Peter C. Gotzsche - Deadly medicines and organised crime
The big epidemics of infectious and parasitic diseases that previously took many lives are now under control in most countries. We have learned how to prevent and treat AIDS, cholera, malaria, measles, plague and tuberculosis, and we have eradicated smallpox. The death tolls of AIDS and malaria are still very high, but that’s not because we don’t know how to deal with them. It has more to do with income inequalities and the excessive costs of life-saving drugs for people in lowincome countries.
Unfortunately, we now suffer from two man-made epidemics, tobacco and prescription drugs, both of which are hugely lethal. In the United States and Europe,
drugs are the third leading cause of death after heart disease and cancer.
I shall explain in this book why this is so and what we can do about it. If drug deaths had been an infectious disease, or a heart disease or a cancer caused by environmental pollution, there would have been countless patient advocacy groups raising money to combat it and far-ranging political initiatives. I have diffculty understanding that – since it is drugs, people do nothing.
The tobacco and the drug industries have much in common. The morally repugnant disregard for human lives is the norm. The tobacco companies are proud that they have increased sales in vulnerable low-income and middle-income countries, and without a trace of irony or shame, Imperial Tobacco’s management team reported to investors in 2011 that the UK-based company won a Gold Award rating in a corporate responsibility index.
The tobacco companies see ‘many opportunities … to develop our business’, which the Lancet described as ‘selling, addicting, and killing, surely the most cruel and corrupt business model human beings could have invented’.
Tobacco executives know they are peddling death and so do drug company executives. It is no longer possible to hide the fact that tobacco is a major killer, but the drug industry has done surprisingly well in hiding that its drugs are also a major killer. I shall describe in this book how drug companies have deliberately hidden lethal harms of their drugs by fraudulent behaviour, both in research and marketing, and by firm denials when confronted with the facts. Just like the chief tobacco executives each testified at a US Congressional hearing in 1994 that nicotine wasn’t addictive, although they had known for decades that this was a lie.2 Philip Morris, the US tobacco giant, set up a research company that documented the dangers of sidestream smoke, but even though more than 800 scientific reports were produced none were published.
Both industries use hired guns. When robust research has shown that a product is dangerous, numerous substandard studies are produced saying the opposite, which confuse the public because – as journalists will tell you – ‘researchers disagree’. This doubt industry is very effective at distracting people into ignoring the harms; the industry buys time while people continue to die.
This is corruption. Corruption has many meanings and what I generally understand by it is how it is defined in my own dictionary, which is moral decay. Another meaning is bribery, which may mean a secret payment, usually in cash, for a service that would otherwise not be rendered, or at least not so quickly. However, as we shall see, corruption in healthcare has many faces,
including payment for a seemingly noble activity, which might be nothing else than a pretence for handing over money to a substantial part of the medical profession.
The characters in Aldous Huxley’s novel from 1932, Brave New World, can take Soma pills every day to give them control over their lives and keep troubling thoughts away. In the United States, TV commercials urge the public to do exactly the same. They depict unhappy characters that regain control and look happy as soon as they have taken a pill. We have already superseded Huxley’s wildest imaginations and drug use is still increasing. In Denmark, for example, we use so many drugs that every citizen, whether sick or healthy, can be in treatment with 1.4 adult daily doses of a drug every day, from cradle to grave. Although many drugs are life-saving, one might suspect that it is harmful to medicate our societies to such an extent, and I shall document that this is indeed the case.
The main reason we take so many drugs is that drug companies don’t sell drugs, they sell lies about drugs. Blatant lies that – in all the cases I have studied – have continued after the statements were proven wrong. This is what makes drugs so different from anything else in life. If we wish to buy a car or a house, we may judge for ourselves whether it’s a good or a bad buy, but if we are offered a drug, we have no such possibility. Virtually everything we know about drugs is what the companies have chosen to tell us and our doctors. Perhaps I should explain what I mean by a lie. A lie is a statement that isn’t true, but a person who tells a lie is not necessarily a liar. Drug salespeople tell many lies, but they have often been deceived by their superiors in the company who deliberately withhold the truth from them (and are therefore liars, as I see it). In his nice little book On Bullshit, moral philosopher Harry Frankfurt says that one of the salient features of our culture is that there is so much bullshit, which he considers short of lying.
My book is not about the well-known benefits of drugs such as our great successes with treating infections, heart diseases, some cancers, and hormone deficiencies like type 1 diabetes. The book addresses a general system failure caused by widespread crime, corruption and impotent drug regulation in need of radical reforms. Some readers will find my book onesided and polemic, but there is little point in describing what goes well in a system that is out of social control. If a criminologist undertakes a study of muggers, no one expects a ‘balanced’ account mentioning that many muggers are good family men.
If you don’t think the system is out of control, please email me and explain why drugs are the third leading cause of death in the part of the world that uses most drugs. If such a hugely lethal epidemic had been caused by a new bacterium or a virus, or even one-hundredth of it, we would have done everything we could to get it under control. The tragedy is that we could easily get our drug epidemic under control, but our politicians who hold the power to make changes do virtually nothing. When they act, they usually make matters worse because they have been so heavily lobbied by the industry that they have come to believe all its luring myths, which I shall debunk in every chapter of the book.
The main problem with our healthcare system is that the financial incentives that drive it seriously impede the rational, economical and safe use of drugs. The drug industry prospers on this and exerts tight information control. The research literature on drugs is systematically distorted through trials with flawed designs and analyses, selective publication of trials and data, suppression of unwelcome results, and ghostwritten papers. Ghostwriters write manuscripts for hire without revealing their identity in the papers, which have influential doctors as ‘authors’, although they have contributed little or nothing to the manuscript. This scientific misconduct sells drugs.
Compared to other industries, the pharmaceutical industry is the biggest defrauder of the US federal government under the False Claims Act. The general public seems to know what the drug industry stands for. In an opinion poll that asked 5000 Danes to rank 51 industries in terms of the confidence they had in them, the drug industry came second to the bottom, only superseded by automobile repair companies. A US poll also ranked the drug industry at the bottom, together with tobacco and oil companies. In another survey,
79% of US citizens said the drug industry was doing a good job in 1997, which fell to 21% in 2005, an extraordinarily rapid decline in public trust.
On this background, it seems somewhat contradictory that patients have great confidence in the medicines their doctors prescribe for them. But I am sure the reason patients trust their medicine is that they extrapolate the trust they have in their doctors into the medicines they prescribe. The patients don’t realise that, although their doctors may know a lot about diseases and human physiology and psychology, they know very, very little about drugs that hasn’t been carefully concocted and dressed up by the drug industry. Furthermore, they don’t know that their doctors may have self-serving motives for choosing certain drugs for them, or that many of the crimes committed by the drug industry wouldn’t be possible if doctors didn’t contribute to them.
It is dificult to change systems and it is not surprising that people who have to live with a faulty system try to make the most out of it, even though it often results in well-intentioned people doing bad things. However, many people at senior levels in the drug industry cannot be excused in this way, as they have deliberately told lies to doctors, patients, regulators and judges. I dedicate this book to the many honest people working in the drug industry who are equally appalled as I am about the repetitive criminal actions of their superiors and their harmful consequences for the patients and our national economies. Some of these insiders have told me they would wish their top bosses were sent to jail, as the threat of this is the only thing that might deter them from continuing committing crimes.
Peter C. Gotzsche - PDF
