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Killing for Profit -- The Corruption of Evidence Based Medicine

Thursday, April 12, 2018

(...not to mention all of that "peer reviewed research" in which SparkPeople puts so much faith... doesn't seem so relevant in light of this, does it?)

I was recently asked, in light of my current chosen course of action on behalf of my health, and with regard to my dogged pursuit of wellness, if I was having on-going testing done to monitor changes, if any, one way or the other.

I responded:

"I haven't had any blood work done for over a year, and I have no plans of having any done for some time at this juncture, at least not until I am at goal weight and my weight has remained stable for at least 6 months.

What would be the point? I have no intention of changing what I'm doing, and I really have no burning need to get into yet another fruitless argument with a medical professional that has never offered me anything more than platitudes, pills, and outdated science (the lipid hypothesis is dead, LOL!).

Unless I can find a functional medicine practitioner to work with me... or a doctor who supports keto/paleo (I'm always looking for one)... there really is no point because weight loss, and the sort of physical changes I'm experiencing, does weird things to blood work that the conventional medical doctor can't understand, or even accurately interpret (there's a post on page two of this thread having to do with interpreting blood tests).

Personally (within the system by which I'm bound), I've come to see blood tests for health concerns as being very similar to the scale for weight loss... good for observing trends over time and within context, but not definitive in of themselves in any given moment.

If I feel seriously unwell and compromised in some way with respect to my health, I will definitely see a doctor without hesitation, but I feel great, overall. As I've said many, MANY times on this bog and elsewhere on SparkPeople, I trust the wisdom of my body, and my body has never let me down... unlike every doctor I've ever seen."

(mic drop)

...And then the following popped into my inbox today!

It's uncanny how this so often works in my life... the following article is much more articulate, with the evidence to back it up... I'm including it in its entirety here because if it disappears (wouldn't be the first time Dr. Fung has been forced by someone's lawyer to remove the truth from his blog), I want a record for my own 'library'.

(Dr. Fung also permits and encourages freely sharing his postings)

THIS is exactly why I no longer have faith in conventional medicine/doctors, and why I very carefully choose whose advice I follow. I now hand the rest of this blog over to Dr. Jason Fung!

The Corruption of Evidence Based Medicine -- Killing for Profit
by Dr. Jason Fung

The idea of Evidence Based Medicine (EBM) is great. The reality, though, not so much. Human perception is often flawed, so the premise of EBM is to formally study medical treatments and there have certainly been some successes.

Consider the procedure of angioplasty. Doctors insert a catheter into the blood vessels of the heart and use a balloon like device to open up the artery and restore blood flow.

In acute heart attacks studies confirm that this is an effective procedure. In chronic heart disease the COURAGE study and more recently the ORBITA study showed that angioplasty is largely useless. EBM helped distinguish the best use of an invasive procedure.

COURAGE study: www.ncbi.nlm.nih.

ORBITA study: www.ncbi.nlm.nih.

So, why do prominent physicians call EBM mostly useless? The 2 most prestigious journals of medicine in the world are The Lancet and The New England Journal of Medicine. Richard Horton, editor in chief of The Lancet said this in 2015:

"The case against science is straightforward: much of the scientific literature, perhaps half, may simply be untrue"

Dr. Marcia Angell, former editor in chief of NEJM wrote in 2009 that,
Drug Companies & Doctors: A Story of Corruption

"It is simply no longer possible to believe much of the clinical research that is published, or to rely on the judgment of trusted physicians or authoritative medical guidelines. I take no pleasure in this conclusion, which I reached slowly and reluctantly over my two decades as an editor"

This has huge implications. *Evidence based medicine is completely worthless if the evidence base is false or corrupted.* It’s like building a wooden house knowing the wood is termite infested. What caused this sorry state of affairs? Well, Dr. Relman another former editor in chief of the NEJM said this in 2002:

"The medical profession is being bought by the pharmaceutical industry, not only in terms of the practice of medicine, but also in terms of teaching and research. The academic institutions of this country are allowing themselves to be the paid agents of the pharmaceutical industry. I think it’s disgraceful"

America's other drug problem: how the drug industry distorts medicine and politics.

The people in charge of the system -- the editors of the most important medical journals in the world, gradually learn over a few decades that their life’s work is being slowly and steadily corrupted. Physicians and universities have allowed themselves to be bribed.

The examples in medicine are everywhere. Research is almost always paid for by pharmaceutical companies. But studies done by industry are well known to have positive results far more frequently. Trials run by industry are 70% more likely than government funded trials to show a positive result. Think about that for a second. If EBM says that 2+2 = 5 is correct 70% of the time, would you trust this sort of ‘science’?

