New
York: Harper Perennial, 2005.
ISBN: 0060568534. Paperback: 368 pages. $13.95
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Frustrated
by increasing numbers of patients arriving with drug advertisements
and a "fixed idea ... of the outcome they wanted ..."
internist John Abramson, MD, concluded he could "... help people
to achieve better health ..." if he uncovered "... what
the scientific evidence really shows and explain this to the public."1:xii
He discovered "... a scandal in medical science."
"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."1:xiii This corruption has been
hidden by a "... complex web of corporate influence ... exacerbated
by an interlocking financial arrangement between "... trusted
medical experts and the medical industry ..." that results
in conflicts of interest.1:xiii According to Dr Abramson
"... there has been a virtual take-over of medical knowledge
in the United States, leaving doctors and patients little opportunity
to know the truth about good medical care ..." And, despite
the "enormous costs," both the quality and delivery of
health care in America has declined. Not only has the industry co-opted
the mechanisms of evaluation of effective treatment for widely accepted
illnesses but it has colonized the healthy population by the construction
of new disorders transforming risk factors into diseases that putatively
require long-term and expensive prophylactic medications.
Beginning
with an examination of a New England Journal of Medicine (NEJM)
article (2000) that claimed a 19% reduction in stroke risk in
a population that took the statin Pravachol compared to those
who had been given a placebo, Dr Abramson reminds us that the
advertised advantage represents the relative risk; but
what matters is the absolute risk; over the six years of
the clinical trial, the absolute risk advantage in this case is
a mere 0.8%--for every 1000 patients who take this statin for
one year there will be one less stroke. For each stroke prevented
the drug cost was $1.2 million--excluding the expense of blood
tests, physicians visits, and patient time. Although the average
age of the patients in the study was 62 years, most strokes occur
in an older population. When a population aged 70 years and older
treated with Pravachol was examined, Dr Abramson discovered 21%
more strokes than in patients given placebo." Given
that there are a number of proven, less expensive, and less hazardous
interventions that reduce stroke risk, the aim of the Pravachol
study "... seemed incontrovertible: to establish 'scientific
evidence,' legitimated by the prestige of the NEJM, that
would lead doctors to believe that they were reducing their patients'
risk of stroke by prescribing Pravachol."1:17
Perhaps
the most graphic example is the now-familiar history of hormone
replacement therapy (HRT). For Dr Abramson, the HRT debacle is
emblematic of the larger issue of pharmaceutical companies attempt
to colonize new and lucrative markets by transforming normal human
development, like menopause or aging, into illnesses requiring
life-long medications.
Commercialization
further hijacks the research agenda by determining what gets studied
and what does not. Pharmaceutical sales and profits, Dr Abramson
insists, make it impossible for practicing physicians to trust
the research that appears in even the most highly regarded medical
journals. He is concerned about the use of "consumer education"
to market drugs and, thus undercut the physician-patient relationship.
This "... hype creates false hope that moves us further away
from real prevention, most of which has to do with a healthy lifestyle,
and drains resources needlessly from far more effective health
interventions."1:166
Dr
Abramson points to The Institute of Medicine findings that "...
behavior and environment are responsible for over 70% of avoidable
mortality." The same study finds that 10% to 15% of deaths
result from inadequate medical care. Yet, 95% of health care spending
targets biomedical interventions, especially pharmaceuticals.
If one of the goals of medical care is to prevent disease, then,
asks Dr Abramson, "... don't doctors have a professional
responsibility to address the unique health needs, habits, and
risks of each individual patient?"1:204-5 "The
most important health care issue, [is to] restore the goal of
medical knowledge creation to improve the health of Americans."1:249
v
Reference
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Abramson J. Overdosed America, the broken promise of American
medicine. New York: Harper Perennial. 2005.
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