Giles Coren - discuss. Does that help?
From the BMJ - 2005. This covers many of the key issues I have concerns about.
The influence of big pharma
Wide ranging report identifies many areas of influence and distortion
A report published last week on "the influence of the pharmaceutical industry" describes a strong United Kingdom pharmaceutical industry, whose net exports are worth over £3bn ($5.6bn; 4.3bn) annually.2 The industry's declared goal is "to bring patients life-enhancing medicines," a goal "not only necessary but noble." The House of Commons health committee examined the means used to achieve this noble end. They found an industry that buys influence over doctors, charities, patient groups, journalists, and politicians, and whose regulation is sometimes weak or ambiguous. For example, the Department of Health, responsible for a national health service that spends £7.5bn on drugs annually, is also responsible for representing the interests of the pharmaceutical industry.
The committee described how the industry taints doctors. Over half of all postgraduate medical education in the UK, and much education of nurses, is funded by the pharmaceutical industry from its annual marketing budget of £1.65bn. The Department of Health spends just 0.3% of this on publishing independent information on drugs. "Key opinion leaders" may receive £5000 for giving an hour's lecture. The committee found this surprising. Their report recommends that the General Medical Council maintain a register of "all substantial gifts, hospitality, and honoraria received by members." In this way, professional self delusion that "marketing does not influence us" may bring outside regulation.
The industry spends £3.3bn annually on research in the UK, financing about 90% of all clinical drug trials, but develops few truly innovative drugs. It influences the interpretation and reporting of results of trials. Negative results can be dismissed as erroneous ("failed trials"), whereas positive ones can be published repeatedly in different guises.3 The committee report recommends establishing an independent register of clinical trials, containing full information and available at the time of product launch, as a condition of authorisation for marketing. Registering all trials at their inception might be better so that "failed" trials can also be scrutinised.
The committee noted that drug advertising deliberately associates brands with attributes that satisfy the emotional needs of the professionals—the "strategy of desire."4 The report recommends closer scrutiny of advertisements and limits to promotion aimed at inexperienced prescribers. It also recommends that medical undergraduates learn more about clinical trials, adverse drug reactions, and marketing by drug companies. Unfortunately, clinical pharmacology has disappeared from many medical school curriculums and will need active resuscitation.5 The report also suggests that marketing and prescribing be limited when a product is first licensed, to allow experience to accrue. The idea of a probationary period is attractive, but formal trials of relative efficacy within the NHS would be better.6
Companies can only market products if they have authorisation to do so from the Licensing Authority. The Medicines and Healthcare Products Regulatory Agency (MHRA) is its executive arm, with an annual income of £65m derived entirely from licensing fees. The committee thought that the need to attract pharmaceutical business could conflict with the MHRA's primary task of protecting the public. They also questioned the thoroughness with which the MHRA reviewed data submitted for licensing, and its ability, after licensing, to detect adverse drug reactions and act on them.
As evidence, the report cites the fact that "only 19 drugs have been withdrawn between 1993 and 2004," but "medicines can be licensed in the absence of adequate data or investigation into possible adverse reactions..." The MHRA cannot win with this analysis: if it withdraws drugs, it has failed in the first place to obtain adequate information to predict adverse reactions; and if it does not, then it has failed to detect adverse reactions. The committee chose rofecoxib as an example. We now know from a large randomised trial that this coxib probably increases the risk of thromboembolism by 1:140 patient years, less than twice the background incidence.7 To confirm such small increases is notoriously difficult.8 9
The spontaneous adverse drug reaction reporting scheme using yellow cards is also criticised. Many reactions go unreported, and increasing their reporting rates would be good.10 However, spontaneous reports describe association, not causation, and rarely provide sufficient evidence for regulatory action. Even with good data on benefit and harm, pharmacovigilance is rarely straightforward—the US Food and Drug Administration may yet agree to re-licence rofecoxib.11 The report urges greater efforts to investigate signals of possible problems, but does not suggest how to command the necessary resources. Matters would improve if the MHRA could require companies to undertake specific studies as a condition of renewal of a marketing authorisation.
The last health select committee report on the pharmaceutical industry was published on the day World War I was declared,12 and its far sighted recommendations such as the registration of all manufacturers, remedies, and therapeutic claims, were ignored in the aftermath. The current wide ranging report correctly identifies many areas of pharmaceutical influence, and the distortions they introduce. The report does not identify the resources to assure that an independent David triumphs over the pharmaceutical Goliath. Unbiased clinical trials, objective drug data, and perfect pharmacovigilance are desirable but probably illusory and certainly expensive.
