Overdosed America

FOX 25 Morning News

2011-06-02T08:38:00.000-07:00

CNN Interview

2011-06-02T07:17:00.000-07:00

Dr. Oz 4 Things Drug Companies Don’t Want You To Know | Secrets Drug Companies Are Hiding

2011-06-02T06:26:00.000-07:00

Doctor Oz Pharmaceutical Companies Exposed; 4 Things Drug Companies Don’t Want You To Know About. rug Companies Under Estimate Dangerous Side Effects, Drug Companies Control Much of the Information Your Doctor Gets About A Drug, You’re Often Prescribed Drugs You Don’t Need, Drugs Target the Symptom Not the Cause;... See story.

The Price of Colonoscopy, NY Tiimes Letter to Editor

2011-02-23T09:33:00.000-08:00

February 22, 2011
http://www.nytimes.com/2011/02/23/opinion/l23colon.html?_r=1&ref=opinion&pagewanted=print

To the Editor:

“States Aim Ax at Health Cost of Retirement” (front page, Feb. 14) describes steps taken by cities and states to control employee health care costs. One city, Wauwatosa, Wis., requires its employees to undergo “colonoscopy at age 50, to help forestall cancer and potentially high treatment costs,” you report.

Colon cancer screening with colonoscopy — viewing the entire colon — has almost completely replaced more limited sigmoidoscopy, which costs as little as one-tenth as much. Yet studies have repeatedly failed to show that colonoscopy reduces the risk of death from colon cancer more effectively than sigmoidoscopy.

Indeed, two national multidisciplinary task forces state that sigmoidoscopy is just as effective. Nonetheless, the American College of Gastroenterology recommends colonoscopy over sigmoidoscopy, and national health care legislation mandates that new coverage include screening colonoscopy.

And therein lies a clue to controlling health care costs. To do that, we need the discipline to apply scientifically based medical knowledge, without commercial interference.

John Abramson
Ipswich, Mass., Feb. 15, 2011

Drug Giant AstraZeneca to Pay $520 Million to Settle Fraud Case, ABC News

2010-04-27T09:56:00.000-07:00

ABC News story. John Abramson is quoted

http://abcnews.go.com/Politics/Health/astrazeneca-pay-520-million-illegally-marketing-seroquel-schizophrenia/story?id=10488647

Prescription medications for healthy people, MPR News

2010-04-08T09:51:00.000-07:00

Prescription medications for healthy people
Broadcast: Midmorning, 04/08/2010, 10:06 a.m.

The Food and Drug Administration's decision to approve the expanded use of the cholesterol-lowering drug Crestor is being hailed by some cardiologists, but critics say they're concerned about promoting medications for healthy people.
Guests

* Steven Nissen, MD: Chairman of the department of Cardiovascular medicine at the Cleveland Clinic.
* John Abramson, MD: Clinical instructor at Harvard Medical School and author of "Overdosed America."

What Does It Take to Break Through the Commercial Spin?

2009-05-23T09:44:00.000-07:00

Investigative Reporting on Medical Science: What Does It Take to Break Through the Commercial Spin?

By John Abramson

‘… it is almost impossible to get the story right when the fundamentally commercial goals for which the study has been done are covered up with so much industry-sponsored expertise.’

http://www.nieman.harvard.edu/reportsitem.aspx?id=100952

Forbes Article - Eat Your Statins

2008-12-09T10:36:00.000-08:00

Matthew Herper with Robert Langreth 11.16.08, 6:00 AM ET

Want to avoid a heart attack? Stop taking your vitamins and switch to a cholesterol-lowering statin drug instead.
...
One statin critic not backing down is John Abramson, author of Overdosed America. He points out that patients on Crestor had the same rate of serious illnesses requiring hospitalization as those on placebo. "You haven't improved their net health," says Abramson. Instead, he argues, you're trading heart attacks and strokes for other serious illnesses. And he contends that not offering weight-loss counseling to an overweight population created an "artificial situation" that exaggerated the benefits of the drug. He's not alone. Stephen Colbert of Comedy Central's fake news show The Colbert Report joked the study was "a great breakthrough in the battle to find things to prescribe to people who don't need them."

http://www.forbes.com/2008/11/15/statins-crestor-jupiter-biz-healthcare-cx_mh_rl_1116statins.html

Newsweek Interview: Pfizer's Headache

2008-10-08T07:25:00.000-07:00

Pfizer's Headache
Lawsuit charges drugmaker was deceptive about Neurontin.
Mary Carmichael
NEWSWEEK, Oct 8, 2008
http://www.newsweek.com/id/162906/
...
In the meantime, Abramson—who wrote about many similar cases in the 2004 book "Overdosed America"—said in an interview that the new charges are just one more example of corruption in the pharmaceutical industry. "There was just a wanton manipulation of what physicians believed to be true," he said. "Physicians have to be able trust certain sources. They can't analyze all the data on all the drugs they prescribe themselves; if they did, the medical system would grind to a halt. So the question is, how do doctors typically receive knowledge? Pfizer knew how that happens—through articles, through continuing medical education, through reviews. And they knew how to jam those airwaves."
...
http://www.newsweek.com/id/162906

Dose of bias is unhealthy

2008-06-11T12:24:00.000-07:00

By John Abramson / As You Were Saying | Saturday, May 31, 2008 | Boston Herald | Op-Ed

Though the pharmaceutical industry does an excellent job of convincing doctors and the public that its mission is to improve our health, don’t be fooled - its real job is to sell drugs for the highest price.

I recently testified at a hearing in federal court concerning alleged illegal marketing activities that resulted in overpayment of several billion dollars for the drug in question. The judge opened the hearing by quoting the highly respected American Law Institute’s statement that the fundamental purpose of a corporation is to maximize profits and return those profits to its shareholders.

Though the pharmaceutical industry does an excellent job of convincing doctors and the public that its fundamental mission is to improve our health, don’t be fooled - its real job is to sell the most drugs for the highest price. And they do so by capitalizing on every opportunity to influence our beliefs about the need for and benefit of their products.

Providing gifts to physicians and financial support to hospitals for continuing medical education are an integral part of the drug industry’s strategy to achieve this goal. If these were the only sources of bias in what doctors believe is the best way to treat their patients, the legislation to ban these activities - courageously passed by the state Senate and pending in the House - would still be vital, but not of such critical urgency.

Unfortunately, they are just the tip of the iceberg. It’s what’s beneath the surface that is the real problem.

Over the past 30 years, the funding of clinical trials has been largely removed from the National Institutes of Health and taken over by the drug and medical device industries. Consistent with their fundamental mission, these industries design their research to maximize their return on investment. Medical knowledge itself has become a commodity, produced for its business value rather than its health value.

It’s not just the commercially biased “educational moments” that are the quid pro quo that come with the gifts to doctors. No, the problem starts with the “scientific evidence” that we doctors read in our most respected journals.

More than two-thirds of the clinical trials that are published in our most trusted medical journals are commercially sponsored. And the odds are five times greater that the commercially sponsored studies will conclude that the sponsor’s drug is the treatment of choice compared to non-commercially funded studies of exactly the same drug. (Wouldn’t it be nice to take those odds to the casino?)

In other words, what we naively think of as objective science is more often than not an extension of marketing - an infomercial.

This is an enormous problem and goes a long way toward explaining why Americans pay twice as much for health care as the citizens of the next 21 wealthiest countries, but actually live two and a half fewer years in good health than the citizens of those countries.

The drug industry has so much money and power that even raising these issues is a third rail for American politicians. The head of U.S. operations for drug maker GlaxoSmithKline recently attempted to wield some of that power when he threatened decreased investment in Massachusetts if the proposed ban on gifts is passed.

So if you want your doctor to be as independent of commercial influence as possible when deciding the best treatment for you and your loved ones, the gift ban is a necessary first step.

But we citizens also must be ready to exercise our power as consumers. The drug and medical device companies should know that blocking this legislation or not participating in a voluntary ban on gifts to doctors could result in a consumer boycott of their drugs and devices that have me-too therapeutic equivalents made by companies that are honoring the ban. This is the way to help the medical industry serve its shareholders by better serving the public interest.

Article URL: http://www.bostonherald.com/news/opinion/op_ed/view.bg?articleid=1097650

deeply concerned at the rate of prescription drug abuse in my city

2008-05-02T11:45:00.000-07:00

I am a twenty year old college student attending the University of Louisville. I am deeply concerned at the rate of prescription drug abuse in my city. It seems that a very high rate of my friends are either prescribed to Alprazolam (primarily in the medication known as Xanax). I am wondering about the true negative effects of this chemical on the brain.

I have noticed that my friends who are abusing these type of anti-anxiety drugs seem like completely different people than they were before they started the abuse. I know (as was cited by you on Coast to Coast last night and as is general fact here in the old Kentucky home) that my general geographical area is a hot spot for the abuse of prescription medications. I have heard that Xanax can actually alter brain chemistry in the long term is this true? I am deeply concerned. Really enjoyed the show last night and I await an answer from someone who seems to actually know what they are talking about. Please email me back.
W.S.

Dear W.S.,
I share your concern about the overmedication of college students. I think the real danger is not so much the biochemical effect on the brain as the way people learn not to deal with the real sources of their anxiety when they take a drug that simply covers up the symptoms. Besides education, the most important pychological task of college years is to leave behind the ways of childhood and emotional dependence on one's family of origin and learn how to become an independent productive and fulfilled adult in this complex world. This is far from an easy task and highs and lows are an inevitable part of the process. To "medicalize" these psychological growing pains can slow down the rate at which people make progress in adopting constructive adults behaviors. Of course, there are times when the subjective discomfort is just too great, but for the most part engaging in talking therapy, I believe, is more constructive than just drugging the symptoms.
Al the best,
Dr. A

Dr. Abramson on Coast To Coast

2008-04-25T10:28:00.000-07:00

Listen to Dr. Abramson on Coast to Coast, Sat night 10 pm-1 am Pacific Time / Sun 2 am to 5 am Eastern Time

Click here for info.

I was put on simvastatin, 40mg

2008-04-25T10:13:00.001-07:00

Feedback:

I was put on simvastatin, 40mg, by my cardiologist for a total cholestrol level of 220. My side effects included muscle aches, severe neck and elbow pain, and alopecia areata in two large patches on my head.

I read the article called "Lipitor" in Business Week and subsequently purchased your book, "Overdo$ed America". After reading the magazine article, I decided to stop taking the drug (I took it for only 3.5 months). After reading the book, I decided not to see the cardiologist again since my cholestrol level was the only reason I was seeing him. I realize that this man is completely influenced by the drug companies, and is probably unable to have an intelligent discussion about other cholestrol reducing options. I walk between 8 and 12 miles per week and do some resistance training. My weight is 225 lbs. and I am 6' 4" tall. I lost 30 lbs slowly since retiring about 6 years ago, and I am still trying to reduce even more. I eat oatmeal 4-5 times per week. I am 62 years old.

Facts in your book are particular disturbing to me. The fact that the FDA is in bed with the drug companies indicates the depth of the health care crisis in America. When you combine this with the political arena where corporations are literally buying congressmen, senators and the executive, as well as a supreme court that has time and again voted to limit liability from lawsuits for corporations, one wonders if there is any hope for the people.

The only power we have is to vote. However, it seems that one party is almost as bad as the other. Couple this fact with the fact that the vast majority of Americans are in-curious, it seems to me that it will take a total collapse of the economy to wake enough people up.
I just don't see enough resolve on the part of people or politicians to make the necessary changes. I hope I'm wrong, but I can only see more of the same. Money talks!

God help us all!

Salute you for having the courage...

2008-04-25T10:08:00.000-07:00

Dear Dr. Abramson,

I have just begun reading your book, "Overdosed America", and I salute you for having the courage to go against the grain and tell the truth about one of the most egregious broken promises of American medicine......I could not help but think of what I have read so far regarding statin drugs when I saw the following article (link below) in which it is stated that strokes have tripled in middle aged women. I don't think that can all be blamed on obesity :

http://news.yahoo.com/s/ap/20080220/ap_on_he_me/obesity_strokes

I have never been a believer in drugs when a natural alternative is available. I reversed my own osteoporosis by following a regimen recommended by the Weil Institute of Wellness at Cornell. I changed my form of calcium supplement from carbonate to citrate, added chelated magnesium in a 2 to 1 ratio , faithfully use a portable stair stepper to increase bone density in hips, and it has worked. I voluntarily discontinued my Actonel, against the advice of my physician, and I feel much better. (I took it for five years,, with no improvement until I began the aforementioned regimen, and I pray that the Actonel did not damage my bones or internal organs)

http://www.medicalnewstoday.com/printerfriendlynews.php?newsid=94058

I bought a copy of your book to give to one of our family's favorite physicians, Dr. Julio Gundian, in the hopes that he will read it with an open mind, and pass the info gleaned within to his colleagues.

Thank you for informing the general public that we are not only being duped, we are being harmed.

Sincerely,
Peggy, FL

Finally Getting the Message

2008-04-25T10:05:00.000-07:00

I'm so glad that the mainstream media, particularly the medical-health and business-health reporters, are finally getting your message. Hopefully now, practitioners and patients will heed your eloquent warning.

Just want you to know since I read your book and said on Amazon.com it was the most important book since Silent Spring, I now surf pubmed.org with equal parts enlightenment and suspicion.
Hope you and yours are well.
Most sincere regards,

Mara, aka "voracious reader"

2008 Appearances

2008-04-16T10:20:00.000-07:00

Medical Grand Rounds Tufts Medical Center, May 30, 2008

Harvard Medical School Library, June 3, 2008

University of Vermont Family Medicine Review/Vermont Day, June 12, 2008

Harvard School of Public Health Conference on Ethical Issues in International Research, June 13, 2008

Canadian Coalition for Health: Is Free Speech more Important than your Health, Toronto,CA March 4, 2008

Benson-Henry Institutre for Mind Body Medicine/Harvard Medical School Coninuing Medical Education Program. Understanding our Critically Ill Health Care System and Offering a Real Alternative, Boston, MA, March18, 2008

Northwest Naturoathic Physicians Convention, Can We Trust the Evidence in Evidence-Based Medicine? Vancouver, British Columbia, April 5, 2008

Therapeutics Initiative, University of British Columbia , Lookin’ For Health in All the Wrong Places: The Commercial Distortion of Efforts to Reduce the Burdent of Heart Disease, Vancouver, British Columbia, April 7, 2008

Direct to Consumer Perspoectives National Convention, What’s Wrong with the American Healthcare System (and How to Make it Right), Washington DC, April 16, 2008

Direct to Consumer Perspectives National Convention, What's Wrong with the American Healthcare System (and How to Make it Right), Washington DC, April 16, 2008

Leadership and Business Strategies for Integrative Health Care, American Hospital Association, Phoenix AZ, May 17, 2008

Conference on Integrative, Complementary and Alternative Medicine and Mental Health, Toronto, Canada, May 24, 2008

Marvard Medical School, Countway Library, Boston MA, June 3, 2008

Harvard School of Public Health CME course: Ethical Issues in International Health, Boston MA, June 13, 2008

Federal Bureau of Investigation, "The Systematic Distortion of Medical Knowledge: Licit and Illicit," Boston MA. June 26, 2008

Western Maine Health System, CME, August 18, 2008

N.Y. State Academy of Family Medicine CME, September 27, 2008

Benson-Henry Institute for Mind Body Medicine/Harvard Medical School

Continuing Medical Education Program, Boston, MA, October 2, 2008

Boston University Medical Students, Primary Care Week, October 6, 2008

Boston University Dept of Psychiatry Grand Rounds, October 23, 2008

Cambridge Health Alliance, Family Medicine Grand Rounds December 2, 2008

Lancet article, Are lipid-lowering guidelines evidence-based?

2007-12-11T15:33:00.000-08:00

Are lipid-lowering guidelines evidence-based?
Lancet: Vol 369 January 20, 2007
J Abramson and JM Wright

Harvard Medical School, Cambridge, MA, USA
Department of Anesthesiology, Pharmacology & Therapeutics and Medicine, University of British Columbia, Vancouver, BC, Canada V6T 1Z3

The last major revision of the US guidelines, in 2001, 1 increased the number of Americans for whom statins are recommended from 13 million to 36 million, most of whom do not yet have but are estimated to be at moderately elevated risk of developing coronary heart disease. 2 In support of statin therapy for the primary prevention of this disease in women and people aged over 65 years, the guidelines cite seven and nine randomised trials, respectively. Yet not one of the studies provides such evidence.

For adults aged between 30 and 80 years old who already have occlusive vascular disease, statins confer a total and cardiovascular mortality benefit and are not controversial. The controversy involves this question: which people without evident occlusive vascular disease (true primary prevention) should be offered statins? With about three-quarters of those taking statins in this category, 3 the answer has huge economic and health implications. In formulating recommendations for primary prevention, why do authors of guidelines not rely on the data that already exist from the primary prevention trials?

We have pooled the data from all eight randomised trials that compared statins with placebo in primary prevention populations at increased risk. 4 Unfortunately, our analysis is imperfect because these trials are not solely primary prevention: 8Â·5% of patients had occlusive vascular disease at baseline. 5 We used two outcomes to estimate overall benefit (benefit minus harm): total mortality and total serious adverse events (SAEs). Total mortality was not reduced by statins (relative risk 0Â·95, 95% CI 0Â·89â€“1Â·01). In the two trials that reported total SAEs, such events were not reduced by statins (1Â·01, 0Â·97â€“1Â·05) (data on SAEs from the other trials were not reported). The frequency of cardiovascular events, a less encompassing outcome, was reduced by statins (relative risk 0Â·82, 0Â·77â€“0Â·87). However, the absolute risk reduction of 1Â·5% is small and means that 67 people have to be treated for 5 years to prevent one such event. Further analysis revealed that the benefit might be limited to high-risk men aged 30â€“69 years. Statins did not reduce total coronary heart disease events in 10 990 women in these primary prevention trials (relative risk 0Â·98, 0Â·85â€“1Â·12). 6 Similarly, in 3239 men and women older than 69 years, statins did not reduce total cardiovascular events (relative risk 0Â·94, 0Â·77â€“1Â·15). 7

Our analysis suggests that lipid-lowering statins should not be prescribed for true primary prevention in women of any age or for men older than 69 years. High-risk men aged 30â€“69 years should be advised that about 50 patients need to be treated for 5 years to prevent one event. In our experience, many men presented with this evidence do not choose to take a statin, especially when informed of the potential benefits of lifestyle modification on cardiovascular risk and overall health. 8 This approach, based on the best available evidence in the appropriate population, would lead to statins being used by a much smaller proportion of the overall population than recommended by any of the guidelines. 9

Why the disagreement? The current guidelines are based on the assumption that cardiovascular risk is a continuum and that evidence of benefit in people with occlusive vascular disease (secondary prevention) can be extrapolated to primary prevention populations. This assumption, plus the assumption that cardiovascular risk can be accurately predicted, leads to the recommendation that a substantial proportion of the healthy population should be placed on statin therapy.

A similar set of assumptions underlie the conclusions of the Cholesterol Treatment Trialists' (CTT) collaboration, a group that undertakes periodic meta-analyses of individual participants' data on morbidity and mortality from all relevant large-scale randomised trials of lipid-modifying treatment. 5 The CTT Collaborators included seven trials of statins for secondary prevention and seven trials of statins for mostly primary prevention. However, instead of analysing these two groups of studies separately, they combine all the studies and report the overall effect. Because they have individual participants' data, the CTT Collaborators have the unique opportunity to analyse the data for the 41 354 people in the true primary prevention group that they have identified as included in these studies. 5 However, they do not report on this pure primary prevention population. Instead they calculate and report the absolute benefit of statins in 47 925 patients with no coronary heart disease at baseline; however, this group includes about 6570 patients with pre-existing cerebrovascular or peripheral vascular disease. Combination of these secondary prevention patients (5-year frequency of major vascular events 25â€“30%) with the true primary prevention group (5-year incidence of major vascular events 9%) inflates the estimate of absolute benefit from 1Â·5% (our estimate) to 2Â·5%.

The CTT collaborators have primary prevention outcome data that can resolve the issues we raise. Subpopulations of particular interest include: men, women, men aged 70 years or older, women below the age of 70 years, people with diabetes mellitus, 20% of people with the lowest bodyweight, people taking more than five drugs, and tertiles of cardiovascular risk at baseline. The following are the outcomes that would be most informative: total mortality, total SAEs, total incidence of cancer, and total cardiovascular events. This analysis would answer the key outstanding questions. First, do the data on primary prevention confirm that there is no overall benefit in adult women of any age and in men aged 70 years and older? And, second, is there significant heterogeneity between the statin treatment effect in primary prevention subgroups compared with that in secondary prevention subgroups?

If the answer to both these questions is yes, the assumption that the benefits for secondary prevention populations can be extrapolated to primary prevention populations is false and the cholesterol treatment guidelines based on this assumption should be revised.

JMW declares no conflict of interest. JA is an expert consultant to plaintiffs' attorneys on litigation involving the drug industry, including Pfizer for its marketing of atorvastatin.

References

1 Third report of the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood pressure in adults (adult treatment panel III) final report: table II.2-3 http://www.nhlbi.nih.gov/guidelines/cholesterol (September, 2002) (accessed Jan 2, 2007)..

2 Third report of the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults, Adult treatment panel III, final report http://www.nhlbi.nih.gov/guidelines/cholesterol/atp3full.pdf (September, 2002) (accessed Jan 2, 2007)..

3 I Savoie and A Kazanjian, Utilization of lipid-lowering drugs in men and women: a reflection of the research evidence?, J Clin Epidemiol 55 (2002), pp. 95â€“101. SummaryPlus Full Text + Links PDF (61 K)

4 C Jauca and JM Wright, Therapeutics letter: update on statin therapy, Int Soc Drug Bull Newsletter 17 (2003), pp. 7â€“9.

5 Cholesterol Treatment Trialists' (CTT) Collaborators, Efficacy and safety of cholesterol-lowering treatment: prospective meta-analysis of data from 90 056 participants in 14 randomised trials of statins, Lancet 366 (2005), pp. 1267â€“1278.

6 JME Walsh and M Pigame, Drug treatment of hyperlipidemia in women, JAMA 291 (2004), pp. 2243â€“2252. Full Text via CrossRef

7 J Shepherd, GJ Blauw and MB Murphy et al., Pravastatin in elderly individuals at risk of vascular disease (PROSPER): a randomised controlled trial, Lancet 360 (2002), pp. 1623â€“1630. SummaryPlus Full Text + Links PDF (113 K)

8 SE Chiuve, ML McCullough, FM Sacks and EB Rimm, Healthy lifestyle factors in the primary prevention of coronary heart disease among men: benefits among users and nonusers of lipid lowering and antihypertensive medications, Circulation 114 (2006), pp. 160â€“167. Full Text via CrossRef

9 DG Manuel, K Kwong and P Tanuseputro et al., Effectiveness and efficiency of different guidelines on statin treatment for preventing deaths from coronary heart disease: modelling study, BMJ 332 (2006), pp. 1419â€“1422.

"As an aspiring doctor, reading Overdosed America was incredibly motivational"

2007-06-23T06:44:00.000-07:00

On 6/13/07, William Carroll wrote:

Dr. Abramson -

I saw this article today in the New York Times and thought of you. It speaks to the downfall of continuing education being funded by drug companies

http://www.nytimes.com/2007/06/13/opinion/13carlat.html?th&emc=th

Diagnosis: Conflict of Interest

By DANIEL CARLAT

Published: June 13, 2007

To be honest, my main reason for writing is simply gratitude. I am a year out of undergrad from Davidson College, North Carolina and will be applying to medical school for fall 08. As an aspiring doctor, reading Overdosed America was incredibly motivational albeit discouraging. I think medicine in this country owes you tremendously for all your efforts to put together statistically sound information comprehensively that was so shrouded to begin with. I can't even imagine how laborious that must've been, as I used to get all hissy just reading journal articles for my human genetics seminar.

Your book reinforced my whole-hearted belief in the importance of preventive medicine, which seems unfortunately in the minority these days. After reading I spoke to numerous adults on statins, etc and I urged them to not only read your book (take it or leave it) but to seek medical knowledge themselves. My girlfriend recently made an interesting comment while we were eating dinner, and watching television. She said, "You know, it used to be cars and beer. Now every other commercial is for a prescription drug."

I have a couple of questions for you:
1. What was the predominant reaction from patients, drug companies, fellow physicians (all parties) upon the release of your book? (If you have a publication regarding this and could refer me that'd be great)
2. How much do you integrate this material into your teachings at Harvard? What do students think?
3. Do the recent changes in the FDA seem promising to you?

Once again, thank you.

Will Carroll

***
Will, Thanks for your e-mail--it's great to know that committed people like yourself are out there thinking hard about these issues. Responding to your questions:

The research for the book was certainly time and energy consuming--about 2 years of living and breathing this project, before even beginning the equally challenging task of translating the findings into readable English. But it was a wonderful 2years of intellectual engagement and discovery, like being a detective on a number of very different but related cases. This did involve throwing personal caution to the wind. In my mind I had granted myself a one year sabbatical after working more than 20 years as a family doctor. One turned to three, but I could not possibly be more gratified with the process. And e-mails like yours confirm that, while the medical system has not changed significantly for the better as a result of the critical scholarship that has emerged, awareness of the core issues is growing and people like yourself will, hopefully, carry this mission forward.

My fellow physicians thought I was truly psychotic--writing a book with the primary thesis that the medical "knowledge" that they believed implicitly was really being produced with the primary mission not of helping them to help their patients, but increasing corporate profits. And they continued to think I was nuts after the book was published. That is, for the first nine days after the book came out, until Vioxx was withdrawn from the market for causing exactly the harm that I presented in Chapter three of the book. Then things changed. I lecture all over the country, primarily to doctors. They get it when I am presenting the real scientific evidence, but I fear that as soon as I am gone and the drug companies bring in their speakers to convince them that their products really have the scientific basis that conforms with their paradigms of good medical practice, the effect of my critique has a relatively short half-life.

A central problem, that I did not address strongly enough in Overdosed America, is that what we take as "knowledge" in areas with commercial potential is far more often determined by the inherent tendency of the marketplace to maximize short and intermediate term financial return on research investments. The end result is that what we naively accept as a Platonic kind of knowledge (a little piece of divine truth) is much more likely to be a market-driven perspective that has primarily a short-term business goal rather than advancing knowledge or the well-being of humanity.

Harvard medical students are interested in these issues, but there does not seem to be much interest in integrating a critical and reflective look at the fundamental structure of medical knowledge production into core of the educational experience.

And finally, the strikingly public failures at the FDA are creating an environment where some greater caution seems to be the order of the day. But I fear this is more smart politics than real change. The legislation does not free the FDA from financial dependence on the drug industry, nor does it set up an independent office of drug safety that is not under the administrative authority of the office of new drugs. This leaves a fundamental conflict of interest: the office of new drugs is not going to be thrilled to learn about the mistakes it made in approving unsafe drugs. There needs to be a separation of power here--but this has been carefully legislated out. Ironically, the best Senator on these issues is conservative Chuck Grassley (R-Iowa), who completely understands the public disservice of drug industry influence at the FDA. There is just too much money and influence from the drug and other medical industries available to politicians. I fear that the Democrats will only be slightly better than the Republicans on these issues--any greater than a perceptible difference will create a backlash from the drug industry and be counter-productive in terms of getting elected, which is the primary job of a politician.

All that said, the future is in your hands. So please do everything to protect your ideals and your integrity. And understand that this requires enormous skill and intelligence, often demanding great self-discipline to get your training and credentials without offending the powers that be too much.

Wishing you all the best. Please keep me posted on how your career is progressing.

Sincerely,

John Abramson MD

Is Evidence-Based Medicine Evidence Based?

2007-04-06T12:54:00.000-07:00

According to the U.S. Centers for Disease Control and Prevention, of the 2.4 million U.S. deaths in 2000, 400,000 were associated with unhealthy diet and lack of physical activity. These are deaths related to the particular way in which civilization has "progressed" upon this planet: high-fat, high-carbohydrate fast foods devoid of fruits and vegetables; a vast multitude of automobiles that make self-propulsion (walking) obsolete as a standard life routine; and couch-potato-creating television sets that not only replace the neighborhood kickball game and hide-and-seek activities that amused me when I was a kid, but also badger us to purchase those same automobiles and eat those same fast foods.

Link

How has the trillion-dollar-plus enterprise we call the health care system responded to this pervasive undermining of our health? By offering more inventions, which—like those cars, fast-food chains, and TV sets—are capable of making money for a small stratum of society. Instead of approaching the health effects of modern civilization through community-wide and public health interventions—banning cars and creating greenbelts within cities, spending more dollars on health education than the food industry spends on advertising, and creating more neighborhood physical activity programs than the auto industry creates cars—we have chosen to address those 400,000 deaths with a few rushed minutes in a sterile exam room populated by a highly trained physician, a passive patient, and a prescription pad.

John Abramson is a physician who spent more than twenty years in those exam rooms, filling out thousands of those prescription pads. But something happened to him that, sadly, happens to few physicians. He began to study epidemiology and research methodology, expanding his viewpoint from a close-up focus on the individual patient to a panorama of the entire population. Carefully reviewing the research literature, he found that spin doctors had been doctoring the evidence. The conclusions he reached from his careful literature review differed from the conclusions published by the authors of the universally accepted clinical practice guidelines—the "evidence-based medicine"—that are the yardsticks against which physicians’ quality of care is measured.

Abramson’s book, Overdosed America, provides detailed arguments on the false conclusions reached from research on such topics as the prevention of coronary heart disease and hip fractures. He explains why those conclusions are distorted: the web of interlocking monetary relationships among the pharmaceutical industry, academic research physicians, the Food and Drug Administration, leaders within the National Institutes of Health, and some of the hallowed organizations that promulgate evidence-based medicine—with the nation’s prestigious medical journals often serving as unwitting collaborators in the distortions.

Overdosed America presents a strong indictment of the evidence that dictates medical practice, a challenge that is credible only because Abramson backs up his statements with detailed analyses of the prevailing evidence. It is beyond the purview of this review to judge whether each of Abramson’s conclusions are scientifically and statistically valid. What can be said, however, is that the seriousness with which he explores clinical issues merits a major debate on those issues within the world’s leading medical journals—untainted by the almost ubiquitous monetary distortions. To give a sense of Abramson’s approach, it is worth summarizing his treatment of an important clinical problem: osteoporosis.

Twenty percent of women over age fifty have osteoporosis, and another 40 percent have osteopenia, thinning of the bones that puts women at risk for osteoporosis. Osteoporosis increases the risk of a serious medical event—hip fracture. Osteoporosis is diagnosed with a bone mineral density (BMD) test. About half of all American women who have a BMD test will be diagnosed with osteoporosis by age seventy-two. The market for pharmaceutical products to manage this condition is enormous. Accordingly, based in part on the work of an expert panel funded by drug companies, current practice guidelines recommend that all women have a BMD test at age sixty-five, or earlier if at greater risk for osteoporosis. The drug Fosamax (alendronate), which improves BMD, was found to reduce the risk of hip fractures for postmenopausal women with osteoporosis by 56 percent. Here, Abramson does what every journal article, newpaper report, and TV airing of a medical advance should do: report the absolute risk instead of trumpeting the relative risk. If, in a hypothetical example, 2 of every 10,000 women with osteoporosis sustained a hip fracture in a year, a relative risk reduction of 50 percent would mean that 1 of every 10,000 women would be spared a hip fracture—a very small improvement. If four of every ten women with osteoporosis sustained a hip fracture in a year, then a relative risk reduction of 50 percent would mean that two of every ten women would be spared a hip fracture—a very large improvement. Relative risk by itself can be highly misleading. Abramson reports the more illuminating facts: 81 women would have to take Fosamax for 4.2 years to prevent one hip fracture, and for women ages 70–79, Actonel (risedronate), a medication similar to Fosamax, had no effect on the number of hip fractures.

What is going on? Why do drugs that improve bone mineral density have little effect on hip fractures? It turns out, according to Overdosed America, that BMD is not a good test to predict hip fractures. BMD mainly measures the outer layer of bone (cortical bone), whereas much of the strength of bone lies in the inner structures of trabecular bone. Drugs such as Fosamax primarily strengthen cortical rather than trabecular bone, which improves the BMD score but may not contribute as much to fracture prevention.

Finally, women age sixty-five and older who engage in regular exercise enjoy twice the reduction in hip fractures achieved with Fosamax. Exercise not only increases bone density but improves muscle strength and balance, thereby preventing falls, the proximate cause of hip fractures. Yet physicians who prescribe drugs such as Fosamax for at-risk women, while ignoring or downplaying the greater importance of exercise, are viewed as "evidence-based" physicians.

Why this lengthy exposition of a clinical issue in a health policy book review? Because readers who might be inclined to view Overdosed America as simply another in the growing number of diatribes against drug companies should be aware that this book makes its arguments in a detailed, well-referenced manner. Moreover, responsibility for the overdosing of America goes far beyond the drug industry, resting equally with the nation’s physicians. I beg all of my physician colleagues to read this book and to think deeply about how we are practicing our chosen profession.

From the British Medical Journal

2007-04-06T12:52:00.000-07:00

The new [cholesterol lowering] guidelines will radically increase the number of people taking cholesterol lowering drugs, said Dr John Abramson, clinical instructor at Harvard Medical School, Boston, Massachusetts, author of Overdosed America: The Broken Promise of American Medicine, and one of the signatories to the petition [sent to the NIH calling for re-evaluation of the recent recommendations for treating cholesterol]. He told the BMJ: "In the one group that could benefit, men aged under 65 with multiple risk factors, you'd have to treat 238 men for one year to prevent one heart attack, and to prevent one death you'd have to treat 526 patients for one year." "While statins are clearly beneficial in certain high risk individuals," said Dr Abramson, "exercising, eating a healthy diet, and not smoking each individually appear to give more protection against heart disease, as well as the added benefit of preventing diabetes, osteoporosis, and multiple other diseases. One can't help wondering whether the ties between the authors and the statin makers contribute--consciously or unconsciously--to their focus on drugs."

Washington Post: Sunday Book World

2007-04-06T12:51:00.000-07:00

Cooking the Books

John Abramson, a clinical instructor at Harvard Medical School and the author of Overdosed America: The Broken Promise of American Medicine (HarperCollins, $24.95), has done what most physicians don't have the time or inclination to do: He's not only read the peer-reviewed articles upon which doctors base their prescribing habits but also has examined the actual study data for some of today's most popular drugs. As a primary care doctor in Massachusetts, he constantly found himself on the receiving end of drug-company pitches. And, he writes, he believed in the integrity of the medical information system -- until he sat down and examined the clinical trial results in detail.

The strength of Overdosed America is in these close readings of the research. Abramson walks the reader through the contradictions he's discovered between the exorbitant claims made for the products and the actual study data -- or between the data and the subsequent medical guidelines promulgated by government-sponsored panels, whose members, he reports, often have financial ties to the companies that make the drugs they're recommending.
Abramson argues, for example, that the benefits of the cholesterol-lowering drugs called statins are nowhere near as great as generally believed, and certainly do not approach the advantages conferred by lifestyle changes that would cost much less. Reviewing studies of the blockbuster anti-arthritis drugs Celebrex and Vioxx conducted years before the recent announcement of Vioxx's dangers, he reports that the two medications, although marketed as safer than an earlier and cheaper generation of products, can actually cause more severe side effects. And he recounts the now-famous story of how drug companies and doctors persuaded millions of menopausal women to go on hormone replacement therapy, which later proved to significantly increase the chances of suffering from breast cancer and heart attacks.
In one particularly enlightening section, Abramson analyzes various methods drug companies use to massage their research data and obtain the results they'd like. "Rigging medical studies, misrepresenting research results published in even the most influential medical journals, and withholding the findings of whole studies that don't come out in a sponsor's favor," he writes, "have all become the accepted norm in commercially sponsored medical research."
Beyond Abramson's focus on the details of medical studies, he covers much the same ground that Angell does, although not quite as comprehensively. Both authors offer a list of suggestions -- some practical, others probably wishful thinking -- for reducing the drug companies' influence. But these ideas remain overshadowed by the much larger and more compelling point: If this is the industry we hope will rescue us from disease, pain and unhappiness, we're in real trouble.
David Tuller is a contributing writer at Salon.com.

San Diego Union Tribune Review

2007-04-06T12:50:00.000-07:00

"Abramson, who has a background in statistics and health policy, took the time to read the full 284-page version of the panel's 2001 report, rather than the 11-page summary that most doctors saw. The results of his careful analysis are enough to shock a healthy heart into failure. He notes that data from the venerable Framingham study - a large, long-term study of risk factors for heart disease - show that elevated total cholesterol levels correlate with an increased risk of death only through the age of 40. Even more astounding is the finding that the risk of death from causes other than coronary heart disease increases significantly with lower total cholesterol levels for both men and women after the age of 50. And that doesn't even touch on the question of the long-term side effects - both known and unknown - of the statins themselves."

British Medical Journal Review of Overdosed America

2007-04-06T12:47:00.000-07:00

With so much negativity towards medicine these days, many doctors must be contemplating ear-plugs and wondering why they are bothering. Thanks to Harvard University researcher and family doctor John Abramson, that negativity is about to be turned up a notch. His book is the latest in a series of searing indictments of a medical profession apparently duped by the false promise of technology, and too often compromised by cold hard cash from the companies selling the drugs and devices. Yet this book comes with a refreshing respect for the healing potential of the doctor-patient relationship, and a clear commitment to making the healthcare system more humane. The title speaks of the United States, but the themes are global.

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Much of the material about drug companies distorting science will be familiar to many readers, but there is a freshness here that carries great appeal. The author combines his personal journey towards increasing scepticism with a clear analysis of where the American health system is failing. The book's focus is big pharma's unhealthy influence, but it places that subject within a much broader global context: the growing commercialisation of medicine; the limits of the biomedical approach; and the moves to widen the ways in which communities and nations can try to improve human health.

As Britain's House of Commons health select committee investigates industry's influence over the entire health system, as authorities in the United States and elsewhere continue to be convulsed by revelations about the dangers of widely prescribed antidepressants, and as a global campaign to re-invent academic medicine takes shape—part run by the BMJ—Abramson's book could not be more timely. What it lacks in terms of a compelling narrative, it makes up for with powerful and engaging insights.

The personal journey starts with this doctor's bewilderment at discovering the truth about COX 2 (cyclo-oxygenase-2) inhibitors, the overhyped new class of anti-arthritis drugs, and his sense of betrayal at finding out that such distortions are no longer uncommon. The story of celecoxib (Celebrex) and rofecoxib (Vioxx), and the far-too-favourable portrayal of their risks and benefits in both marketing materials and published trials, is told through anecdotes about interactions with real patients.

Particularly fascinating is Abramson's argument that marketing campaigns encouraging unnecessary demand are undermining the trust between a doctor and patient. It is not a new argument, but he has a moving formulation of it. With great discomfort, we hear how this family doctor wrote a prescription for a much advertised pill that he was convinced his patient did not need, in order to maintain a relationship with that patient. In another scene, the author wonders how many people he may have injured in the 1980s, by prescribing a notorious class of anti-arrhythmic drugs, belatedly shown to take life away rather than save it. Importantly no one is singled out for blame in this book, but rather "the enemy is us."

Moving from the personal to the political, the book explores the abundant evidence about the far-reaching pharma influence over medical practice, education, and research: from the friendly drug reps to the rigged trials, from the timid regulators to the bought-off thought leaders. "Doctors who allow their reputations and academic positions to be leveraged by drug companies for commercial purposes provide a crucial link in the chain of corporate influence," Abramson writes. The media also come in for criticism for their mindless "break-through cure" formulas in medical news stories, boosting sales more than enlightening readers or viewers.

As I read this book, and watched the wider global debates about commercial influences on medical science, one question kept demanding an answer. Given what we know now of the distortion of medical knowledge and practice, why aren't more doctors, health professionals, policy makers, and patients clamouring for a form of health care characterised by much greater independence from unhealthy commercial influences?

American Medical Association, Allan S. Detsky

2007-04-06T12:46:00.000-07:00

This book (or one like it) should be required reading for all medical students and doctors, who should be well informed about the potential for bias introduced by the conflicts of interest Abramson delineates. The book may also help patients if it turns the tide against a system that "leads patients to demand that a doctor prescribe a drug that provides no better relief and causes significantly more serious side effects" (p 36) at a substantially higher price and teaches people to understand what the phrase "ask your doctor" really means.

Bookslut Review of Overdosed America

2007-04-06T12:33:00.000-07:00

Anyone with a half dozen neurons still firing in the old noggin should realize that is what "direct to the consumer" advertising is all about. Those TV ads, magazine ads, newspaper ads, billboards, spam, junk mail and on and on ad nauseum don't care if you have received the correct diagnosis (you can decide that for yourself, can't you?), or know anything about other treatments. They want your money, stupid!

Dr. John Abramson opens the subject in Overdosed America: The Broken Promise of American Medicine by maintaining that these same companies are now able to twist the results of studies presented in what in the past has been regarded as reliable sources of information: medical journals! The esteemed New England Journal of Medicine, the Journal of the American Medical Association, the Lancet and others have reported studies in which the sponsoring medical/pharmaceutical companies have been able to adjust the results given or the manner in which they are given, solely to increase sales! "Rigging medical studies, misrepresenting research results published in even the most influential medical journals, and withholding the findings of whole studies that don't come out in a sponsor's favor have all become the accepted norm in commercially sponsored medical research."

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Those television ads are more than just annoying. They hurt the consumer two-fold. First, they can convince the consumer they have disorders or diseases they do not. The obvious example is the ad campaign for depression/social anxiety/premenstrual irritability, but it goes further back than that. In 1942, premarin was approved by the FDA for the treatment of menopause symptoms. The drug was originally created to treat a minority of women for only a few years, but Wyeth-Ayerst began to market the drug as Hormone Replacement Therapy (HRT) and convinced millions of women that menopause was a disease. Years later, studies were finally released showing an increased risk of heart disease, breast cancer, dementia, stroke, blood clots, etc. Even after this, HRT is still advertised on the television.

The marketing campaigns also hurt the consumer by wasting billions of dollars of the pharmaceutical companies' money, and allowing them to focus on renaming drugs and disorders instead of finding new treatments and cures. There is currently a shortage of tetanus vaccines because vaccines do not make pharmaceutical companies money. Drugs that consumers will be convinced they need to take the rest of the lives, like antidepressants and cholesterol medication, is where the real profits are. Out of the 78 new drugs approved by the FDA in 2002, only 17 of them contained new active ingredients.

As a practicing pharmacist, I agree with the doctor’s conclusions and his belief that it is only going to get worse, until there are some major changes in the regulatory agencies involved. He further charges that this bias not only decreases the quality of the treatment, but is responsible for the horrendous cost of medical treatment today, and explains why we, as Americans, pay more than anyone else in the world but are receiving far from the best treatment.

This book is well written and covers several areas of medical treatment to illustrate the author’s points. There may be too much statistical analysis for some, but you can skip the numbers and rest assured the author has done the math to back up his assertions. One thing I would have liked to have seen is more of the author’s recommendations on trustworthy information sources. He does include a few, and maybe that is all there is currently. This isn’t so much a happy ending story of "Here is the problem and we have fixed it." It is more a rallying the masses with "Here is the problem and this is what you can do to help (yourself and medicine in general)."

I recommend this book to anyone who has ever been sick, is being treated for something now, or realizes they make get sick sometime before they die. Did I leave anyone out? Obviously everyone has a stake in this, and here is some good information you need before you consent to anything.

Overdosed America On About.com

2007-04-06T12:29:00.000-07:00

This fascinating, informative and very readable book is written by a doctor who was so concerned about the pharmaceutical companies ability to distorting medical knowledge that he took a year out to research and write it. Dr Abramson believes we are risking our health, our bank balances, as well as the impartiality of our medical profession as they are often misled about the real results of drug research.

John Abramson focuses on a number of current concerns and illustrates some of them with case histories from a few of his own patients. His insights into the way the adverse research findings of Vioxx and Celebrex were handled is just one example of how he believes profit comes before health.

Link
He shows us how information was suppressed on the serious cardiovascular side effects that were evident in the research of these Cox-2 inhibitor medications, used in the treatment and control of arthritis. Vioxx and Celebrex were promoted for their minimal gastrointestinal side effects, but the deaths from sudden cardiac death, heart attack, unstable angina, TIA's and blood clots, were hidden.

Dr Abramson paints a worrying picture of U.S. healthcare. Doctor's research is biased by drug company salaries, medical journal printing research that they do not scrutinize or validate, the systems of the Food and Drug Administration that result in failure to correct misleading information and act as an independent watchdog, and the way we are influenced by drug company advertising to demand certain treatments from our medics.

There are some surprising statistics in his book too. For instance, the US spends twice as much per person on healthcare than other industrialized nations yet it ranks 22nd out of 23 countries on healthy life expectancy. Of 56 drugs approved for use between 1995 and 2000 only 13% contained new active ingredients.

The good news amongst his concerns about HRT (hormone replacement therapy) side effects, exaggerated claims of cholesterol treatments and the serious side effects of Cox-2 arthritis drugs, is that we can do a lot ourselves to improve our health.

A must read for you, your doctor and the medical profession.

John Abramson is currently a member of the clinical faculty of Harvard Medical School teaching primary care. His book Overdo$ed America: The Broken Promise of American Medicine is published by Harper Collins.

Blogcritics.org

2007-04-06T12:22:00.000-07:00

The medical profession which John Abramson writes about in Overdosed America does not resemble a Norman Rockwell painting in any way. The current state of affairs is rather more dangerous and damaging - for both Americans' health and their pocketbooks - than even your family doctor may realize. Overdosed America charts how this state of affairs came about, what the costs have been in both dollars and lives, and what Abramson, a practicing physician and teacher at Harvard, sees as the best case scenario to fix current problems and reform the system to meet current and future needs.

Link
Where the book really shines is in Abramson's detailed chapters exploring how the medical industry has, since World War Two, valued profits over lives when developing treatments for everything from menopause to heart disease. These chapters constitute the bulk of the book and have a tendency to feel long and dry, a problem for a book written for a lay audience. I fought the urge to skip ahead to the last three chapters, Abramson's recommendations, mainly out of a perverse desire to see how often the drug companies have defrauded and deceived the public. The facts disclosed here are truly stunning, and worth reading for shock value alone. But they also go a long way toward creating a fuller picture of the crisis in American health care.

Time and again Abramson painstakingly details the triumph of commercial interests over scientific evidence. As familiar as this refrain is to anyone familiar with the Bush administration, Abramson traces the beginnings of this state of affairs to the Food and Drug Administration's 1942 approval of Premarin (estrogen) "for the treatment of symptoms associated with menopause." (159) Wyeth-Ayerst still holds the patent for processing "PREgnant MARe's urine" into a drug effective at relief of symptoms felt by a minority of women, which "last no more than two to five years." (ibid.) Marketed as part of a hormone replacement therapy (HRT) to protect all women against the ravages of old age, over 20 million American women bought into this therapy. Effects of HRT included: a "66% higher chance of getting breast cancer," a 50% increase in the risk of developing Alzheimer's disease, and a 15% chance of suffering at least one "adverse event" - heart attack, stroke, blood clots, dementia, breast cancer, and so on - after five years of therapy. (ibid.)

Abramson discusses many other cases, all with the same bottom line: American pocketbooks are more important to the medical industry than American lives. If this doesn't sound like an urgent problem in need of an immediate solution, next time you're over at your grandparent's house, open up their Reader's Digest. About 40% of the advertisements are for new and popular drugs.

Abramson discusses in Part Three of the book alternatives to biomedical (drug and surgery) therapies, supporting options such as lifestyle counseling and increased exercise regimens with study after scientific study proving their effectiveness. This is not to the detriment of biomedical therapies, which he is careful to note are valuable in situations "from emergency surgery... to the treatment of strep throat." (204) However, when the U. S. Centers for Disease Control and Prevention report that "'half of all deaths that occurred in the United States in 2000 could be attributed to... largely preventable behaviors and exposures,'" it may be time to look beyond the latest and greatest and most expensive pill, and return to a little common sense and conventional wisdom.

