By Dr. Mercola
It’s old news that drug companies essentially “bribe” doctors
into prescribing their drugs by lavishing them with gifts –
branded pens and coffee mugs, free lunches, golf outings,
“educational” trips to the Caribbean … all have been regarded as
fair game in the past, although now such free goodies are
heavily discouraged.
Just how much influence such gifts had on doctors has long
been debated (although the research suggests it did
have a significant impact … why else would the drug companies
put so much money into it?). But regardless, sound medical
research published in a reputable medical journal should have
much more influence …
A pen with a drugmaker’s name emblazoned on the side couldn’t
possibly persuade a physician to prescribe a drug more than
clinical data published in a medical journal.
Yet, what many people do not understand is that much of the
scientific research published in journals is bought-and-paid-for
by the drug industry as well.
A far more covert – and far more influential – practice than
showing up at a physician’s office with a free pizza and a
duffel bag full of coffee mugs, by controlling medical research
itself the drug industry can make it virtually impossible for a
well-meaning physician to decipher the truth about the
medications he or she is prescribing to you.
Most Medical Journals Depend on Big Pharma Advertising Dollars
In The American Scholar, author Harriet Washington
writes:1
“… while we still gravely debate whether physicians’
loyalties can really be bought for a disposable pen or a
free lunch, the $310 billion pharmaceutical industry quietly
buys something far more influential: the contents of medical
journals and, all too often, the trajectory of medical
research itself.
… Flimsy plastic pens that scream the virtues of
Vioxx and articles published in the pages of The
New England Journal of Medicine would seem to mark the two
poles of medical influence. Scarcely any doctor admits to
being influenced by the former; every doctor boasts of being
guided by the latter.
In fact, medical-journal articles are widely embraced as
irreproachable bastions of disinterested scientific
evaluation and as antidotes to the long fiscal arm of
pharmaceutical-industry influence.
And yet, 'All journals are bought — or at least
cleverly used — by the pharmaceutical industry,' says
Richard Smith, former editor of the British Medical Journal
…”
It starts with advertising dollars, as pharmaceutical ads can
make up 97-99 percent of a medical journal’s advertising
revenue. As the featured article reported:
“ … medical journals themselves advertise to
drugmakers, flooding the pages of pharmaceutical-industry
publications such as Medical Marketing and Media to vie for
the attentions of Big Pharma. The Journal of the American
Medical Association (JAMA) bills itself in
advertising as 'a priceless audience at a price you can
afford,' while the Annals boasts: 'With an audience of more
than 90,000 internists (93 percent of whom are actively
practicing physicians), Annals has always been a smart buy.'
In 2003, drug companies spent
$448 million on advertising in medical journals. The ads
promote not only drugs but also subsidized seminars and
“training opportunities” that usually take place in tropical
locations.
Of course, oftentimes the ads are only agreed upon if there will
also be a positive mention of the product in an editorial piece;
sometimes the drug maker will even have their own writers
generate the content! It has been calculated that the return on
investment on medical journal ads is between $2.22 and $6.86 for
every dollar spent, with larger and older brands at the higher
end.
Long-term returns may be even higher when you consider that
one ad viewed by a physician could result in hundreds or even
thousands of drug purchases, based on the prescriptions he or
she writes.
At least certain medical journals are attempting to regain
their unbiased reputations; in 2011 the journal Emergency
Medicine Australasia announced it would no longer accept
pharmaceutical advertisements, citing growing evidence that the
drug industry "distorts research findings and engages in dubious
and unethical publishing practices."
Why Most Medical Research Cannot be Trusted
The sad truth is, there's no easy way to determine what you
can trust when it comes to medical research and official
treatment guidelines. So much of it has been tainted by
financial conflicts of interests. It's well known that studies
funded by industry or conducted by
researchers with industry ties tend to favor
corporate interests.
That's why it probably comes as no surprise that many so-called
"experts"
are very much on the drug industry's payroll -- but they
masquerade as independent medical experts or even state
officials during their "day jobs."
It is, by the way, 100% legal for drug companies to pay
medical professionals to promote their products. The drug
industry also often pays the expert medical reviewers who
evaluate medications or medical devices for the journals. The
featured article continues:2
“Today, medical-journal editors estimate that 95
percent of the academic-medicine specialists who assess
patented treatments have financial relationships with
pharmaceutical companies, and even the prestigious NEJMgave
up its search for objective reviewers in June 1992,
announcing that it could find no reviewers that did not
accept industry funds.”
The conflict of interest within this practice is obvious,
which is why the drug industry often keeps quiet on their actual
payments, as do the medical professionals involved. Although
many medical, educational and research institutions require
faculty members to disclose such potential conflicts of
interest, many do not actively monitor employees' activities.
Financial disclosures are also added into medical journals,
but the reader will only learn which company may have paid an
expert author, not how much or what other ties to industry they
may have. Unfortunately, even if you scour the medical
literature to determine what the consensus is on any given
medical topic, what you'll find is an overwhelming preponderance
of data in favor of the drug approach that in no way, shape or
form reflects the reality of the scientific investigation that
went into that specific drug.
