Peter Gøtzsche became a physician thirty years ago. He is a specialist in internal medicine. Before co-founded The Cochrane Collaboration in 1993, he worked in the drug industry nearly for a decade. Maybe for this reason, he knows deeply how this important corporations works, their logics and their distorting practices. But soon wanted to know more about manipulating conducts of Big Pharma: during several years, he dipped into the writs of lawsuits to drug companies and searched scientific evidences of crucial and intended occultations of clues leading to health risks, and all this lead him to the conclusion that some drugs kills and pharmaceuticals usually drives as mafia groups that practice crime corporately. All the evidences he compiled has feeded his last book «Deadly medicines and organised crime: how big pharma has corrupted healthcare», that has been translated into spanish and had been presented in Spain last week.
He kindly accede to be interviewed for «Demedicalize-it!». He talk about this book and his vision about some other controversial issues that has been of his interest and study all along his prolific life. The book will be edited by «Los libros del Lince«, and will be sure, at least, polemic.
You dedicate your book to «to all honest people who work in the pharmaceutical industry.»
There are many good people in the industry who would like to see their top bosses behind bars, just like I would.
Some say that you had to sign an insurance to cover potential claims of pharmaceuticals mentioned in your book. Since publishing the book last summer, have you had any legal complaints?
It is too late to threaten with lawyers once a book is out and my book is so well documented that there is no sound basis for a law suit. I have not had legal complaints.
In the book you talk about your experience working in the pharmaceutical industry, a poorly known fact of your biography. First as commercial rep, then in the marketing department and finally in a Medical Affairs department, overseeing clinical studies and applications for registration of drugs and new indications. I guess you where looking for being a little more outside the trade wars. However, your experience indicates that the medical departments of pharmaceutical companies transited under marketing strategies paths. Is that still the case? What then remains outside the scope of the market within a pharmaceutical?
The medical departments have little freedom today and the type of research they do have marketing aims. So, today, it is hard to tell the difference between a marketing department and a clinical research department; in fact, salespeople often conduct fake trials whose sole purpose is to sell drugs
Founder of Merk Co., George W. Merck, had the famous motto «We try never to forget that medicine is for the people. It is not for the profits. The profits follow, and if remembered that info we have, doing lot never failed to appear». That was in 1950. This motto remains as a part of the code of conduct of the company, and is cited in textbooks and MBA Masters as core values of the whole pharmaceutical industry. In the same years, John McKeen became Pfizer’s president. His philosophy was different: «so far as humanly possible, we aim to get profit out of everything we do.» This struggle between social responsibility and profit accumulation has marked the history of the pharmaceutical industry, but it seems that the latter has gained in the last 20 years.
It is all about profits. No matter what the industry says in their PR campaigns, it is all about sales of drugs. If the drug industry was truly concerned about people, we would use far less drugs than we do. Our societies are immensely overdosed. Marketing, lies about drugs and corruption are responsible for this.
«Torturing data until they confess» is a widespread practice? So easy it is to manipulate the statistics?
Anyone who has performed a clinical trial knows that there are many ways you can manipulate your results, and this is what the drug industry does routinely when an honest approach to the data does not yield the result that the salespeople need
In Spain, doctors who don’t receive drug reps are called “taliban”…
I wonder who would call them that. It is the other way round. Doctors who receive salespeople are exposed to people whose job it is to terrorise common sense
The role of whistleblowers is essential to uncover many of the corrupt or criminal schemes inside the enterprises. In a study about origins of fraud, the Association of Certified Fraud Examiners found that many of the allegations of illegal practices come from tip-offs, and that half of them are made by workers themselves. Experts call for laws establishing special protection for whistleblowers and specific channels of complaints, and even rewards systems. Are usual whistleblowers in the pharmaceutical industry? Do the pharmaceutical companies facilitates the whistleblowers labour?
Many fraud cases have been exposed by whistleblowers who often suffer a terrible fate. We therefore need to legislate to protect them as well as we can. The whistleblowers are heros who on many occasions have exposed organised crime with a death toll of thousands of patients. The drug companies do everything they can to intimidate whistleblowers, as they are bad for their business, just like mobsters go after those who “sing”.
If spies and military intelligence systems are used against mafia of illegal drugs and arms, why not to use them to prosecute the criminal activities of the pharmaceutical industry?
That is an interesting suggestion I have never thought about.
You also propose jail for company executives who perpetrate acts of reckless and wilful negligence against public health. Is there any case?
There are a few cases. The risk of a jail sentences is one of the very few means that could have a preventive effect for the worst crimes in the drug industry. The top executives see themselves as respectable citizens but a criminologist who interviewed many of them described them as ruthless bastards.
Other industries operating in the healthcare market –i.e., homeopathy, nutritionals, technological gadgets, etc-, do they imitate the same criminal behaviors of drug companies?
No, definitely not to that extent. The drug industry ranks at the top in terms of the frequency of crimes and the severity of the crimes, among all industries.
In Japan there is a term, Yakugai, which specifically identifies the damage caused by drugs that become relevant in public health. In your book is mentioned a public health crisis caused by a drug classically recommended for holiday tummy, Enterovioform (clioquinol). Although we had strong data in the early 70’s associating the drug with a form of damage to the nerves of the eyes, it was not until a decade later when the drug was withdrawn from the market, after leaving behind a trail of thousands of persons affected. Why regulatory agencies takes so long to act?
