How big pharma deceives us

 Most of the information in the post comes from posts I wrote in 2015. You have likely never read those posts or have forgotten the information, which, by the way, comes from a book written by Marcia Angell, the former editor in chief of The New England Journal of Medicine. She says, among other things, that the pharmaceutical industry has become “a marketing machine to sell drugs of dubious benefit.”

Here are some of the ways big pharma deceives:

Over charging. The cost of the drug is unrelated to the costs of research and development, as they would have us believe. Instead, the costs, which are continually rising, are based on what the public is willing to pay.

Manipulating research findings to make drugs look good. As much as 90 percent of published medical information—the kind of information that doctors rely on—is flawed, according to the world’s foremost expert on the credibility of medical research.

Rewarding doctors to promote their drugs. Companies spend more than four billion dollars nationwide in payments to doctors as incentives for attending industry-sponsored conferences, as well as for promoting their drugs at the conferences.

Rewarding doctors to prescribe their drugs. The rewards to doctors range from meals to generous honoraria for speaking at conferences. As a rule, the doctors who prescribe the most are rewarded the most.

Promoting old drugs as new. Most of the new drugs approved by the FDA are “me too” drugs—old drugs whose molecules have been only slightly altered so they can appear as new. They are more expensive but no more effective than the old models.

Passing off their professionally written articles as the work of academics. Drug companies pay professional writers to produce academic papers according to the companies’ specifications then reward the academics for adding their names to them.

Passing off marketing as “education.” The so-called “education” programs come out of drug companies’ marketing budgets, which, collectively in 2001 amounted to $19 billion. By masquerading marketing as education, big pharma can evade legal constraints on marketing activities.

Let's hope new legislation has some impact on this behavior.

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.

Forget your annual checkup (redux)

This was the title of my second blog post, published on January 10, 2015. You probably never saw it. Here’s a revised version:

I had my last annual checkup in 2002. On that occasion my doctor informed me that my cholesterol was high. I’m not worried about mine and don’t believe in taking cholesterol-lowering drugs. Because I didn’t want to argue, I simply never went back for another checkup. It turns out, eliminating annual checkups is probably a wise decision for most of us.  

You probably get annual checkups because you think they might prevent you from becoming ill. I used to think that also. But I have since learned that reputable medical organizations agree with my stance. For example, one of the recommendations of the Society of General Internal Medicine’s “Choosing Wisely” campaign is “Don’t perform routine general health checks for asymptomatic adults” [my italics]—asymptomatic meaning you feel fine. Regularly scheduled general health checks, according to this group of doctors, “have not shown to be effective in reducing morbidity, mortality or hospitalization, while creating a potential for harm from unnecessary testing” [my italics again]. This conclusion was the result of studies that included nine trials of 155,899 patients.

After examining the records of 182,000 people from 1963 to 1999, the Cochrane Collaboration, an international group of medical researchers, came to the same conclusion. So did the United States Preventive Services Task Force — an independent group of experts making evidence-based recommendations about the use of preventive services. The Canadian guidelines have recommended against these exams since 1979.

Plenty of doctors say the same thing. For example, Dr. Ezekiel J. Emanuel, oncologist, and a vice provost at the University of Pennsylvania, says, “from a health perspective, the annual physical exam is basically worthless.” Dr. Michael Rothberg, a primary care physician and health researcher at the Cleveland Clinic, tries to avoid giving physicals. "I generally don't like to frighten people, and I don't like to give them diseases they don't have. If you get near doctors, they'll start to look for things and order tests because that's what doctors do." Dr.Ateev Mehrotra at the Harvard Medical School says annual physicals are a waste of money, costing us about $10 billion a year, which is more than we spend on breast cancer.

I've now gone for 22 years without an annual physical exam. Works for me.

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.

White hair returns to brown!

 Slow news day.

Here’s an interesting article I read in the New England Journal of Medicine: A 51-year-old man with chronic myeloid leukemia had been tread for a year and a half with a medicine called nilotnib, a “tyrosine kinase inhibitor.” When he visited the oncology clinic for a routine follow-up, the medical personnel were surprised to see that his normally white hair (photo on left) had returned to the brown of his younger self.

During the same period, he had not started any other new medications and had used no hair-coloring products. Other than his hair returning to brown, the scientists saw no other changes in his hair, skin, or "mucosal pigmentation." Molecular testing showed a “deep molecular response,” which sounds impressive although I’m not sure what it means.

Don’t try this at  home.

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.

Inhalers make climate change worse

 Many people use inhalers to treat asthma and chronic obstructive pulmonary disease, conditions that are often exacerbated by the effects of climate change, principally smoke from wildfires. It turns out that inhalers themselves contribue to climate change.

Metered-dose inhalers, which are commonly used in the U.S., use hydrofluorocarbon aerosol propellants to help deliver medication into the lungs. These types of propellants are greenhouse gases that trap heat and carbon dioxide. In 2020, Americans used roughly 144 million metered-dose inhalers—the greenhouse gas equivalent of driving half a million cars for a year.

Incidentally, in 1987 the Montreal Protocol outlawed the ozone-depleting propellant called HCFC (hydrochlorofluorocarbons; note the extra chloro). When pharmaceutical companies switched to the newer propellant, they patented the new formulation, after which inhaler costs skyrocketed.

Dry-powder inhalers, such as those used in Sweden, are an effective alternative to the aerosol propellant type used by most people in the U.S. Unfortunately, some inhaled dry-powder medications are not yet available in the U.S., or they are not covered by insurance. Government agencies, insurers, and hospitals can help by creating a demand for nonpropellant inhalers, a move that would help persuade pharmaceutical companies to bring more of them to market.

Fortunately, pharmaceutical companies are now developing metered-dose inhalers using new propellants that have virtually no global warming effects. If and when they're brought to market, we can probably expect an extravagant price hike.

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.