Authors: John Abramson
clinical guidelines and, 127, 130, 227
diabetes web sites, 230
public relations campaigns and, 163
non-steroidal anti-inflammatory drugs (NSAIDs), 6–7, 24, 25, 29–36
Norpace, 114
Norvasc, 245
Novartis, 109, 212
Nurses’ Health Study, 63, 66–67, 202, 229–30
nutrition.
See
diet
obesity, 204, 222, 229–30, 235–37
observational studies, 64–68
omission of data, 29–31
Omnicom, 109
organ transplantation, 43, 44
Osler, Dr. William, 197, 208
osteoarthritis, 190–94.
See also
Celebrex and Vioxx
osteopenia, 210, 215
osteoporosis, 210–20
drugs, 246–47
marketing of hormone replacement therapy for, 62–64
Our Bodies, Ourselves
, 219
overuse of medical services, xix–xx, 52–53, 84, 178–81.
See also
supply-side medical care
OxyContin (oxycodone), 102–3, 121
pain control, 121–22, 191
paradigms, medical, 202–3
Pasteur, Louis, 189, 194–95
patents, 153, 241
patients
medical consumerism of (
see
marketing; medical consumerism)
persons vs., 56–57, 206–8
relationship of, with doctors (
see
doctor-patient relationship)
responsibility of, 256–60
rights of, and health insurance, 80, 162–63
uninsured, xxi, 20, 46, 253–54
unrepresentative study, 16–17, 33, 103–4, 206–8, 251
Paxil, 116–17, 163, 243
peer review.
See also
medical journals
hidden data and, 106
reforming, 252
Percocet, 102–3
performance, health care system, 46–47, 180–81, 184, 210, 248–49
persons, patients vs., 56–57, 206–8.
See also
patients
Pfizer, 21–22, 107–9, 119, 232–33
pharmaceutical industry.
See
drug companies
Pharmaceutical Research and Manufacturers of America (PhRMA), 122, 154, 160, 245
Pharmacia Corporation, 23–24, 30, 104–5
physical fitness.
See
exercise
placebos, 14, 102–3
polio, 42, 241
politics.
See
government, U.S.
postapproval studies, 29
poverty, disease and, 204
pravastatin (Pravachol), 13–18, 133, 136–37, 142–46, 165, 227–28
preapproval clinical trials, 29
prednisone, 33
preemptive pain medication, 102–3
Premarin.
See
hormone replacement therapy (HRT)
premature research termination, 70, 104–5, 243–44
prescribing habits
commercial influence on, 120–24
drug company access to, 126
medical consumerism and, 155–57
prescription drug coverage.
See also
health insurance
commercial incentive of, 21–22
HMOs and managed care plans, 79–80
Medicare, 244–49
preventive care, 49, 166.
See also
lifestyle health factors
Prilosec, 43, 101–2, 246
primary care, 11, 78, 82–85, 208.
See also
doctor-patient relationship
primary care doctors
breast cancer and, 39
diminishing role of, 82–85
drug ads and, 156
HMOs and, 75–76, 78
persons vs. patients and, 208
ranking of innovations by, 44, 114–15, 181–83
specialists and, 255–56
Procter and Gamble, 135
professional societies, 127
profits.
See also
costs, medical
marketing and, 158–59, 163, 242
media, 166–67
medical industry, xxi, 110, 253
medical journal, 112–13
statin drugs, 135, 147–48
supply-side medical services, 179–80, 184–85, 254–55
surgical procedures, 174–78
universal health insurance and, 253–54
progestin, 62, 70
promotional campaigns.
See
marketing
Pronestyl, 114
PROSPER study, 145, 246
PROVE IT study, 146, 246
psychotherapy, 11, 232–33
publication bias, 113–17.
See also
commercial research bias
Public Citizen, 86, 121, 167
public relations campaigns, 63, 159–63.
See also
marketing
Pub-Med web site, 28
pulmonary edema/congestive heart failure, 7–8
Purdue Pharma, 121–22
quality, health care, 46–47, 180–81, 184, 210, 248–49, 254–56
Quinaglute, 114
rabies, 194–95
raloxifene, 217
randomized controlled trials (RCTs), 64–68, 250
ranitidine, 246
rationing, health care, 162–63
red meat consumption, 45, 238
relationships.
See
conflicts of interest; doctor-patient relationship
relative risk, 14–16, 165–66, 229
Republican Party, 90–91, 247
research companies, 95, 109–10.
See also
medical research; commercial research bias
resident doctors.
See
medical education
Response Oncology, 51
responsiveness, health system, 48
review articles, Celebrex and Vioxx, 25–27, 33, 37
Rezulin, 86–88
rheumatoid arthritis drugs.
See
Celebrex and Vioxx
risedronate, 214–15
risk, absolute vs. relative, 14–16, 165–66, 229
risk factors, 205–6
Rockefeller Foundation, 196–97
Rorer Foundation, 212
safety, 86, 160–61.
See also
side effects
sales reps, drug company, 124–26
Salk vaccine, 42, 241
salt, 238
samples, free drug, 124–26
Sandoz (Novartis), 109, 212
scans, MRI and CT, 44, 181–83
Schering AG, 89
Schering-Plough, 148, 152–53, 157
science, medical.
See
medical education; medical research
scientific evidence, spinning.
See
commercial research bias
screening, 49, 235
Scully, Thomas A., 247–48
sedentary lifestyle.
See
exercise
self-censorship, journal, 113
septic shock, 161–63
side effects
advertising and, 150–51
antidepressant drugs, 116–17
Celebrex, 32
Claritin, 153
coronary artery bypass surgery, 173
hormone replacement therapy, 69
Vioxx, 36
significance, statistical, 14, 26
sleep, depression and, 10–11
SmithKline Beecham, 163, 212
smoking
cancer and, 234–35
coronary heart disease and, 129, 201, 221, 222
diseases and, 49, 204, 237
heart attacks and, 100–101
strokes and, 20, 225
social anxiety disorder (SAD), 163, 232–34
specialty care, 82–85, 255–56
speech, commercial, 37–38, 157–59
spinal fusion surgery, 177–78
spinning of scientific evidence.
See
commercial research bias
standards of care.
See
clinical practice guidelines
statin drugs
biomedical model and, 201
cancer and, 145–46
commercial research bias and, 13–22
continuing education and, 119
coronary heart disease and, 221 (
see also
cholesterol guidelines of 2001)
C-reactive protein (CRP) test and, 164–66
diabetes and, 231
Medicare prescription drug bill and, 246
statistics
absolute risk vs. relative risk, 14–16, 165–66, 229
statistical significance, 14, 26
strokes, 225–28.
See also
coronary heart disease (CHD)
hormone replacement therapy and, 58, 70
statin drugs and, 13–22
Vioxx and, 26
studies.
See
commercial research bias; medical research
subjective experience, 206–8
sugar consumption, 236, 238
suicide, antidepressant therapy and, 116–17
supply-side medical care, 169–85
costs, 184–85
failure of, 254–56
heart attack care, 169–73
market pressures and, 174–78
medical services vulnerable to overuse, 178–80
more care vs. better care, 180–81
MRI and CT scans, 181–83
neonatal care, 173–74
terminal care, 183
surgical procedures, 43, 174–78
Tagamet, 43
tendonitis, 6–7
terminal care, 183
termination, premature study, 70, 104–5, 243–44
tests.
See
diagnostic tests
thought leaders, 119
tobacco.
See
smoking
total cholesterol, 18–20.
See also
cholesterol
training.
See
medical education
transparency, data, 27–28, 94, 105–6, 251–52.
See also
data
transplantation
bone marrow, 41, 51–52
organ, 43, 44
trazodone, 11
tricyclic antidepressants, 116
trust.
See also
doctor-patient relationship
medical journal articles and, 17, 93–94, 106, 112–13
myth of excellence and, 39–42, 50–53
tuberculosis, 49, 195
type 2 diabetes, 222, 228–31
ulcers, 9, 28, 29, 43
unbiased information, 167, 219
uninsured patients, xxi–xxii, 20, 46, 253–54.
See also
health insurance
United Kingdom, 174, 250
universal health insurance, xx–xxi, 20, 46, 253–54.
See also
health insurance
University of British Columbia Therapeutics Initiative, 167
university-based research, 94–95, 109, 196–97
United States.
See
government, U.S.; health care system, U.S.
unnecessary medical services, xix–xx, 52–53, 84, 178–81.