Outcome reporting among drug trials registered in ClinicalTrials

Selective Publication -- Negative trials (those that show no benefit for the drugs) are likely to be suppressed. For example, in the case of antidepressants, 36/37 studies that were favourable to drugs were published. But of the studies not favorable to drugs, a paltry 3/36 were published. Selective publication of positive (for the drug company) results means that a review of the literature would suggest that 94% of studies favor drugs where in truth, only 51% were actually positive. Suppose you know that your stockbroker publishes all his winning trades, but suppresses all his losing trades. Would you trust him with your money? But yet, we trust EBM with our lives, even though the same thing is happening.

NEJM: Selective Publication of Antidepressant Trials and Its Influence on Apparent Efficacy

Let’s look at the following graph of the number of trials completed versus those that were published. In 2008, the company Sanofi completed 92 studies but only a piddly 14 were published. Who gets to decide which gets published and which does not? Right. Sanofi. Which ones do you think will be published? The ones that favor its drugs, or the ones that prove their drugs do not work? Right. Keep in mind that this is the only rational course of action for Sanofi, or any other company to pursue. It’s idiotic to publish data that harms yourself. It’s financial suicide. So this sort of rational behavior will happen now, and it will not stop in the future. But knowing this, why do we still believe the evidence based medicine, when the evidence base is completely biased? An outside observer, only looking at all published data, will conclude that the drugs are far, far more effective than they are in reality. Yet, if you point this out in academic circles, people label you a quack, who does not ‘believe the evidence’.

Rigging of Outcomes -- Or consider the example of registration of primary outcomes. Prior to year 2000, companies doing trials did not need to declare what end points they measured. So they measure many different endpoints and simply figured out which one looked best and then declared the trial a success. Kind of like tossing a coin, looking at which one come up more, and saying that they were backing the winning side. If you measured enough outcomes, something was bound to come up positive.

In 2000, the government moved to stop these shenanigans. They required companies to register what they were measuring ahead of time. Prior to 2000, 57% of trials showed a positive result. After 2000, a paltry 8% showed good results. More evidence of the evidence base being completely corrupted by commercial interest, and the academic physicians who were getting rich on it tacitly allowing corruption because they know that you don’t bite the hand that feeds you.

‘Advertorials’ -- Or this example of a review paper in the NEJM that fracture rates caused by the lucrative bisphosphonate drugs were “very rare”. Not only did the drug companies pay lots of consulting fees to the doctors, three of the authors of this review were full time employees! To allow an advertorial to be published as the best scientific fact is scandalous. Doctors, trusting the NEJM to publish quality, unbiased advice have no idea that this review article is pure advertising. Yet, we still consider the NEJM to be the very pinnacle of evidence based medicine. Instead, as all the editors of the journals sadly recognize, it has become lucre-based publishing. Mo money = better results.

NEJM: Bisphosphonates and Fractures of the Subtrochanteric or Diaphyseal Femur

Money from Reprints -- The reasons for this problem is obvious to all -- it’s insanely profitable for journals to take money from Big Pharma. Journals want to be read. So they all try to get a high Impact Factor (IF). To do this, you need to get cited by other authors. And nothing boosts ratings like a blockbuster produced by Big Pharma. They have the contacts and the sales force to make any study a landmark. A less obvious benefit is the fees that are generated by Big Pharma purchasing articles for reprint. If a company publishes an article in the NEJM, they may order several hundred thousand copies of the article to be distributed to unsuspecting doctors everywhere. These fees are not trivial. The NEJM publisher Massachusetts Medical Society gets 23% of its income from reprints. The Lancet -- 41%. The American Medical Association -- a gut busting 53%. No wonder these journals are ready to sell their readers (ordinary physicians) down the river. It pays. Who needs journalistic ethics when there’s a Mercedes in the driveway? Mo money, baby. Mo money.

Editors, Publishers, Impact Factors, and Reprint Income

Bribery of Journal Editors -- A recent study by Liu et al in the BMJ shed more light on the problem of crooked journals. Crooked journal editors. Editors play a crucial role in determining the scientific dialogue by deciding which manuscripts are published. They determine who the peer reviewers are. Using the Open Payments database, they looked at how much money the editors of the most influential journals in the world were taking from industry sources. This includes ‘research’ payments, which are largely unregulated. As mention previously, much ‘research’ consists of going to meetings in exotic locale. It funny how many conferences are held in beautiful European cities like Barcelona, and how few are done in brutally cold Quebec City.

