Dr. Fung writes on a topic that our corporate media
won’t touch.The 2nd paragraph sounds like a
paste from Prof. Ben Goldacre’s Bad
Pharma:How Drug Companies Mislead
Doctors and Harm Patients. The
rest of this blog could have been taken from chapter 8 of Prof. Marcia Angells,
Truth About the Drug Companies:How They
Deceive Us and What to DO About It.And if you want to read about the
consequences of this there is by Prof. Peter Gotzsche, Deadly Medicines and Organised
Crime:How big pharma has corrupted healthcare.His
book won the British Medical Association’s Medical
Book Award.Another great article by Dr. Fung.
This article needs sequels:1) that government legislators are in bed with Pharma and how their
changes made starting with Reagan has changes has made the universities
business partners of industry (a topic covered by Prof Angell, supra); 2), How
the FDA sees its job as promoting drugs (an insider’s account of the
approval process, condensed from Gotzsche’s book supra ); 3) How the evidence
basis of medicine has been systematically distorted to promote chronic
conditions and then treat them with fake fixes (see healthfully.org for some examples);
4) the broken reporting of side
effects; 5)that most drugs worth
their side effects (see book
by doctors Debre and Evens); 6) the take-over of medical education by pharma through
their KOL (Key Opinion Leaders) system. Their
KOLs besides giving CME classes (as Dr. Fung reports), they also write the
medical textbooks, the clinical
guidelines, and are the experts appearing in our corporate media.I have written a sympathetic account of the working situation of doctors.It is as Prof. Goldacre states, a perverse
system produces perverse results. To change the results, we need to change the
A behind-the-scenes look at medical educationSept 8, 2016
Today, I’m going to take you on a little
behind-the-scenes tour of what really happens with medical education and Big
Pharma from my perspective as a community physician. Sometimes I forget that
not everybody understands this, since many of my friends are physicians.
Doctors get continuing medical education (CME) through events like
lectures and conferences. CME is necessary because many physicians practise for
30 or 40 years, and medicine is changing continuously, so they cannot rely on
their medical school training, which might have happened in the 1960s. Doctors are
required to get a certain
number of hours of CME every year. You might imagine that doctors learn from
unbiased experts dedicated to learning. Actually, nothing is further from the
truth. The dirty little secret is that virtually all CME is sponsored
heavily by Big Pharma giving them huge influence over what information is
presented to doctors.
Every single level of CME has been corrupted by $$$. Let’s
at the bottom.
In virtually every hospital in North America, there are lectures
called ’rounds’. They happen in every specialty and almost every single day,
mostly at lunchtime. What a great idea. Doctors would spend lunchtime teaching
each other the intricacies of their specialty. Sorry, no. Most doctors are too
lazy to prepare a full hours worth of lecture topic. Most are too busy to spend
an hour listening a the lecture anyway. So, the friendly drug rep from Big
Pharma helpfully gets lunch for everybody. Free lunch! That helps bring in the
audience, but it doesn’t help the fact that they still need a speaker.
Once again, the drug rep is able to produce speakers! Big Pharma
hires doctors to give lectures. Of course, these doctors are still too lazy to
produce their own talk, so luckily, Big Pharma also makes the entire slide kit
with full notes so all the doctor needs to do is parrot the words written for
him. He only lends his name to give these lectures the sheen of respectibility.
You can be sure that these ’rounds’ always support the use of more and more
The standard rate in Canada to give one of these talks is $1500
for a single hour of work. Very lucrative, even if it means you need to
intellectually prostitute yourself. Of
course, there is no shortage of doctors willing to give these talks. Some
doctors give talks several times per week. Almost
every doctor at the major universities is available for hire.
Next, there are the dinner lectures. These, once again are
helpfully organized by the Big Pharma drug reps. They invite local doctors to
hear an ‘expert’.
Once again, the doctor selected is ‘conveniently’ provided with the entire
presentation to give like a trained monkey – delivering the exact message Big
Pharma wants. Who are these doctors selected to speak? The ones that prescribe
the most drugs, of course. So, they have no problem giving these talks because
they already believe it. It’s essentially a giant infomercial.
According to regulations, these dinners are not supposed to be
lavish. They should be the equivalent of cafeteria meals. Does that happen? Not
a chance in hell. These dinners are held at the fanciest restaurants available.
Of course, it comes with wine and a 3 course dinner, which normally would cost
about $150 per person. The speaker gets $1500 for one hour.
I must confess here. I have given a few of these talks, but have
only done 1 in the last five years, because it was a journal club specifically
requested by my friend. However, I only present my own slides and I do not
accept any restrictions on what I say. I stopped giving these lectures because
I was just disgusted. The doctors in the audience were mostly interested in
eating and clearly not even listening. It was awful. The money is good, but my
soul paid the price.
The next place a doctor might expect to get CME is through
conferences and other symposia. Often these are arranged through official
sounding organizations – usually something like ‘Canadian Association of
Superior Medical Knowledge’ (does not really exist). The public, of course,
thinks these are legitimate organizations. The doctors know full well that
these are puppet organizations funded by multiple drug companies. This allows
them to pay salaries to physicians to do little other than be the figurehead –
always from a prominent university to give the organization a respectable
veneer. You know, science director, medical liaison etc.
