[3]. An example of where
it could be "corrupting" would be when a politician increases, say, fuel
economy standards ostensibly to reduce smog but actually to reduce CO2
emissions (but here [3] again applies).

c) _(no)_ Without explicit discussion and coordination, the variation and
competition among individuals in "knowing what's best" tends to neuter its
influence. "I know what's best for you" behaviors generally require explicit
discussion and coordination (e.g. a "conspiracy") to have any significant
effect. This is in large part because of (a). Where it can have some tacit
effect may be at the intersection, among all those who have power, of myriad
"know-what's-best-for-you" sentiments. When, say, these interests are
representative of perhaps 40-55% of the population, this will be a slim
intersection indeed. And it's very unlikely to include the commission of
atrocities.

d) _(yes)_ It's at least possible that this could happen (if, e.g., "knowing
what's best for you" was responsible for Communism's poor outcomes)

e) _(yes)_ Through speeches and, say, "community organizing" "know what's best
for you" behaviors can certainly coordinate the behavior of multiple
individuals.

So, could you explain how 'All of the "I know what's best for you"
sentiments/beliefs qualify.' ? Especially how they satisfy a, b, and c?

[1] [http://fixcongressfirst.org/blog/2010/lessig-on-neo-
progress...](http://fixcongressfirst.org/blog/2010/lessig-on-neo-
progressives/)

[2] hence "exception that proves the rule"

[3] absent regulation, avaricious private interests, who seek to increase
their own wealth, will be a much more lucrative source of campaign funds than
private interests that are promoting a cause that is remuneration-free

------
crag
This is nothing new. The same has been going on in drug trials for years.

The trials are paid for by the company making the drug. With FDA and
(sometimes) NIH oversight of course. But the FDA is terribly under funded. And
the NIH is already a tool for the pharm industry.

And if a company's drug gets into trouble, a few calls to a few of our elected
officials takes care of the little fact right quick.

We only hear about it when people die. Remember Vioxx?

~~~
ramanujan
The FDA is not underfunded. Its budget has more than doubled from 2006 to
2011:

[http://articles.latimes.com/2010/feb/11/nation/la-na-fda-
bud...](http://articles.latimes.com/2010/feb/11/nation/la-na-fda-
budget11-2010feb11)

When a business fails, its budget is cut as customers leave it in droves for
other businesses. But when the FDA fails, the idea is to throw more money at
it, to increase the budget of a failure.

The problem is that the FDA is a monopoly. When it fails, which happens
routinely, people should be able to look to alternate reviewers -- like the
European or Japanese regulatory bodies. That doesn't happen right now.

~~~
archgoon
>The FDA is not underfunded. Its budget has more than doubled from 2006 to
2011:

How much does it need to do its job? Has the amount of work stayed constant
between 2006-2011? Was it properly funded in 2006?

~~~
fleitz
It needs zero because the market will provide these services. Or if it doesn't
it would be clear that consumers didn't want these services.

~~~
hessenwolf
Why would the market provide these services?

We could start to pay a company to tell us which drugs were safe, but they
would only have one customer who would tell everybody else.

~~~
thomas11
I'm not convinced it would actually work, but what the OP probably meant is
that the pharma companies would pay the certification companies so they could
put a "Certified by X" sticker on their packaging. The better X would certify,
the more they could ask from the pharma company, so the market would reward
proper certification.

~~~
hessenwolf
Erm... that's just the same as it is now. Pharma companies pay scientists to
statistically test there products. My first year stats professor described how
difficult it is to say to your employer after a year and a lot of cash that
their toothpaste did not perform statistically significantly better than the
placebo. How many more consultancy contracts are you going to get?

------
za
"The vast majority of drugs - more than 90 per cent - only work in 30 or 50
per cent of the people," Dr Roses said. "I wouldn't say that most drugs don't
work. I would say that most drugs work in 30 to 50 per cent of people. Drugs
out there on the market work, but they don't work in everybody."

\-- Allen Roses, worldwide vice-president of genetics at GlaxoSmithKline 2003

[http://www.independent.co.uk/news/science/glaxo-chief-our-
dr...](http://www.independent.co.uk/news/science/glaxo-chief-our-drugs-do-not-
work-on-most-patients-575942.html)

~~~
gruseom
That's misleading. Many of the most profitable pharmaceuticals (e.g. SSRIs, as
Irving Kirsch devastatingly established - see
<http://news.ycombinator.com/item?id=2622912>) are known not to work anywhere
near that well, if "work" means significance beyond placebo. There is even
powerful evidence against the claim that they work at all.

------
billswift
Derek Lowe provides an excellent commentary on the article, both what it gets
right and what it gets wrong.

[http://pipeline.corante.com/archives/2011/06/07/even_worse_t...](http://pipeline.corante.com/archives/2011/06/07/even_worse_than_reality.php)

------
ssdsa
Are there any other non-native speakers who thought of drug lords when reading
the headline?