Of course, the difficulty, which both doctors and patients face here, Abramson states, is that non-biomedical therapies are often strongly reliant upon behavioral changes. These behaviors - lifestyle choices - are more difficult to prescribe and adhere to. Just ask anyone who has tried to quit smoking.

Further, the extent to which the big drug companies are able to influence medical opinion reminds one of the great investigative journalism of the American press. Abramson writes "experts with financial ties to the drug companies dominate the FDA's Advisory Committees and the panels that write the clinical guidelines that define the standards of care for practicing doctors." (250) As if it isn't enough to control the testing and approval of new biomedical therapies, "the medical industry even funds the majority of doctors' [required] continuing education." (ibid.) This points toward a conflict of interest throughout the medical industry, but, as Abramson is right to point out, "the drug companies have no more responsibility to oversee the public's health than the fast-food industry has to oversee the public's diet." (ibid.)

With that information, plus all of the other facts, figures, and recommendations that Abramson reports in Overdosed America, it will be obvious to any reader that America's health care industry has become corrupt. Significant, long-term changes need to be made everywhere from medical school classrooms to drug company boardrooms. John Abramson's report is an eye-opening look beyond that Norman Rockwell façade. The lesson he wants us to learn is that an apple a day is still the right dose.

therubins.com

2007-04-03T16:31:00.002-07:00

Dr. Abramson traces the "industrial colonization" of medicine and academia by the pharmaceutical industry...His book is in line with past muckrakers, including Upton Sinclair, Ida Tarbull, Lincoln Steffens, Rachael Carson, I.F.Stone, Seymour Hirsch and many others.

Link

The take home message from Overdo$ed America is that we need to be more critical consumers of scientific evidence "and the recommendations of 'thought leaders' on the payroll of the drug and other medical industries." (P. 259). He invariably cites evidence of "false" information on how "the sponsors (drug company) presentation of 6-month data…are not statistically valid or supportable" (Note #30, p. 264). Pharmaceutical companies distort medical knowledge, mislead doctors and compromise patient’s health and reap the profits of this endeavor.

Dr. Abramson concludes with a challenge to his readers to "consider the responsibility of citizenship in this time of excessive medical profiteering and corporate influence, and to take up one of the most important challenges of our time: high-quality health care for all based on the translation of well-ordered science into accurate, unbiased medical information." (p. 260).

Part II: Substance

This is a well organized and easy to read book with references to "notes" in the back of the book that provides the source of his information. The notes are really his bibliography, and well worth reading. The inconvenience is that one has to flip pages back and forth from the body of the book to the notes.

The substance of the book is presented clearly, concisely and in a clinically pertinent way. However, the reader would like to read what the "other side" has to say about the same issues. The book will serve as a primer for anyone wanting to know more about the interaction between pharmaceutical companies, and medical care. The book strengthens the growing idea that the consumer take a more active role in health care and make a commitment to become more interactive with the treating physician, but not loosing sight how life-style also effects health. This could prove especially difficult for the frail elderly, a growing cohort group needing medical attention.

Part III: Structural analysis

Structurally, Overdo$ed America consists of three parts, totaling 260 pages, with 45 pages of notes and a bibliography of 4 pages. It has a retail listed price of $24.95.

Part I, A FAMILY DOCTOR’S JOURNEY OF DISCOVERY, lays out his personal journey to defining his biopsychosocial approach to medicine. The subtitles of the six chapters in part I clue the reader to the message he is trying to get across: "Medicine in Transition: Caring for Patients at the Crossroads"; "Spinning the Evidence: Even the Most Respected Medical Journals Are Not Immune"; "False and Misleading: The Misrepresentation of Celebrex and Vioxx"; "The Myth of Excellence"; "A Case in Point: The Saga of Hormone Replacement".

In these chapters, Dr. Abramson suggests instances of "unfortunate chapters in medical history" (p.52) and concludes, "that the commercialization of medicine wasn't just causing doctors to prescribe unnecessary drugs and procedures. It was actually subverting the quality of medical care. The only thing that appears to be certain about health care in our country is that we aren't getting the health care we're paying for." (p. 53)

Part II of Overdo$ed America is titled "The Commercialization of American Medicine" and has six chapters: "American Medicine's Perfect Storm": "A Brief History"; "The Commercial Takeover of Medical Knowledge"; "The Snake and the Staff: Duping the Doctors"; "A Smoking Gun: The 2001 Cholesterol Guidelines"; "Direct-to-Consumer: Advertising, Public Relations, and the Medical News"; "Follow the Money: Supply-Side Medical Care".

In these chapters, Dr. Abramson reviews the impact on medicine of the transition from traditional indemnity insurance to HMOs and managed care plans that now dominate the delivery of medicine in this country. Dr. Abramson corrects the impression that managed care companies do not serve patients well. "The data about the actual effect of managed care tell a very different story. The quality of care has neither improved nor deteriorated under managed care." (Italics added for emphasis) Yet, one could ask, why does the United States rank 37th in the world in healthcare, while we spend almost 15% of our GDP on care, a figure that is twice as high as countries that deliver better healthcare. Dr. Abramson places a lot of the blame on lack of primary care practitioners (his own field). He explains this dearth of primary care physicians as due to "less prestige among peers, intrudes more into one's personal life, and pays less than most other specialties." (p. 85) His facts may be right, but one wonders how his own bias may enter into these conclusions.

Part II shows how medical knowledge has been transformed from a public good, "measured by its potential to improve our health, into a commodity, measured by its commercial value." (p. 91) He traces medical research from an academic and scientific activity funded by public money to a commercial activity funded by private sources tied into the pharmaceutical and biotech industry. There is nothing intrinsically illegal about such arrangements, but Dr. Abramson questions whether it is possible to serve the public interest and commercial interests simultaneously. Are we paying an enormous amount of money for some mediocre medicines? Are we as patients’ demanding new medicines and techniques because we are ingrained with the idea that "new" is better?

Dr. Abramson at one point cites an editorial that appeared in the Journal of the American Medical Association (2003; 2128-2131): "Medical research, even if it is conducted by the pharmaceutical industry, is not solely a commercial enterprise designed to minimize personal gain or company profits. The responsible conduct of medical research involves a social duty and a moral responsibility that transcends quarterly business plans or the changing of chief executive officers." It is a simple organizational fact that the first priority of leaders of any company is survival of their company; they are for-profit companies. The companies’ highest priorities are their own goals of the survival, growth and financial well being of the company. The question is whether this is the best for the public or whether pharmaceutical companies have to integrate, along with their commercial interests, a social responsibility factor into their mission that is more reflective of the "public good"

Other interested players in the healthcare game will also have to reconsider their role. Dr. Abramson points out how the cost of care and health outcomes varies by regional, ethnic and socioeconomic levels in Medicare patients with a first diagnosis of heart attack, broken hip or cancer of the colon. The source of this data is a study from the Annuls of Internal Medicine, Principal Investigators Drs. John Weinberg and Elliot Fisher. (The reference in the Notes section fails to give the year the study was published.) He concludes: "The bottom line appears to be that once an adequate amount of care is being provided, as in the lowest-spending regions of the country for Medicare patients, more care is worse care. This seems to be particularly true for the kind of care that is pushed into service by supply side pressure." (P. 180-181). Citing four features shared by the medical services that are most vulnerable to overuse because of supply-side push, Dr. Abramson involves the patient, the medical technology service providers, the doctors and the hospitals in a process that disconnects costs from health care value.

Part III is titled "Taking Back Our Health" and has three chapters: "The Knee in Room 8: "Beyond the limits of Biomedicine"; From Osteoporosis to Heart Disease: What the Research Really Shows about Staying Healthy"; "Healing our Ailing Health Care system, or How to Save $500 Billion a Year While Improving Americans' Health". The headings of these chapters speak for themselves. If you do not have the time to read this book, the last chapter is a must read. It is a concise yet comprehensive guide for the reader to understand steps to provide quality healthcare to all Americans.

Part IV: Conclusions derived from Overdo$ed America

The public may have to rid itself of the notion that the answer to all health problems lies primarily in a pill or a fancy medical procedure. People need to take some responsibility for their health by staying mentally active, eating a well balanced diet, getting regular exercise, avoiding smoking and excess alcohol. These are all proactive, preventative steps that have a strong positive influence in the health of an individual.

At the same time, the government must maintain a level of responsibility to eliminate potential environmental pollutants that are a danger to health, as well as enforcing standards of health care and drug surveillance such that they minimize the risk of medication induced mortality or morbidity. This can only come about if the government enforces its statutory clout to penalize offenders without depriving them of their right to defend themselves. At the same time, the penalty has to be severe enough to get the offender to stop.

The FDA Division of Medication Errors and Technical Support (DMETS) is the place to start to achieve these goals. They will need additional financial and political support and stronger influence on other divisions within the FDA to which they report their findings. An alternative would be the establishment of, an independent panel, similar to the independent advisory panels that exist to give recommendations for drug approval. Those serving on such a panel would not have any connection to the pharmaceutical industry I.e. a consultant positions, no pharmaceutical grant money, no equity in pharmaceutical companies etc. The panel would act in an oversight role, monitoring research studies and follow-up when drugs and medical technologies are approved for clinical use.

Fixing blame with the pharmaceutical industry, or the FDA as a standard setting organization, or healthcare providers will not solve the problem; successful change requires a team effort. All key stakeholders must work together toward the lasting changes needed to providing much more information about the real benefits of the drugs in place as well as the various advanced medical technologies in use. At the same time, the consumer must take some responsibility for maintaining good health practices, as we must expect from drivers of cars to practice safety without excusing the drug manufacturer or car manufacturer from maintaining a high degree of public safety in their product.

Description of author

John Abramson, a family medicine physician who had spent time administering to the health needs of individuals in Appalachia, was a Robert Wood Johnson Fellow at Case Western University, and then worked for 20 years in a private family medicine practice in Massachusetts. His practice was integrated into the Lahey Clinic, and he is now on the faculty of Brandeis University School of Social Policy and teaches at Harvard School of Medicine.

"this book should be read by everyone..."

2007-04-03T16:31:00.001-07:00

"The real story about the drugs we take -- this book should be read by everyone before they pop another pill." -- Susan Love, M.D., MBA

"an important act of self-care..."

2007-04-03T16:30:00.002-07:00

"Reading Overdosed America is an important act of self-care. Not only is this book essential for all those who want to intelligently reclaim responsibility for their own health, but it should be required reading for all health care professionals who are truly committed to their clients' welfare." -- Cheryl Richardson, author of Take Time for Your Life, Life Makeovers and Stand Up for Your Life

"a book every American should read..."

2007-04-03T16:30:00.001-07:00

"Most Americans assume that the scientific information provided to patients and physicians is accurate, that clinical practice is guided by science, and that as a result more medical care means better medical care. Overdosed America provides a compelling and well-documented analysis of why each of these assumptions is wrong. It is a book every American should read." -- Elliott Fisher, M.D., MPH, Professor of Medicine, Dartmouth Medical School

"fulfills all of the criteria..."

2007-04-03T16:29:00.002-07:00

"Overdosed America fulfills all of the criteria for high quality in health services: the right diagnosis and the right prescription at the right time. It is required reading for everyone: Americans will learn about the perverse incentives in their health care system, and those abroad will learn of the perils of importing what the United States is now trying to sell them." -- Barbara Starfield, M.D., MPH, University Distinguished Professor, Johns Hopkins University & Medical Institutions

"a clear explanation..."

2007-04-03T16:29:00.001-07:00

"I have taught with Dr. Abramson for several years; he is a superb family doctor, researcher, and communicator. In Overdosed America he uses these skills to present a clear explanation of how American medicine has gone astray. The book is a must-read for patients and doctorsï¿½ concerned about health and the quality of medical care."-- Herbert Benson, M.D., author of The Relaxation Response and The Breakout Principle

"reveals the greed and corruption..."

2007-04-03T16:21:00.000-07:00

"Some of the nation's worst drug dealers aren't peddling on the street corners, they're occupying corporate suites. Overdosed America reveals the greed and corruption that drive health care costs skyward and now threatens the public health. Before you see a doctor, you should read this book." - Eric Schlosser, author of Fast Food Nation

Excerpts from Chapter 14

2007-04-03T16:19:00.000-07:00

This is the mother of all sleights of hand: the transformation of medical science from a public good whose purpose is to improve health into a commodity whose primary function is to maximize financial returns. As a result of this sleight of hand, the gap is widening between the scientific evidence that impartial experts (not paid or threatened by the medical industry, not biased by other personal concerns, and granted unrestricted access to all of the evidence) would agree upon and the perceptions that actually drive American health care. This growing gap is at the core of the crisis in American medicine. And why are we surprised? The drug companies have no more responsibility to oversee the public's health than the fast-food industry has to oversee the public's diet.

The substitution of narrow corporate interests for medical progress has produced some dramatic excesses. When the manufacturer of Paxil performs nine clinical studies on the treatment of adolescents for depression and finds that Paxil is no more effective than placebos and, in fact, significantly increases the frequency of "emotional labilityï¿½ (including suicidal thoughts and attempts), it's no problem. The company publishes one study that shows a benefit, fails to publish the other eight, and markets away. When British drug authorities spill the beans? No problem. A task force of the American College of Neuropsychopharmacolgy is convened, and concludes that the new antidepressants are safe for adolescents after all. Too bad the task force didn't have access to some of the information that was available to the British drug authorities. But perhaps that didn't seem like so much of a problem, because, according to the New York Times, "Critics of the medicines noted that 9 of the 10 task force members had significant financial ties to the pharmaceutical industry. . . .ï¿½ (However, the task force insisted that no industry money financed their report.) What to do when the FDA epidemiologist in charge of analyzing all the antidepressant studies involving children concludes, just like the British drug authorities, that twice as many children treated with the new drugs (except Prozac, which is available as an inexpensive generic) became suicidal, and that the FDA should therefore discourage doctors from treating children with these drugs? Just bar the expert from testifying at the FDA's public hearing. Then don't make him available for an interview with the New York Times, which reported the story on April 16, 2004

You don't like the way the study of an expensive drug for blood pressure is going? A nonissue -- just stop the study before the results reach statistical significance.

Endovascular Technologies (a wholly owned subsidiary of Guidant, the company that manufactures implantable defibrillators) manufactured a $10,000 device to repair aortic aneurysms that dangerously malfunctioned in a third of the 7600 patients in whom it had been used. Did this frequency of malfunction stop Endovascular Technologies? No. The company reported 7 percent of these events to the FDA and sold on. According to a plea agreement entered into with the United States government in 2003, the company belatedly disclosed another 2628 serious malfunctions and 12 deaths. No problem. It agreed to pay $92 million to cover criminal and civil penalties and then picked up with business as usual on other products.

Your drug company just received an official warning letter from the FDA for the "false and misleadingï¿½ marketing of Celebrex, Vioxx, Pravachol, or OxyContin? No problem. The FDA's corrective action is unlikely to displace the false information already firmly planted in the public's mind.

And the list goes on. Controlling medical costs in this near free-for all commercial grab is not just impossible, it is a contradiction in terms. Does it make sense to talk about reducing national expenditures for cars or clothes or beer? Medical care, by far the largest consumer commodity in the United States, is now no different.

Welcome - Message to Readers

2007-04-01T11:43:00.000-07:00

Hello Friends, Welcome to my website. Here you will find regular updates about my efforts to assure that you are getting unbiased health care information.
....

Thank you for your courage...

2007-03-27T15:46:00.001-07:00

Dear Dr. Abramson, thank you for your "Overdosed America" I learned about one week ago from People's Pharmacy and from you. Thank you for your courage to write and to speak about this horrible topic, that is embarrassing the USA.

As a neurologist, several years ago I started to protest against over-advertised Interferons for Multiple Sclerosis.Learning that statins if taken too long, damage muscles and nerves including heart muscle, I tried to share this message with patients and with Cardilogists. No success. Seeing patients overtreated with antipsychotics and antidepressants and developing either unvoluntary movements or seizures I tried inform patients and reach psychiatrists. I lost my job.

