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  • He Who Pays The Piper Calls The Tune by Malcolm Kendrick, MD

    Posted by .(JavaScript must be enabled to view this email address)
    Thursday, January 14, 2010 1:57 pm Email this article
    And what song do we expect the pharmaceutical company wishes to hear sung by international medical opinion leaders? In general it goes like this ‘Use more of the new expensive drugs. For they will make you well.’ To the tune of Amazing Grace.

    How much money does it take to get an international opinion leader to sing for their supper? That depends. In the case of Dr Bryan Brewer, a leader at the National Institutes of Health, it took $57,000/year.

    ‘Brewer, as a leader at the NIH was part of a team that gave the nation new cholesterol guidelines that were expected to prompt millions more people to take the daily pill. He also has written favourably of a specific brand of cholesterol medication, Crestor, which recently proved controversial.

    What doctors were not told for years is this. While making recommendations in the name of the NIH, Brewer was working for the companies that sell the drugs. Government and company records show that from 2001 to 2003, he accepted about $114,000 in consulting fees from four companies making or developing cholesterol medications, including $31,000 from the maker of Crestor (AstraZeneca)’

    -- Los Angeles Times, Jan 11, 2005

    (This article was written by Malcolm Kendrick, MD, author of the wonderful, eye-opening, paradigm-shifting book The Great Cholesterol Con: The Truth About What Really Causes Heart Disease and How to Avoid It .) NIH Researcher Takes $508K from Drug Company

    Dr P.Trey Sunderland III takes $508K from drug company and endorses their drug

    However, this is relative peanuts compared to Dr P.Trey Sunderland III, a senior psychiatric researcher at the NIH. He took $508,500 in fees from Pfizer Inc. whilst collaborating with them, and endorsing their drug.


    Medical Opinion Leaders Paid By Drug Companies

    All medical opinion leaders are paid large sums of money by drug companies

    But these two are not, in any way, unique. Medical opinion leaders, those who put their names to the research and claim to write the clinical papers (you don’t believe they actually write clinical papers do you? – how touchingly naive) are all paid very large sums of money by the pharmaceutical industry.

    Quite how much they get paid is somewhat difficult to ascertain. The exact amounts will remain a well-guarded secret between the opinion leader and their accountant. But I have been involved in doling out such payments, and the amounts soon add-up.


    Medical Opinion Leaders Can Make Tens of Thousands for Airfare to Meetings

    Medical opinion leaders may collect airfare from multiple drug companies

    One of the best scams is that an opinion leader will be invited to talk, or present, at a major medical meeting. There are certain individuals who travel and talk all over the world. They will then be invited by another company to talk at the same meeting. Then another company, then another. A conversation ensues which goes something like this:

    Opinion leader (having already had five other invitations): ‘I like to book my own travel, so just send me the money for an air-fare, first class, eight thousand dollars. Thank you.’ (The ‘Thank you’ is optional, and rarely used).

    Do the maths. If one company is already flying an opinion leader to a meeting, and he Hoovers up five sets of air-fares from other companies, he – for it is almost always a he - can make forty thousand dollars in air-fares before the meeting even starts.

    To be fair to the pharmaceutical companies, they can, and do, become somewhat enraged by such behaviour. But they are usually so terrified of upsetting a big cheese, who may then walk over to another company, that they just pay up anyway.


    Medical Opinion Leaders May Chair Two Meetings At the Same Time

    Medical opinion leaders may collect make as much as $100K during a 5-day meeting

    What really makes pharmaceutical companies mad is when an opinion leader agrees to chair two meetings – at the same time. I have been to a meeting when the chairman walked out, went across the corridor, and introduced a meeting – for another company – before returning. Then spent three hours dotting between the two meetings. An impressive display of juggling no doubt, but I don’t think the companies involved were terribly impressed.

    What’s the going rate for such activities? The figures vary. Cardiology seems to be the biggest payer, and the highest fee I have heard of was $20,000 to chair a two hour meeting. You must remember that this is $20,000 plus air fares, accommodation, drinks, meals, entertainment etc. and this individual would also have been taking part in advisory boards, presenting at other symposia etc. It is not impossible for a top level opinion leader to make $100,000 during a five day meeting.

    Fair enough, these are hugely hard working, highly intelligent individuals at the top of their profession. What they are paid is peanuts relative to a CEO of a major company. Why shouldn’t they demand, and get, huge fees?


    These Medical Opinion Leaders Advise the NIH and FDA

    Medical opinion leaders who collect these fees make recommendations on drugs to NIH and FDA

    No reason, except that these are the people who advise the NIH and the FDA. They also write the guidelines which set the standards for more humble doctors to follow. They, basically, decide which drugs are good and bad, and what treatment should be followed. In the end, what they say flows down and defines the drugs that your doctor will prescribe to you. We hope, and expect, that such advice will be untainted by commercial considerations. Some hope.


    Panel Who Wrote Cholesterol Guidelines Paid by Drug Industry

    The panel who wrote the National Cholesterol Education Panel (NCEP) guidelines had financial ties to the drug companies

    When the latest National Cholesterol Education Panel (NCEP) guidelines were unveiled, none of the panel members disclosed any affiliation to the pharmaceutical industry. I was part of a group (the centre for science in the public interest CSPI) who wrote to the National Heart Lung and Blood Institute (NHLBI) – the group under which the NCEP operates. (NHLBI is part of the National Institutes for Health). We had a number of objections, but number one was that no financial disclosures had been made.

    Surprise, surprise, it turned out that every single member of the NCEP panel had close association with statin manufacturers, and had been paid varying – huge – sums of money by them. We thought you knew, bleated Dr. Barbara Alving for the NHLBI.

