Increasingly I am noticing pharmaceutical influence on medical attitudes. The book Overdosed America by Dr. John Abramson exposes the tactics employed by drug companies to fund strategic trials, optimize outcomes, suppress unfavorable data, and market new medications to patients and physicians alike. Dr. Abramson’s newer book called Sickening is waiting on my night stand. Yes, pharmaceutical innovation has transformed healthcare when we think about antibiotics, the COVID vaccine, and others. But chronic disease meds have gotten out of hand. We should not be surprised that their efficacy and safety is routinely overstated. Just like doctors have an obligation to our patients, drug companies have an obligation to their share holders. The problem is that manufacturer fanaticism about the newest drug trickles down to prescribers. The tactics, elegant as they are disturbing, could fill another post.
In the hospital, there is ongoing excitement around a class of drugs called SGLT2 inhibitors. These block reabsorption of glucose in the kidneys so that you pee out more sugar. They are approved by the FDA not only for diabetes, but for congestive heart failure and chronic kidney disease. Trials like EMPA-REG, EMPOROR, CANVAS, and CREDENCE demonstrated advantages of SGLT2 inhibitors compared to placebos. The catch? These trials are funded, designed, conducted, and promoted by the manufacturers of the drug in question. With billions of dollars on the line, do we think they are always objective? Doesn’t matter, you might say, since there are checks and balances downstream. Unfortunately, journal editors and medical associations are barred access to primary trial data, which is declared proprietary in advance by the drug company. Instead these trusted journals and medical associations receive manufacturer-approved data to make their secondary analysis. The information that becomes medical knowledge is contaminated at its source. And there have been countless scandals in which unsafe drugs are recalled and the manufacturer is found to have suppressed relevant drug complications.
Our pharmaceutical model is a disservice not least for drawing the conversation away from lifestyle medicine. Notice how drug trials don’t include groups of patients who reduce red meat, or go for walks. Based on vast observational and mounting experimental data, simple lifestyle changes likely outperform the most celebrated chronic disease medications.
For fun, I ran a word count for sections of the CREDENCE trial, which is widely cited in support of an SGLT2 inhibitor. The conflict of interest section is longer than the discussion itself.
herbivores.life 