Some of above medications can be helpful when taken not too long and not too much. Even Bextra and Vioxx could be of great help to people if taken for very short period of time and only periodically.

If I can be of any help in this matter please let me know. Thank you again.
Kindly. Joanna Woyciechowska, MD, PhD, BC Neurologist.

"When Health Policy is the Problem" with Bruce Spitz in The Journal of Health Policy, Politics, and Law (editorial)

2007-03-26T11:46:00.001-07:00

"The contribution by Spitz and Abramson...might be best thought of as an admonitory tract, the sort of piece that Thomas Paine was prone to write in prior to the American Revolution.

Cold-hearted tug fails women

2007-03-23T15:53:00.000-07:00

Cold-hearted tug fails women: 'Go Red' overlooks all the hidden risks
By JOHN ABRAMSON and JUDY NORSIGIAN

[This article was originally published in the Atlanta Journal-Constitution on February 2, 2007, in response to the "Go Red for Women Day" campaign.]

The "Go Red for Women Day" campaign today to increase awareness of heart disease and stroke should be called "See Red for Women Day."

Despite being endorsed by some of our most trusted institutions like the American Heart Association and the National Heart, Lung, and Blood Institute, this event isn't just about protecting your health. It's also about exploiting your concerns about health.

Remember that it was only a few years ago that post-menopausal women and their doctors were being told that hormone replacement therapy would help women live longer and prevent heart disease, stroke, and Alzheimer's Disease. And for women unconvinced by these promises, celebrity icons of female allure, like Lauren Hutton, were hired to make the case a different way.

Women with access to the best health careâ€”better educated, wealthier, receiving more preventive care â€”were the most likely to be among the many millions of women without menopausal symptoms who took hormones believing they were protecting their health. But these women probably weren't aware that, notwithstanding the definitive recommendations of many experts, there hadn't been a single gold standard clinical trial showing these near-miraculous claims to be true. The Women's Health Initiative finally debunked these grandiose claims and led to the reduction in hormone use that is almost certainly the reason for the recent drop in breast cancer incidence.

Back to the present and the Go Red for Women campaign with its slogan, "Fight the Number 1 Killer of U.S. Women." Yes, heart disease is the number one killer, but at some point, hopefully at a ripe old age, all of our hearts will stop beating. For women under the age of 75, cancer claims 78 percent more women's lives than heart disease. Yes, you should "know your numbers," as the Go Red campaign suggests, but not the ones you're probably thinking of - your cholesterol levels and the thresholds set by the National Cholesterol Education Program's guidelines for starting a cholesterol-lowering statin drug.

These guidelines recommend that women without heart disease who have two or more risk factors and a "moderately high" risk of heart disease be "offered" statin therapy, if their bad cholesterol (LDL) level is 100 or higher. The experts who formulated the guidelines insist that their recommendations are based on scientific evidence from recent clinical trials.

But it's just like the hormone replacement therapy story. The experts who wrote the guidelines cite seven studies that they claimed show cholesterol-lowering statins to be beneficial for such women with a 10-20 percent risk of developing heart disease in the next 10 years. But, as one of us (JA) pointed out in a recent peer-reviewed article in the respected British medical journal the Lancet, there has never been a single clinical trial showing that statin therapy is beneficial for women who don't already have heart disease or diabetes. Not one. Even the guideline authors admit that clinical evidence to support their recommendations is "generally lacking" and that their recommendations are made by "extrapolation of data from men."

We think this is exploitation not extrapolation.

Women are different from men in many ways, including heart disease risk. Furthermore, the experts who have access to the results of all the major clinical trials know whether the combined data really show whether statins benefit women who don't already have heart disease or diabetes. But the experts aren't saying. With 13 out of 14 of these studies sponsored by drug companies that market statins, one would have expected widespread publicity if the data do, in fact, show a significant benefit for women.

There are much more important numbers for women to focus on, such as: how many times a week they exercise (ideally at least several times); how many servings of fruits and vegetables we eat daily (ideally five or more); how often we eat red meat (ideally less than a pound a month); how many grams of trans fats we eat (ideally 0); and how often we smoke (ideally never) or drink (ideally not more than two alcoholic drinks in a day).

Taking statin pills certainly requires less effort than living a healthier lifestyle. And taking a statin would almost certainly lower your cholesterol numbers. But there's no evidence that it would achieve the real goal: reducing your risk of heart disease or improving your overall health.

With this much confusion, we'd like to be able to turn to our doctors for advice. But they, too, are influenced by the drug companies' spin as well as pressure to follow the guidelines' exaggerated recommendations. They also may be unaware of the growing evidence pointing to adverse effects of these drugs.

Complicating the statin issue even more for women, the five studies of statins that examined the risk of breast cancer found a 33 percent higher rate in women taking statins than in those taking placebos. There were not enough women in these studies to make this increase statistically significant, but clearly more research is needed here. In fact, a large clinical trial based at the University of California, San Diego, is now quantifying the extent to which statin users experience a variety of adverse effects.

Pfizer, one of the sponsors of the "Go Red for Women" campaign and the maker of the best-selling drug of all time â€“ the cholesterol-lowering drug Lipitorâ€”may want you to think that taking statins is the best way to avoid heart disease. But what you can do for yourself is much more important than what any pill can do for you.

John Abramson MD is the author of "Overdosed America," a clinical instructor at Harvard Medical School, and serves as an expert consultant to plaintiffs' attorneys in litigation involving the drug industry. Judy Norsigain is executive director of Our Bodies Ourselves, a nonprofit women's health education and advocacy organization.

Excerpts From Chapter 13

2007-03-23T13:47:00.000-07:00

In 1995, Fosamax, the brand name for alendronate, was the first of the new generation of drugs approved by the FDA for the treatment of osteoporosis. Fosamax works by attaching itself to the surface of bone, interposed between the osteoclasts and the bone the osteoclasts are trying to absorb. Randomized clinical trials of Fosamax published in medical journals show dramatic reductions in the relative risk of hip fracture for women with osteoporosis. In a study published in JAMA in 1998, for example, women with an average age of 68 and a T score of - 2.5 or less who took Fosamax for four years were 56 percent less likely to suffer a hip fracture than women in the control group.

This sounds like very good news for women with osteoporosis, but how many hip fractures were really prevented? With no drug therapy at all, women with osteoporosis had a 99.5 percent chance of making it through each year without a hip fracture -- pretty good odds. With drug therapy, their odds improved to 99.8 percent. In other words, taking the drugs decreased their risk of hip fracture from 0.5 percent per year to 0.2 percent per year. This tiny decrease in absolute risk translates into the study's reported 56 percent reduction in relative risk. The bottom line is that 81 women with osteoporosis have to take Fosamax for 4.2 years, at a cost of more than $300,000, to prevent one hip fracture. (This benefit does not include a reduction of less serious fractures, including wrist and vertebral fractures. Most vertebral fractures cause no symptoms.)

[. . . ]

What about using these drugs to prevent osteoporosis? Fosamax and Actonel were approved by the FDA to treat women with osteopenia based on studies that showed that they significantly increase the bone density of these women. It is important to remember, however, that bone density is only a surrogate end point; the real reason for taking these drugs is to reduce fractures, and hip fractures in particular. The study of Fosamax published in JAMA in 1998 (mentioned earlier) also included women with osteopenia. Did Fosamax reduce their risk of fracture? The results show that the risk of hip fractures actually went up 84 percent with Fosamax treatment.* The risk of wrist fractures increased by about 50 percent (that figure may be statistically significant -- but this can't be determined from the data as presented in the article).

How can it be that drugs approved for the prevention and treatment of osteoporosis succeed in increasing bone density but have such limited impact on reducing hip fractures? The answer can only inspire awe at Mother Nature's elegance. There are two types of bone. Eighty percent of the body's bone is made up of the hard and dense outer layer called cortical bone. In some areas of the body, bones also have an internal structure of trabecular bone, which works like an organic three-dimensional geodesic dome, providing additional strength in the areas of the skeleton most vulnerable to fracture, such as the hips, wrists, and spine.

The lacelike structure of trabecular bone creates a much greater surface area than the densely packed cortical bone and therefore allows the former to be more metabolically active when the body needs calcium. Its greater metabolic activity also makes trabecular bone more vulnerable than cortical bone to the changed balance between osteoclast and osteoblast activity. As a result, when bone mass starts to decline in women, trabecular bone is lost more quickly than is cortical bone. Once the architecture of these internal struts is lost, there is no structure left onto which calcium can be added. (See Figure 13-1.) The new bone, formed as a result of taking the osteoporosis drugs, is then formed primarily on the outer part of the bone, the cortical bone. This increases the score on the bone density test but does not necessarily contribute proportionately to fracture resistance.

From one physician to another - THANK YOU

2007-03-23T10:20:00.000-07:00

A reader who is "unsupervized" (Dallas, TX USA)

I have been a physician for 10 years. I have seen my profession gradually being taken over by the pharmaceutical industry. I have seen countless patients harmed - alas even killed - by drug reactions and polypharmacy.

I have sat and listened to countless drug representative presentations that were outright falsehoods and misrepresentations. It has been months - maybe even years that I have had available to me a medical education conference that was not somehow tainted by drug company money and therefore propaganda.

I have repeatedly had patients in my office begging me for medication that they do not need. They want it simply because it was on TV News last night - and came with a promise of metaphysical salvation. I spend much time every day dissuading patients from taking medication they simply do not need - indeed may even cause real medical problems.
The issues that are discussed in this book are very very real - and the scary part is I do not see my fellow physicians doing a single thing to address these huge problems.

Dr. Abramson - thank you for hopefully what will be the opening salvo in a very important battle.

Publisher's Overview

2007-03-23T10:16:00.000-07:00

We all know that health care and prescription drug costs are skyrocketing, but few doubt the excellence of American medicine. John Abramson, M.D., an award-winning family doctor on the clinical faculty at Harvard Medical School, reveals, in the same clear language that he used with his patients, how the corporate takeover of clinical research and medical practice is compromising Americans' health. You -- and your doctor -- will be stunned by his findings.

For twenty years, Dr. Abramson cared for patients of all ages in a small town north of Boston. But increasingly his role as family doctor was undermined as pressure mounted to use the latest drugs and high-tech solutions for nearly every problem. Drawing on his background in statistics and health policy research, he began to investigate the radical changes that were quietly taking place in American medicine.

At the heart of the crisis, he found, lies the changed purpose of medical knowledge -- from seeking to optimize health to searching for the greatest profits. The lack of transparency that has become normal in commercially sponsored medical research now taints the scientific evidence published in even our most prestigious medical journals. And unlike the recent scandals in other industries that robbed Americans of money and jobs, this one is undermining our health.

The hormone replacement debacle, it turns out, is not an isolated case. The same kind of commercial distortion now pervades the information that doctors rely upon to guide the prevention and treatment of common health problems, from heart disease to stroke, osteoporosis, diabetes, and osteoarthritis.

The good news, as Dr. Abramson explains, is that the real scientific evidence shows that many of the things that you can do to protect and preserve your own health are far more effective than what the drug companies' top-selling products can do for you -- which is why the drug companies work so hard to keep this information under wraps.

In what is sure to be one of the most important and eye-opening books you or your doctor will ever read, John Abramson offers conclusive evidence that American medicine has broken its promise to best improve our health and is squandering more than $500 billion each year in the process.

Isn't it time to learn the facts, discuss these issues with your doctor, and reclaim the good health and medical care that all Americans deserve?

Recent Speaking Appearances, 2007

2007-03-21T10:32:00.000-07:00

Harvard Medical School Continuing Education: Mind/Body Medicine Clinical Training
Boston MA. 02.25.07

Indian Health Services, National Combined Councils "Can We Trust the Evidence in Evidence-Based Medicine"
San Diego CA. 02.13.07

Harvard Medical School: "Why Primary Care Don't Get No Respect"
Boston, MA. 02.08.07

Gila River Health Indian Community Health Center: "The Growing Gap Between Evidence-Based Medicine and Good Health Care"
Sacaton, AZ. 02.06.07

Renown Medical Center, Grand Rounds
Reno, NV. 02.05.07

Sutter Medical Center, Family Medicine Grand Rounds
Santa Rosa, CA. 02.02.07 - 02.04.07

McDougall Program Health Conference
Santa Rosa, CA. 01.25.07

Dept. of Psychiatry Grand Rounds, Massachusetts General Hospital, Boston, MA 10/5/07
North Atlantic Health Sciences Libraries, When the Facts Aren’t True, What’s a Librarian to Do?, Woodstock VT, 10/29/07

Prescription Access Litigation Dinner, Keynote Speech
Washington, D.C. 01.25.07

Panelist at George Washington University: Relations with the Pharmaceutical Industry,
Washington, D.C. 01.25.07

new book!

2007-03-19T15:24:00.000-07:00

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Introduction

2007-03-11T12:07:00.000-07:00

Just before I left my practice to write this book, one of my longtime patients, Mrs. Francis, came in for a visit. I always enjoyed seeing Mrs. Francis, a widow then in her mid-eighties. Her greeting was warm and her presence made the exam room feel comfortable - an oasis in the midst of daily time pressures, multiple tasks, and complex patient challenges. During this visit, Mrs. Francis asked why I was leaving. This wasn't just a casual question, nor did I feel that she was prying. Over the years, we had enjoyed many conversations, and I felt as if she genuinely wanted to understand what had gone into my decision. I did my best to explain.

I told her that over the last few years a profound shift had been taking place in the culture of American medicine. I explained that tests unlikely to improve patient care were being routinely ordered and expensive drugs that had not been shown to be any more effective or safer than the older drugs they were replacing were being routinely prescribed. I told her that the research I had been doing at night and on weekends was confirming my sense that much of the ï¿½scientific evidenceï¿½ on which we doctors rely to guide our clinical decisions was being commercially spun, or worse; and that many of the articles published in even the most respected medical journals seemed more life infomercials whose purpose as to promote their sponsors' products rather than to search for the best ways to improve people's health.

I told her that many of my patients were being drawn in by the growing number of drug ads and medical news stories; that patients were increasingly arriving for their visits with a firm (if not fixed) idea of the outcome they wanted instead of the expectation that the best medical care would emerge from open discussion of their symptoms, concerns, and exam and then mutual consideration of the options. I told her that when I tried to refocus patients on interventions proved to be safe and effective, many were reacting as if I were purposely trying to withhold the best treatment, making me choose between providing the best care and yielding to their demands in order to maintain the healing potential of our relationship. Finally, I told her that I had come to the conclusion that the best way I could help people to achieve better health was to find out what the scientific evidence really shows and explain this to the public - in much the same way that she and I had talked over the years - and to other medical professionals.

That was the best answer I could give Mrs. Francis at the time. I wasn't sure what I was going to find when I turned my full attention to these issues. But it was becoming clear that American medicine was like a runaway train picking up speed, fueled by the commercially generated belief that ever-increasing medical spending is necessary to achieve good health. It was also becoming clear that the train's brakes were failing. It seemed to me that, despite a few clear and brave voices, there was no effective counterbalance to the influence of commercially sponsored research. Nor was there even a way to determine whether all this expensive new care actually led to better health. And it as also clear that this crisis would soon come to a head when the burden of relentlessly increasing medical costs became more than many Americans could bear.

What I found over the next two and a half years of ï¿½researching the researchï¿½ is a scandal in medical science that is at least the equivalent of any of the recent corporate scandals that have shaken Americans' confidence I the integrity of the corporate and financial worlds. Rigging medical studies, misrepresenting research results published in even the most influential medical journals, and withholding the findings of whole studies that don't come out in a sponsor's favor have all become the accepted norm in commercially sponsored medical research. To keep the lid sealed on this corruption of medical science - and to ensure its translation into medical practice - there is a complex web of corporate influences that includes disempowered regulatory agencies, commercially sponsored medical education, brilliant advertising, expensive public relations campaigns, and manipulation of free media coverage. And last, but not least, are the financial ties between many of the most trusted medical experts and the medical industry.

Excerpted from Overdosed America. Copyright Â© 2004 by John Abramson, M.D. All rights reserved. Harpercollins Publishers.

