Stick A Fork In It: The Pharmaceutical Industry
TL;DR - They undercut health by stealth, accumulating power and wealth
In 1994, the nation’s health regulator, Health Canada, introduced a user fee funding model that brought on pharmaceutical companies as partners to finance key aspects of drug regulation. In effect, they invited the fox to guard the henhouse. Although regulators and pharmaceuticals have always had a cozy relationship, this development consummated their union. As it stands today, 90% of funding for drug regulation comes from the pharmaceutical industry. The problem with this is the obvious conflict of interest arising from the principal-agent relationship, whereby Health Canada’s concern for public safety and the pharmaceutical industry’s profit motive are not always compatible. As a result, this model has been the subject of ongoing and justifiable criticism, especially given its shifting priorities. Since this arrangement took effect:
New drug application funding and staffing increased three to four times, whereas product safety monitoring received no additional resources. This increased the difficulty of monitoring, reviewing, and recalling previously approved drugs, because more drugs make it to market, and there are comparatively fewer resources for their necessary, continual evaluation.
Safety and efficacy data from industry-run clinical trials can be withheld from the public. Abetted by Health Canada, the pharmaceutical industry makes legal claims of “trade secrets” and “confidential business information” to protect their data, but this reduces transparency for substances of public interest, keeping doctors in the dark about relevant information that can – and has – put patients at increased risk.
The regulatory process for drug approvals has been sped up. Where there are shorter approval times, more serious safety concerns tend to follow, and between 1995 and 2010, nearly 24% of approved drugs were later found to have serious safety issues.
Unfortunately, the medical journals are also compromised by the pharmaceutical lobby. In 2004, the editor of leading journal The Lancet, Richard Horton, wrote that “journals have devolved into information laundering operations for the pharmaceutical industry,” which employ various strategies to boost positive results and suppress negative ones. In 2005, the former editor of the British Medical Journal (BMJ), Richard Smith, wrote that “medical journals are an extension of the marketing arm of pharmaceutical companies.” Back in 2001, the editors of 13 general medical journals wrote a commentary in the Canadian Medical Association Journal decrying the changing incentives of medical research, which led to waning funding for independent researchers with reputations for intellectual rigor and honest hypothesis testing, while increasing funding for studies designed to target regulatory approval. The net effect of this is more drugs on the market and less critical review of their performance. Clearly, these trends are not in the public’s best interests. The last couple decades have seen a lot of ink spilled on this topic – to the point it’s basically an open secret that the integrity of medical journals has been debased – but consequential policy changes have not been forthcoming. And so long as the status quo remains, extra doses of “healthy” skepticism are recommended.
“Corporate sponsors have been able to dictate the terms of participation in the trials, terms that are not always in the best interests of academic investigators, the study participants, or the advancement of science generally. Investigators may have little or no input into trial design, no access to the raw data, and limited participation in data interpretation.”
– Editors of 13 General Medical Journals, Canadian Medical Association Journal. September 18, 2001.
Of further concern, doctors and medical schools are also enveloped by the pharmaceutical industry’s tentacles. Exposing this in detail, Global News released a bombshell four-part investigation on this topic in the summer of 2019. Part one explained how Purdue Pharma, the infamous creator of the wildly addictive opioid OxyContin, would wine and dine doctors, serenading them with “carefully honed” key messages to sway them into prescribing the product. Among those messages were that OxyContin was not addictive, that it was “safe and effective,” and that doctors were “opiate-phobic” if they had an “irrational” fear of opiates. Draw your own parallels to the terms “anti-vax” and “vaccine hesitancy.”
Part two of the series elaborated on drug representatives’ influence over physicians, explaining how drugs are aggressively promoted early in their lifecycle before concrete evidence of their safety and efficacy emerge. Why? Quoting from a British Medical Journal (BMJ) study cited in the investigation, independent studies have shown that “85-90% of new products over the past 50 years have provided few benefits and considerable harms.” Additionally, new drugs are typically more expensive than older or “off-patent” drugs because prices of the former are artificially inflated via exclusive production rights, while prices of the latter are determined on the open market where producers compete to offer the best prices. For new drugs, this means there is a limited window of opportunity to cash-in before exclusivity expires and any deceptive data is exposed. Considering the meager cost-benefit profile of most new drugs, which needlessly burdens patients, drug plans, and taxpayers with excess costs, why should new drugs receive even the slightest benefit of the doubt? Shouldn’t the default position of doctors and regulators be to presume that pharmaceutical-sponsored trial data is incomplete or misleading? Why isn’t it a requirement for safety and efficacy to be proven by independent studies?
