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.
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.
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/)
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