An inspiration to the medical community...

2007-02-19T15:41:00.000-08:00

I can't think of a word to express my feelings to Dr. Abramson's book. Maybe a thank you will do... He is an inspiration to the medical community. I wish our doctors that I work has the same compassion and dedication as he has, a good heart and a genuine concern to his fellow human being. Very few could do what he has done.

Respectfully yours,
Gardenia M. Shrine, RN

Gardenia, Thanks so much for your kind words.

Wishing you all the best,
John Abramson MD

How can we get the media involved in educating the public?

2007-02-19T15:38:00.000-08:00

Dr. Abramson,

Thank you for your excellent work in "Overdosed America". I wish more Americans would take the time and interest in learning why our health care system is broken and how it is affecting our society.

How can we get the media involved in educating the public about what is really going on with the drug companies, FDA, etc.?

Ellen Small
Pittsburgh

Ellen, The most important thing to do is contact your local media and let them know that you are interested in hearing the high cost and low quality of our health care, as well as the role that the drug companies are playing in distracting our attention and resources from the most important ways to protect and preserve our health. Remember that the $4.6 billion spent each year on advertising to the pubic by the drug industry creates some incentive for the media to be supportive of the drug industry. That's why it's so important to make your opinions known.

All the best,

John Abramson MD

I am a health services researcher and really enjoyed your book...

2007-02-05T16:14:00.000-08:00

I am a health services researcher and really enjoyed your book, Overdosed America. I would like to cite it in my own work and was wondering if an electronic copy was available so I could more easily cite some of the many great passages that you include.

Thanks,
Lisa Maiuro, MSPH, Ph.D.

I am a health services researcher and really enjoyed your book...

2007-02-05T15:43:00.000-08:00

your discussion on WOR radio...

2007-02-02T15:46:00.000-08:00

I caught a small amount of your discussion on WOR radio the other night with Dr. Hoffman. I take a statin and was looking for that publication you mention in that english journal of medicine. Do you have a link I can use to read.
Thanks
Bob Foley

Bob, There will soon be a couple of article posted on the web site that will be helpful, and there is a whole chapter in Overdosed America that discusses medical studies and recommendations about cholesterol-lowering drugs.

All the best,
John Abramson MD

I have familial hypercholesterolemia...

2007-02-01T15:47:00.000-08:00

Hi,
I had the opportunity to hear part of your appearance on Dr. Hoffman's radio program. I am very interested in the topic of statins. I take Lipitor (and Zetia) for my high cholesterol. I have familial hypercholesterolemia. My total cholesterol without the medication is about 420-430. With the medication it is about 200-220. Do you have information about how people with familial hypercholesterolemia can be helped without the statins? Any information would be greatly appreciated. Thanks...Bill

Bill, We don't have evidence from clinical trials specifically about familial hypercholesterolemia. My hunch is that the program you are on is redcing your risk of developing heart disease. But please don't forget that routine exercise, eating a healthy Mediterranean style diet, not smoking, and drinking in moderation each at least as important as the statin for you. You will get a much better picture from the discussion in Overdosed America about the relative importance of each of these "interventions."

All the best,
Dr. A

Recent Speaking Appearances, 2006

2006-12-21T10:48:00.000-08:00

Washington University, "Pharm-Free Day"
St. Louis, MO. 11.28.06

University of New Hampshire, Masters in Public Health Program Grand Rounds
Durham, NH, 11.07.06

American Public Health Association: "Drug manufacturers, the FDA, and U.S. health care"
Boston, MA. 11.04.06 - 11.05.06

Sharp Rees Steely Medical Group of San Diego, Continuing Medical Education
Laguna Cliffs, CA. 10.04.06 - 10.05.06

"I am constantly amazed by the way the media twist the facts about prescription drug"

2006-12-08T16:12:00.000-08:00

Bought your book and loved it. I am very motivated to get even more exercise, lose weight and eat right, which I try to do anyway, but this was a big encouragemen. Thank you.

I am constantly amazed by the way the media twist the facts about prescription drugs. It was so blatent this morning on the CBC morning show where their resident doctor was strongly encouraging people to take their statin medicines (at a even higher dose, and even if they have no history of heart disease, and how it is just terrible how people are so noncompliant) and immediately after her segment, the announcement that this was sponsored by Brisol-Myers Squibb. I believe they make Pravachol.
Keep up the good work at educating people.

Of note, my husband and I are in our late 50s, have never taken any prescription drugs (except antibiotics for root canal), have excellent cholesterol and blood pressure, and have never had any type of surgery. I was encouraged to take hormone replacement a few years ago which I declined and feel better now than at any other time in my life. Menopause is great.

Joan K

Joan, Thanks for your kind words. I am happy to have played even a small role in your improved health habits. The bottom line about statins for women is that there is still not a single randomized controlled trial that shows that statins are beneficial for women who don't already have heart disease or diabetes. But there is good evidence that women who adhere to healthy lifestyle (regular exercise, Mediterranean style diet, not smoking, drinking in moderation, and maintaining a reasonable body weight) develop 80% less heart disease than the women who don't do those things (but only 3% of American women follow these healthy habits). So keep up the good work and I hope that you have a primary care doctor with whom you can talk honestly about these issues.
All the best,
Dr. A

"one of the great challenges facing American medicine"

2006-12-08T15:56:00.000-08:00

Great stuff. You have hit on one of the great challenges facing American medicine with powerful intelligence, clarity of thought and the stones to call it like it is. Making physicians aware of the problem is a good thing, but I fear that changing the culture from the physicians' side of the equation will not happen in our lifetimes. I think we agree the solution will probably be political when the economic pressures to reduce medical costs reach a boiling point. We are close if not already there. It will be interesting too see if the gov't. has the will to do battle with big Pharma. P

P.R. MD

"I am constantly amazed by the way the media twist the facts about prescription drug"

2006-12-08T15:49:00.000-08:00

I Bought your book and loved it. I am very motivated to get even more exercise, lose weight and eat right, which I try to do anyway, but this was a big encouragemen. Thank you.

I am constantly amazed by the way the media twist the facts about prescription drugs. It was so blatent this morning on the CBC morning show where their resident doctor was strongly encouraging people to take their statin medicines (at a even higher dose, and even if they have no history of heart disease, and how it is just terrible how people are so noncompliant) and immediately after her segment, the announcement that this was sponsored by Brisol-Myers Squibb. I believe they make Pravachol.
Keep up the good work at educating people.

Of note, my husband and I are in our late 50s, have never taken any prescription drugs (except antibiotics for root canal), have excellent cholesterol and blood pressure, and have never had any type of surgery. I was encouraged to take hormone replacement a few years ago which I declined and feel better now than at any other time in my life. Menopause is great.

Joan K

Joan, Thanks for your kind words. I am happy to have played even a small role in your improved health habits. The bottom line about statins for women is that there is still not a single randomized controlled trial that shows that statins are beneficial for women who don't already have heart disease or diabetes. But there is good evidence that women who adhere to healthy lifestyle (regular exercise, Mediterranean style diet, not smoking, drinking in moderation, and maintaining a reasonable body weight) develop 80% less heart disease than the women who don't do those things (but only 3% of American women follow these healthy habits). So keep up the good work and I hope that you have a primary care doctor with whom you can talk honestly about these issues.
All the best,
Dr. A

Radio Interview, Florida NPR

2006-12-08T11:23:00.000-08:00

"9 out of 10 Americans are concerned about the cost of health insurance".

"Medical student debt is pushing idealist young students toward specialties instead of primary care..."

"To insure all Americans would cost about two hundred billion dollars, and we're wasting six hundred and fifty billion on health care that's unnecessary or harmful".

op-ed from the LA Times: "Healthcare Code Blue"

2006-11-03T11:25:00.000-08:00

Not only do Americans spend more than anyone else on health care, much of what we buy isn't the best stuff.
By John Abramson

JOHN ABRAMSON, a clinical instructor at Harvard Medical School, is the author of "Overdosed America."

November 3, 2006

IF AMERICAN MEDICINE were a patient, he would weigh 350 pounds and be gaining fast. Despite being repeatedly counseled about the dangers of morbid obesity, he would be making at best half-hearted attempts to mend his gluttonous ways. Meanwhile, his doctors, insurance company, politicians and regulators would remain in a deep state of denial, clutching the illusion that their patient, other than being a bit overweight, was in tip-top health.

Truth be told, the U.S. medical system is headed for multiple organ failure.

The spiraling cost of healthcare is well known: $7,100 per person this year, projected to increase to $12,000 in 2015 and compounding at more than double the rate of inflation. Already, medical care gobbles up one-sixth of the GDP. Even so, we ask ourselves, how better to spend our money than on the best healthcare in the world?

Not so fast. The facts show that these enormous expenditures may be buying us the best amenities in medical care â€” but not the best health.

For example, Canada spends only 60% as much per person on healthcare as the United States . Yet, since 1980, the longevity of all Canadians has improved more rapidly than that of only white Americans. (In other words, these statistics aren't skewed by the unconscionable racial and socioeconomic disparities in U.S. health and healthcare.) Yes, the "queues" in Canada can involve delays in nonemergency care. But these could be shortened with relatively small increases in funding. An article in the U.S. journal Health Affairs investigating the number of Canadians who come here to avoid these waits found the number so small that it asked, "A tip with no iceberg?"

Britain spends only 40% as much as we do on healthcare. But according to the Journal of the American Medical Assn., middle-class insured Americans "are much less healthy than their English counterparts" (who are insured because all Brits are insured).

In fact, although Americans spend twice as much per person on healthcare as the other 21 wealthiest countries, data from the World Health Organization show that we live the shortest amount of time in good health â€” 2 1/2 years less than the average in the other countries ( 69.3 versus 71.8 years).

Reviewing a Dartmouth Medical School study that found higher mortality rates in areas that spent the most on Medicare, professor Elliott Fisher concluded that "perhaps a third of medical spending is now devoted to services that don't appear to improve health or the quality of care â€” and may make things worse." This means that the U.S. is wasting more than $650 billion a year â€” half again more than the entire Defense Department will spend this year, including the cost of the war in Iraq â€” on unnecessary and often harmful care.

How can this be? One factor is specialists. Both U.S. and international studies show that the more a healthcare system relies on primary care, the better the outcomes and the lower the cost. But American medicine is heavy on specialists and getting heavier. In just the last eight years, the number of graduates of U.S. medical schools choosing careers in family practice and adult primary care has plummeted by more than half. Americans know they're paying more â€” and fear they're getting less. A Kaiser Family Foundation poll this month found that nine out of 10 consider the following issues important in determining their vote Nov. 7: problems with quality of their healthcare; the cost of health insurance and prescription drugs (the U.S. is the only industrialized country that lets drug companies charge whatever the market will bear); and the number of uninsured (47 million and growing by 1 million a year).

One would think that politicians would be eagerly tapping into these strong voter sentiments. So why are we hearing so little about healthcare as the election nears? Is this because politicians on both sides of the aisle are being influenced by the powerful medical industries? Certainly this plays a role. But there is an even more basic reason. Our government has become almost fundamentalist in its reliance on market-based, pro-business solutions to social problems. No politician wants to be tarred with the charge of promoting "socialized medicine."

The problem is, our healthcare system is exquisitely well designed to maximize profits but exquisitely poorly designed to provide the best healthcare most efficiently. And even our nonprofit medical institutions shape the care they offer based on their own bottom lines instead of the health needs of the communities they serve.

In Washington, we've got a Food and Drug Administration that's much better at protecting the interests of the drug and medical-device industries than those of patients.

And even in the midst of this pivotal congressional election campaign, few politicians are addressing the crisis in affordable, quality healthcare. Is this any way to run a democracy?

Back to our patient, American medicine. He'll probably end up getting stomach-shrinking surgery at a cost of $27,000. Unless he's one of the unlucky 40% who develop complications, in which case it could cost $65,000 or more. We all deserve better.

From a doctor of 25 years

2006-08-19T15:57:00.000-07:00

Dr. Abramson,

Just what I was looking for and now I want more. I was family doctor for ten years. Then I did my own thing for ten years. Then I worked in drop in clinics - supermarket medicine. Now I am back in family practice or giving it a go.

Just had walk along Ahipara beach with my wife. Topic of conversation - my future. Do I want to work as a pill pusher? The polypharmacy going on where I am at the moment astounds me. Pushing pills onto people who have no desire for them or understanding what they are taking them for - mind blowing. This place is low decile area.

Last night at a peer review group meeting it was apparent that most docs in the room would not be prescribing to themselves what they do for their patients?
It's extraordinary!

My dad was a family doc in rural setting - he was so proud of his work and what he did for his patients. Now ones smells cynicism creeping in everywhere. Jerome Hoffman suggest we be skeptical not cynical - tricky to maintain this balancing act.

How often have I heard recently docs talking about putting their kids off from taking up medicine.

My brother is GP in UK. He talks of ticking boxes and prescribing as per guidelines so money comes into his practice. Some of these guidelines he disagrees with. You want the money doc - do what you are told.

Your book is fantastic. You let the facts speak for themselves. I do hopem it has a profound impact.

I want more - especially with regards to information on drugs.

Thank you
Dr. Andrew B.

Dr Andrew,

Thanks for you kind note. I certainly understand your predicament. The best sites that I know of to get good information about drugs are Therapeutics Initiative ( http://www.ti.ubc.ca/ -British Columbia), the Oregon Drug Effectiveness Review Project ( http://www.ohsu.edu/drugeffectiveness/reports/final.cfm ) and the National Instititue of Clinical Excellence ( http://www.nice.org.uk/ United Kingdom).

Though easy to get discouraged, it is all the more important to do good work.

All the best,

John Abramson MD

From a nurse practitioner working in correctional health

2006-08-10T15:59:00.000-07:00

Hi, John
Just now listening to your last interview on C2C â€” I get behind. You are not only my hero but my role model as well; I am a 62-year-old man, a nurse practitioner working in correctional health. All my patients are convicted felons, every one of them. However, they are all someone's father, brother, son â€” someone's loved one and I do my best.
On the upside of correctional medicine, all the drugs I prescribe are generics and I never have to stop to talk with drug detail reps â€” never! Yes, I agree with you on almost everything; my exception is your comment about salt.
The ancient word for salt was 'hal'; hence, I would assume that halitosis really means that a person's breath smell like salt. In that case, 'hallelujah' may translated to: "Glory be, I found the salt". Throughout the ages, civilized people highly prized and paid dearly for sodium. So, why is it now so bad for our health? Where can I access information that salt restriction is actually beneficial?
Thank you,
Keith

Keith,

Thanks for your kind letter. On the salt issue, you may be correct for most people--but nobody's yet figured out how to identify the people are who are going to be harmed by salt. The Center for Science in the Public Interest wrote an excellent epidemiological piece about the harms of salt (available on the internet). This issue may be analogous to the push to give all school children Hepatitis B vaccine, choosing to immunize everyone when it's still possible to be sure to immunize those children who will go on to adopt high risk lifestyles and behaviors in the future.

Not sure about how best to procede on salt, but I am sure that the work that you are doing with prison inmates is tremendously important--a health care provider treating prisoners as fundamentally worthy human beings is probably the most rehabilitative thing that can be done. So please keep up the good work and know that giving even one person the opportunity to see himself as worthy is a great achievement.

All the best,

John Abramson MD

Thanks for writing the book, and a case history about sleep

2006-02-15T16:15:00.000-08:00

Dear Dr. Abramson,
Thank you for doing all of the legwork for this book!! Being employed on the fringe of the medical profession, I've had my suspicions regarding this and have always tried to avoid prescription drugs as a general rule and have always been fairly healthy and active. However, I was having some problems with excessive sleepiness and after what I believe was a very thorough workup (thyroid, Lyme, etc) I was referred for a sleep study; overnight and MSLT the next day. I was diagnosed with "CNS Hypersomnolence", a cousin to narcolepsy. I don't think the MSLT neurological study was a "lie" but this resulted in me going down the slippery slope of trial and error of various types of stimulants until I found the one that I could tolerate, i.e. Adderall XR and Adderall "regular", of which I was taking both types each day and I STILL couldn't stay awake, and the up/down action of the medication was very annoying. I informed my practitioner that I didn't want to be on these for the rest of my life, and also informed my "sleep specialist" of the same. I was told that I'd be endangering myself and more importantly, others by not taking the medications. I work at home and rarely have to drive anywhere, but through research and consultations with alternative practitioners, I have found a safe, effective way to stay awake through nutritional supplements and herbal remedies. I still have to take a nap now and then but I can actually sit down and not fall asleep, watch a whole movie and stay awake, walk my dog and stay awake, etc. It is much easier on my wallet to buy 2 boxes of herbal tea and a few vitamins a month rather than pay for clinic visits and 2 potentially addictive prescription drugs. I don't believe we (humans) were meant to live as our culture and economy now dictate and the govt. and drug companies know it, are fabricating diseases as well as telling us to "make time for 8 gazillion other things" for a more fulfilling life, and giving us all the pills we need in order to do that. Well, I'm refusing to be a sheep.