R E Ferner, director</STRONG>
West Midlands Centre for Adverse Drug Reaction Reporting, City Hospital, Birmingham B18 7QH (r.e.ferner@bham.ac.uk )
See also Reviews p 911
Competing interests: RF is director of the West Midlands Regional Monitoring Centre of the Committee on Safety of Medicines (CSM), and a member of the CSM sub-committee on pharmacovigilance, and CSM working groups. The views expressed here are personal and do not represent the views of the committee or subcommittee.
References
- <LI value=1>British Medical Association. Secret remedies: what they cost and what they contain. London: British Medical Association, 1909. <LI value=2>House of Commons Health Committee. The influence of the pharmaceutical industry. http://www.parliament.the-stationery-office.co.uk/pa/cm200405/cmselect/cmhealth/42/42 pdf (accessed 5 Apr 2005). <LI value=3>Melander H, Ahlqvist RJ, Meijer G, Beermann B. Evidence b(i)ased medicine—selective reporting from studies sponsored by pharmaceutical industry: review of studies in new drug applications. BMJ 2003;326: 1171-3.[Abstract/Free Full Text] <LI value=4>Ferner RE, Scott DK. Whatalotwegot—the messages in drug advertisements. BMJ 1994;309: 1734-6.[Free Full Text] <LI value=5>Maxwell S, Walley T. Teaching safe and effective prescribing in UK medical schools: a core curriculum for tomorrow's doctors. Br J Clin Pharmacol 2003;55: 496-503.[CrossRef][ISI][Medline] <LI value=6>Ferner RE. Newly licensed drugs. BMJ 1996;313: 1157-8.[Free Full Text] <LI value=7>Bresalier RS, Sandler RS, Quan H, Bolognese JA, Oxenius B, Horgan K, et al. Cardiovascular events associated with rofecoxib in a colorectal adenoma chemoprevention trial. N Engl J Med 2005;352: 1092-102.[Abstract/Free Full Text] <LI value=8>Jick H. The discovery of drug induced illness. N Engl J Med 1977;296: 481-5.[Abstract] <LI value=9>Clark DWJ, Layton D, Shakir SAW. Do some inhibitors of COX-2 increase the risk of thromboembolic events? Linking pharmacology with pharmacoepidemiology. Drug Safety 2004;27: 427-56.[CrossRef][ISI][Medline] <LI value=10>Smith CC, Bennett PM, Pearce HM, Harrison PI, Reynolds DJM, Aronson JK, et al. Adverse drug reactions in a hospital general medical unit meriting notification to the Committee on Safety of Medicines. Br J Clin Pharmacol 1996;42: 423-9.[CrossRef][ISI][Medline] <LI value=11>Tomlinson H. Pfizer drug withdrawn over fears of side-effects. Guardian Apr 8 2005; 18.
- Select Committee on Patent Medicines. Report from the Select Committee on Patent Medicines: ordered, by the House of Commons, to be printed, 4th August, 1914. London: Printed under the authority of His Majesty's Stationery Office by Darling and Son, 1914.
Last edited by David Bailey; 25th-July-2008 at 10:50 PM.
Giles Coren - discuss. Does that help?
I do get where you're coming from (believe it or not) but that report was published in 2005. The last 3 years have seen a lot of change in research, not least because of Northwick Park. And I'm afraid I'm going to have to stop there (I can't discuss it further on a forum)
Anyway, back on topic...
We (lovely ladies) fall for bas*tards for many different things - initially we don't always realise they're one
Speaking from experience () I know that the ones* I fell for, I was attracted to because of their confidence. I then realised in due course it was pure arrogance. It boosted my ego thinking that they wanted to be with me. Shame it then completely destroyed my confidence in the process...
* and yes, plural, sometimes a girl just doesn't learn...
Ditto.
I'm afraid this is not the place to debate pharma policy or the ABPI Code.
I will leave you with one thought. That is the thought of bias in reporting.
The Commons Committee said, "Over half of all postgraduate medical education in the UK, and much education of nurses, is funded by the pharmaceutical industry".
