Now that the Pfizer attempt to take over Astra Zeneca has failed it is relevant to take a detailed look at the drug companies. In particular we need to know what exactly they achieve in terms of improving standards of public health and the costs involved.

In fact it is not necessary to dig very deeply to find that there are some very murky aspects. Only last year, a book entitled, “Deadly Medicines and Organised Crime: How Big Pharma Has Corrupted Healthcare” (1), was released. It was written by Peter Gøtzsche, who is the head of the Nordic Cochrane Centre and a person who can speak with authority. In a foreword, Drummond Rennie, deputy editor of the Journal of the American Medical Association, demonstrates how his credibility is based on his:

unique scientific abilities, research, integrity, truthfulness and courage of the author. Gøtzsche’s experience is unequalled. He has worked in sales for drug companies either as a drug company representative pitching pills to doctors or as a product manager. He is a physician and a medical researcher and has built a reputation as head of The Nordic Cochrane Centre.”

Rennie trusts him because he knows him to be correct about events where he has independent knowledge

In another foreword (2) written by Richard Smith, a former editor of the BMJ some of the key points are summarised:

  • He begins by describing a story in which Peter was invited by the Danish Society for Rheumatology to speak to the theme “Collaboration with the drug industry. Is it THAT harmful?” Peter started his talk by enumerating the “crimes” of the meeting’s sponsors. Pfizer, for instance, had been fined $2.3 billion in the United States for  promoting off label use of four drugs, while Merck, the last sponsor, had, said Peter, been responsible for the deaths of thousands of patients with its deceptive behaviour around a drug for arthritis. It was therefore no surprise that in the following year all but one of the companies declined to sponsor the meeting.
    • The drug industry has fallen foul of the US Department of Justice many times in cases where companies have been fined billions. Peter describes the top 10 cases in detail, but there are many more. It’s also true that they have offended repeatedly, calculating perhaps that there are large profits to be made by flouting the law and paying the fines. The fines can be thought of as “the cost of doing business” like having to pay for heat, light, and rent. Hundreds of thousands are killed every year by prescription drugs. Many will see this as almost inevitable because the drugs are being used to treat diseases that themselves kill. But a counter-argument is that the benefits of drugs are exaggerated, often because of serious distortions of the evidence behind the drugs, a “crime” that can be attributed confidently to the industry.
  • Most of Peter’s book is devoted to building up the case that the drug industry has systematically corrupted science to play up the benefits and play down the harms of their drugs. As an epidemiologist with very high numerical literacy and a passion for detail, so that he is a world leader in critiquing clinical studies, Peter is here on very solid ground. He describes how the industry has bought doctors, academics, journals, professional and patient organisations, university departments, journalists, regulators, and politicians. These are the methods of the mob.
    The book doesn’t let doctors and academics avoid blame. Indeed, it might be argued that drug companies are doing what is expected of them in maximising financial returns for shareholders, but doctors and academics are supposed to have a higher calling. Laws that are requiring companies to declare payments to doctors are showing that very high proportions of doctors are beholden to the drug industry and that many are being paid six figures sums for advising companies or giving talks on their behalf. It’s hard to escape the conclusion that these “key opinion leaders” are being bought. They are the “hired guns” of the industry.
  • Peter is very clear that this is a book about the failures of the whole system of discovering, producing, marketing, and regulating drugs. It is not a book about their benefits. In fact he has the audacity to suggest that the activities of the drug industry amount to organised crime. The characteristics of organised crime, racketeering, is defined in US law as the act of engaging repeatedly in certain types of offence, including extortion, fraud, federal drug offences, bribery, embezzlement, obstruction of justice, obstruction of law enforcement, tampering with witnesses, and political corruption. Peter produces evidence, most of it detailed, to support his case that pharmaceutical companies are guilty of most of these offences. This may seem to be outrageous but it the following quote is attributed to a former vice-president of Pfizer, who said:

“It is scary how many similarities there are between this industry and the mob. The mob makes obscene amounts of money, as does this industry. The side effects of organized crime are killings and deaths, and the side effects are the same in this industry. The mob bribes politicians and others, and so does the drug industry …”

All of this is very worrying. Most of us are convinced that drugs play a vital role in treatments for most diseases. We usually expect our GP to produce a prescription for some form of medication when we suffer from any illness. The total costs make up a substantial proportion of the NHS expenditure. If the above allegations are genuine then many of these are ineffective and therefore a waste of money.

Peter Gøtzsche is not the only one to make these allegations and I will return to this issue in future blogs.

REFERENCES

  1. Peter Gøtzsche(2013). “Deadly Medicines and Organised Crime: How Big Pharma Has Corrupted Healthcare” Radcliffe Publishing London
  2. Richard Smith (2013) http://blogs.bmj.com/bmj/2013/09/10/richard-smith-is-the-pharmaceutical-industry-like-the-mafia/