Drugs and money

Whenever you criticise any aspect of so-called alternative medicine, the alt-med fans invariably start complaining that you're ignoring the evils of pharmaceutical companies, that you've somehow been brainwashed by Big Pharma, or even that you're secretly in their employ.

It seems to me a pretty obvious projection of a flawed, all-or-nothing, black-and-white kind of thinking. The reasoning (or what passes for it) is that one side has to be all good, therefore the other has to be all bad. Well, no. In this case one is only mostly good and the other is only mostly useless.

Do I have blind faith in Big Pharma and everything it produces? No, because I'm not quite that silly. I wouldn't trust Big Pharma any further than I'd trust Big Oil, Big Mining or Big Homeopathy.But it's true that most sceptical bloggers tend not to write a whole lot about evils of Big Pharma (the doctor and journalist Ben Goldacre being one particularly notable exception). So let's have a look at some of the ways in which pharmaceutical companies can be unethical, unscrupulous and even exhibit a lethal disregard for the safety of the people who buy their drugs.

The very worst thing that drug companies can do is misrepresent the dangers of new drugs — and they seem to do that quite a bit.

Perhaps the most infamous recent case is that of the arthritis drug Vioxx, which was found by an Australian Federal Court judge to have been responsible for doubling the risk of heart attacks, many of which were fatal. In 1999 Merck's own research showed that Vioxx was associated with a big increase in the risk of heart attack, but the company took it to market anyway. By the time it was taken off the market in 2004, analysts from the US Food and Drug Administration estimated Vioxx could have caused 88,000 to 139,000 heart attacks — 30 to 40 per cent of which were probably fatal. Merck has denied liability and the Australian court decision is under appeal.

One of the ways in which pharmaceutical companies can make their drugs look  safer and/or more effective than they really are is simply to withhold or obscure inconvenient trial results. Another is through the widespread practice of medical ghostwriting, in which ostensibly independent researchers put their names to journal articles that have been written at the behest of drug companies.

 Is there anything that can be done about this? Well, it might help if there was mandatory registration of all clinical drug trials — Australia's clinical trial registry is voluntary.

Big Pharma also deserves a kicking for refusing to give AIDS drugs off-licence to the developing world. The drug companies complain that they need the money from sales for research and development but, as Goldacre points out in his excellent book Bad Science, they spend more than twice as much on marketing and administration as they do on R&D.

The bottom line is that it's all about the bottom line — which is why drug companies are more interested in inventing new erection pills to sell to well-off Western men than they are in developing treatments for deadly diseases that affect millions in poor countries. (It'd be nice if governments started spending more money on such things, but don't hold your breath).

Drug companies get around bans on advertising prescription drugs direct to consumers by running ads that ''raise awareness'' about medical conditions that link to websites that plug their drug. Visits and gifts from pharma company reps can influence doctors' decisions when prescribing drugs (Doctors might think they don't but they can find some links to the research here).

The list of dodgy things that drug companies do goes on and on. It's good to know about them. It's good to be able to ask your doctor why he or she is prescribing you a particular drug, and on what evidence. But it's important not to lose sight of the fact that it's science-based medicine that his given us much of the health and longevity we enjoy today. After all, the life expectancy in the Western world didn't double in a century because of advances in magical memory water.

What do you think? Is Big Pharma behaving badly? Are governments doing enough to hold it to account? What can we do to improve things? Or is criticism of the industry overblown?

Courtesy: Sydney Morning Herald