Dr. John Abramson's Overdosed America: The Broken Promise of American Medicine (OR, How Medical Research Lost Its Credibility)

I have written many times before about the ways that Big Pharma cheats with medical research, and how so much of what appears in the press and on television, as well as much of what our doctors tell us about pharmaceuticals they prescribe, lacks credibility.

One of my favorite books on this topic is Dr. John Abramson’s Overdosed America: The Broken Promise of American Medicine. In it, he tells the sad story of how medical research lost its way, and gives an excellent overview of the history of medical research, and how it went from being almost 100% reliable to nearly 80% unreliable. 

As Dr. Abramson describes it, in the early 1980s, when he started analyzing and critiquing scientific articles, he didn’t find any instances of data being manipulated or compromised. Research was clean, the way doctors expected it to be. The National Institutes of Health funded most of the drug studies and, as one expert put it: in the 1970s, medical scientists thumbed “their academic noses at industrial money.”

But, and as government money dried up, things began gradually to change, and pharmaceutical companies picked up the slack. Abramson writes that “by 1990, almost two-thirds of the requests for research funds from the NIH were not granted”; he describes the gradual change from government funded research to corporate-funded research. By 2002, 80% of clinical trials were funded by drug and biotech industries. Quoting from the book:

Control over clinical research changed -- quietly at first, but very quickly, and with profound effects on medical practice. The role of academic medical centers in clinical research diminished precipitously during the 1990s as the drug industry turned increasingly to new independent, for-profit medical research companies that emerged in response to commercial funding opportunities. These companies could gain access to patients for clinical research through community-based doctors, or play a larger role in research design, data analysis, and even writing up the findings and submitting complete articles to journals for publication. By 2000, only one-third of clinical trials were being done in universities and academic medical centers, and the rest were being done by for-profit research companies that were paid directly by the drug companies.

As the drug industry started to call more and more of the shots, scientific integrity all but vanished. Dr. Abramson quotes Dr. Drummond Rennie, deputy editor of the Journal of the American Medical Association (JAMA) as saying in 1999 of medical researchers and research: “They are seduced by industry funding. . . .It’s a race to the ethical bottom.”

A POSITIVE SIGN?

Dr. Abramson reports that a promising event occurred in 2001, when the editors of 12 of the top medical journals made genuine efforts to stop this trend, by issuing a statement calling for objectivity and ethics in medical research. They warned that the “use of commercially sponsored clinical trials ‘primarily for marketing . . . makes a mockery of clinical investigation and is the misuse of a powerful tool.’” (See my Part 3 of my three-part exposé, “The JAMA Controversy,” where I detail JAMA editor Catherine DeAngelis’ efforts to stop this proverbial “race to the ethical bottom.”)

But unfortunately, even this warning did not stem the tide of Pharma’s duplicitous behavior, which still exists today.  In spite of everything, Dr. Abramson writes that “most doctors still hold fast to the basic tenet of their training: that the scientific evidence reported in respected peer-reviewed medical journals is to be trusted and serve as the basis of good medical care.” I would imagine that he wonders, like I do, how most doctors can continue to hold on to their fervent belief in medical research -- in spite of all the evidence.

I believe their niaveté stems from the fact that many of them simply haven't read -- or have ignored -- the many articles that have been written in both the medical and lay presses about Big Pharma’s financial involvement in every aspect of medical research. I therefore hope that patients will start sharing some of this information with their doctors. A good place to start might be with Honest Medicine’s article, “Financial Ties Between Big Pharma and the Medical Establishment: 37 Selected Articles Published Between 2005 and 2008”, which contains actual links to each and every one of the articles it cites. It's very important that patients learn to take the lead, and help to share important information with their doctors!

 

Comments

[Mark E. Messinger]

It's amazes me that a large newpaper like the Houston Chronicle would run this on the front page.

[Jan Buntyn]

I'm currently reading your book, just beginning it.
I thought you would appreciate this online CNN article.
http://money.cnn.com/galleries/2009/news/0907/gallery.healthcare_nurses/2.html

[Hilary Day]

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