Okay, so maybe my blog about math yesterday wasn’t the most popular blog of all time. I can take the hint! Back to normal topics for now 🙂
But then again, perhaps today’s blog will be even more unpopular, or at least controversial.
Today I’d like to talk about something that’s been on my mind a while: clinical trials, the pharmaceutical industry, and marketing.
There is a book published in 2012 by Ben Goldacre entitled Bad Pharma which talks at great length about the misuse of these factors, amongst other things, that is contributing to an industry of health care at both the financial and health costs of citizens around the world.
Here is an excerpt from his introduction:
“Drugs are tested by the people who manufacture them, in poorly designed trials, on hopelessly small numbers of weird, unrepresentative patients, and analysed using techniques which are flawed by design, in such a way that they exaggerate the benefits of treatments. Unsurprisingly, these trials tend to produce results that favour the manufacturer. When trials throw up results that companies don’t like, they are perfectly entitled to hide them from doctors and patients, so we only ever see a distorted picture of any drug’s true effects. Regulators see most of the trial data, but only from early on in a drug’s life, and even then they don’t give this data to doctors or patients, or even to other parts of government. This distorted evidence is then communicated and applied in a distorted fashion.
In their forty years of practice after leaving medical school, doctors hear about what works through ad hoc oral traditions, from sales reps, colleagues or journals. But those colleagues can be in the pay of drug companies – often undisclosed – and the journals are too. And so are the patient groups. And finally, academic papers, which everyone thinks of as objective, are often covertly planned and written by people who work directly for the companies, without disclosure. Sometimes whole academic journals are even owned outright by one drug company. Aside from all this, for several of the most important and enduring problems in medicine, we have no idea what the best treatment is, because it’s not in anyone’s financial interest to conduct any trials at all. These are ongoing problems, and although people have claimed to fix many of them, for the most part they have failed; so all these problems persist, but worse than ever, because now people can pretend that everything is fine after all.”
I have to preface by saying that I think that the process for clinical trials, if done correctly, can yield good hard scientific data which we can then use to help people. It has produced many medicines that have saved countless lives. Unfortunately, for a vast majority of these trials, as Mr. Goldacre states above, there are often many other factors at play that skew that data. A fine example of this is highlighted in this Harvard Med School Article about the clinical trial process of antidepressants and it’s prescription to children.
Some of the key points in this article:
“Most psychiatric drugs have not been adequately tested in children, and some drug combinations occasionally prescribed for children — particularly stimulants and antidepressants — have not been fully tested even in adults. We don’t know enough about either the risks or the benefits of these medications to say whether they are being overused or underused.”
– if so then why have they even been approved to be used on any age group?
“Children’s adverse reactions are inadequately monitored in everyday practice. Researchers who study side effects in children sometimes ask the wrong questions, or not enough questions. The FDA has a voluntary program in which physicians report severe and novel side effects. But the more predictable and apparently milder side effects may also be important, especially in the long run — which is not illuminated by clinical trials that rarely last more than a few months.”
– it seems the system we have in place is setup to not care about the long term side effects of prescription drug use. Is it not unethical and irresponsible then as health care professionals to allow their continued use? Is money really all that matters?
“The public is becoming concerned about possible overmedication. Critics fear that physicians are adopting chemical solutions to the emotional problems of children because of pressure from insurers and health maintenance organizations.”
– perhaps my favourite excerpt; it sums up the state of medicine in our culture quite perfectly.
I take a look at Ayurveda, and I see in it so much science, from thousands of years ago, before written word even. In that science there are things they somehow knew about even before they knew how to write it down, including the complexities of our nervous system, circulatory system, hormones, respiration, etc. It boggles my mind how they came up with it all. And though it came from a time when these things were passed down through stories, often involving myths and legendary gods, I don’t think that should discredit it at all. Do we shun doctors because they take the Hippocratic Oath? That oath starts like this:
“I swear by Apollo the physician, and Aesculapius the surgeon, likewise Hygeia and Panacea, and call all the gods and goddesses to witness, that I will observe and keep this underwritten oath, to the utmost of my power and judgment.”
It is extremely hypocritical (pun intended) to dismiss Ayurveda because of it’s roots in spirituality when medical science itself is as well.
Although commonly misconceived as being part of the original oath, the phrase “First do no harm” was thought to be added later. Still, that should be the centre of all health. If you can’t help the patient, then at least do not harm them further. It is completely irresponsible to continue to pretend that the pharmaceutical system we have in place follows this axiom. In fact, it does do harm, and in many cases, we don’t even bother to understand what that harm is completely. But I am not blaming MD’s for this. It must be extremely difficult to get funding to do research, and they exist within a corrupt framework. It’s a difficult job.
I resonate with Ayurveda because I know it can help change things. It can make trials better. It has the ability to properly assess a person’s disposition towards certain diseases, craft a treatment both medicinally and in lifestyle for them that is non intrusive, and help everyone regardless of their nature to nurture themselves towards health in body, mind, and soul (if you believe in such a thing). Then, and only then, if nothing is working, should invasive drugs or surgeries be used (or in the case of life or death emergencies).
I’ve said it before, Ayurveda and western medicine are not mutually exclusive. If they could work together, we could all benefit.
Ayurveda is so useful because it treats everyone, every disease, and every medicine as unique. It works with the patient to understand how the disease specifically affects them, and then tweaks the treatment to match the person and their disease. There is no one size fits all solution. Just because a trial shows 92% of patients reported success with “minimal” side effects, it does not mean we should push to put it on a shelf. We should take a step back and see if Aryuveda has an answer. It can probably tell you why certain people were having any side effects in the first place, and how to counteract, minimize, or prevent them entirely.
Hopefully these articles and this entry in my blog have sparked some questions in your mind about how we over-medicate as a society. And, as always, I wish you good health.