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:

Dishonest Doctors

One of the critical questions to ask whenever reading a medical journal article is, “Who funded the study?” In most journals, researchers are required to identify their sources of funding, so what’s the problem? Well, researchers can obscure the true origin of financial support: They can hide it, disguise it, or even launder the money through a front group. A case in point is a study downplaying the risks of lung cancer that was funded in part by the Foundation for Lung Cancer: Early Detection, Prevention, and Treatment. That doesn’t sound so bad until you realize it was underwritten by millions of dollars from a tobacco company. There’s no obligation to “disclose a funding source’s source of funding,” which allows “companies to evade financial disclosure requirements” and makes it harder to “follow the money trail.”

As I discuss in my video Disclosing Conflicts of Interest in Medical Research, why does the funding source matter? Every single one of eight reviews covering over a thousand studies found that research funded by industry is more likely to make conclusions that are favorable to industry. For example, why do some review articles on the health effects of secondhand smoke reach different conclusions than others? The only factor found was whether an author was affiliated with the tobacco industry. “This is a disturbing finding. It suggests that, far from conflict of interest being unimportant in the objective and pure world of science…it is the main factor determining the result of studies.”

Not that we’d even know, because 77 percent of authors failed to disclose the sources of funding. And that’s another problem: The responsibility to disclose funding sources is left entirely up to the authors. So, how many researchers divulge the truth? Evidently, a law was passed in Denmark requiring physicians to register any time they worked with industry, which allowed researchers to cross-reference the studies physicians published to see how honest they were. Forty-eight percent of the time, the conflicts of interest were not disclosed, “reinforc[ing] the perception that physicians simply don’t take conflict of interest seriously” (or at least Danish physicians don’t).

What about the United States? Historically, there had been “no means of confirmation or verification” when an American doctor said they had no conflict of interest. Then in 2007, hip and knee replacement companies were forced to pay hundreds of millions of dollars in fines for giving orthopedic surgeons illegal kickbacks. “[M]any orthopedic surgeons in [the] country made decisions predicated on how much money they could make—choosing which device to implant by going to the highest bidder….[W]e expect doctors to make decisions based on what is in the best interests of their patients,” said the Department of Justice’s U.S. Attorney of the District of New Jersey, “not the best interests of their bank accounts.” Part of the settlement was that the companies would have to make public all the payments they made to physicians. The release of those records offered a rare opportunity to see if physicians were telling the truth on disclosure forms. And, lo and behold, more than half of payments were not disclosed, totalling millions of dollars.

That was for surgeons and medical device companies. What about doctors and drug companies? The same thing happened: Drug companies were forced to disclose who they were paying off. In looking at the publications of the doctors who got the most money—at least $100,000—the study found that they were worse than the surgeons. In 69 percent of the cases, they failed to disclose their industry ties. The problem is that we just assume researchers are going to be honest and tell the truth, but these “findings suggest that the accuracy and completeness of [conflict-of-interest] disclosures cannot be assumed.” So, even when a paper says no conflict of interest, who knows if it’s really true.

A long-time editor-in-chief of the New England Journal of Medicine wrote a scathing piece on drug companies and doctors who failed to disclose hundreds of thousands of dollars from drug companies like GlaxoSmithKline, which has been fined literally billions of dollars for activities such as bribing and suppressing data. When GSK got results that were “commercially unacceptable,” the company just buried them. Billions of dollars in fines get assessed, but for drug companies, that may just be the cost of doing business. “As reprehensible as many [drug] industry practices are…much of the medical profession is even more culpable.” We can expect drug companies to prioritize the bottom line, but maybe we should expect more from the healing profession.


What else might your doctor not be telling you? See:

Good examples of conflicts of interest include:

Instead of just disclosing conflicts of interest, how about getting rid of them? That’s the subject of my video Eliminating Conflicts of Interest in Medical Research.

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:

Meat Industry Response to Meat Being Labeled Carcinogenic

The most extensive report on diet and cancer in history is constantly being updated with all the new research. As I discuss in my video The Palatability of Cancer Prevention, in its update on colorectal cancer a few years ago, various meats were implicated, including processed meat as “a convincing cause of colorectal cancer,” which is its highest level of evidence that “effectively means ‘beyond reasonable doubt.’” More recently, processed meat was confirmed as a carcinogen by the World Health Organization. The main message was that “the best prevention of colorectal cancer is the combination of higher physical activity with a fibre-rich and meat products poor diet.” A decrease by half a turkey sandwich’s worth of meat might lower the total number of colorectal cancer cases by approximately 20 percent. There are several implications of this cancer guideline update, but a paper in the industry publication Meat Science decided “to focus on the consumer side of the story, since every consumer is a patient and vice-versa at some point in the future.” But chronic disease need not be invariably a consequence of aging.

“Although the epidemiological evidence for the relationship between colorectal cancer risk (at least!) and processed meats intake cannot be denied,” the Meat Science authors suggest further research. For example, compare the risk of consuming meat to other risky practices—alcohol, lack of physical activity, obesity, and smoking. Compared to lung cancer and smoking, maybe meat won’t look so bad!

Consumers, however, probably won’t even hear about the cancer prevention guidelines. “Consumers today are overloaded with information….It is thus probable that the dissemination of the [World Cancer Research Fund’s] update on colorectal cancer drowns in this information cloud.” And, even if consumers do see it, the meat industry doesn’t think they’ll much care.

For many consumers in the Western world, “the role of healthfulness, although important, is not close to taste satisfaction in shaping their final choice of meat and meat products…It is hence questionable that slightly revised recommendations based on the carcinogenic effects of meat consumption will yield substantial changes in consumer behavior.”

Doctors and nutrition professionals feed into this patronizing attitude that people don’t care enough about their health to change. A classic paper from The American Journal of Clinical Nutrition, a leading journal, scoffed at the idea that people would ever switch to a “prudent diet,” reducing their intakes of animal protein and fat no matter how much cancer was prevented. “The chances of reducing consumptions of fat, protein foods, or indeed of any food to a significant extent to avoid colon cancer are virtually nil.” Consider heart disease. We know we can prevent and treat heart disease with the same kind of diet, but the public won’t do it. “[T]he diet,” they said, “would lose too much of its palatability.”

“The great palatability of ham,” in other words, “largely outweighs other considerations…[although] health and wellbeing are increasingly important factors in consumer decisions.” A 1998 Meat Science article feared that “[u]nless meat eating becomes compatible…with eating that is healthy, wholesome, and safe, it will be consigned to a minor role in the diet in developed countries during the next decade.” That prediction didn’t quite pan out. Looking at a graph of total meat consumption per person over the last 30 years or so, intake rises and rises. In 1998, when that Meat Science article worrying about the next decade of meat consumption was published, we see intake rise even further. It does then seem to kind of flatten out before it starts falling off a cliff. Indeed, meat consumption dipped down about 10 percent  but has surged back up. Still, millions of Americans are cutting down on meat.

So don’t tell me people aren’t willing to change their diets. Nevertheless, we continue to get diluted guidelines and dietary recommendations, because authorities are asking themselves, “What dietary changes could become acceptable?” rather than just telling us what the best available science says and letting us make up our own minds about the cancer risk as we feed ourselves and our families.


How Much Cancer Does Lunch Meat Cause? Good question—watch the video!

Can simply cutting down on meat consumption extend our lifespan? Find out in Do Flexitarians Live Longer?. For my overview on cancer prevention, check out How Not to Die from Cancer.

I think the role of health authorities is to share with patients the pros and cons of all the options and let the patients, their families, and their doctors decide together what’s right for them. I’ve produced a number of videos on this issue, including:

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: