Forty years ago this year (god, can it be so long?), I joined the pharmaceutical industry. Its reputation then was little better then than it is now, various companies having weathered scandals in the previous two decades. In the 1950s Pfizer was top UK company by a long way, on the back of its tetracycline antibiotics. Oxytetracycline was promoted via golf weekends for doctors, and a dimpled ball emblazoned with the brand name Terramycin was famously brandished in the House of Commons in the late 1960s by Gwyneth Dunwoody MP. Not many years later I was working for Pfizer, and doctors still asked me for golf balls, I suspect only half in jest. In the 1960s Roche was forced to repay excessive profits from benzodiazepine anxiolytics, and of course the now long gone Distillers Company presided over the worst ever case of teratogenic damage from a drug.
So even in 1974 I was under no illusion that the pharmaceutical industry was whiter than white, and indeed I pretty quickly realised that its watchdog the ABPI was somewhat dentally challenged. Pharma was then, and is now, no different from any other big business; it will do what it can get away with. Hence it’s not surprising that it has become a whipping boy for a community of apologists for unreason. Every alternative medicine blog post seems to trigger a cascade of comments which wallow in the same delusion, that there is a massive conspiracy by Big Pharma to hide and discredit all the fantastic discoveries of maverick researchers.
Well let me give you Big Pharma’s perspective on all this. Having spent most of the last 40 years doing clinical research, I have never encountered anyone who cares two hoots (or even one hoot) about competition from alternative medicine. For most people in industry it’s nowhere on their radar. This to me is a cause for frustration, as I am very hard pressed to recruit anyone from pharma to doing voluntary work to tell the truth about complementary and alternative medicine (CAM). Everyone is far too preoccupied with working their socks off to get trials completed and data submitted to regulators. Most people in my experience work very long hours to do this, training is a never-ending commitment, and career development is a constant concern. Nobody has the time or energy to worry for example about whether acupuncture will undermine their efforts to develop a new analgesic.
OK, the detractors will say that I may well be right about coal face workers, but this conspiracy is perpetrated by the companies’ `secret police’ who are sealed off from the researchers. My response to that is “Where’s the evidence?”. For example, Lynne McTaggart says in her blog “….we suffered a sustained attack on our magazine What Doctors Don’t Tell You by two pharmaceutically-supported organizations”. Every time she says something like this I ask for the evidence, and there is never any reply. This is an infallible rule. Whenever the pseudo-science community is asked for robust evidence there is no proper reply. They may well respond with irrelevance or repetition, but never with evidence. Of course, Mc Taggart is not helped by her inability to distinguish between the ABPI and the British Pharmacological Society.
So I say it again – there is no evidence of any Big Pharma conspiracy against CAM. It is 100% a myth, because the industry quite frankly can’t be bothered.
The problem is of course a version of the Joseph Goebbels one. The bigger the lie, the more it will be believed. In this case, the lie is pumped up by repetition. I’m sure it’s absolutely believed by most people who repeat it, but I’m also suspicious that some of them know it’s a lie. Why would they lie? Because they have a vested interest. Lynne McTaggart makes a living as a writer and publisher. It suits her to support her business with statements that will encourage sales of her magazine. Is she actually lying? That could only be answered if we knew what’s going on in her brain, ie does she know that there is actually no conspiracy? I would expect any professional journalist to be sure of their sources (oh dear, we know how this is honoured more in the breach!), so I don’t think there is any excuse for not knowing that. I’ll just leave you with that thought.
None of this is to say that pharmaceutical companies are faultless, as I have said. Overall, most prescription drugs have mediocre effects, a few are very effective (and often only in a minority of people), and some are useless. Most are based on known mechanisms of action and all have been tested in clinical trials. Some clinical trials have been well designed, some have not, and far too many have never been reported. All drugs have side effects, because you can’t have positive effects without a risk of negative ones. Drugs only get authorisation to be marketed if the risk:benefit ratio is considered favourable by the regulators, but as we know that isn’t a perfect system. Drug companies on average spend twice as much on sales and marketing as they do on R & D, which to my mind is indefensible. Having said that, there is nothing on this planet that people use that someone doesn’t have to sell. Trade is what makes prosperity, and I have no problem with companies employing sales people to sell their medicines to doctors. I just think that what the sales people say should be the truth and the whole truth.
Incidentally, there has always been a widely held view, or even a myth, that drugs comprise a huge proportion of modern health care cost. The reality is that they cost about 10% of the NHS budget, and that has been the same for decades. I have always thought it odd that there should be this terrible furore over selling drugs to the NHS, when nobody worries about the promotion of ambulances or MRI scanners. But I digress.
Of course, Ben Goldacre’s `Bad Pharma’ was welcomed with open arms by the propagators of the Big Pharma myth. The confirmation that drug companies talk up benefits and don’t shout loudly about side effects was music to their ears. But what do we hear from purveyors of CAM? It’s not just a matter of large scale exaggeration of CAM’s benefits, because mostly they do much worse than that, by actually inventing effects that don’t exist. While they are at it, they seize anything that implies bad news for real medicines. Last year the aforementioned What Doctors Don’t Tell You ran the headline “HPV Vaccine Kills 1700 Girls”, with a reference to a US study. If you read the study, you find that it wasn’t even designed to measure safety, but was all about assessing uptake of the vaccine. The authors actually said that the rate of deaths was low for that very large population, which had received millions of doses. The headline was a lie. Pharmaceutical copy-writers might be a dodgy bunch, but they don’t try that on.
It’s very interesting to see the CAM crowd getting so exercised over the conspiracy myth, when they are nowhere to be seen on the real issues. The serious problem of hidden clinical trial data has been exposed not by Lynne McTaggart, John Benneth, Steve Scrutton or any of that ilk. No, the whole thing was triggered by that scourge of the quacks, Ben Goldacre. Why was that? The reason is that the supporters of fantasy medicine have not the slightest understanding of drug development, or of science in general. In contrast, the AllTrials campaign is one of sceptics, none of them funded by Big Pharma, CAM, or any other commercial interest. They are doing it for no other reason than that they care about the truth, they know what science is, and they don’t like to see it abused.
Which brings me to a key point. What is truth? I think it’s knowledge based on evidence. As such, it is extremely powerful. Now the CAM crowd does not know the difference between myth and truth, and in particular doesn’t understand the power of truth. For that reason, they don’t grasp why sceptics have been so effective in combatting false claims. They think we can only have done it because we are bankrolled by Big Pharma. It is beyond their narrow comprehension that a rather small group of unpaid and dedicated people could have had such a damaging effect on pseudo-science. But they will have to accept that eventually, because it’s the truth.
Yes, I have been paid by Big Pharma as an employee and as a consultant. But none of that was even remotely connected with attacking CAM. I have been paid by the Advertising Standards Authority to advise on complaints brought to them, but as it happens none of those involved CAM. I lecture quite often on evidence based health care and on CAM, and never accept fees for that (they are occasionally offered but I always refuse).