I’ve been reading up on the pharmaceutical industry. First a series of books and now some review articles and literature. As I’ve had more contact with the medical profession, I’ve become more interested it’s inner workings. And for the most part, they are pretty shameful. I’m not speaking here about the everyday practice of medicine, but instead many of our own colleagues in medical schools. The basic story is one of a tight coupling of medical school research and pharmaceutical companies (both schools and researchers have direct financial interests in the products they evaluate). This isn’t a new story; what I find surprising about it is its depth. Marcia Angell has done a good job chronicling it in the NY Review of Books – here, on the pricing, practice and effectiveness of pharmaceuticals, and here, on the ties ties between doctors and companies, a story Angell calls “corruption.” There are two things I find interesting in the latter article (and the pharmaceutical industry in general): first, that modern drugs are much like “cure-all” tonics of days gone by. They get approved by the FDA for one thing, and then they employ a kind of shot-gun method to see if they can get a single study to show it could be used for others – suppressing countervailing evidence in the process.
[It reminds me of this Simpsons episode, which I keep trying to embed, but for some reason it fails every time on wordpress. You can find the video here. I want to embed it because I’m sick of seeing the picture of my last post. For those of you who are also sick of it, I apologize.]
The second interesting thing is that the differences between Prozac, Paxil, Zoloft, Celexa, Serzone, and Effexor and a placebo are so small as to be unlikely to be of clinical significance. This research on, “The Emporers New Drugs” I found quite surprising (see an abbridged version here, the full PDF here). I have gotten particularly worked up about this when I speak to my friends who became physicians, or my father’s colleagues (he was a physician) who are involved in these trials – in part because of the near relentless smugness with which I am needled about the “scientific merit” of my own discipline. Perhaps not a surprise some readers, I haven’t handled this particularly well. At one point I presented views of the psychiatric profession that would have made any scientologist proud. I’m having dinner with several more of these folks tomorrow evening. I hope they don’t poke fun at sociology. I might lose it. They, no doubt, will leave thinking, “that guy could really use X drug.” X being that drug which pays for the most free “conferences” they attend in Hawaii.