Payments by US pharmaceutical and medical device manufacturers to US medical journal editors: retrospective observational study

Of all journal editors that could be assessed, 50.6% were on the take. The average payment in 2014 was $27,564. Each. This does not include an average $37, 330 given for ‘research’ payments. Other particularly corrupt journals include:

This is slightly horrifying. Each editor of the Journal of the American College of Cardiology received, on average $475 072 personally and another $119 407 for ‘research’. With 35 editors, that’s about $15 million in bribes to doctors. No wonder the JACC loves drugs and devices. It pays the private school bills. Mo money = we’ll publish your crooked studies for you. Mo money, baby, mo money.

Publication Bias -- The evidence base that EBM depends upon is completely biased. Some people think I’m really anti-Pharma, but this is not really true. Big Pharma companies have a duty to their shareholders to make money. They have no duty to patients. On the other hand, doctors have a duty to patients. Universities have a duty to remain unbiased.

It is the failure of doctors and universities to keep their greedy paws out of the corrupting influence of Big Pharma money that is the problem. If Big Pharma is allowed to spend lots of $$$ paying off doctors and universities and professors, then it should do so to maximize profits. That is their mission statement. Doctors love to blame Big Pharma companies because it takes peoples gaze off the real problem -- lots of doctors taking $$$ from anybody who will pay. The pharma industry is not the problem. *Bribery of university doctors is the problem* -- one that is easily fixed if the political will exists.

Consider this study.
Discontinuation and non‐publication of neurodegenerative disease trials: a cross‐sectional analysis

Looking at studies in the field of neurodegenerative disease, researchers looked at all the studies that were started but never finished or never published. Approximately 28% of studies never made it to the finish line. That’s a problem. If all the studies that don’t look promising for drug candidates are not published, then it appears that the drugs are way way more effective than they really are. But the published ‘evidence base’ would falsely support the drug. Indeed, Pharma sponsored trials were *5 times more likely* to be unpublished.

Imagine you have a coin flipping contest. Suppose a player call ‘Big Pharma” chooses heads, and also pays the coin flipper. Every time the coin flipper pulls up tails, the results don’t count. Every time it comes up heads, it counts. This happens 28% of the time. Now, instead of a 50/50 split of heads and tails, it’s more like a 66/34 split of heads/tails. So the ‘evidence based medicine’ lover claims that heads is far more likely to come up than tails, and castigates people who don’t believe the results as ‘anti-science’.

Evidence based medicine depends entirely upon having a reliable base of evidence (studies). If the evidence base is tampered with, and paid for, then EBM as a science is completely useless. Indeed, the very editors whose entire careers have been EBM have now discovered it to be worthless. Does the CEO of Phillip Morris (maker of Marlboro cigarettes) smoke? That tells you all you need to know about the health risks. Do the editors of the NEJM and the Lancet believe EBM anymore? Not at all. So neither should we. We can’t believe evidence based medicine until the evidence has been cleaned up from the corrupting influence of commercial interests.

Financial conflicts of interest (COI), also known as gifts to doctors, is a well accepted practice. A national survey in the New England Journal of Medicine in 2007 shows that 94% of physicians had ties to the pharmaceutical industry. This gravy train only rides in one direction. From Big Pharma to the wallets of doctors. Sure Big Pharma can simply pay doctors directly, and it does plenty of that. It’s no surprise that medical students with more exposure to pharmaceutical reps develop a more positive attitude towards them. Many medical schools have limited exposure of medical students in response, but declined to get off the gravy train themselves. There is a simple relationship between how prominent a physician is (more articles published -- almost always academic doctors and professors) and how much money they take from Big Pharma. *Mo prominent = mo money.* Further, there is a ‘clear and strong link’ between taking industry money and minimizing the risk of side effects of medications. What, you thought people teach at prestigious institutions like universities for the good of mankind? Maybe that’s why they went there, but that’s not why they stay. They came for the science. They stayed for the money.

NEJM: A National Survey of Physician-Industry Relationships

Medical student exposure to and attitudes about pharmaceutical companies.

Association between industry affiliation and position on cardiovascular risk with rosiglitazone: cross sectional systematic review.

So here’s a damning list of all the problems of EBM:
1. Selective Publication
2. Rigged outcomes
3. Advertorials
4. Reprint Revenues
5. Bribery of Journal Editors
6. Publication Bias
7. Financial Conflicts of Interests

When the evidence base of medicine is bought and paid for, people die. Unfortunately, doctors and universities have been willing participants in this game of killing for profit. We need to end it now. End the corruption of the universities. Stop the bribery of doctors. Stay tuned, the non-profit Public Health Collaboration, currently based in the UK, but soon encompassing Canada, Ireland, USA, and Australia is gearing up to tackle this issue of corruption in medical science.

The PHC Conference 2018 will be held in London at the Royal College of General Practitioners in May!

For more, check this video trailer:


Dr. Fung is a Toronto based kidney specialist, having graduated from the University of Toronto and finishing his medical specialty at the University of California, Los Angeles in 2001. He is the author of the bestsellers ‘The Obesity Code’ and ‘The Complete Guide to Fasting’. He has pioneered the use of therapeutic fasting for weight loss and type 2 diabetes reversal in his IDM clinic.

How we have been lied to by Big Pharma (YouTube video)

Dr. Fung's Blog

...and I loved this article almost MORE:
(I can't wait to read the book)

Why I'm Giving Up on Preventative Care - How contemporary Medicine is Testing Us to Death

...and then there was this: BUSTED!

Goldman Sachs asks in biotech research report: 'Is curing patients a sustainable business model?'

Goldman Sachs analysts attempted to address a touchy subject for biotech companies, especially those involved in the pioneering "gene therapy" treatment: cures could be bad for business in the long run.

"Is curing patients a sustainable business model?" analysts ask in an April 10 report entitled "The Genome Revolution."

"The potential to deliver 'one shot cures' is one of the most attractive aspects of gene therapy, genetically-engineered cell therapy and gene editing. However, such treatments offer a very different outlook with regard to recurring revenue versus chronic therapies," analyst Salveen Richter wrote in the note to clients Tuesday. "While this proposition carries tremendous value for patients and society, it could represent a challenge for genome medicine developers looking for sustained cash flow."

Richter cited Gilead Sciences' treatments for hepatitis C, which achieved cure rates of more than 90 percent. The company's U.S. sales for these hepatitis C treatments peaked at $12.5 billion in 2015, but have been falling ever since. Goldman estimates the U.S. sales for these treatments will be less than $4 billion this year, according to a table in the report.

"GILD is a case in point, where the success of its hepatitis C franchise has gradually exhausted the available pool of treatable patients," the analyst wrote. "In the case of infectious diseases such as hepatitis C, curing existing patients also decreases the number of carriers able to transmit the virus to new patients, thus the incident pool also declines … Where an incident pool remains stable (eg, in cancer) the potential for a cure poses less risk to the sustainability of a franchise."

The analyst didn't immediately respond to a request for comment.

The report suggested three potential solutions for biotech firms:

"Solution 1: Address large markets: Hemophilia is a $9-10bn WW market (hemophilia A, B), growing at ~6-7% annually."

"Solution 2: Address disorders with high incidence: Spinal muscular atrophy (SMA) affects the cells (neurons) in the spinal cord, impacting the ability to walk, eat, or breathe."

"Solution 3: Constant innovation and portfolio expansion: There are hundreds of inherited retinal diseases (genetics forms of blindness) … Pace of innovation will also play a role as future programs can offset the declining revenue trajectory of prior assets."

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What I'm currently up to in the name of health and wellness:

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Member Comments About This Blog Post
    Ramona - i was on VirtaHealth.com telemedicine with focus on keto protocols - that might be of interest. I’m currently doing a chemo thing but thinking I need to completely rethink. I have a naturopath that I will see soon...should have stayed in contact with her months ago but got involved in focusing on other health issues before I discovered the cancer... I need to spend more time reading Dr Fung’s articles that I also get in email!

    Julia who needs to get to sleep !!
    501 days ago
    Ramona, another point that has to be considered; medical training (veterinarian as well) is long ( at least 10 years including the undergrad required to even get into med school) with high tuition rates and poor remuneration for work done during residencies. Most who finish are looking at huge student debt, upwards of $C200,000. Then if and when they enter a practice overhead costs such as rent, secretarial and nursing staff, utilities, pension plans and upgrading come out of their salaries. Here in Nova Scotia a family doctor at most is paid $250,000. Specialists, who train even longer, have higher salaries but the same costs. The lure of monies from big Pharma must be hugely enticing under these circumstances.
    601 days ago
    A little too complicated for me, as english is not my native tongue... my experience is that doctors I meet are different, as for helth problems from lifestyle tha goal for health care in Sweden today seem to be to get the patient active with exercice and good food choices rather than pills.
    601 days ago
    Excellent, thank you for sharing. It is a known that doctors here in Canada have regular visits from drug reps who leave samples of their companies' products. Any of the family doctors I have visited over the years have used those wisely, passing them on to patients who will use them properly or who might not be able to afford them at the drug store. In that regard I have been lucky but I do know of others that pass them out like candy ( antibiotics for viral infections for example).
    An unfortunate side of medical training is the lack of time spent on nutrition, at most medical schools it amounts to less than one day in four years of study. Again I am fortunate in that my family doctor has embraced vegetarianism so we have a lot of knowledge we can share with each other.
    Finally, the big elephant, that of drug companies (and others) funding research at universities. A famous example is that of Dr. Colin Campbell (The China Study) who for years did major research at Cornell, basically for the USDA and about the importance of dairy in human diet. When he had his Eureka moment and questioned the role of dairy on poor health outcomes his funding was immediately ended.
    Unfortunately Dr. Fung's audience is basically the 5% who are knowledgeable and concerned.
    602 days ago
    Yes. I so admire him for braving publishing that, too. Western medicine the money model needs to go.