“Physicians don’t have access to the full data and the drug companies still choose what to publish. They don’t say anything about negative results… so the development of new products is about selective ignorance.”
On a related note, the investigation cited Adriane Fugh-Berman, the director of a project to advance evidence-based medicine at Georgetown University Medical Center called PharmedOut, who said the sad truth of the matter is “doctors think they can extract the good information from the bad, and they can’t. That’s been documented.” Echoing this sentiment, renowned Canadian emergency care physician, professor, and author, Dr. Joel Lexchin, told CTV Newsin a September 2017 interview that, “we know from studies in other countries that, even though doctors may not realize it, they can be influenced by payments they get from pharmaceutical companies.” He poignantly added that “some doctors might be concerned about this… and if you’re concerned about it then perhaps you should stop taking the money.”
To be clear, it’s not that doctors are sellouts who callously trade patient health for material wealth. Far from it. The majority are well-intentioned and care a great deal about their patients’ well-being, but they have grown too trusting of untrustworthy institutions, and too comfortable with the pharmaceutical industry’s influence. To that end, parts three and four of the investigation explained how doctors, medical schools, and hospitals, have difficulty maintaining their impartiality because pharmaceutical companies are constantly doling out spoons full of sugar to help their medicines go down. Part three explained how millions of dollars are funneled into medical schools by sponsoring textbooks, running courses and workshops, funding faculty research, and more. All of that normalizes relationships with drug representatives and affects the prescribing habits of doctors. Lastly, part four investigated payments and donations to hospitals and doctors, explaining how paid speeches, trial participation, advisory board membership, and travel expenses for conferences influence prescriptions, and also that Canada has weak transparency rules and institutional safeguards.
“[Purdue Pharma] dramatically changed physicians’ prescribing habits of opiates. The interesting thing is that these messages were false, and they knew them to be false at the time, and they didn’t care. And even when evidence emerged – which was pretty quickly – that people were dying of OxyContin overdoses, they still persisted.”
For their part, pharmaceutical companies are well-aware of their duplicitous tendencies, and shockingly unconcerned by them. Prescription drugs are among the leading causes of death in the US and Europe (Canada does not track this statistic), and that includes drugs taken in the correct doses. Additionally, medical errors are thought to be a significant cause of death in both Canada and the US. Flouting the law and flaunting their disregard for the devastation their products have caused, in January 2020 Dr. Joel Lexchin explained that some pharmaceutical companies even have “a position they euphemistically called vice-president in charge of going to jail.” This means that, if anything, penalties for bribing physicians, suppressing adverse trial results, and deceitful marketing – all of which are habitual practices for pharmaceutical giants like Pfizer – are merely business expenses to be weighed against revenues, similar to how the banking industry approaches fines for money laundering, market manipulation, and other violations. Presciently, Dr. Lexchin added that, “it all comes in cycles and the next disaster will be just as bad.” In other words, the pharmaceutical industry’s response to covid was perfectly predictable; it was a golden opportunity to push new products and generate record profits, regardless of patient safety.
From education to practice to regulation to research, the pharmaceuticals have the healthcare industry in a bearhug. Having compromised any institution that might push back against their corrupt practices, modern pharmaceuticals are no longer a means to an end – to health – but an end unto themselves, which uses the healthcare system as its means. And as a result of allowing itself to be dominated by the products it was meant to master, the healthcare industry has seemingly become disinterested and powerless to stop the veritable epidemic of harmful side effects caused by pharmaceuticals. It may be a tough pill to swallow, but all this implies that the slogans “follow the science” and “trust the experts” were misleading because they ignored the tragic truth that both ‘science’ and ‘experts’ are conspicuously manipulated by the pharmaceutical industry.
“Evidence suggests that commercial distortions of the review process and aggressive marketing contribute to both undermining beneficence as health care's raison d'être and to the epidemic of harm to patients.”
– Doctors Donald L. Wright, Joel Lexchin, and Jonathan J. Darrow. Journal of Law, Medicine & Ethics. Fall 2013.
This post is part of an article called Stick A Fork In It: The Barbecue Rebellion & The Rude Awakening, which is available in its entirety on my Substack:
