Why Doctors are So Drug Happy

Who funds most of the studies that show drugs are safe and effective? The drug companies themselves. This is the topic of my video Eliminating Conflicts of Interest in Medical Research.

“It is self-evidently absurd to look to investor-owned companies for unbiased evaluations of their own products…One result of the bias in this literature is that physicians learn to practice a very drug-intensive style of medicine. Even when lifestyle changes would be more effective, physicians and their patients often believe that for every ailment there is a drug.” It’s gotten so bad that “[p]hysicians can no longer rely on the medical literature for valid and reliable information.” That’s quite an accusation. Says who? Says a long-time editor of the New England Journal of Medicine, one of the most prestigious medical journals in the world.

To help expose some of the conflicts of interest corrupting the medical profession, the Drug Company Gift Disclosure Act was introduced in Congress where it died year after year until it was successfully integrated into the Affordable Care Act. Now, there’s a database detailing which doctors get the billions of dollars that are dished out, “permit[ting] patients to make better informed decisions when choosing health care professionals and making treatment decisions.” (I explain how you can easily look up your own doctor in my video Find Out If Your Doctor Takes Drug Company Money.)

In 2008, medical groups endorsed a version of the Act that didn’t require public disclosure unless doctors got at least $500 in gifts, but the 2009 version got stricter, requiring disclosure if you pocketed even $100, leading groups like the American Academy of Family Physicians to start to get a bit nervous. The final wording in Obamacare, however, requires disclosure of even a $10 meal, leading countries around the world to look to the United States for leadership in healthcare ethics. You don’t see that every day!

Now that we have this massive public record, we can really see how honest doctors have been. The financial disclosures by the authors of all the American College of Cardiology and American Heart Association guidelines were matched to the public disclosures of the hundreds of thousands of dollars they received from Big Pharma. The result? “The overall agreement between author and company disclosure was poor.” Nationally, female physicians each received thousands of dollars less than male doctors on average from drug companies each year, though it’s not clear if this is because the women were more ethical or the industry was sexist.

What about conflicts of interest for online clinical support websites? “Point-of-care evidence-based medicine websites allow physicians to answer clinical queries using recent evidence at the bedside” of a patient. Clinicians caring for patients are increasingly reviewing treatment recommendations on these sites to make clinical decisions in real time. For instance, if you’re with a patient, you can just whip out your phone and check one. It’s important that “[m]embers of groups developing formal clinical guidelines are discouraged from interacting with the health industry in a manner that may create a conflict of interest.” Researchers examined one such website called UpToDate, which seemed to provide the most comprehensive diagnoses. Did they find any conflicts of interest? Yes, in every single UpToDate article they examined.

So what do we do with this information? Let’s say we see an article claiming that candy consumption is not associated with health risks and the authors disclose that their research was supported by the National Confectioners Association, a group that used to run ads that said things like: “Put candy in their school lunch. It’s good for them.” We may want to take the results of that article with a grain of salt.

“The problem with financial COIs [conflicts of interest] is that you simply don’t know what to believe.” Maybe this “preoccupation with disclosure hijacked the debate…” Maybe, as Dr. Kassirer, the former chief editor of the New England Journal of Medicine, critiqued, the focus instead should be on eliminating commercial conflicts, not just disclosing them. It’s like campaign finance reform, where the issue is managed more by public disclosure rather than getting money out of politics. Indeed, he writes that “the vast attention paid to failure to disclose conflicts of interest is misplaced, and that more attention must be focused on the financial conflicts themselves.”

After Dr. Kassirer effectively resigned from the New England Journal of Medicine, disillusioned with the direction they were taking, Dr. Marcia Angell took over. She was the first female chief editor in the journal’s hundred-year history and lasted about a year. Medical journals “consistently refer to ‘potential’ conflicts of interest,” she wrote, “as though that were different from the real thing, and about disclosing and ‘managing’ them, not about prohibiting them. In short, there seems to be a desire to eliminate the smell of corruption, while keeping the money. Breaking the dependence of the medical profession on the pharmaceutical industry will take more than appointing committees and other gestures. It will take a sharp break from an extremely lucrative pattern of behavior.”


Why do funding sources matter? See my video Disclosing Conflicts of Interest in Medical Research.

The shameful practices of supposed science-based medicine websites, like UpToDate, are the very reason I started NutritionFacts.org in order to share the best available evidence without corrupting commercial influence. If you value my work, please consider becoming a supporter by making a recurring monthly donation to the 501c3 nonprofit that keeps NutritionFacts.org growing and thriving.

In health,
Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live, year-in-review presentations:

The Disconnect Between Science and Policy

Back in 1912, when hardly anyone smoked cigarettes, lung cancer was like a museum curiosity: extremely rare. In the next few decades, however, it rose dramatically around the world, roughly fifteen-fold. But researchers had already nailed it way back then. By mid-century, the evidence linking lung cancer and tobacco was considered overwhelming. Says who? Says the tobacco industry’s own research scientists in an internal memo. We now know that “senior scientists and executives within the cigarette industry knew about the cancer risks of smoking at least as early as the 1940s.”

Publically, though, they said things like, “Sure there are statistics associating lung cancer and cigarettes. There are statistics associating lung cancer with divorce, and even with lack of sleep. But no scientist has produced clinical or biological proof that cigarettes cause the diseases they are accused of causing.”

What was the government saying? My video American Medical Association Complicity with Big Tobacco includes several real cigarette advertisements, including one in which a leading U.S. Senator advises readers to smoke Lucky Strikes. Who wouldn’t want to “give [their] throat a vacation,” as another ad proclaimed? Others assured “not one single case of throat irritation,” and how could your throat and nose be adversely affected when cigarettes “are just as pure as the water you drink”? What if you do feel irritation from smoking? No problem—your doctor can write you a prescription for cigarettes, according to an ad from the Journal of the American Medical Association. After all, “don’t smoke” is advice hard for patients to swallow, as we’re told in another ad.

This reminds me of the recent survey of doctors that found the number-one reason doctors don’t prescribe heart-healthy diets was their perception that patients fear being deprived of all the junk they’re eating. After all, Philip Morris reminded doctors in an ad that we want to keep our patients happy and to “make a radical change in habit…may do harm.”

The tobacco industry gave medical journals big bucks to run ads like the ones I’m sharing with you. Should we be concerned about a conflict of interest? Not if we listen to Philip Morris, who assured us their “claims come from completely reliable sources” based on studies conducted by “recognized authorities…whose findings have been published in leading medical journals.” They even kindly offered to send free packs of cigarettes to doctors so they can test them out themselves and invited physicians to “make the doctors’ [smoking] lounge your club” at the American Medical Association convention.

What did the AMA have to say for itself? Like most other medical journals, they accepted tobacco ads but asserted that “[p]ostmortem examinations do not reveal lesions in any number of cases that could be definitely traced to the smoking of cigarettes.” So, as far as the AMA was concerned, case closed.

In fact, even after the Surgeon General’s Report on Smoking and Health came out, the American Medical Association, American Cancer Society, and Congress continued to drag their feet. The government was still subsidizing tobacco, just as our tax dollars subsidize the sugar and meat industries today. The AMA actually went on record refusing to endorse the Surgeon General’s report. Could that have been because they had just been handed ten million dollars from the tobacco industry?

Today the money is coming from big food. The American Academy of Family Physicians has accepted large sums of money from Coca-Cola “to fund patient education on obesity prevention.” I wonder what that pamphlet will say.

Who was featured as a top partner on Coca Cola’s website? The American College of Cardiology.

Just as it would have been hazardous to your health to take the medical profession’s advice on your smoking habits in the 1950s, it may be hazardous to your health today to take the medical profession’s advice on your eating habits.


If the balance of scientific evidence favors plant-based eating, why isn’t the medical profession at the forefront of encouraging people to eat healthier? That’s the question this video tries to answer. Looking back to smoking in the 1950s, we can see how all of society, the government, and even the medical profession itself could be in favor of habits that decades of science had already overwhelmingly condemned as harmful.

For more on the influence industry can have on food policy, see:

In health,
Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live, year-in-review presentations:

What to Eat to Cure High Blood Pressure

High blood pressure ranks as the number-one risk factor for death and disability in the world. In my video, How to Prevent High Blood Pressure with Diet, I showed how a plant-based diet may prevent high blood pressure. But what do we do if we already have it? That’s the topic of How to Treat High Blood Pressure with Diet

The American Heart Association (AHA), the American College of Cardiology (ACC, and the Centers for Disease Control and Prevention (CDC) recommend lifestyle modification as the first-line treatment. If that doesn’t work, patients may be prescribed a thiazide diuretic (commonly known as a water pill) before getting even more meds until their blood pressure is forced down. Commonly, people will end up on three drugs, though researchers are experimenting with four at a time. Some patients even end up on five different meds.

