As I’ve often written on this blog, one of my motivations for leaving corporate medicine and starting my own boutique practice is the opportunity to work much more extensively with my patients on lifestyle and other “holistic” modes of care, rather than working in an environment where the time pressures and financial incentives are oriented towards treating every problem that comes my way with a pill. As I’ve also written, this is not because I think pills are always, and in all situations, bad, but rather because lifestyle is usually much more effective than pills for promoting health and longevity; because a healthy lifestyle has (unlike pills) no negative side effects; and because it gives me a more rounded set of tools with which to help my patients. But let me add another reason why it’s best to avoid pills when reasonably possible: medicine is a big business, and like all big business, sometimes prone to corruption.
I want to stress that most people involved in medicine are honest folks who are trying to do the right thing. The average doctor, nurse, or research scientist – even when they may be wrong – is working from a place of good intentions. But we have countless examples in our history of scandalous corner cutting at businesses all throughout the economy, from car manufacturers (Toyota, Ford, and Volkswagen, to name a few famous scandals), to airplane manufacturers (hello Boeing), to energy companies (remember Enron?) It would be naive to think that the corporations that make up our healthcare system are immune from the same pressures and temptations.
Here are just a few well known examples of this:
A few years ago it was revealed that, during the 1960s, the sugar industry paid several Harvard doctors to publish research that absolved sugar of helping to cause heart disease, and instead pointed the finger at fat and cholesterol. To be clear, there is plenty of controversy about whether fat and cholesterol are in fact causal of heart disease, and it may still be the case that these nutrients do play a role. What’s not controversial to anybody who is paying attention is that sugar is indeed very bad for human health, and probably a much bigger risk for heart disease than fat. However, thanks in part to this bribe on the part of the sugar industry, that didn’t become widely appreciated until decades later, and to this day many of my patients who came of age during the 1970s, 80s, and 90s, (when the anti-fat message was it its peak) worry inordinately about the fat in their diet and their cholesterol levels while remaining concerningly unaware of just how much sugar they are ingesting.
In 1999, a seemingly revolutionary new drug was released to the US market. Tamiflu promised to treat the flu virus, shortening the duration of its course and reducing the risk for severe complications that can lead to hospitalization or, more rarely, death. It became an instant blockbuster. But a 2014 review found that the company that makes Tamiflu fudged much of the preliminary research that led to the drug’s approval, and that in fact Tamiflu has almost no effect on the flu at all. The scientific consensus is that Tamiflu should only be used sparingly, in elder adults with multiple chronic health problems (that is to say, the ones who are most at risk for severe complications of the flu), as the benefits of it are so negligible as to be virtually non-existent for all other groups of patients. But old habits die hard, and patients still routinely ask for this medication every winter, and several million prescriptions are still written for it in the United States each year.
Not strictly in the realm of medicine, but a few years ago it was revealed that Monsanto paid off scientists to do research suggesting that glyphosate, the main chemical in their popular herbicide “Roundup”, is safe for humans. In fact, it almost certainly isn’t, and much research is now implicating this chemical in, amongst other problems, human obesity. (The theory being that Americans are constantly ingesting tiny amounts of glyphosate because most commercial crops, including grains, are sprayed with it, and that this cumulative ingestion builds up in human tissue and disrupts endocrine signaling pathways that would otherwise help people to maintain a normal body weight).
As Joseph Heller wrote in his wonderfully satirical novel Catch-22: “just because you’re paranoid doesn’t mean they aren’t after you.”
What to do with all of this? Throw out all of modern science? No, of course not. Nor do I think we should shun modern medication in all situations. Not all data is corrupt, and just because something is brought into the world via the profit motive doesn’t mean that it isn’t a good product.
But it doesn’t hurt to be a bit skeptical of anything big pharma is peddling, and where possible, to avail ourselves of less chemical solutions to our health problems.