Thanks for writing the book, and a case history about sleep

2006-02-15T16:03:00.000-08:00

Dear Dr. Abramson,
Thank you for doing all of the legwork for this book!! Being employed on the fringe of the medical profession, I've had my suspicions regarding this and have always tried to avoid prescription drugs as a general rule and have always been fairly healthy and active. However, I was having some problems with excessive sleepiness and after what I believe was a very thorough workup (thyroid, Lyme, etc) I was referred for a sleep study; overnight and MSLT the next day. I was diagnosed with "CNS Hypersomnolence", a cousin to narcolepsy.I don't think the MSLT neurological study was a "lie" but this resulted in me going down the slippery slope of trial and error of various types of stimulants until I found the one that I could tolerate, i.e. Adderall XR and Adderall "regular", of which I was taking both types each day and I STILL couldn't stay awake, and the up/down action of the medication was very annoying. I informed my practitioner that I didn't want to be on these for the rest of my life, and also informed my "sleep specialist" of the same. I was told that I'd be endangering myself and more importantly, others by not taking the medications. I work at home and rarely have to drive anywhere, but through research and consultations with alternative practitioners, I have found a safe, effective way to stay awake through nutritional supplements and herbal remedies. I still have to take a nap now and then but I can actually sit down and not fall asleep, watch a whole movie and stay awake, walk my dog and stay awake, etc. It is much easier on my wallet to buy 2 boxes of herbal tea and a few vitamins a month rather than pay for clinic visits and 2 potentially addictive prescription drugs. I don't believe we (humans) were meant to live as our culture and economy now dictate and the govt. and drug companies know it, are fabricating diseases as well as telling us to "make time for 8 gazillion other things" for a more fulfilling life, and giving us all the pills we need in order to do that. Well, I'm refusing to be a sheep.

Praise from a pulmonary specialist of 20 years

2006-01-18T16:05:00.000-08:00

Feedback:

I just got your book today; started reading it after dinner; and kept on going until I was done. It has inspired me to enhance my efforts to reduce the influence of big pharma on the clinical practice guidelines, clinical research, and prescription habits of pulmonary specialists. During my 20 years of practice, I have seen all of this first-hand. Thanks for taking the time to research and write this superb book. P.E., MD

Dear Dr. P.E.,

Thanks for your comments. Even after spending 4 years in front of a computer what feels like 24/7 trying to unravel the commercial bias intruding into medical care, I am constantly surprised. Like this example that I missed the first time around from the recent JAMA meta-analysis about statins and cancer:

The article concluded:

"CONCLUSIONS Statins have a neutral effect on cancer and cancer death risk in randomized controlled trials. We found that no type of cancer was affected by statin use and no subtype of statin affected the risk of cancer.
JAMA. 2006;295:74-80
www.jama.com"

But this is just not true. The following table, from the same article shows a 33% statistically significant increase in the risk of breast cancer:

Table 2. Subgroup Analysis
____________________No. of Events/ ______________________
_________________Total No. of Participants __________________
_________________|=============|_____________________
Outcome____No. of___Statin___Control____Odds Ratio ___Q Stat__
Measures___Studies___Group___Group____(95% Conf) ___P Value_
Breast cancer __ 5 ___ 81/16875 __ 64/16901 __ 1.33 (0.79-2.26) ___ .047

This is a particularly important finding, given the lack of evidence of benefit of statins for primary prevention. And even for secondary prevention in women, statins reduce further CV events and mortality, but have not been shown to reduce overall mortality.

You are doing a great service to your patients by your dedication to real scientific evidence. But, I know this is a real challenge because the commercial and sociological currents are strong going in the other direction.

Wishing you all the best,

John Abramson

Drug profits infect medical studies (L. A. Times op-ed by Dr. Abramson)

2006-01-07T11:28:00.000-08:00

Several of our most venerated scientific journals have recently been besmirched by allegations of scientific misconduct. Shocking? We should be just as shocked as Inspector Renault when he discovered gambling at Rick's Cafe in Casablanca.
(Read the full story at LATimes.com)

Mistrial in Merck case -- video of Dr. Abramson on CNN/Money

2005-12-12T11:30:00.000-08:00

A federal judge declared a mistrial today in a lawsuit brought against Merck and its painkiller, Vioxx. Read the article on CNN/Money, which features a video of Dr. Abramson (Windows Media Player required).

Link

Interview with Ellen Kagan (mp3 audio)

2005-12-01T11:31:00.000-08:00

Audio Recording (mp3 format) of Ellen Kagan's interview with Dr. John Abramson, author of Overdosed America: The Broken Promise of American Medicine, on â€œYour Health Care - Choice or Chance.â€

Mp3 link

Conflicted Medicine, by Ingfei Chen

2005-10-31T11:34:00.000-08:00

Article on collusion between pharmaceutical companies and medical research centers, citing Dr. John Abramson and "Overdosed America."
Chen writes discusses how studies were and are conducted at medical centers with pharmaceutical-company funding, which makes many wonder whether they can trust drug trials anymore.

Link

Pills to avoid heart attacks? Hard to swallow (Op-Ed article in L.A. Times, by John Abramson and Merrill Goozner)

2005-10-21T11:35:00.000-07:00

IS POPPING A PILL the best way to reduce your risk of a heart attack?

That's the message Americans and their doctors hear almost every day. The Journal of the American Medical Assn., for instance, reports in its Oct. 12 issue that the growing use of statin drugs in the United States is largely responsible for falling cholesterol levels over the last decade. Coupled with new data showing that the number of heart disease deaths is falling in the U.S., it sounds like great news.

Unfortunately, putting those two facts together gives Americans the wrong prescription for the most effective way to minimize their risk of heart disease.

First of all, cholesterol levels in the U.S. actually fell faster before statins entered widespread use in the early 1990s, as some Americans decreased their consumption of saturated fats. But, despite the falling cholesterol levels, National Institutes of Health data show that the U.S. is still lagging badly behind most of the other industrialized countries in eliminating heart disease as a major cause of premature death.

Not only that, but during the period when statin use exploded in the U.S., the death rate from heart disease was actually falling faster in most of the other countries â€” which use half as many cholesterol-lowering drugs and a third as many cardiac procedures to open clogged arteries. How can we be taking more than twice as many statins and receiving three times as many cardiac procedures and still have higher death rates from heart disease?

The problem is that while U.S. doctors and public health authorities focus on drug therapy (often working hand in hand with researchers funded by the drug industry), the nation ignores what the scientific evidence really shows to be the most effective way to prevent heart disease: adopting a healthy lifestyle.

For instance, the Nurses Health Study, which began in 1976, shows that women who follow five healthy lifestyle habits â€” routine exercise, a Mediterranean-style diet (high in fruits, vegetables, unprocessed grains and olive oil; low in dairy fat, red meat and trans fat or partially hydrogenated fat), not smoking, moderate drinking and maintaining a reasonable body weight â€” develop only 17% as much heart disease as those who don't. Sadly, only 3% of U.S. women do those things.

On the other hand, not a single randomized, controlled study shows that cholesterol-lowering statin drugs benefit women without preexisting heart disease. Yet ubiquitous television and print advertising encourages women to talk to their doctors about cholesterol, and a recent survey showed that two-thirds of Americans have.

How about people over 65, those most likely to be taking a statin? A recent study of European seniors showed that 60% of their deaths from all causes could be attributed to not following simple health habits.

On the other hand, a study published in the British journal the Lancet showed that not treating high-risk seniors with a cholesterol-lowering drug increased their risk of death by an insignificant 3%.

Obviously, healthy lifestyle is far more important for seniors. But they are much more likely to emerge from their doctor visits with a prescription for a statin than a realistic plan to adopt a healthier lifestyle.

There's no doubt that statins can help some people, especially those who already have heart disease and men at very high risk of developing it. But the scientific evidence is clear: Most heart disease results from the way we live our lives, and there's no magic pill to help us change that.

So why all the brouhaha about getting so many people on statins? It's an exquisite example of bank robber Willy Sutton's law: That's where the money is.

JOHN ABRAMSON is the author of "Overdosed America" (Harper Collins, 2004) and a clinical instructor at Harvard Medical School. MERRILL GOOZNER is the author of "The $800 Million Pill" (University of California Press, 2004) and the director of the Integrity in Science program at the Center for Science in the Public Interest.

"The Effect of Conflict of Interest on Biomedical Research and Clinical Practice Guidelines: Can We Trust the Evidence in Evidence-Based Medicine?"

2005-09-01T11:38:00.000-07:00

Journal of the American Board of Family Practice (with Barbara Starfield, Distinguished Professor, Johns Ho

"In this highly commercialized environment, how do we sustain the ideals that brought us to family medicine? We now know enough about the limitations of â€œevidenceâ€ to be much more cautious about what passes for it. Perhaps the family medicine journals, individually or in concert, could start sections of their journals for the specific purpose of critically reviewing the results of published trials. Finally, we family physicians have a professional responsibility to be less naive about the inherent divergence of our patientsâ€™ and the drug companiesâ€™ best interests. Our patients must come first."

Link

Feedback from a Physical Therapist: August 6, 2005

2005-08-06T16:17:00.000-07:00

Dear Dr. Abramson,

I read your book today from cover to cover. I have read quite a few books on this topic, but I feel that your book is as good as it gets. I am a practicing physical therapist working in Early Intervention (home care). Daily my patients parents seek my advice on health related issues especially when the medical intervention that their children are receiving does not produce the desired outcomes. Much of the care that is given sounds like the parents and child have a 2 minute meeting with the doctor, a culture is done, and a prescription is provided.

I am in my fifties. As a child, I was priveleged to have a family physician who came to our home with his black bag in tow, and he spent quite a bit of time doing a medical intake and examination, and he would then diagnose with remarkable accuracy.

It has been frustrating to "progress" from that kind of medical care to modern standards of practice. Your book not only explains how this transition happened, but it amply exposes how it threatens the quality of our current medical care and our health.

I thank you for your courage and for your effort in producing Overdo$sed America.

As an aside, I recently read "The Cholesterol Myths" by Dr. Uffe Ravnskov. This book takes a very critical look at all of the major cholesterol studies that were done in the last century. Are you familiar with this work? It appears to provide a lot of support for your "Smoking Gun" chapter.

Thanks again and best regards,
Ari Meisel

General Inquiry: July 5, 2005

2005-07-05T16:18:00.000-07:00

Dear Dr. John,

I first heard your interview on Air America Radio with Sam Seder and quickly went out and purchased Overdosed America. What a great book! I am recommending it to everyone. I was visiting my mother over the long 4th of July weekend ans asked her what, if any, drugs she was currently taking. She informed me that she just recently went off her 11 year HRT prescription but is still taking her hypertension drub LISINOPRIL. While this made me very nervous, I was relieved that she was no longer taking the HRT. My concern now is that she is being prescribed a drug that may not be necessary. She has always been in good health. Her current dosage is 40mg/day. I visited the FDA website to learn more about the effectiveness and safety of this drug. Is there another site that I can visit which is less scientific where I can find out if she should continue her prescription? I would greatly appreciate any guidance you can provide.

Regards,

Joseph ALbano()

JOSEPH,
DEPENDING ON YOUR MOTHER'S OTHER MEDICAL ISSUES, THIS MAY OR MAY NOT BE THE BEST DRUG FOR HER. A GOOD SOURCE OF NON-TECHNICAL MEDICAL INFORMATION IS PUBLIC CITIZENS' "WORST PILLS/BEST PILLS" WEBSITE. FOR SOMEONE LIKE YOURSELF WHO IS INTERESTED IN THESE ISSUES, THE SMALL SUBSCRIPTION FEE IS WELL WORTH THE QUALITY INFORMATION AND TIME SAVED.
BEST WISHES TO YOU AND YOUR MOTHER,
JOHN ABRAMSON MD

Comment on Overdosed America: July 3, 2005

2005-07-03T16:20:00.000-07:00

Thank you...thank you...thank you! From an RN of thirty years who did not have the "scientific evidence" to back up what I have been telling my patients over...and over...and over about the problems prescription drugs as a quick fix, and the need for a healthy diet, exercise, and to not smoke. I tell them the Dr. cannot cure you, that he can only treat the symptoms, and drugs come with side effects, and side effects need to be weighed against the benefit.
I had a 95 year old MI pt who was on Heparin and refusing the Lipitor at HS. The resident talked her into it, telling her it will increase her life expectancy by 30%! She informed me that she was not planning on taking these meds when she went home, as she read that Lipitor can affect the liver. She went on to tell me that she was use to walking on a treadmill on a regular basis, and they were keeping her in bed, which could cause her harm. She went on to say that "you know, so many of my neighbors are on so many prescription drugs, and they seem to have more problems because of the drugs, and are always in and out of the hospital! That very day, and when I went home, there was the article, stating the efficacy of Lipitor had not been proven for those over the age of 75!

That was perhaps the most outrageous example...

Obviously, I could go on and on and on. I was told by a nurse on a floor I was working that 90% of nurses are on antidepressents. I thought it was suppose to be a joke. I was the only nurse working there that shift that was NOT on antidepressants! I find it frightening.

Again, thank you for making me feel SANE!

Linda

Harvard doc: You may not need that Lipitor

2005-06-20T11:39:00.000-07:00

"American health care may not be the best at improving health most effectively and efficiently but it is certainly the best in the world at generating profits for the drug industry,'' Abramson said.

Link

Doctor's prognosis: Health care ills rooted in market-based system, by Maryann Ullman, in the Vermont Guardian

2005-06-17T11:43:00.000-07:00

The U.S. health care system is in a state of emergency due its focus on commercial, rather than health, values according to a former family doctor turned activist.

Dr. John Abramson, author of the book Overdosed America: The Broken Promise of American Medicine, spoke in Brattleboro Thursday evening at an event sponsored by Vermont Citizens Campaign for Health.

â€œHeâ€™s questioning long-held assumptions held by the medical community,â€ said Richard Davis, executive director of VCCH, which is sponsoring an ongoing series of talks to help foster support for a single payer health care system in Vermont.

â€œHeâ€™s bucking the trend that health care should be based on profit. Heâ€™s providing some very defensible arguments and information for moving to universal health care, and moving to a system that actually keeps people healthy. Thatâ€™s radical to some people,â€ Davis said.

One of Abramsonâ€™s arguments is that medical spending has little to do with actual quality of care, and may even have an inverse relationship. In a graph of 22 industrialized countries, Abramson showed that Japan spends among the least on health care per person, and has the highest rate of life expectancy. Twenty other countries cluster around the middle, and the United States, in the opposite corner by itself, has the most expensive health care, and the lowest life expectancy.

â€œWeâ€™re the only industrial country that doesnâ€™t have universal health care,â€ Abramson pointed out. â€œWeâ€™re the only health care system that is run like a free-market entrepreneurial system.â€

A lot of money gets wasted on endorsing products and services that donâ€™t necessarily even help people, he said, and sometimes even harm them. For example, he compared the United States to Canada, saying far more people get bypass surgery here who donâ€™t need it, despite the fact that it causes cognitive problems in 50 percent of the elderly. But they do it because hospitals stand to make $20,000 to $40,000 per surgery.

According to Abramson, $600 billion gets spent every year in the United States on unnecessary and often harmful medical care. â€œYou could have universal health care three times over for that,â€ he said.