    602 days ago
    Thanks for sharing the article. It speaks to the need for A-1 critical thinking skills to survive in this crazy world.
    The many ads on TV for drugs I think illustrates your point. These beautiful and slick ads must be costly to produce and air to us. Concern for our health and welfare is probably not the only motivation. And then when they list the possibilities of adverse reactions you have even more doubt.

    That being said, I see a physician's assistant and I do put a great deal of trust in both her motivations and her critical thinking skills. I feel like I get better care from her than I have ever received from any type of doctor. She is as likely to recommend meditation as medication.

    602 days ago
    interesting stuff
    602 days ago
  • ALOFA0509
    Great Stuff!! Its always been about emoticon . There is no money in Cures...

    Thank You for sharing all these studies! I'll have to dive into them further this weekend!! emoticon

    Upton Sinclair's Quote: "It's difficult to get man to understand something, when his Salary is dependent on him not understanding it"

    602 days ago
    ...burden in our health care system. Recently went through a series of test with a general practitioner for him to tell me I’m perfectly healthy... yet then why did I feel that way? Well... a keto lifestyle was an answered pray. Food is medicine.
    602 days ago
    A natural health care practitioner may be worth your interest. I wish I could see one here, but they are not cheap and not covered under our health care system, which is such a shame, as they are the ones who could truly help and heal and lessen the
    602 days ago
    602 days ago
    Thank you, Ramona for sharing Dr. Fung's post. Sobering.
    603 days ago
    I took myself out of the corrupt medical moneymaking machine a long time ago.
    603 days ago
  • PHOENIX1949
    emoticon I appreciate your informative, thought-provoking blogs.
    603 days ago
    Wow, that's a brave guy: and he's practising out of Toronto??
    603 days ago
    Apparently I need to reiterate... I DID NOT WRITE THE ARTICLE I'm sharing here. While I can speak to my own opinions and experience, I don't have the training or knowledge to expose this topic as Dr. Fung has done!
    603 days ago
    I'm with you! I don't trust doctors either. They're knowledge of healthy eating is next to nil. Ever have a conversation with an obese Nurse Practitioner about why a certain test should be done and if you question their "logic" they can't give you an answer except that you're of a certain age? ROFL. Some of them are more brain washed than their patients.
    Now that health insurance is so ridiculous we can't afford it and see a doctor even if we wanted to.
    603 days ago
    Awesome blog. You have compiled so much information and presented here in a very factual presentation. Congratulations on all that investigation.

    You do have to be your own advocate in all dealings with medical care. I have read a lot of positive material about Keto diet and all of it makes total sense to me. My daughter is now a keto convert and she is so much healthier, has lost tons of weight, is much more emotionally balanced, has much more energy than she ever has in her whole life. Thankfully her doctor is very supportive and understands the fluctuations in blood work results.

    I honestly think that countries that have socialized medicine have health care that is superior to the US. As soon as big Pharm money as well as all the money in testing, etc is taken out of the equation, then the quality of medicine is able to be judged much more on the outcomes. Also, the everyday person is able to go get care when they first notice a symptom and catch a disease process earlier instead of waiting until they are at stage 4 and expecting a miracle.

    Thanks so much for all your information.

    603 days ago
    But...one blood panel is not enough. My doctor would support that .
    603 days ago
    I confess, I read with freat interest about halfway while promusing I will return to it later...I will also look into the good dr when back home ( Toronto). I get your initial point, and agree , to a point. Some evidence cannit be shuffked aside, but
    603 days ago
    Wow! Is't it just time for change!

    I don't see medical practitioners unless I KNOW I have a real problem. Otherwise, whole, natural food is my medicine!

    603 days ago
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