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24 November 2013

Interview with the Author of « Big Pharma, An All-powerful Industry that Toys with Our Health »

I am currently reading "Big Pharma", a very revealing book about the ways in which the pharmaceutical industry is toying with our health.  The Nouvel Observateur interviewed the author, Mikkel Borch-Jacobsen, on the parts of the book about the drug "misinformation" on the Internet and environmental pollution of medications. (The book is not yet available in English.)

"For information on health, the Internet is completely unreliable"
by Anne Crignon , Nouvel Observateur , 29 September 2013 (translated from French by the Editor of this blog)

Mikkel Borch-Jacobsen publishes "Big Pharma". Interview.

Mikkel Borch-Jacobsen, 20 July, at his home in Paris, the day he finished "Big Pharma". Born in 1951 of Danish parents, MIKKEL BORCH-JACOBSEN grew up in Strasbourg and studied philosophy in France, where he defended his doctoral thesis before a jury which included Derrida, Levinas and Lacoue-Labarthe. He left for the United States in 1986, where he currently teaches literature at the University of Washington in Seattle.

In "Big Pharma", Mikkel Borch-Jacobsen… has asked a group of Anglo-Saxon authors to refine his study of a milieu that he has been scrutinizing for the past ten years: the pharmaceutical industry.

BibliObs: There is a debate in France. Some believe that we are now in an era of medical misinformation or manipulation by prescribers, scientific knowledge being "in the hands of” drug manufacturers; and those who complain are often perceived as Manichaean accusers. Has medical knowledge been corrupted?

Mikkel Borch-Jacobsen: Unfortunately, the answer is yes. Research and medical information are completely under pharmaceutical influence, to a degree that very few people are aware of. Here in France, the public was shocked by the case of Mediator, which highlighted ties of interest between Servier and experts who were supposed to evaluate the efficacy and safety of their products. The case was treated in the manner of a scandal, that is to say, as a transgression and an exception to the rule. This case is of course scandalous - people died - but it is by no means an exception. Quite the contrary, the case of the Mediator illustrates a corruption of biomedicine by industry that has become quite common, if not systemic, throughout the world.

You give many examples in "Big Pharma."

With supporting figures and documents, we relate in detail how the dangers of certain drugs were knowingly concealed or minimized: antidepressants of the Prozac type, the second-generation antipsychotics, hormone replacement therapy, the antidiabetic medicines Avandia and Resulin, the drug against gastric reflux Propulsid, opioid analgesics such as OxyContin, appetite suppressants "Fen-Phen" in the United States or the anti-cholesterol drug MER/29.

The list of health scandals is literally endless. Each time, hundreds, thousands, or in some cases tens of thousands of people have died or have suffered serious side-effects. None of these scandals would have happened if the procedures of scientific and regulatory control had not been faulty. We regularly learn that experts maintain multiple financial relationships with laboratories producing the same drugs they have to evaluate. It is the same for health agencies and authorities. Not only can they not do without experts to do their job, but also they are themselves in a constant situation of conflict of interest.

We should be aware that the U.S. Food and Drug Administration (FDA) and WHO are 50% financed by funds from industry, the European Medicines Agency (EMA) 70%, the Swedish Agency 95%, and so on. How can we expect these institutions do not show goodwill towards their preferred "partner", which for them is the industry? This can go very far. Epidemiologist and former SPD member Wolfgang Wodarg in our book tells how WHO let itself be completely manipulated by the manufacturers of vaccines and antivirals during the false alert of the H1N1 flu pandemic.

Are doctors also manipulated in this regard?

Where would you like them to find objective information about the drugs they give to their patients? Their main source is from medical visitors. It is clear that this information is only marketing, disguised as science. Ditto for continuing medical education in France, three quarters of which is provided by industry. Ditto for the medical press, which is notoriously aided by industry advertisers.

With regard to the major peer-reviewed scientific journals, they have become, according to Richard Horton, former editor of "The Lancet", "information laundering operations for the pharmaceutical industry" . Studies published in these journals are almost always favorable to evaluated drugs, simply because laboratories do not publish negative studies.

It is estimated that 50% of industry-funded clinical trials remain invisible because they are unfavorable to the drugs concerned. This is obviously a total perversion of the concept of "evidence based medicine" since researchers and physicians have access only to favorable "evidence" and remain unaware of the risks and / or inefficacy of drugs. Contemporary biomedicine looks more and more like one of those "Potemkin villages" where poverty was hiding behind sham facades when the procession of Empress Catherine II of Russia passed by.

You also explain in your book that the Internet is a key cog in this disinformation enterprise. In what way?

Typically, pharmaceutical marketing targets doctors since they are the ones who prescribe drugs. This is why pharmaceutical marketing occurs most often in the guise of science, since we must convince physicians a priori skeptical of industry commercials.

The advent of the Internet has changed the game by allowing laboratories to directly address patient-consumers and create the needs that they then ask prescribers to meet - "Talk to your doctor." Today, patients are no longer passive vis-à-vis medical knowledge. They inform themselves via health sites like Doctissimo, participate in social networks specializing in their pathology, form virtual communities, where members exchange information and advice. Seven out of ten persons in France use the Internet for information on health.

