Clinical Trials on Vaccines : the Revelations of a Doctor

Meehan MD on the poor science of the recent Danish MMR Autism Study

Published on 6 March 2019, by Jim Meehan, MD

 

Undisclosed financial ties between guideline writers and pharmaceutical companies

One in five Australian clinical guideline writers have potentially relevant undisclosed links to drug companies

Abstract

Objectives
To investigate the proportion of potentially relevant undisclosed financial ties between clinical practice guideline writers and pharmaceutical companies.

Design
Cross-sectional study of a stratified random sample of Australian guidelines and writers.

Setting
Guidelines available from Australia’s National Health and Medical Research Council guideline database, 2012–2014, stratified across 10 health priority areas.

Population
402 authors of 33 guidelines, including up to four from each area, dependent on availability: arthritis/musculoskeletal (3); asthma (4); cancer (4); cardiovascular (4); diabetes (4); injury (3); kidney/urogenital (4); mental health (4); neurological (1); obesity (1). For guideline writers with no disclosures, or who disclosed no ties, a search of disclosures in the medical literature in the 5 years prior to guideline publication identified potentially relevant ties, undisclosed in guidelines. Guidelines were included if they contained recommendations of medicines, and writers included if developing or writing guidelines.

Main outcome measures
Proportions of guideline writers with potentially relevant undisclosed financial ties to pharmaceutical companies active in the therapeutic area; proportion of guidelines including at least one writer with a potentially relevant undisclosed tie.

Results
344 of 402 writers (86%; 95% CI 82% to 89%) either had no published disclosures (228) or disclosed they had no ties (116). Of the 344 with no disclosed ties, 83 (24%; 95% CI 20% to 29%) had potentially relevant undisclosed ties. Of 33 guidelines, 23 (70%; 95% CI 51% to 84%) included at least one writer with a potentially relevant undisclosed tie. Writers of guidelines developed and funded by governments were less likely to have undisclosed financial ties (8.1%vs30.6%; risk ratio 0.26; 95% CI 0.13 to 0.53; p<0.001).

Conclusions
Almost one in four guideline writers with no disclosed ties may have potentially relevant undisclosed ties to pharmaceutical companies. These data confirm the need for strategies to ensure greater transparency and more independence in relationships between guidelines and industry.

Reference. Image credit sciencemag.

Doctors’ unconscious instinct to reciprocate med reps’ gifts

What Big Pharma knows about people’s hardwired instinct to return the favor when given a gift

Abstract

… “You might reasonably ask whether a modest meal with a pharmaceutical sales rep matters all that much. You might also be surprised by what a small gift can buy. In recent years, social psychologists and marketers have demonstrated that the pull of reciprocity is exceedingly powerful in human beings, often acting on us in ways we may not consciously appreciate. Perhaps it’s too much to suggest that free pens were responsible for the opioid epidemic. But it’s become more and more clear that a gift, even from a salesperson, can make the receiver feel obliged to give something in return.” …

Read Did Free Pens Cause the Opioid Crisis? on the atlantic, about the role of medical representatives in the promotion of pharmaceuticals in general, and the opioid crisis in particular.

Unbiased information on medicines : Why is it needed?

Pharmaceutical promotion practices HAI webinar, Oct 2018

Dr Barbara Mintzes (University of Sydney) joins Health Action International for an expert webinar on pharmaceutical promotion practices.

It’s a moral requirement to make money when you can to sell the product for the highest price, Pharma CEO says

Pharmaceutical executive defends 400 percent price hike

“I think it is a moral requirement to make money when you can . . . to sell the product for the highest price.”

“The point here is the only other choice is the brand at the higher price. It is still a saving regardless of whether it is a big one or not,”

“I agree with Martin Shkreli that when he raised the price of his drug he was within his rights because he had to reward his shareholders,”

“If he’s the only one selling it then he can make as much money as he can,”
“This is a capitalist economy and if you can’t make money you can’t stay in business.”

said Nirmal Mulye. Nostrum chief executive, in an interview…
read Pharma chief defends 400% drug price rise as a ‘moral requirement’ in the Financial Times September 11, 2018

La prévention pharmacologique : un traitement qui rapporte

L’apogée médicale serait-elle déjà loin ?

Publié par Luc Perino, médecin généraliste, humeur du 06/06/2018

Le succès médical de l’insuline en 1921 s’est accompagné d’un succès commercial moyen, car malgré l’obligation d’un traitement à vie, la cible des patients était étroite. Dans les années 1940, l’extraordinaire efficacité des antibiotiques s’est doublée d’un succès commercial sans précédent, mais les traitements étaient courts, car immédiatement efficaces.

Trop peu de patients d’un côté, et des patients trop vite guéris de l’autre, les industriels ont vite compris qu’aucun de ces deux miracles médicaux n’était véritablement miraculeux pour le commerce. Il fallait des cibles larges et des traitements à vie. Cette évidence mercatique allait définitivement réorganiser l’activité de l’industrie pharmaceutique. Avec une ténacité aboutissant progressivement à canaliser la recherche médicale, à détourner l’éducation sanitaire de la population vers une prévention pharmacologique et, in fine, à circonscrire la recherche clinique et l’enseignement universitaire.

Aujourd’hui, la très grande majorité des prescriptions médicamenteuses s’adresse à des maladies virtuelles (facteurs de risque) ou potentielles (gènes ou cancers dépistés) qui n’ont jamais été cliniquement vécues par les individus et ne le seront probablement jamais. Cette médicamentation de la société a créé de nouvelles maladies iatrogènes (celles-ci réellement vécues), et des addictions plus nombreuses et plus graves que les classiques addictions aux drogues illicites.

Depuis l’halitose (mauvaise haleine passagère) transformée en maladie chronique en 1920 pour vendre un désinfectant ménager transformé en médicament contre l’exclusion sociale, la liste des maladies et concepts pathologiques nouveaux créés par cette recherche marchande ne cesse de s’accroître. Ménopause, dysfonction érectile, dysphorie prémenstruelle, insomnies crées par les benzodiazépines, timidité, décrets d’anomalies métaboliques, tristesse ou fatigues passagères, allergies alimentaires factices, hyperactivité, colère, hypertensions labiles ou approximatives, dépressions ou migraines chronicisées par leur traitement, dépendance irréversible aux opioïdes, pour ne citer que les plus connues.

Mais il serait injuste de n’accuser que big pharma et d’élaborer une théorie du complot. La réalité est plus simple, la naïveté anthropologique qui a façonné les religions se déplace et se prolonge en d’autres croyances : une gélule peut retarder la sénescence ou compenser les extravagances nutritives, un comprimé peut supprimer l’angoisse existentielle ou régler les conflits conjugaux.

Il ne nous reste plus qu’à espérer qu’il subsistera encore au moins 1% de la recherche pour les vrais, jeunes, rares et graves malades et pour les millions de morts par infections tropicales. Sinon, l’apogée de la médecine serait déjà loin derrière nous, car si les transhumanistes ont résolument décidé de prendre le relais commercial, ils n’ont pas l’intention de prendre le relais médical ni d’assumer la charge clinique.

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