Sunday, February 13, 2011

Under the Influence of Big Pharma

As is probably clear to anybody who knows me, I'm a big reader. I read at the rate of roughly one non-fiction adult book per day (like half a book on weekdays and three on Saturday). I also read a fair number of children's books because I volunteer in the children's department of the regional library. I also a lot of medical journal articles, mostly but not entirely culled from pub med.

I've read many disquieting things about diabetes in the past few years. I've read studies whose evidence didn't agree with the conclusions authors took from them. I've read media articles promoting "cures" when the research they cite didn't support their conclusions, or there was already a reason to know it wouldn't work. I've read studies that were clearly biased by design, intended usually to show the superiority of a more expensive treatment. I've read studies in which the set up wasn't biased but the data collection was.
I've read studies showing that NPH-Regular users have A1cs as low as Lantus-Humalog users, many studies showing that drops in A1cs for people switching to pumping are typically not sustained for more than a year. I've noticed over and over a bias in that things wanting to show evidence of helping diabetes pick only people with elevated A1cs, so that even the control group, if there is one, has a reduction in A1c.
I've followed the media as it reports on wonder drugs, and I've followed the downfalls of numerous diabetes medications (mostly for type 2s).

Despite all this, I am aware that there are many conditions, type 1 diabetes among them, for which medication is essential.

Yesterday I read a book entitled Mad In America: Bad Science, Bad Medicine, and the Enduring Mistreatment of the Mentally Ill by Robert Whitaker. I picked it up because it was a snazzy looking paper back. It chronicles the treatment of those with mental illness- schizophrenia in particular- in the United States. It makes an extremely strong argument that taking "antipsychotic" medications WORSENS schizophrenia outcomes, and that the evidence of this has been there for all to see since the 1950s, and that the modern medical establishment has turned willfully away from the evidence.
I hoped, as I read the book, that after I finished it I would find some criticism explaining why the book was wrong. What the flaws in the arguments were.
The criticism I found was... well, it was nit picking. They complained he left out a study. Big whoop. They complained some of his analogies were simplistic- yes, but so what? None of them truly could argue that he was wrong.

Reading about the sins of companies that make some of my medications makes me scared. Reading about the willingness of doctors to do experiments clearly not in the interest of patients, ditto. It also gives me pause regarding clinical trials. Whitaker talks about clinical trials in which the trial was clearly misrepresented to patients. There have been at least a couple clinical trials for diabetes products in which patients were hurt, and it has not escaped my notice that clinical trials for diabetes often target the very newly diagnosed, who just happen to be more vulnerable to false hopes, and less aware of how livable diabetes is.

I don't know what to end this post with. I don't have a resolution. I'm just becoming more and more aware of how public perception of disease is molded by big phama, and I don't like it.


htimm=) said...

Interesting Jonah. I always love your well thought out posts. I love that you read and educate yourself on so much. I have a loved one that I have watched deteriorate because of the Big Pharma influence. She started with anxiety that she got meds for and then that led to depression and insomnia and she got meds for those which led to other issues and more meds. She now takes a cabinet full of medications on a daily basis and is always tired or sick and really only functions at about 30-40% of where she was prior to the meds for anxiety. It is sad.

I am currently researching the "natural" treatments for T1D. I would never use my daughter as a guinea pig. I am actually the one trying the different ways of eating etc. I don't have T1D so there is no way to tell if it would give my daughter better glycemic control. I would love to hear your thoughts on things like the Paleo diet or the raw food approach. My conclusion is that the psycho-social detriments for a 7 yr old out weight any health benefits that she might get and in general trying to get more greens in is always a good thing. I don't think it would "cure" her and I certainly don't want to ever give her false hope or think that insulin is bad for her.

Keep reading and keep on blogging about your research, I like reading your thoughts.

Reyna said...

First off...I whole-heartedly agree with Heidi. I am fascinated by your reading, your thoughts, and your blog comments. Although...I have to make me feel dumb sometimes (hehe).

I agree and I am a bit scared of Big Pharma. I realized the dangers when reading Cheating Destiny. Sad. Scary. pissed me off.

Good to see a post from you Jonah! How are you feeling?

Scott said...

There's nothing you need to do to end this post, but thank you for sharing this! I agree that you are right about conclusions unsupported by evidence (why then, do they call it evidence-based medicine?), yet it seems to happen fairly regularly. Anyway, the best thing you can do is share these observations with others who might appreciate them!

Vera said...

Thanks for sharing this with us! And, not knowing wether it makes things better or worse, those things are not always done on purpose but sometimes just out of stupidness. E.g. the published article (which got over 100 citations), in which a doctor re-invents the integral. (Mary M. Tai, A Mathematical Model for the Determination of Total Area Under Glucose Tolerance and Other Metabolic Curves, Diabetes Care, Vol. 17, Nr. 2, Feb. 1994)
With such scientists how can there be hope...