This means that there would be half as much medical education if drug companies did not pay for it. Somehow the Commons Committee has painted that in a bad light
Any "players" from the world of MJ?
Well, neither will the Pope deny the existence of the virgin birth, the ascension, the immaculate conception, transubstantiation or the trinity. This is encapsulated in the phrase 'Is the pope a catholic?' traditionally used in response to questions like 'are you coming to the pub?'.
From the second website listed on google in response to 'bells palsy remission rates':
"You have probably found this website because you are desperately seeking information about a medical condition which terrifies you. Try to relax – statistics tell that you are likely to recover completely from Bells Palsy."
Right. After all, not as if big pharma gave us Viagra, anti-depressants, anti-malarials, pain-killers, anti-fungals, antibiotics, and - a personal favourite of mine - recombinant Factor VIII, which is not made from human blood and therefore removes the risk of being injected with HIV, hepatitis, and other nasty infectious stuff.
[Dodgy Transylvanian accent]
Ah But you see my Barry. Ve Do exist in many deeferent forms. I my self am a Data vampyre .. I vont to drain your leetle vuns and zeros
[/Dodgy Transylvanian accent]
[Dodgy Transylvanian accent]
Mwah-ha-ha.. Mwah-ha-ha.. I'm draining you ov your bandvidth as ve speak. Are you finding the internet a leetle slower today perhaps? Mwah-ha-ha
VUN BIT PER SECOND! HA HA HA!! TWO BITS PER SECOND HA HA HA!! THREE GLORIOUS BITS PER SECOND HA HA HA!! Ah how I love to Count zeez bits per second..
[/Dodgy Transylvanian accent]
Somebody call Twirly.
Beo's read Jivelad's jibes at the pharmaceutical industry and decided not to take his meds this morning...
I've had it twice, once in my 20's and last year.
The first time it my face never fully recovered. I could no longer blow up balloons.
On both occasions I was treated with steroids.
At present, my face still isn't 100%, but oddly enough i have now got my dimples back.
Didn't realise reiki would help. As I've said before my Reiki man has gone AWOL.
I think people in the Emergency Services, like firemen, ambulance, police, doctors etc., have learnt that they have to keep their solar plexas closed when dealing with horrific events.
Similarly, solicitors like Barry would come across a lot of negative stuff through thier jobs.
Have you noticed that to dance properly you have to open your solar plexus?
If you are dancing with someone giving off bad vibes then you automatically close it and can't dance properly.
HelenB says that she was duped into opening to a "drainer". They have lots of tricks.
In the old days - i think 17th century Italy - but not sure - I read some stuff about how men duped heiresses into marrying them.
They had to "prove" they loved the woman, in spite of them only loving her money.
To trick her they would put white powder on their faces because -
Lovers turn pale at the sight of their beloved.
Another trick was to put a chemical in the eye to dilate the pupils because -
A lover's pupils dilate at the sight of the beloved.
Also muscles tension - corsets - because a lover's muscle's tighten at the sight of the beloved.
This would be no use as a guide at a MJ night because it's too dark to see if his face is pale.
The pupils will be dilated due to enjoyment of dancing
The muscles will be pulled in for dancing.
No, but there's a slight difference between superstition and alternative medicine.
The condition was caused by swelling which pinched the facial nerve causing paralysis.
Reiki is a deeply relaxing treatment (in fact, it's not unusual for people to fall asleep during it).
Therefore, the start of my recovery could be because of some 'mystic force' or because the relaxation allowed the swelling to subside somewhat. Either way, directly or indirectly, it is a fair assumption that the recovery was affected by the Reiki.
IMHO the relaxation explanation is much more likely than pure coincidence.
Thanks, it was one of the more frightening experiences I've had.
Indeed, but try relaxing when you look like a drooling fool, can't blink, can't drink, don't want anyone to see you and you've just found out that there are thousands of people who NEVER recover fully from Bell's Palsy.
That's the trouble with the internet, it's much easier to find horror stories that happy endings. After all, those of us that do recover completely, rarely bother to tell forums, etc about it.
Hi Barry - I would not describe them as 'jibes'. If you're looking for a similar word, maybe 'jab' would be closer.....
And to continue the big pharma theme.....I think Helen B mentioned how there has been "a lot of change" in the last 3 years. Well, the point is that there is such a huge amount of inertia - and as I said, the underlying model is flawed - to the detriment of patients.