    In addition, as Dr. Alving wrote in response. ‘Individuals who are most expert in a subject area are the ones most suitable to serve on a guideline panel for assessing the science and developing clinical recommendations. They are also often the very people whose advice is sought by industry.’


    People Critical of the Cholesterol Hypothesis NOT Asked to Participate in NCEP Guidelines

    No one who opposes the cholesterol hypothesis was included in creating the National Cholesterol Education Panel (NCEP) guidelines

    True, Dr Alving, but there are people out there - for e.g. Uffe Ravnskov – to pluck a name from the air - who has written a book, and hundreds of articles, critical of the idea that lowering cholesterol with statins is a good thing. He is an expert in this area – even if his views make him somewhat of a scientific pariah. Was he asked to take part in the creation of guidelines to bring some much needed balance to the discussions?


    Only Statin Supporters Chosen for NCEP Guidelines

    Only people who support the use of statins were chosen to participate in creating the National Cholesterol Education Panel (NCEP) guidelines

    No, the only people chosen were the people who were absolutely and completely in favour of prescribing statins, and who were all being paid vast sums of money by statin manufacturers. The reality is that anyone who dares to criticise the established dogma will never be invited, never, ever. There are no critical voices, no discussion of the central issues. In this way dissent is, effectively crushed. And this is true of all therapy areas.


    Medical Opinion Leaders Supported by Drug Companies

    Opinion leaders are supported by the drug industry, thus they are all pro-industry and pro-drug

    Currently the situation is thus:

    It is almost impossible to become an ‘opinion leader’ unless you do the clinical trials paid for by the pharmaceutical industry. These are the biggest, highest profile studies, and the results are presented at major medical meetings, and published in the high profile medical journals.

    Ergo, opinion leaders are almost all supported and promoted by the industry. From the very start, they are a self-selected group. Pro-industry, pro-drug use. Usually, pro-specific drug.


    Medical Opinion Leaders Decide On Medical Treatment For Everybody

    Opinion leaders who supported by the drug industry are invited onto committees that decide medical treatment for all

    These people write the editorials and speak to the press and take part in discussion and symposia and presentations. They are then invited onto prestigious committees that decide on the medical treatment for all of us.


    Medical Opinion Leaders Don’t Realize They Are Bias

    Opinion leaders paid by drug companies should be kept away from making recommendations

    I am sure that they don’t think they are biased at all. But they come with built-in bias. In my opinion, they should be kept a million miles away from any decisions on guidelines, but because there are no other ‘experts’ out there, they are always and inevitably chosen - ‘Who else is there?’ And because of this we end up with madness. I shall leave you with an example of such madness.


    Norway, One of the Healthiest Countries

    However, guidelines say that 90% of Norwegian men 49 and older should take drugs for the rest of their lives!

    A group of doctors in Norway decided to review the 2003 European guidelines on blood pressure and cholesterol lowering. Norway, as you may or may not know, is one of the healthiest countries in the World, with one of the longest life expectancies. It was also rated as having the highest quality of life in the World. People in Norway are extremely healthy and pretty wealthy. The rate of death from heart disease has also fallen dramatically over the last thirty years or so.

    Here is a country, surely, that should be reasonably content with their overall health.

    Not so, not so at all. According to the guidelines, by the age of twenty-four, 50% of Norwegian men had a blood pressure, or cholesterol level requiring drug treatment. By the age of forty-nine, this had risen to 90%. (Getz L et al. Scand J Prim Care, 2004.)


    Medical Madness

    This is medical madness traced back to experts who have been paid by the drug companies

    Ninety per cent of Norwegian men aged forty-nine need to take drugs for the rest of their lives! If this isn’t medical madness, then I cannot imagine what is. And it is a guideline based madness that can be directly traced back to a group of ‘highly objective’ experts who have all been paid extremely large sums of money by pharmaceutical companies who make blood pressure and cholesterol lowering drugs.


    How is This Allowed?

    Medicine seems to be the only area where paid experts are allowed to set standards

    I cannot for the life of me think of any other area of human enterprise whereby someone who is paid enormous sums of money by a commercial organisation would be allowed to set the standards in which those commercial organisations operate. Let alone an area of such importance. The closest analogy I can think of would be a judge, who had been paid a million dollars by Microsoft, being asked to sit to preside over an anti-trust suit against Microsoft. (I thought of writing Mafia instead of Microsoft, but lost the nerve).


    Would a Judge Be Allowed to Judge A Case In Which He Had Been Paid?

    Would a judge be allowed to judge a case where he had been paid by one of the parties? No, never.

    No judge would ever be allowed to pass judgement over an organisation that had just paid him several hundred thousand dollars, with more to come – assuming the ‘correct’ verdict was reached. It would never, ever, be allowed. (Yes I know it probably happens, but you are supposed to try and keep quiet about it, otherwise you end up in jail).


    This Should Be Illegal

    It should be illegal for people paid by the drug industry to set national guidelines

    Yet in medicine this happens all day, every day. It’s utterly flagrant, and no-one even bothers to try and hide it. In my opinion, it is a complete and total and absolute scandal. It is corrupt, and it should be illegal… I am not holding my breath for any action any time soon.



    Article Previous Published on THINCS.org

    This article was previously published on THINCS.org

    This article was previously published on THINCS.org (The International Network of Cholesterol Skeptics).

    I republished the article here with Dr. Kendrick’s permission.


    Malcolm Kendrick’s Contact Info

    Malcolm Kendrick’s Email Address—.(JavaScript must be enabled to view this email address)

    Dr. Malcolm Kendrick can be reached at .(JavaScript must be enabled to view this email address).

    Malcolm Kendrick, MD is the author of the wonderful, eye-opening, paradigm-shifting book book The Great Cholesterol Con: The Truth About What Really Causes Heart Disease and How to Avoid It .)


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