This is often presented as a democratic empowerment of patients. These persons, we are told, no longer allow themselves be told because they have at their disposal multiple sources of information. But the information is hardly regulated. It is often influenced by industry. For example, there is a blogger who has since the summer been adversely criticizing "Big Pharma", long before publication of the book. She argues that the French do not need to be alerted about the evils of the pharmaceutical industry, because they have become "e-patients" who find critical information on the Internet. Can she really be ignorant that this concept of "e-patient" comes directly from the arguments of marketers in the industry? They have been actively promoting it for several years (some examples here ,here and here )?

Big Pharma asks nothing better than that patients inform themselves on the Internet, because it is on their information they will inevitably fall. As explained by the public health expert, Antoine Vial, in our book, medical information has a price and that found on the health and social network websites is only free and immediate because labs or communication agencies have paid to place a particular content or to obtain such and such data.

Faced with free information, we must always ask "Who?”. Who paid for the site of this patient organization or prevention campaign? Who started the buzz about this pathology or drug? Who is behind this blog? Far from being a counter-power to the misinformation machine of the pharmaceutical industry, the Internet is constantly speaking in favor of it. We absolutely cannot trust the Web to obtain objective and quality information on medicines. Even the online encyclopedia Wikipedia is manipulated.

Through WikiScanner which detects suspicious changes to an entry, you would be able to see what is written or removed by certain companies on Wikipedia. Can you give some examples?

WikiScanner reveals the anonymity of changes by users whose computers are registered under IP addresses belonging to large companies or organizations like the CIA. Thus it has been shown that a computer of the pharmaceutical company Abbott Laboratories was used to remove the reference to a scientific paper that showed that the drug Humira against osteoarthritis doubled the risk of developing serious infections and tripled the risk of developing certain types of cancer. The same computer was used to remove all information about the risks of cardiovascular events presented by another Abbott product, the anti-obesity drug Meridia. You should know that Meridia has since been withdrawn from the market because of these risks, which illustrates the severity of the redactions made ​​by Abbott.

In the book, we focus on the changes to the entry "Quétiapine" by User "chrisgaffneymd" from a computer belonging to the pharmaceutical giant AstraZeneca. Quétiapine, marketed under the brand name Seroquel, is a second generation antipsychotic which has all kinds of risks and side effects: suicide tendency, significant weight gain, diabetes, cardio-vascular accidents, tardive dyskinesia, neuroleptic malignant syndrome.

But as revealed by an anonymous blogger, user 'chrisgaffneymd "has systematically eliminated all references to these side effects in the entry “Quétiapine". He also inputted into the entries of other second-generation antipsychotics, in order to emphasize their side effects to thwart competition. A real professional job, obviously made ​​by a psychiatrist (User name ends with "md", which seems to indicate that he is an MD, a “Medicinae Doctor”). What astonishing cynicism!

The entry " bipolar disorder "was also amended by this same “chrisgaffneymd."

Yes, and also the entry,"bipolar spectrum". We can ask why an employee of a pharmaceutical company is interested in the definition of a psychiatric disorder, but the answer is obvious to anyone who knows a bit about the practices of Big Pharma. In (re)defining the diagnostic criteria of a disease, we can indeed significantly increase these criteria -.and therefore sales – of a given drug. This is what marketers call in their industry jargon "condition branding", i.e. the promotion of disease.

Instead of selling a drug, industry promotes a disease for which the drug is indicated. This can be done by expanding the criteria for an existing disease or artificially modifying the definition to expand the market of a drug. This can also be a disease created from scratch, as the now famous "premenstrual dysphoric disorder" which was integrated into the "DSM", the manual of psychiatric disorders, helping to provide a new market for Eli Lilly’s Sarafem, a drug recycling the molecule Prozac, which had reached the end of its patent.

"Bipolar disorder" qualifies what could be called "extension of the domain of the disease" ...

Yes, great expression! “Bipolar disorder" was introduced in 1980 in the nosology of the "DSM-III" to replace manic depression. The latter is conventionally defined as a mood disorder where the patient swings between states of hyperactivity and manic states of deep depression. Clearly this was a serious and relatively rare psychosis, for which antipsychotics were given.

Yet in subsequent editions of the "DSM", commissions, composed 100% of experts with ties of interest to pharmaceutical companies, have introduced a "bipolar disorder II", which were added forms of less severe depression and/or hyperactivity. We were led to begin to speak of a "bipolar spectrum" including virtually any form of mood instability and affecting all age groups from unruly children to the depressed elderly. All these were called either "bipolar disorder" and treated with ... second-generation antipsychotics such as AstraZeneca's Seroquel! Now you understand why the man from AstraZeneca was interested in the entries under Bipolar Disorder in Wikipedia.

When considering his additions and amendments, we see immediately that it was basically essential for him to redefine depression and hyperactivity as hidden or misdiagnosed bipolar disorder – in other words, in order to expand the Seroquel market. It is through operations of "condition branding" of this kind that the antipsychotic market has literally exploded over the past ten years to reach a turnover of $18 billion per year. By aggressively promoting the concept of "bipolar disorder", the antipsychotic and antiepileptic manufacturers have managed to capture the market previously held by Prozac-type antidepressants and psycho-stimulants like Ritalin.