They organize one or two day conferences at hotels which usually
includes about 6-8 hours of lectures full of ‘experts’. These conferences, if
you had to pay for hotel space and speakers would normally cost about $500 per
person to put on. However, doctors usually only pay $25 for two days of
lectures and this includes breakfast, snack and lunch! With a wink, they are
Sad to say, these are, once again, thinly disguised drug
infomercials. Almost all of the speakers are university doctors, who know a
good payday when they see it. I attended one of these many years ago. Two
prominent university professors presented about diabetes. “There is a wonderful
treatment that lowers weight, blood pressure and blood sugar with no side effects.
It’s called exercise.” Oh, this sounds promising.
He then spent the next 59 minutes of his 60 minute lecture talking
about … drugs.
The very next speaker, who writes the Canadian Diabetes guidelines
said “The first, second, and third line treatment of diabetes is lifestyle,
lifestyle, and lifestyle”. Oh, this sounds promising. She then spent the next
59 minutes of her 60 minute lecture talking about … drugs. Oh, what drug
Perhaps you think that things are better at the major
universities. Sorry, that’s not really true either. The people who are promoted
in the university hierarchy are not those that are the most intelligent. No,
it’s those who bring in the most research dollars. Of course, it’s extremely
difficult to get funding from governments. Instead, it’s far easier and far
more lucrative to get drug company funding for research. This is often in the
form of endowments and endorsed chairs. The biggest suck-up to Big
Pharma gets the promotions. It’s sickening.
What happens to all the money you donate to ‘support research
diabetes’? Well, most of it goes toward paying for fancy hotels, fancy meals
and fancy trips. Oh, of course, they can’t call it that. Instead, conferences
are held in swanky hotels in far-away places. Why do most doctors go to the
‘European Conference on Amazing Medical Knowledge’? (does not really exist).
Let me tell you, it’s not to get amazing medical knowledge. Hell, that’s
available online for free in your underwear.
No, the main purpose is to visit Paris, or Copenhagen, or
Barcelona. You take the research dollars donated in good faith and spend
several thousand of them to go to Spain. You listen to one lecture and spend
the next 3 days going to the fanciest restaurants you can find – all for
research, of course. I know. The research budget is used to pay for airfare,
hotel and meals. Of course, you usually meet up with drug reps for even fancier
meals. I did this 20 years ago, when I was a student at the University.
Everybody knows the game. Except you, that is.
Too harsh? Well, let’s think about this logically. Consider
hundreds of millions of dollars raised for diabetes and breast cancer and heart
disease and so on. What do we have to show for it? Almost all of the drugs
developed for all disease are performed by drug companies. Virtually nothing
useful comes out of the universities.
All of the funding ever done at the universities adds up to a
giant zero. While you might imagine that doctors and academics at major
universities are immune to the influence of Big Pharma, you’d be exactly wrong.
These institutions are on the take on a
massive scale. They don’t simply take a few dollars here and there, they
dollars. They are the biggest drug
whores on the planet. They give the word ‘whore’ a bad name. At least the sex
worker is upfront about what is about to happen. Academic doctors give the
entire group a black eye. They take blood money and pretend that they are
giving you an unbiased opinion.
Colorado, for example, received $1 million from Coca Cola in order
to establish an advocacy group that, surprise, surprise would downplay the risk
of sugar. You, as the public would have assumed that this opinion exonerating
sugar was coming from academic physicians who have thought long and hard and
researched day and night about the best diet. You would have been exactly
wrong. Their opinion, backed by the name of a prestigious university, is for
sale to the highest bidder. These same doctors and researchers are always the
ones talking about how you can’t trust all the opinions on the internet. Turns
out, the last person to trust was them! Dr. Blair from the University of
Colorado was busy blaming the media for the obesity crisis when he was taking
blood money to fuel the crisis. They returned the money, but only when it was
exposed in the New York Times. Otherwise, we would have been reading opinions
that we believed were honest ones from university professors, but were nothing
more than paid infomercials.
Dr Sievenpiper – List of conflicts of interest
The list goes on and on. The Academy of
Nutrition and Dietetics received $1.7 million from Coke. They represent the
dieticians of America. Do they have our best interests at heart? No, you can’t
bite the hand that feeds you. So sugar is fine and calories are the problem.
Yes, because eating 100 calories of sugar and 100 calorie of broccoli are
equally fattening. Right.
Coke has spent $120 million since 2010 to fund research. Research
that will undoubtedly show that sugar is not to blame for obesity. This makes
the few bucks the community doctor makes seem like chump change.$120 million dollars!And then the academics will bleat on
and on about how we must follow evidence based medicine when the entire
evidence base has been corrupted by commercial interests. Hippocrites.
Consider the case of Dr. John Sievenpiper.
He is one of the most outspoken, staunchest defenders of dietary sugar. He is
constantly in the media defending sugar. Oh, it turns out he receives money
from the Corn Refiners Association! In hispaper in the Annals of Internal Medicinedefending, you guessed it, sugar,
here’s his list of conflicts of interest. As a physician, I’m well aware that
academic physicians opinions are for sale. It’s pretty obvious. They spend
their days reading and writing research. Which is great, except that doctors
get paid to see patients. So academic doctors often do not make as much as
their community colleagues. They make it up by taking drug company money. They
are trading the prestige of their institution for dollars. I know this.
Unfortunately, most of the public does not.
So be careful who you listen to. There’s a lot of paid
infomercials out there that you don’t even know about. Ultimately, you must
decide who to trust based on their message, not their titles. Your life, very
literally, depends on it.