Book Review: Deadly Medicines and Organized Crime

Grade: A

Mind Blown! I mean it.  I've been skeptical of the pharmaceutical industry for many years, but I don't know of anything as impressive as this book.

This book is not written by some anti-drug hack.  Dr. Peter Gotzsche co-founded the Cochrane Collaboration in 1993 and established The Nordic Cochrane Centre the same year.

I first heard about the Cochrane Collaboration in my high school debate class when my teacher was discussing the greatest collection and analyses of medical knowledge in the world.

Yeah - the author of this book helped found it and he has worked in medical research and meta-analysis of data for most of his life.  He became Professor of Clinical Research Design and Analysis in 2010 at the University of Copenhagen.

Basically - this guy knows what he is talking about. He is a physician who has prescribed medications, he has been a "drug rep" and helped sell medications, and he has since analyzed more studies than any researcher I've read.

The only reason this book doesn't get an A+ is because it is so amazingly heavy on research and medical terminology that it is unlikely to be read by the general public.

This book meticulously and methodically shows how deeply entrenched the pharmaceutical industry is in EVERY level of medicine.

I knew they offered free lunches, free drug samples, and they paid for speakers at medical conferences.  I knew they used to give out free pens and paper, and toys, and clocks.  I even knew they had some pull at the FDA.  I had no idea about all the rest.

MEDICAL JOURNALS

This was the part that scared me the most. 

The BMJ (British Medical Journal)'s former editor said "medical journals are an extension of the marketing arm of the pharmaceutical companies." - p. 64

WHAT?!  Medical journals are where I get my trustworthy information.  It's where I can find double blind randomized control trials that have been peer-reviewed.  They are the gold standard for research!

Journals are where I proudly hang my hat.  I don't need to listen to drug reps - I read the New England Journal of Medicine.  The best in the world!

It turns out journal editors can be bought off - just like everyone else.  Even the best medical journals in the world - New England Journal of Medicine, Lancet, BMJ, Annals of Internal Medicine and JAMA - have all accepted drug money to publish misleading information or bad studies.

The New England Journal of Medicine (likely the most respected medical journal in the world) is as guilty as the rest.  32% of all trials published in their journal were solely funded by drug companies.

NEJM even changed their policy in 2002 to allow authors to write about products in which they had a financial interest.

Journals make HUGE money from advertisements and reprints.  If they publish a study beneficial to a drug company - that company promises to buy reprints in order to show them to physicians.

The Lancet made over £1.5 million on orders for a reprint of just one of their editions.  - p. 65

The Annals of Internal Medicine lost over $1 million in advertising revenue after it published a study that was critical of industry advertisements. - p. 65

Journals have a financial interest in making their article abstracts sound beneficial for new drugs.  Reprints will be ordered.  The more they allow a study to minimize or hide side effects - the more money they'll make.

Journal corruption is just one small chapter in this book.  Gotzsche also details corruption in clinical trials, seeding trials, TV ads, the FDA, patents, professional organizations, and even CME (Continuing Medical Education.)

Doctors have to stay current.  To keep our board certification we have to log hours of continuing education.

60% of all CME is paid for and provided by drug companies - so guess what most of us are learning?  Exactly what they want us to.

Drug companies are not changing.  They get caught in their fraud and they either say it was "one bad apple" or "mea culpa: we've now changed our ways."

It's all lies.

If you look at the 3 years span from 2010-2012 you'll find these cases:
 
2012: Abbott paid $1.5 Billion for Medicaid fraud
2012: Johnson and Johnson fined $1.1 Billion for hiding side effects
2011: GlaxoSmithKline paid $3 Billion for illegal marketing of off-label drugs.
2010: AstraZeneca paid $520 Million for fraud
2010: Novartis paid $423 Million for illegal marketing
the list goes on...

They aren't changing.  Drug companies know how to make money - and these lawsuits are already factored in to the profit predictions.  They know that these fines are worth it.  The fraud makes them more money than they will ever be fined.