For example on fragmentation:
-----------------
New research suggests, though, that these SSRI antidepressants also increase the risk for bleeding ulcers (Archives of General Psychiatry, July 2008). These drugs have been on the market for two decades, but only in the past several years have researchers recognized a link between upper GI bleeding and these antidepressants.
Part of the delay is because our medical system is fragmented. Psychiatrists prescribe antidepressants, but they rarely see people with serious digestive distress. Gastroenterologists see people with bad bellyaches, but may not associate a hemorrhage in the stomach with an antidepressant.
When the right hand doesn't know what the left hand is doing, patients can suffer. Uncoordinated care can lead to complications from many medications.
Take antibiotics, for example. Doctors often prescribe drugs like Cipro or Levaquin for sinus or urinary-tract infections. One side effect of these medications that might come as a surprise is tendon rupture.
----------------
This is NOT evidence that the Pharma industry needs to change. It is an INDICATION that there could be better checks and balances in the medical profession.
As an aside, in the mid 19th century the hospital became more commonplace. It was only when a significant number of patients were treated in one place, the hospital, that doctors put two and two together and realised that their treatments were killing more patients than they were saving - you actually stood more chance of surviving your illness if you stayed in your home
Medicine has been with us for at least 2,000 years. But very little changed until the 1860s. Since then there has been a constant series of improvements. The most significant, IMHO, has been the move, in recent decades to evidence based medicine. You need evidence that the treatment works and is likely to do more good than harm.
The reason that harmless treatments like Reiki and homoeopathy became established is that they do no harm. Those treatments became established at a time that medical treatment did significant harm.
Now that we are in a time of evidence based medicine, I believe that all treatments should be considered based on the evidence. I have seen no peer reviewed evidence that many of the softer treatement options have any affect on the progression of disease. As far as I am aware, the only one of the softer options that has been shown to have a significant effect is acupuncture - even then there is a question mark about where you stick the needles and if it makes any difference where they are stuck
This brings me neatly back on-topic. What of the example of the ba*tard who claimed to have a blood clot on the brain? As the years have progressed he's probably found a way to claim that he is rarely without pain - let's hope that, at least, is true
So......evidence based medicine. That's the point of the article Andy: the pharma companies fail to look at their drugs holistically over a sufficient period of time. So we end up with products which look for their 'evidence' within the constraints of the particular diesease profile over a very short time frame - and so miss all the side effects. And the underlying issue is that many of the products are essentially xenobiotic in nature.
Anyway, you end up with this kind of situation: BBC NEWS | Health | US backs statin use for children - as the report says: "...despite little information about long term safety..."
I'm sure you will say proudly: "It's different in the UK" - however, I am looking at this on a wider basis than the UK.
I looked a mess, but as I was on steroids for a week and had masses of energy, I went out about 5 of those nights that week.
The people at ceroc were really kind and concerned and asked me to dance.
There's a case for that probablity now too, what with the Super Bugs. You may survive the op, but not the hospital hygiene.Holistic Homepathic medicine is the forerunner of Allapathic medicine, not the other way around.
The reason that harmless treatments like Reiki and homoeopathy became established is that they do no harm. Those treatments became established at a time that medical treatment did significant harm.
Allapathic medicine started around the Dark Ages I think, and is still with us. That's probably why all the medicine women/witches were burnt at the stake. Males saw the money in Allapathic and wanted rid of them
The same happened in obstitics, men wanted the "power" over even women's childbirth labour.
In fact Allopathic Doctors got the idea of vacinations from Homeopathy.
Last edited by Astro; 27th-July-2008 at 06:25 PM.
Well, there's the rub, isn't it? What would you say that the difference is - given that alternative medicine is based entirely on wishful thinking?
(Am currently reading Trick or treatment, co-authored by the world's first professor of alternative medicine, an ex-practitioner of homeopathy, named Edzard Ernst. He and his fellow author (Simon Singh) conclude that homeopathy is bunkum, and I just read the part where I found out for the first time that a good part of the West's excitement and obsession with acupuncture was created by untruthful and dishonest films and events in which propoganda about superiority of 'TCM' was advanced by, in one case, giving huge doses of local and non-drowsy anaesthesia to a patient having open-heart surgery and then pretending that it was the acupuncture needle in the earlobe that was dealing with all the pain.)
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