To be blunt up front – SBM is not apologetic about the pharmaceutical industry. We get zero funding from any company, and have no ties of any kind to “big pharma.” In today’s world I have to spend time making that clear, because despite the reality critics are free to assume and falsely claim that our message is coming straight from the bowels of hell (a.k.a. the pharmaceutical industry).
We promote science-based medicine and criticize pharmaceutical companies along with everyone else when they place other concerns ahead of scientific validity, or promote bad science, for whatever reason.
It has become fashionable, however, to not only criticize the pharmaceutical industry but to demonize them – and the term “big pharma” has come to represent this demonization. Cynicism is a cheap imitation of skepticism – it is the assumption of the worst, without careful thought or any hint of fairness.
A recent article by Martha Rosenberg is an excellent representation of the mindless demonization of the pharmaceutical industry – good for scoring cheap points, but very counterproductive. She essentially accuses big pharma of inventing diseases in order to sell their products.
The premise strikes me as profoundly naive – which diagnostic entities are considered legitimate diseases is actually a complex question that is debated within the medical field. Rosenberg acts as if diseases can be invented out of whole cloth and then imposed upon medicine by a pharmaceutical executive. It is a grand-conspiracy type of thinking which erodes under scrutiny.
After hinting at anti-vaccine leanings, she writes:
Now pharma is back to creating new diseases, patients, risks and “awareness campaigns” faster than you can say thimerosal (the vaccine preservative that started the backlash.)
No – thimerosal did not start the backlash, Andrew Wakefield demonstrably did, with the MMR vaccine that never contained thimerosal. Thimerosal was simply act 2, after the evidence failed to find a link between MMR and autism (and of course there is also no link between thimerosal and autism either). But Rosenberg acts as if the anti-vaccine movement is a justified backlash against the excesses of big pharma – nice historical revisionism.
The sad fact is, Rosenberg might have a kernel of a legitimate point if she did not come across with her anti-scientific conspiracy mongering. That is why such demonization is so counterproductive – it actually backfires and let’s pharmaceutical companies off the hook for their real excesses.
Harriet Hall, for example, wrote an excellent piece on osteopenia – (Osteoporosis Drugs: Good Medicine or Big Pharma Scam?) which takes a properly nuanced and balanced approach to such questions. Do we really need to be treating pre-osteoporosis? The evidence should ultimately guide us. What pharma is guilty of doing is jumping prematurely on the bandwagon of a questionable diagnosis because it is a new market for them.
I think the same is true of the drugs that are now approved for the treatment of fibromyalgia – a controversial diagnosis, to say the least. But here we see more complexity and nuance. The FDA requires that a drug be indicated to treat a disease – not a syndrome or symptom. So there is no drug indicated for treating neuropathic pain as a symptom – drugs have to be indicated for diabetic neuropathy or post-herpetic neuralgia.
This forces pharmaceutical companies to find a disease, even when they have a drug that can potentially alleviate a symptom. Fibromyalgia is the perfect example of this – the very diagnosis itself is mostly used as a garbage pail diagnosis for vague syndromes of muscle pain and tenderness with fatigue and poor sleep. But you cannot get FDA approval to treat vague muscle pain.
Meanwhile, doctors are struggling to understand these syndromes and come up with a proper system of labeling what we find. We don’t want to prematurely use the “disease” label, but we also need to recognize patterns of patient complaints. I prefer terms like “myofascial pain syndrome” because it says what it is without implying a specific disease.
But regulation exists in its own world, and the FDA demands a disease label. So we have drugs, which are likely fine for the symptomatic treatment of myofascial pain, indicated for a dubious diagnosis (at least as it is often applied) like fibromyalgia. But it is doctors that invented the concept of fibromyalgia, and we still debate about it.
Rosenberg, however, cuts through all this nuance and goes for the simplistic and cynical conspiracy theory – pharma “invented” fibromyalgia to sell its drugs. She writes:
Nothing proves pharma’s when-the-medication-is-ready credo better than the legions of people who have fibromyalgia now that Cymbalta, Savella and Lyrica are available to treat it.
This is more historical revisionism. Having lived, and practiced medicine, through the fibromyalgia controversy it is clear that what happened is fibromyalgia became a popular diagnosis for the common vague syndrome I described above. Much after fibromyalgia became a popular diagnosis, some pharmaceutical companies saw it as a potential market. Rosenberg therefore has it backwards.