What’s wrong with skipping the lifestyle modification step and jumping straight to the drugs? Because drugs don’t treat the underlying cause of high blood pressure yet can cause side effects. Less than half of patients stick with even the first-line drugs, perhaps due to such adverse effects as erectile dysfunction, fatigue, and muscle cramps.

What are the recommended lifestyle changes? The AHA, ACC, and CDC recommend controlling one’s weight, salt, and alcohol intake, engaging in regular exercise, and adopting a DASH eating plan.

The DASH diet has been described as a lactovegetarian diet, but it’s not. It emphasizes fruits, vegetables, and low-fat dairy, but only a reduction in meat consumption. Why not even more plant-based? We’ve known for decades that animal products are significantly associated with blood pressure. In fact, if we take vegetarians and give them meat (and pay them enough to eat it!), we can watch their blood pressures go right up.

I’ve talked about the benefits to getting blood pressure down as low as 110 over 70. But who can get that low? Populations centering their diets around whole plant foods. Rural Chinese have been recorded with blood pressures averaging around 110 over 70 their whole lives. They eat plant-based day-to-day, with meat only eaten on special occasions.

How do we know it’s the plant-based nature of their diets that was so protective, though?

Because in the Western world, as the American Heart Association has pointed out, the only folks getting down that low on average were those eating strictly plant-based diets, coming in at about 110 over 65.

So were the creators of the DASH diet just not aware of this landmark research done by Harvard’s Frank Sacks? No, they were aware. The Chair of the Design Committee that came up with the DASH diet was Dr. Sacks himself. In fact, the DASH diet was explicitly designed with the number-one goal of capturing the blood pressure-lowering benefits of a vegetarian diet, yet including enough animal products to make it “palatable” to the general public.

You can see what they were thinking. Just like drugs never work—unless you actually take them. Diets never work—unless you actually eat them. So what’s the point of telling people to eat strictly plant-based if few people will do it? So by soft-peddling the truth and coming up with some kind of compromise diet, the on a population scale maybe you’d do more. Ok, but tell that to the thousand U.S. families a day that lose a loved one to high blood pressure. Maybe it’s time to start telling the American public the truth.

Sacks himself found that the more dairy the lactovegetarians ate, the higher their blood pressures. But they had to make the diet acceptable. Research has since shown that it’s the added plant foods—not the changes in oil, sweets, or dairy—that appears to the critical component of the DASH diet. So why not eat a diet composed entirely of plant foods?

A recent meta-analysis showed vegetarian diets are good, but strictly plant-based diets may be better. In general, vegetarian diets provide protection against cardiovascular diseases, some cancers, and even death. But completely plant-based diets seem to offer additional protection against obesity, hypertension, type-2 diabetes, and heart disease mortality. Based on a study of more than 89,000 people, those eating meat-free diets appear to cut their risk of high blood pressure in half. But those eating meat-free, egg-free, and dairy-free may have 75% lower risk.

What if we’re already eating a whole food, plant-based diet, no processed foods, no table salt, yet still not hitting 110 over 70? Here are some foods recently found to offer additional protection: Just a few tablespoons of ground flaxseeds a day was 2 to 3 times more potent than instituting an aerobic endurance exercise program and induced one of the most powerful, antihypertensive effects ever achieved by a diet-related intervention. Watermelon also appears to be extraordinary, but you’d have to eat around 2 pounds a day. Sounds like my kind of medicine, but it’s hard to get year-round (at least in my neck of the woods). Red wine may help, but only if the alcohol has been taken out. Raw vegetables or cooked? The answer is both, though raw may work better. Beans, split peas, chickpeas, and lentils may also help a bit.

Kiwifruits don’t seem to work at all, even though the study was funded by a kiwifruit company. Maybe they should have taken direction from the California Raisin Marketing Board, which came out with a study showing raisins can reduce blood pressure, but only, apparently, compared to fudge cookies, Cheez-Its, and Chips Ahoy.


The DASH diet is one of the best studied, and it consistently ranks as US News & World Report’s #1 diet. It’s one of the few diets that medical students are taught about in medical school. I was so fascinated to learn of its origins as a compromise between practicality and efficacy.

I’ve talked about the patronizing attitude many doctors have that patients can’t handle the truth in:

What would hearing the truth from your physician sound like? See Fully Consensual Heart Disease Treatment and The Actual Benefit of Diet vs. Drugs.

For more on what plants can do for high blood pressure, see:

In health,

Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live, year-in-review presentations: