It is simply no longer possible to believe much of the clinical research that is published, or to rely on the judgment of trusted physicians or authoritative medical guidelines. I take no pleasure in this conclusion, which I reached slowly and reluctantly over my two decades as an editor of The New England Journal of Medicine.
Over the past two decades the pharmaceutical industry has moved very far from its original high purpose of discovering and producing useful new drugs. Now primarily a marketing machine to sell drugs of dubious benefit, this industry uses its wealth and power to co-opt every institution that might stand in its way, including the US Congress, the FDA, academic medical centers, and the medical profession itself.
A review of seventy-four clinical trials of antidepressants, for example, found that thirty-seven of thirty-eight positive studies [that praised the drugs] were published. But of the thirty-six negative studies, thirty-three were either not published or published in a form that conveyed a positive outcome.
It is time for the scientific community to stop giving alternative medicine a free ride There cannot be two kinds of medicine — conventional and alternative. There is only medicine that has been adequately tested and medicine that has not, medicine that works and medicine that may or may not work. Once a treatment has been tested rigorously, it no longer matters whether it was considered alternative at the outset. If it is found to be reasonably safe and effective, it will be accepted.
Consider the clinicaltrials by which drugs are tested in human subjects.5 Before a new drug can enter the market, its manufacturer must sponsor clinicaltrials to show the Food and Drug Administration that the drug is safe and effective, usually as compared with a placebo or dummy pill. The results of all the trials (there may be many) are submitted to the FDA, and if one or two trials are positive—that is, they show effectiveness without serious risk—the drug is usually approved, even if all the other trials are negative.
In economic terms, health care is a highly successful industry - profitable, growing, and virtually recession-proof - but it's a massive burden on the rest of the economy.
Drug companies say they need to charge ever-higher prices to cover their research costs, but they spend far less on research and development than they do on marketing and administration, and afterwards they actually keep more in profits.
The pharmaceutical industry likes to depict itself as a research-based industry, as the source of innovative drugs. Nothing could be further from the truth. This is their incredible PR and their nerve.
The United States is the only advanced country that permits the pharmaceutical industry to charge exactly what the market will bear, whatever it wants.
The use of psychoactive drugs - including both antidepressants and antipsychotics - has exploded...[yet] 'the tally of those who are disabled...increased nearly two and a half times.
Few things a doctor does are more important than relieving pain. . . pain is soul destroying. No patient should have to endure intense pain unnecessarily. The quality of mercy is essential to the practice of medicine; here, of all places, it should not be strained.
The pharmaceutical industry isn't the only place where there's waste and inefficiency and profiteering. That happens in much of the rest of the health care industry.
Why should anyone - the state, the medical profession, or anyone else - presume to tell someone else how much suffering they must endure as their life is ending?
Pharmaceutical companies have too much influence over the education of physicians in this country. They have too much control over the evaluation of their own products, and that's a conflict of interest. I think the industry needs to be regulated, but I've never suggested taking it out of the market altogether.
There is something so biologically implausible that your attitude is going to cure a disease. Theres a tremendous arrogance to imagine that your mind is all that powerful.
Alternative medicine plays into this exaggerated notion that you can prevent disease simply by doing the right thing.
You see that the people who are drawn to alternative medicine are often fairly healthy and they go to alternative medicine for what I call the 'symptoms of life.' Fatigue, joint pains, inability to concentrate, perhaps, the kinds of things that anyone over twenty-five gets at some point.
I do think that we are an overmedicated society.
Illness and death are not optional. Patients have a right to determine how they approach them.
Brand-name drugs have no competition, since the government grants them very long, exclusive marketing rights.
Probably most dying patients, even when suffering greatly, would choose to live as long as possible. That courage and grace should be protected and honored, and we should put every effort into treating their symptoms.
We should be willing to spend the money in return for the innovation.
Health care is a need; it's not a commodity, and it should be distributed according to need. If you're very sick, you should have a lot of it. If you're not sick, you shouldn't have a lot of it.
Liberals are wrong to think that opposition to health reform is a rejection of big government. If health reform consisted of extending Medicare to everyone, people would be delighted. There are millions of 64-year-olds out there who can hardly wait to be 65.