How Negative Research Gets a Positive Spin
The fact is, there are many ways to turn an otherwise
negative study positive, including choosing study participants
who are more likely to benefit from the treatment or even
hiding, or simply not publishing, negative results; in fact,
researchers of industry-funded studies often sign gag orders
that forbid them from publishing, discussing or analyzing data
without permission of the funder. According to Marcia Angell,
former editor-in-chief of the New England Journal of
Medicine (NEJM):
3
“Any reputable journal is at the mercy of what is
submitted to it and must choose from whatever comes over the
transom. Many studies never see the light of day because
their findings are negative. There is a heavy bias toward
positive studies, and this negative bias is a real problem.
A company may conduct 1,000 trials; if two are positive,
they get FDA approval and are published. The other 998 never
see the light of day. In fact, half of all study data is
never published.”
In a tongue-in-cheek essay in the British Medical Journal,
titled “HARLOT — How to Achieve Positive Results Without
Actually Lying to Overcome the Truth,”4
it’s wittily explained exactly how industry insiders can help
make their drugs look good:5
- “Comparing their drug to a placebo. A placebo, such
as a sham or 'sugar' pill, has no active ingredient, and,
although placebos may evoke some poorly understood medical
benefits, called the 'placebo effect,' they are weak:
medications tend to outperform placebos. Placebo studies are
not ethical when a treatment already exists for a disorder,
because it means that some in the study go untreated.
However, if you care only that your new drug shines in
print, testing against placebo is the way to go.
- Comparing their drug to a competitor’s medication in
the wrong strength. Too low a dose makes the rival drug look
ineffective. Too high a dose tends to elicit worrisome side
effects.
- Pairing their drug with one that is known to work
well. This can hide the fact that a tested medication is
weak or ineffective.
- Truncating a trial. Drugmakers sometimes end a
clinical trial when they have reason to believe that it is
about to reveal widespread side effects or a lack of
effectiveness — or when they see other clues that the trial
is going south.
- Testing in very small groups. Drug-funded
researchers also conduct trials that are too small to show
differences between competitor drugs. Or they use multiple
endpoints, then selectively publish only those that give
favorable results, or they 'cherry-pick' positive-sounding
results from multicenter trials.”
Did You Know the Drug Industry Also Pays Ghostwriters?
One cross-sectional survey found that more than 20 percent of
articles published in six leading medical journals during 2008
were likely
written by honorary and/or ghostwriters.6
For medical journals, ghostwriting usually refers to writers
sponsored by a drug or medical device company, who make major
but uncredited research or writing contributions.
The pharmaceutical company hires a medical education and
communications company, which is a company paid almost
exclusively by pharmaceutical companies to write articles,
reviews, and letters to editors of medical journals in order to
cast their products in a favorable light. (Since they pay
substantial amounts to have these articles written, it
automatically implies that it will be written to their
specifications.)
Once the article is written to their satisfaction, the
pharmaceutical company then starts "shopping around" for an
academic physician or physicians who are well known in the
field, encouraging them to put their name on the article.
From there, they "massage" the article past peer review in
one of the more prestigious medical journals, preferably one
that strongly influences practicing doctors. Once the article is
published, the pharmaceutical company then purchases tens of
thousands of reprint copies to be distributed to doctors’
offices by their pharmaceutical representatives. The
unsuspecting doctor thinks the study is reliable since it
clearly appears to be written by a leading name in the field and
has been published in a prestigious peer-reviewed medical
journal.
Why would medical journals play along with this apparent
sham? Perhaps the primary incentive to play it loose is that
it's very lucrative for them, as the reprints purchased by the
pharmaceutical companies for distribution are quite expensive.
And medical journals are, after all, for-profit businesses. In
some cases, some of the leading publishers have even sunk so low
as to publish entire sham journals. The featured article stated:7
“Elsevier publishes 2,000 scientific journals and
20,000 book-length works, but its Australasian Journal of
Bone and Joint Medicine, which looks just like a medical
journal, and was described as such, was not a peer-reviewed
medical journal but rather a collection of reprinted
articles that Merck paid Elsevier to publish. At least some
of the articles were ghostwritten, and all lavished
unalloyed praise on Merck drugs, such as its troubled
painkiller Vioxx. There was no disclosure of Merck’s
sponsorship.
Librarian and analyst Jonathan Rochkind found five
similar mock journals, also paid for by Merck and touted as
genuine. The ersatz journals are still being printed and
circulated, according to Rochkind, and 50 more Elsevier
journals appear to be Big Pharma advertisements passed off
as medical publications. Rochkind’s forensic librarianship
has exposed the all-but-inaccessible queen of medical
publishing as a high-priced call girl.”
How Can You Make Educated Health-Care Decisions?
When your physician prescribes you a medication, even if he
or she has reviewed the relevant published data, there is
virtually no way to know whether that drug is truly safe or
effective. The well from which that data has been drawn has been
"poisoned" so that it's nearly impossible to decipher what is
real and what is a fabrication.
Since it is very well established that most prescribed drugs
do absolutely nothing to treat the cause of disease, it would be
prudent to exercise the precautionary principle when evaluating
ANY drug claim, as it will more than likely be seriously flawed,
biased, or worse … and, of course, I always advise taking
control of your health, which you can easily do by reviewing my
comprehensive nutritional plan that summarizes my 30 years
of clinical experience and treating 25,000 patients. I put this
together so you can stay well and avoid falling into the
dangerous, deceitful traps discussed in this article.
© Copyright 1997-2013 Dr. Joseph Mercola. All Rights Reserved.