They are generally more keen to protect the drug industry’s commercial interests than to protect the public. It is very sad but true.
A Cochrane review detected replicated results of the same trial with the antipsychotic olanzapine up to 142 times in different publications (journals and conference proceedings). The same lie repeated 142 times becomes a truth? Has flooding of scientific publications market became a strategy for promoting sales?
Indeed, and although being rather extreme, the olanzapine example is typical. The drug industry uses the same tactic as Joseph Goebbels used in Nazi Germany and as all dictators use: just repeat the same lie and make sure that you are the only source of information people have, and they will tend to believe it. The drug industry’s own trials are often the only trials that have been carried out, so we have no independent source of information.
Your «hall of shame of the pharmaceutical industry» has become a classic. You cite 10 examples of major promotional frauds according to the volume of the companies. The cases collected are just until 2012 If you’d like to update this list, what would you include?
I have not come across a single drug company that doesn’t commit crimes as part of their business strategy. I merely selected the ten biggest ones for convenience.
In the middle of global economic and financial crisis, between 2007 and 2012, world consumption of drugs has risen a 32%. What proportion of this increase is due to the criminal practices you claim in your book?
I cannot say but it is a large part of it, as off-label promotion, which is illegal, is immensely profitable.
According to a recent report by the IMS Institute, the global pharmaceutical market will continue to increase in the forthcoming years. Forecasts predict that will grow by 4% annually over the next three years, driven by emerging countries (especially the BRIC countries -Brazil, Russia, India and China-). Are there evidences that these countries are imitating fraudulent behaviors that some pharmaceutical companies have committed in Europe and USA?
When crime pays, crime will increase and it will be everywhere. This is what we have seen, both for illegal and legal drugs, and we will expect the crimes to be worst in countries that have a tradition for corruption and weak regulation.
By the way. What do you think about the fact that the largest provider of data on global pharmaceutical market is a private company like IMS Institute?
Those who participate in all this have a common interest in overtreating our citizens.
The market for clinical trials has been offshored in a brutal way, traveling in the last decade mainly to Eastern Europe and Southeast Asia. Are there minimum ethical and legal guarantees in these countries?
It is of great concern when trials are outsourced to countries where corruption is standard practice. It is well-known that research results can be bought and that ethics and legal issues can be “negotiated”.
So, is it the quality of biomedical research related in some way with the democratic quality of countries where it takes place?
Yes, this has been well documented.
The biggest myth that has fallen from my altars after reading your book is the lack of anti-inflammatory efficacy of nonsteroidal anti-inflammatory drugs (for example, in treating sports injuries). It reminds me of another great paradox: the limited protective effect of the popularly regarded as «stomach protectors», the proton-pump inhibitors. However, the transmission of these fake memes is more effective than the best ad campaign. But are these memes casual or do they obey to predefined strategies?
The lies of the drug industry are by no means casual, they are deliberate and very well planned. Nonsteroidal anti-inflammatory drugs are harmful for sports injuries, not only because of their lethal harms, but also because they delay healing and because a reduction in pain can make an injury worse and even make it chronic, as the athletes resume training too early.
You propose preventing information from pharmaceuticals on drug effects about indications not legally approved. Would it contribute to restrict the unjustified outside-label use?
The most effective preventative strategy I can imagine is to make marketing of drugs illegal, which would make the armies of salespeople redundant.
I would add one more to your Decalogue of myths about the pharmaceutical industry: «marketed drugs respond always to global health needs of the population». Do we have the drugs we need?
It is much more profitable for the drug industry to invent diseases, which are not even true diseases, than to invent drugs. We have far too many drugs and we use them far too much, also in situations where non-drug interventions would be both more effective and safer.
There are many international initiatives that have been launched in recent years calling for greater transparency in the investigation –AllTrials campaign- conferences to analyze the prevention of overdiagnosis -Preventing Overdiagnosis-, journals and professional organizations who call for setting limits to medicine -Too Much Medicine, BMJ; Less is More, JAMA Internal Medicine; Choosing Wisely, American Board of Internal Medicine-etc. Are there reasons for hope?
We have reached a tipping point where people have started to realise that the drug industry has become much too powerful and that it costs far too much for us, not only in monetary terms, but also in terms of far too many drug-induced deaths and persistent harms. There were many books criticising the drug industry before mine and I have therefore been surprised by the impact my book has had. I give many lectures all over the world, both for professionals and lay people, and many TV channels have sent documentaries or plan to do so based on my book. To me, this has to do with the tipping point. People have had enough, and as my book has more than 900 references, the many inconvenient truths I have documented cannot be ignored.
After reading your book, as a clinician I just want to substitute a lot of prescriptions drugs by recommendations of readings! Is the thirst for knowledge therapeutic itself? Any Cochrane review about it?
I am not aware of any Cochrane reviews about this but I agree that reading can be helpful for many things, including health problems. There is nothing like reading if you have trouble falling asleep, and the effect doesn’t disappear after two weeks, as it does when you take sleeping pills; you don’t get a hangover next day; you don’t increase your risk of traffic crashes; and you don’t become dependent like you do on sleeping pills. It is decades ago I took my last sleeping pill and we don’t have any in the house.