What we do have to recognize is that, now that there are drugs indicated for fibromyalgia, those pharmaceutical companies that make those drugs are invested in the reality and popularity of the diagnosis. They may therefore seek to distort the debate in that direction.
Rosenberg also embarrasses herself by criticizing the notion that there is an epidemic of sleep disorders in our society – the evidence suggests that there is, and it is under-treated. She further goes after adult ADHD and adult autism. The alternative is that autism and ADHD are childhood diseases only and always spontaneously resolve by adulthood – a scientifically untenable, and even laughable, position.
She further completely distorts the notion of “treatment resistant” conditions. She misinterprets that fact that many drugs are initially approved for adjunctive (add-on) therapy. This is not because the notion of “treatment resistance” was invented by big pharma. It is partly due to the fact that it is easier to do clinical trials where a new treatment is added to an established treatment, rather than to prove equivalence as stand alone therapy. So pharmaceutical companies go after the low-hanging fruit to maximize their return on investment.
Also – some patients are difficult to treat, and when one approach is not adequate it is nice to have more options. Rosenberg somehow turns this into a negative.
Conclusion
Rosenberg’s approach to this complex issue is simplistic, naive, and conspiracy-mongering. She brings no useful insight to the discussion. She also demonstrates nicely the method of “demonizing” a convenient target – re-write history, white wash over all complexity and nuance, and cast everything into a maximally sinister light.
But further Rosenberg shows that taking such an approach is highly counterproductive. The pharmaceutical industry, like every industry, needs an effective watchdog to guard against abuse and excess. I also think they require thoughtful and effective regulation (although this question is difficult to disentangle from political ideology).
Rosenberg and other big pharma conspiracy theorists make ineffective watchdogs and critics, because their criticisms are paper thin and easily countered . By not recognizing the complexity of the issues involved, or making any attempt at fairness, Rosenberg is easily dismissed.
If I were a conspiracy nut I might even suspect that people like Rosenberg are actually fronts for big pharma, used to create a straw man of criticism that they can then easily knock down to show that all criticism is weak and invalid.
- Yes, But. The Annotated Atlantic. - November 7th, 2009 [November 7th, 2009]
- Health Insurance Benefit Costs by Region - November 8th, 2009 [November 8th, 2009]
- For an Operator, Please Press... - November 8th, 2009 [November 8th, 2009]
- Pollyanna With a Pen: Maine Governor Signs 18 New Health Care Bills into Law - November 8th, 2009 [November 8th, 2009]
- AMA Sounds the Alarm, Medicare Making Yet Another Attempt to Cut Reimbursement - November 8th, 2009 [November 8th, 2009]
- Mass Governor Asks Blue Cross to Keep Higher Employer Contribution - November 8th, 2009 [November 8th, 2009]
- Lifespan and Care New England Plan Monopoly (Again) - November 8th, 2009 [November 8th, 2009]
- Dirigo Health: Con Artists, Liars, and Thieves? - November 8th, 2009 [November 8th, 2009]
- New Orleans: Health Challenges - November 8th, 2009 [November 8th, 2009]
- August a Flurry of Activity - November 8th, 2009 [November 8th, 2009]
- Maine's Dirigo Health Savings One-Third of Original Estimate - November 8th, 2009 [November 8th, 2009]
- “Methodolatry”: My new favorite term for one of the shortcomings of evidence-based medicine - November 8th, 2009 [November 8th, 2009]
- Suzanne Somers’ Knockout: Dangerous misinformation about cancer (part 1) - November 8th, 2009 [November 8th, 2009]
- A science-based blog about GMO - November 8th, 2009 [November 8th, 2009]
- A Not-So-Split Decision - November 8th, 2009 [November 8th, 2009]
- Military Medicine in Iraq - November 8th, 2009 [November 8th, 2009]
- The effective wordsmithing of Amy Wallace - November 8th, 2009 [November 8th, 2009]