He concedes that Canada does need more money in its health care system, but says thatâ€™s because the country made a political decision to cap it, not because the system is flawed.

According to the Institute of Medicine, 70 percent of preventable health problems are due to lifestyle and environmental factors. But most of the money goes to direct medical care.

â€œWeâ€™re spending 75 percent of our money on 30 percent of the problem,â€ said Abramson. â€œOne of the reasons why we donâ€™t do it, why itâ€™s a threat to have universal health care, is that it would threaten the profit structure. We would have to find real determinants of health problems.â€

He pointed to 1980, the onset of the Reagan era, when university medical researchers began accepting funding from drug companies for their work, as funding from the National Institutes of Health dropped. â€œAs thereâ€™s been this privatization of knowledge, thereâ€™s been a weakening of oversight,â€ he said. â€œUniversities arenâ€™t going to so it anymore. Theyâ€™re addicted to the drug money. We canâ€™t count on them anymore. Why not just consolidate everything and have the advertising agencies oversee it all?â€

According to a 2003 poll by the Kaiser Foundation, 79 percent of Americans favor health coverage for all, even if it means giving up tax cuts.

Two recent polls in Vermont find wide support for universal coverage. One poll, for WCAX-TV, found that 67 percent of Vermonters favored a publicly-funded health care system, and a recent Vermont Public Radio poll found that 42 percent of Vermonters favored such a system.

The Democratically-controlled Vermont Legislature passed a bill that would have moved Vermont toward a universal health care system, but Gov. Jim Douglas, a Republican, has pledged to veto the bill. Despite the veto, the state's 2006 spending plan does include funding for a commission to evaluate various approaches to providing publicly-funded universal health coverage.

â€œThereâ€™s a real failure of our system to implement the will of the people,â€ said Abramson.

Help: My doctor wants to put me on a statin drug

2005-05-30T16:26:00.000-07:00

DEAR DR. mY OVERALL HEALTH IS EXCELLENT, AND MY LIFESTYLE IS EXTREMELY HEALTHY. IN SPITE OF THIS, AND WITH NO OTHER RISK FACTORS, EXCEPT A HIGH LDL MY DR. IS PRESSURING ME TO GO ON STATINS. I DISAGREE WITH THIS FOR MANY OF THE REASONS YOU MENTION IN YOUR BOOK. HE IS BECOMING INCREASINGLY ANNOYED WITHME, AND I AM AFRAID HE WILL REFUSE TO TREAT ME IF I DON'T COMPLY.I FEEL I AM BEING HELD HEALTH-HOSTAGE. WHAT CAN I SAY TO CONVINCE HIM THAT I,M NOT TRYING TO COMMIT SUICIDE,BY NOT GOING ALONG WITH THIS. HE PRACTICALLY LAUGHED IN MY FACE WHEN I SUGGESTED THAT HE READ YOUR BOOK- HELP !!!!!!- THANK YOU REGINA

Regina,

Your problem is not at all uncommon and highlights the bind that American patients and doctors are currently in.

First of all, it sounds to me like you might not even qualify for statin therapy under the current guidelines:
• 2 or more major risk factors (woman over 55, smoker, high blood pressure, HDL cholesterol < 40, or strong family history--first degree male relative < 55 years of age or female < 65 years of age)
• AND have a 10-20% risk of developing heart disease over the next 10 years according to the Framingham risk score
• AND have an LDL above 130

That said, even if you do qualify there is still absolutely no evidence from the gold standard of medical research, randomized controlled clinical trials, that lowering cholesterol with a statin is beneficial for women who don’t already have heart disease or diabetes.

Perhaps you can arrive at a compromise with your doctor: that because you are doing the things that reduce your risk of heart disease by 83% already (exercising regularly, eating a healthy diet, not smoking, drinking in moderation if at all and maintaining a health body weight) and because there is no evidence that a statin will help, you suggest that you wait one year to see how the medical thinking evolves on this issue. In the meantime you will continue with all the healthy lifestyle habits that are each more likely to protect you from heart disease than is taking a statin.

Hope this is helpful. Please let me know what happens.

Sincerely,

John Abramson MD

PS: I would encourage you to bring this letter to you next doctor visit to facilitate discussion about these important issues.

The Courage to do the Right Thing

2005-05-08T16:28:00.000-07:00

In the middle of reading your book, I just declined a many-thousand dollar contract writing for the president of an extremely large pharmaceutical company. Frankly, I appreciate your helping me have the courage to do the right thing.

Ten years ago, I published "Cultures of Healing: Correcting the Image of American Mental Health Care" (W.H. Freeman), and I’ve recently started a new project expanding the perspective of that work to healthcare in general. Consequently, I know the literature criticizing the pharmaceutical companies extremely well. Your book, rivaled only by Jerry Avorn’s, seems to me the most trenchant of the lot. Thanks for writing it.

Bob Fancher
http://www.mind-for-hire.com

Bob,
"Lead us not into temptation..." In this topsy turvey world, it can be difficult to make the choices that stand the test of time.
Congrats to you,
John Abramson MD

Children, Adolescents and Zoloft

2005-05-07T16:29:00.000-07:00

I am writing to you on behalf of Christopher Pittman. Chris is the child in the middle of the “Zoloft” trial. He was tried as an adult, found guilty and is serving 30 years in prison.
We at Justice for Juveniles (www.justiceforjuveniles.org) are writing letters to politicians and newspapers and everyone else we can think of so more people will learn the facts of his case. We have started a petition to have the SC Legislature change the laws concerning trying children as adults including children under the influence of prescription drugs. It is:
http://www.thepetitionsite.com/takeaction/429258617?ltl=1114889662
Would you sign our petition or bring this matter to the attention of anyone who might be interested but if so it would be appreciated. Thanks.

Sheila Maloney

*******

"When Health Policy is the Problem" with Bruce Spitz in The Journal of Health Policy, Politics, and Law (editorial)

2005-05-01T11:47:00.000-07:00

"The contribution by Spitz and Abramson...might be best thought of as an admonitory tract, the sort of piece that Thomas Paine was prone to write in prior to the American Revolution.

City Club of San Diego Presents Dr. John Abramson (video)

2005-04-08T11:49:00.000-07:00

Primary care physician Dr. John Abramson takes aim at the pharmaceutical industry in "Overdosed America," his recent book that questions the biased and, at times, faulty research that leads doctors to over-prescribe medicines to their patients in this address to the Catfish Club and City Club of San Diego.
Watch it now using RealPlayer.

Note From a Writer

2005-02-05T16:35:00.000-08:00

I just wanted to tell you that your book is absolutely brilliant. I am a professional writer, working in the health field for the past several years, often with doctors. Your book is beautifully organized and written, filled with hard-hitting opinions and vital information. Not only up to date but ahead of its time (as in the Vioxx and Celebrex issues.) I cannot thank you enough.

From Retired Med School Professors

2005-02-05T16:34:00.000-08:00

Dr Abramson

Both my brother and I are retired med school professors, and, perhaps surprisingly, politically conservative. We read Time, Newsweek, National Review and TAS and a lot of other serious publications-- not that I consider the healthcare mess to primarily a political issue, but we have noted that these magazines are more apt to do book revues of such issues. I am surprised by many of the books revued which are obviously very politically biased, but your book doesn't carry the least hint of political bias. I have considered writing some editors suggesting that they take a look at your book. Do you think that would do any good? A large number of letters might have some impact. I have also considered writing to the IN Senators and representatives from my district.

I don't mean to sound cynical, but it seems that the majority of people don't worry about the right things as long as they are fat and prosperous.

I wish i could do more.

Letter from a reader

2005-02-05T16:33:00.000-08:00

To say only thank you seems such an injustice. I haven't finished reading your book, which I found at our local library, and they have this week taken Vioxx off the market and I'm sure Celebrex will follow. This past year, I fired my OBGYN because he thought every woman should be on HRT for her entire life and I felt I wasn't judged as an individual with my own history. I'll be giving a copy of this book to my family doctor because she has been trying to get me to have a bone density test and now I feel it will only tell me what I already know, which is that at 51, I am aging.

I will never look at drug commercials the same way again. They seem as dangerous as advertising that cocaine and marijuana are okay. If there wasn't so much money involved, possibly our government would be more worried about us and not profits.

Thank you for opening my eyes. I know I will be a more informed consumer and patient in the future.

Linda Dallal
Dewitt, MI

Academic corroboration

2005-02-05T16:32:00.000-08:00

Subject: Congrats on "Overdosed"

Dear John,

I read your book today from cover to cover and found it really excellent. I have just joined Yale where I head their Global Health division and hope to focus on building a stronger global case for prevention and health promotion-I attach two recent pieces of work I have completed on this as an introduction.

For almost 10 years I have been at WHO where I headed the team that developed the Framework Convention on Tobacco Control, and more recently, the Global Strategy on Diet, Physical Activity and health. I also had responsibility forour CVD and other chronic disease programs. I experienced first hand the pharma pressures in our work you refer to on osteoporosis, hypertension guidelines, use of HRT and so on. And my main interest is highlighting why prevention does not get attention, dollars or political support.

You have exquisitely highlighted one set of pressures in the best way I have ever read. Would be keen to see if we could get you to Yale at some point both to present your findings but more importantly to see if we could plan future work...would be vaulable for example if you could globalise your findings; and I am working on the global constraints to prevention that bring in the tobacco and food companies.

Hope this gets to you and keen to interact.
With regards,
Derek YachDerek Yach
Professor of Global Public Health
Yale University School of MedicineDepartment of Epidemiology and Public Health

I RESPOND:

Dear Derek,

I read your paper today and feel the same kind of personal naivete', disappointment, and concern about health in the developing countries that I have tried to evoke about health care in the US. Congratulations to you for framing the issue so well, and for calling attention to the impending healthconsequences of what is often presumed to be the benefit of rising prosperity associated with integration into global markets.

Clearly our work fits together, each supporting the other. My contribution is to document and explain the population failure of expensive downstream approaches to treating chronic conditions in the US, including the trans-generational chronic condition of low birth-weight babies. (Though mention must be made of the instances where the most lucrative care alsohappens to be the best care--like former President Clinton's highlypublicized heart surgery--the outcomes of individual acute treatment cancertainly be beneficial.)

The adoption of this approach to chronic disease prevention and treatment in developing countries will have about the same effect as the adoption of tobacco, highly processed foods, and minimally active lifestyles. All unfortunately bring benefit to trans-national corporations and a small numberof people within the developing countries, but the overall effect on the population as a whole is harm. I don't have to tell you that, analagous to the point you make about harming the environment in your paper, what is good for economic development (and an integral part of what we in the US call economic freedom) is often not good for population health. Therein lies theenormous challenge of this work within the US and, as you taught me this morning, in the developing countries as well.

I would be honored to present my work at Yale, perhaps "Don't Do As We HaveDone: The Failure of Downstream Treatment of Chronic Disease in the UnitedStates." And even more honored to work together on these issues.

Sincerely,
John

Letter from a physician

2005-02-05T16:30:00.001-08:00

I loved your book. In 1964, I edited The Bulletin of Drug Reactions in Neurology and Psychiatry. The American Psychiatric Association would not accept a paid ad by us, looking for subscribers. I called Walter Barton, MD, medical director of the APA. He told me: "The drug companies pay us a lot of money to advertise. They won't like your publication. We will not accept your ad." Forty years ago, my own APA was a whore for the drug industry.

Thomas P. Lowry, MD
Dr. Lowry, Thanks for you wonderful letter. What do you think it will take to get people to understand that our system of generating and disseminating medical knowledge is not designed to improve Americans' health most effectively, but to generate the greatest profits? My personal approach was to write Overdosed America, and to continue to try to spread the word in language that non-medical people can understand. If you have any ideas about how to spread the word please let me know. And please don't be shy about recommending to the book to friends--I am sure that your opinion is well respected. Is it OK with you if I post your comments on my website?

Sincerely, John Abramson

I'm delighted to hear your response; I expected some sort of mass electronic reply. Of course you can use my comments. I am 72, walk vigorously 30 minutes a day. I had a slight elevation in my LDL. My internist suggested going on Lipitor. Now that I'ved read your book I have some grave doubts anout the wisdom of that. My two best friends in their mid-seventies have both had coronary bypass surgery, with visible loss of cognitive power. Maybe I'll try Christian Science! In brief: a great book and I enjoyed your response.

Thomas P. Lowry, MD

Tom,
I just sent the following message to a large city public health director. The latter part is relevant to your situation. Onward Christian Scientists (mostly):

Statins in women. First of all, there is no evidence from randomized controlled studies to date of a significant benefit of statins in primary prevention for women. Is this just because the studies have not yet been large enough? There is evidence on both sides, but the two most relevant studies that I know of are:

A study published in JAMA a couple of weeks ago reporting on 7300 health women who had been followed for the past 31 years and found that elevated cholesterol contributed absolutely nothing to women's risk of death. [JAMA, 2004; 292:1588-1592] The ASCOT study randomized 2000 high risk women without heart disease to recieve Lipitor or placebo. Those who took Lipitor developed 10% more heart attacks than the women who took placebos. A large randomized controlled study is necessary to answer the question. But the evidence to date does not appear adequate to me to recommend that women take statins for primary prevention. (One would have thought that "First Do No Harm" would still be on experts' minds after the HRT debacle.) And also, the evidence is quite clear that about 80% of the risk of heart disease for women has to do with health and lifestyle habits--the premature and exaggerated attention on cholesterol has distracted doctors' and patients' attention away from the interventions that we know are far more effective at preventing heart disease (as well as osteoporosis, breast cancer, chronic lung disease, stroke, diabetes...) Given the relative benefits and even potential benefits, the nearly singular focus on cholesterol-lowering with statin drugs, in my opinion, undermines the effectiveness of preventive health care being provided to American women.

Similarly another study published a couple of weeks ago in JAMA shows that elderly folks who exercise regularly, eat a Mediterranean style diet, don't smoke, and drink in moderation have only 1/3 the death rate of those who don't do those things. And similarly, the PROSPER study shows that statins don't help elderly women (70-82) with and without heart disease, nor elderly men and women for primary prevention. But in this study statins did significantly increase the risk of getting cancer, and the risk increased in each of the four years of the study lending credence to the finding.

Hope this is helpful,
John

Feedback from a pharmacist

2005-02-05T16:30:00.000-08:00

Great, yet disturbing read. As a retail pharmacist recently out of school, I find it appauling that we can not trust the literature which I just learned to understand. I truely hope I see the necessary changes you describe take place during my lifetime. I do my best to recommend time-tested generics and OTCs to customers and doctors when they are appropriate. Nothing like using an ARB as a first line antihypertensive, huh? It's all good old fashion American consumerism best displayed when a new customer tells me, "I'm allergic to all dem geriatric subscriptions...Brand only." Each day in the pharmacy is now different after reading your book. I have a new purpose of helping people use more proper medications.

Thanks. Colin

Doctored Research?

2005-01-10T15:13:00.000-08:00

Flasks of Cash, Harvard Magazine, November-December 2003.

Link

Medical Reporting In a Highly Commercialized Environment (PDF)

2005-01-10T11:54:00.000-08:00

Unraveling the commercial bias that colors much of our medical research is a complicated undertaking, at best. Journalists often donâ€™t have the statistical and research expertise to cut through the pro-industry spin, nor are they given the time needed to analyze complex research data.

Move to switch statins to non-prescription in US

2005-01-10T11:53:00.000-08:00

"Dr Abramson thinks the focus on lowering cholesterol levels is distracting us from more effective interventions: "Statin therapy can clearly benefit people at very high risk, like those who already have heart disease. But studies repeatedly show that most people who do not already have heart disease derive greater protection from regular exercise, a healthy diet, and not smoking than from taking a statinâ€”though the two approaches are not necessarily mutually exclusive." (British Medical Journal: 2004;329:704)

Link

WBUR: On Point: "Cholesterol Nation"

2004-07-14T11:55:00.000-07:00

Dr. Abramson comes into the show at 22 minutes, 50 seconds to rebut the latest recommendations to lower the threshold for starting cholesterol-lowering statin drugs, making the point that there is no evidence that the drugs help women of any age or men over 70 who do not already have heart disease. Listen to the response of the lead author of the recommendations.

Link