In April 2009 in "Books", for an issue devoted to the pharmaceutical industry well before the breaking of the Mediator affair, you issued this striking formula: “We launch a disease as we launch a brand of Jeans”…

Yes, and in "Big Pharma” we give many examples of diseases or syndromes promoted by laboratories for the purpose of patent cycles and commercial strategies: depression, Alzheimer's disease, fibromyalgia, metabolic syndrome, gastro-esophageal reflux disease, social phobia, and many more. Not to mention risk factors where thresholds are manipulated to include more and more "patients who are unaware [they are patients]".. cholesterol, hypertension or osteoporosis. Every day brings a new "disorder", a new "syndrome" that requires mandatory treatment with medication.

In just the past two weeks, we have received the right in France of two enthusiasts, one from "Liberation" and the other, "Elle" to mention the "sexual revolution" promised by feminine Viagra: women suffering from "hypoactive sexual desire" (i.e. a bit sluggish libido) will want to make love five times a week again thanks to Lybrido, one of the many aphrodisiacs in preparation in the lab pipeline. Lybrido has not yet even been authorized for marketing, while communications agencies are already working actively to promote in the press the new "sexual dysfunction" that must be cured.

In your book, you talk at length about the issue of health risks ...

Yes, it's a huge problem, which we are just beginning to be aware of. Medicines are far from being innocuous products, either for our bodies or for the ecosystems to which we belong. They are synthetic products industrially manufactured, exactly the same way as all sorts of other synthetic products that we have been dumping for nearly a century into the water, air and soil of our planet - pesticides, herbicides, dioxin, phthalates , PCB, PVC, bisphenol A, etc..

These artificial molecules act in a largely unpredictable way on the organizations with which they come into contact for the first time or at doses not found in nature. This is true for the synthetic products I just mentioned, and it is also true for drugs, which may prove to have what is called euphemistically "adverse medical events" (NDE). Usually the issue is avoided by speaking of "side effects", as if these were negligible.

But it’s enough to look at the numbers of drug reactions to see that drugs pose a real public health problem. It is estimated that NDEs are responsible for 197,000 deaths per year in Europe, making it the fifth leading cause of hospital deaths. The figures are almost the same in the United States, keeping in proportion in mind: a 1998 study estimated at 2.2 million the number of serious NDE’s per year, with 100,000 deaths.

We usually consider drugs as essentially beneficial substances, but in reality they also have all kinds of risks that are multiplied by their mass industrial distribution. The more we consume drugs, the more we increase our risk of getting sick. Clinical trials are absolutely unable to guarantee against these risks because they are conducted on too limited a number of cohorts and over periods that are too short. It is only when the drugs are tested on entire populations and for decades that we can properly assess the effects - and then, it is often too late. Look at what happened with the synthetic hormone diethylstilbestrol [treatment given to pregnant women in the 70s, supposed to prevent, miscarriages, Ed]: its effects on the second and now third generation are being reported ...

You also deal with a topic rarely discussed: environmental risks.

This is the most disturbing. We know that during the last twenty years, certain synthetic products ubiquitous in our environment, such as PCBs and bisphenol A, disrupt the endocrine system of animals and humans by mimicking or blocking natural hormones. The same applies to certain drugs, including synthetic hormones like ethinyl estradiol, found in almost all birth control pills. These products, once excreted, are found in the rivers and in the sea where they affect the reproductive systems of fish, the birds that eat them - and ultimately, ours.

No later than a few months ago, a study found traces of tamoxifen in some bottled waters. Tamoxifen, a synthetic hormone used in the treatment of breast cancer, is an endocrine disruptor.

Other drugs also act as endocrine disruptors, antidepressants of the Prozac type which are known to affect sexual and reproductive functioning in humans. They too are dumped into the rivers and seas where they slow the growth of tadpoles and alter reproductive functions in shellfish, before getting in the water that comes out of our tap. In reality, the water of our rivers and that which we drink have become a drug broth where we find a mix of antibiotics, beta blockers, anticonvulsants, anti-inflammatories, anticancer drugs, antihistamines, anti-hypertensive drugs, statins, and so on.

It is not only in taking drugs sold in pharmacies that we expose ourselves to iatrogenic risks. Due to the production and industrial use of these molecules, we are all exposed to the environment, whether we like it or not. The truth is that the pharmaceutical industry is a polluting industry, just as much as the agro-chemical industry, and that drugs have become environmental disruptors. Moreover, environmental protection agencies are beginning to worry about drug toxicity in the environment, but very discreetly. We well understand the reason, because it is a politically and economically explosive issue. What would happen if Big Pharma drugs proved as dangerous for the environment and public health as common chemical waste?

Interview by Anne Crignon "Big Pharma, an all-powerful industry that toys with our health", coordinated by Mikkel Borch-Jacobsen, Les Arènes, 524 p., 22.80 euros.

Original article in French :

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