See also
supply-side medical care
unrepresentative study patients, 16–17, 33, 103–4, 206–8, 251
user fees, FDA, 85–86, 249
uterine cancer, 62, 70
VANQWISH study, 175
ventricular fibrillation, 98
verapamil, 104
VIGOR study, 26–27, 33–36.
See also
Celebrex and Vioxx
Vioxx.
See
Celebrex and Vioxx
Warner-Lambert, 87–88
Warning Letters, FDA
to Bristol-Myers Squibb, 227–28
decline in, 157–58
drug company responses, 244
to Eli Lilly, 217
to Merck, 36
to Pharmacia Corporation, 23–24, 32–33
web sites
commercially biased, 79, 218–19, 230–31
FDA reports and data, 28, 37
osteoporosis, 218–19
Public Citizen, 167
weight reduction.
See
diet
western diet, 234–35
Wilson, Dr. Robert, 60–62
women
coronary heart disease and, 139–43, 223
exercise and, 238–39
healthy life expectancy of, 47
hormone replacement therapy for (
see
hormone replacement therapy)
osteoporosis and, 210–20
strokes and, 16
World Health Organization (WHO), 45–48, 133, 211–12
worstpills.org web site, 167
WOSCOPS study, 136–37, 139, 201
Wyeth-Ayerst, 59, 63, 68
Xigris, 161–63
Zantac, 43, 246
Zocor, 133, 142
Zoloft, 116, 232–33
Zomax, 118
First and last
I thank Charlotte Kahn, who has been my inspiration, facilitator, and most fearless critic. She gave me the courage to explore the big issues and helped me focus my investigation, but most of all provided me with unfailing encouragement about the importance of this project.
Gail Winston, at HarperCollins, disproved almost everything I had been led to expect from a publisher. She coached me patiently throughout the process: from organizing themes to structuring chapters to crafting the language to preparing the final manuscript. Even more important, she was always enthusiastic and always believed in the value of telling this story fairly and completely. I quickly learned to trust Gail’s wise advice. Christine Walsh, also at HarperCollins, provided support and adroitly focused my attention on necessary details.
Kris Dahl, my agent, understood the importance of these issues immediately—even though this must have sounded like a wild story when we first met in March 2002—and has provided guidance since.
Delia Marshall skillfully, tirelessly, and compassionately labored with me to help organize the argument and improve the language. Her attention to detail and commitment to bringing forth the important points are greatly appreciated.
Besides showing me that well-researched, unflinching investigative writing can make a difference, Eric Schlosser provided friendly writer’s advice. He reassured me that the personal havoc that builds toward the end of a project is “normal.” And he suggested that I work with Ellis Levine, who would provide excellent legal advice and help me produce a better book. Ellis certainly did both. His attention to detail helped to ensure that I was telling this at times far-fetched-sounding tale fairly and accurately, and his literary sense helped me to tell the story better.
Bruce Spitz first introduced me to the pleasures and challenges of health policy research in 1981. We have been colleagues (intermittently) and friends (consistently) since, and I greatly appreciate the advice and guidance that he has provided over more than 20 years.
Many people have offered expert suggestions, and I am grateful for their efforts: Barbara Starfield, M.D., MPH; Elliott Fisher, M.D., MPH; Susan Love, M.D.; James Wright, M.D., Ph.D.; Marcia Angell, M.D.; Joe Vitale, M.D.; Arminee Kazanjian, Dr. Soc.; Richard Yospin; William Taylor, M.D.; Marty Farnsworth Richie; Paul Spirn, M.D.; Eve Leeman, M.D.; Stanley Sagov, M.D.; George Mann, Sc.D., M.D.; Larry Sasich, Pharm.D.; Richard Einhorn, M.D.; Professor Richard Lewontin; and Michael Klein, M.D. Herbert Benson, M.D., has provided sage advice and made many suggestions as these ideas have developed over the past five years. The inaccuracies that remain are my own.
Mike Curtis at the
Atlantic Monthly
read an early version of the chapter on Celebrex and Vioxx and confirmed its importance while at the same time gently suggesting that I be kinder to my readers. Melissa Ludke, from
Nieman Reports,
encouraged me to write about the press coverage of C-reactive protein.