September 28, 2012
We of the dancing moose have been tracking the fucked-up-ness of the pharmaceutical industry for quite a while, and even blogged some of it over the last six or seven years. For instance, the inappropriate medicalisation of minor conditions and attendant hard-sell of prescription remedies, manipulating lawmaking, the general desire to screen and drug the whole population, the corrupt links between drug-makers and the psychiatric experts who determine what drug shall be the default prescription, their insane profit driven priorities (erection pills over medicines), noting that legal drugs kill more than illegal, the insane PR lengths the industry goes to, and so forth.
But the latest revelation is actually beyond the fucking pale.
The Guardian’s piece from last week, The drugs don’t work: a modern medical scandal is a really extraordinary expose of big pharmaceutical companies’ practices.
Essentially, those psychiatric drugs that are tested and proven effective? That testing process is dodgy. Intentionally, consciously.
Drugs are tested by the people who manufacture them, in poorly designed trials, on hopelessly small numbers of weird, unrepresentative patients, and analysed using techniques that are flawed by design, in such a way that they exaggerate the benefits of treatments. Unsurprisingly, these trials tend to produce results that favour the manufacturer. When trials throw up results that companies don’t like, they are perfectly entitled to hide them from doctors and patients, so we only ever see a distorted picture of any drug’s true effects. Regulators see most of the trial data, but only from early on in a drug’s life, and even then they don’t give this data to doctors or patients, or even to other parts of government. This distorted evidence is then communicated and applied in a distorted fashion.
The pharmaceutical companies exercise controls over the process, so that they can kill studies that aren’t going the way they want. They engage in selective reporting – just plain not reporting studies (often larger and more significant than those on which the effectiveness is claimed) which fail to show positive effects.
How broken is this? Industry funded studies are four times more likely to report positive results. This is a total rape of scientific methodology for financial gain. This is dishonesty leading directly to suffering so fucking corporations can make money.
I did everything a doctor is supposed to do. I read all the papers, I critically appraised them, I understood them, I discussed them with the patient and we made a decision together, based on the evidence. In the published data, reboxetine was a safe and effective drug. In reality, it was no better than a sugar pill and, worse, it does more harm than good. As a doctor, I did something that, on the balance of all the evidence, harmed my patient, simply because unflattering data was left unpublished.
Nobody broke any law in that situation, reboxetine is still on the market and the system that allowed all this to happen is still in play, for all drugs, in all countries in the world.
The author goes on to examine the systemic failings of the system of drug testing and prescription. It is hella worth reading.
What particularly gets me angry is the misapplication of the disease model of mental illness. We are being lied to about our nature, about our minds, and being drugged with horrible shit that has hideous side effects and often doesn’t help – and this is being done knowingly.
What goes on in our heads is not just a question of brain chemistry; our brain chemistry, and our general state of being, is a result of being human beings embedded in the world, acting and receiving feedback from those actions. Our troubles and their solutions are both to be found in that same domain, not a pill.
Bonus note: most of our drugs are synthesised from plants. The general reductionist belief in isolating a single active ingredient from a plant itself is largely driven by profit, and to make researcher’s lives easy. However, we are complex beings, and plants are complex, and the interactions between them are complex. See this article from Dr Andrew Weil: Why Plants are (usually) better than drugs for some examples of how whole plant remedies work.