This book made me look at my life.  I'll graduate from fellowship in four months and begin my career as a Child and Adolescent Psychiatrist.

I know there are good medications.  There are caring doctors.  There are honest people working as drug reps.  There are intelligent and ethical researchers at the FDA and at pharmaceutical companies.  There are honest, discerning journal editors who want to publish the truth.

I simply don't trust drug companies to give any of these people accurate information.

Peter Gotzsche's book is heart-breakingly accurate.  I highly recommend it.

(Because of this book, I have started a facebook group for prescribers called "Doctors Without Sponsors" to help increase awareness and encourage others to decrease their reliance on drug companies' information and money.  I also recommend signing this pledge: http://noadvertisingplease.org/sign/)

Book Review: Dante’s Inferno (1308 AD)

Preface #1 -  I could write many blog posts about the history of this epic poem, why Dante wrote it, what it meant politically, and who all the characters were in his life.  But you can just read Wikipedia instead and you’ll get the gist of it.

Preface #2 - I am reviewing the 1954 translation by John Ciardi.  (If you’re going to read a 300 page poem, written 700 years ago in Italian, you want to take time to find the best translation)

This translation is ideal because each Canto (chapter) starts with a half page summary of the chapter.  Then you read the poetic chapter.  Then you find 3 pages of notes about the chapter, who the characters were and what they meant to Dante and Italian culture in the 14^th Century.

MY REVIEW: This book is excellent. 

It is an amazing work by a magnificent poet which explains what Hell might look like.  He details the suffering and punishment for each kind of sin.  As he descends further and further through the 9 circles of Hell, he finds people he knew, politicians, religious leaders, rival poets, etc…  He describes why each one is there, why they are suffering, and what they would tell those still living if they could.

The First Circle of Hell is genius.  There is no suffering, it feels like heaven.  It is reserved for the righteous and virtuous who were not baptized in life.  Here he finds Homer, Cicero, Hippocrates, Plato, Aristotle, Socrates and many others.  They are not destined to suffer at all, but are only in hell because without baptism they cannot be allowed into heaven.

Then Dante starts the descent into progressively more horrific suffering as he details the gradation of sin.  First Lust, then Gluttony, Greed, Wrath, and Heresy.  When Dante gets to the 7^th circle of hell which is reserved for the Violent - he breaks it into 3 levels.  1 – Violence against others.  2 – Violence against self.  3 – Violence against God and Nature.

Circle 8 is when he really hits his stride.  This circle is reserved for the Frauds and Dante details the ten different kinds of Fraud and why each is worse than the last: Seducers, flatterers, those who sold church offices, false prophets, corrupt politicians, hypocrites, thieves, evil counselors, the “sowers of Discord” and at last the imposters.  Dante doesn’t pull any punches as he describes which Catholic Pope is found in each section. He then even details Muhammad’s suffering for leading people away from Christianity. 

Circle 9 is the last circle of Hell where Satan himself lives.  This is saved for those who committed the sin of betrayal.  Cain who killed Abel, Antenor of Troy who betrayed his city to the Greeks, Ptolemy who invited all his enemies to a banquet of truce, and killed them all.

In the bottom of Circle 9 is the worst place in all of hell: Judecca.  This is where the three-headed Satan abides with one sinner being torn to shreds in each of his three mouths.  Brutus and Cassius are in the mouths on the sides, suffering eternal torment from Satan for their betrayal of Julius Caesar.

In the central most vicious mouth is Judas Iscariot, who betrayed the Lord Jesus Christ.  Judas’ head is being constantly gnawed by Satan's jaws as his back is forever being skinned by Satan's claws.

The poem is then complete.

The detail of this poem is exquisite.  The profound symbolism is aweing as each sinner suffers in a manner symbolic of the pain they caused others in life. 

I don’t know if I will ever read parts 2 and 3 (Purgatory and Paradise), but I am glad I read this literary classic.  It was well written, and in its own way, it was very inspiring.  I recommend it.