- A Science Lesson from a Homeopath and Behavioral Optometrist - November 8th, 2009 [November 8th, 2009]
- Join CFI in opposing funding mandates for quackery in health care reform - November 8th, 2009 [November 8th, 2009]
- Mainstreaming Science-Based Medicine: A Novel Approach - November 8th, 2009 [November 8th, 2009]
- Those who live in glass houses… - November 8th, 2009 [November 8th, 2009]
- J.B. Handley of the anti-vaccine group Generation Rescue: Misogynistic attacks on journalists who champion science - November 8th, 2009 [November 8th, 2009]
- When homeopaths attack medicine and physics - November 8th, 2009 [November 8th, 2009]
- The cancer screening kerfuffle erupts again: “Rethinking” screening for breast and prostate cancer - November 8th, 2009 [November 8th, 2009]
- All Medicines Are Poison! - November 8th, 2009 [November 8th, 2009]
- When Loud Wins: Will Your Tax Dollars Pay For Prayer? - November 8th, 2009 [November 8th, 2009]
- It’s All in Your Head - November 8th, 2009 [November 8th, 2009]
- The Skeptical O.B. joins the Science-Based Medicine crew - November 8th, 2009 [November 8th, 2009]
- The Tragic Death Toll of Homebirth - November 8th, 2009 [November 8th, 2009]
- What’s the right C-section rate? Higher than you think. - November 8th, 2009 [November 8th, 2009]
- Recombinant Human Antithrombin – Milking Nanny Goats for Big Bucks - December 13th, 2009 [December 13th, 2009]
- Does C-section increase the rate of neonatal death? - December 13th, 2009 [December 13th, 2009]
- Man in Coma 23 Years – Is He Really Conscious? - December 13th, 2009 [December 13th, 2009]
- Why Universal Hepatitis B Vaccination Isn’t Quite Universal - December 13th, 2009 [December 13th, 2009]
- Ontario naturopathic prescribing proposal is bad medicine - December 13th, 2009 [December 13th, 2009]
- Naturopaths and the anti-vaccine movement: Hijacking the law in service of pseudoscience - December 13th, 2009 [December 13th, 2009]
- The Institute for Science in Medicine enters the health care reform fray - December 13th, 2009 [December 13th, 2009]
- Neti pots – Ancient Ayurvedic Treatment Validated by Scientific Evidence - December 13th, 2009 [December 13th, 2009]
- Early Intervention for Autism - December 13th, 2009 [December 13th, 2009]
- A temporary reprieve from legislative madness - December 13th, 2009 [December 13th, 2009]
- A critique of the leading study of American homebirth - December 13th, 2009 [December 13th, 2009]
- Lose those holiday pounds - December 13th, 2009 [December 13th, 2009]
- Endocrine disruptors—the one true cause? - December 13th, 2009 [December 13th, 2009]
- Acupuncture for Chronic Prostatitis/Chronic Pelvic Pain Syndrome - December 13th, 2009 [December 13th, 2009]
- Evidence in Medicine: Experimental Studies - December 13th, 2009 [December 13th, 2009]
- Midwives and the assault on scientific evidence - December 13th, 2009 [December 13th, 2009]
- The Mammogram Post-Mortem - December 13th, 2009 [December 13th, 2009]
- An Influenza Recap: The End of the Second Wave - December 13th, 2009 [December 13th, 2009]
- The End of Chiropractic - December 13th, 2009 [December 13th, 2009]
- Cell phones and cancer again, or: Oh, no! My cell phone’s going to give me cancer! (revisited) - December 20th, 2009 [December 20th, 2009]
- Another wrinkle to the USPSTF mammogram guidelines kerfuffle: What about African-American women? - December 20th, 2009 [December 20th, 2009]
- Acupuncture, the P-Value Fallacy, and Honesty - December 20th, 2009 [December 20th, 2009]
- The One True Cause of All Disease - December 20th, 2009 [December 20th, 2009]
- Communicating with the Locked-In - December 20th, 2009 [December 20th, 2009]
- Are the benefits of breastfeeding oversold? - December 20th, 2009 [December 20th, 2009]
- Measles - December 20th, 2009 [December 20th, 2009]
- Radiation from medical imaging and cancer risk - December 21st, 2009 [December 21st, 2009]
- Multiple Sclerosis and Irrational Exuberance - December 21st, 2009 [December 21st, 2009]
- Medical Fun with Christmas Carols - December 22nd, 2009 [December 22nd, 2009]
- Lithium for ALS – Angioplasty for MS - December 23rd, 2009 [December 23rd, 2009]
- “Toxins”: the new evil humours - December 24th, 2009 [December 24th, 2009]
- 2009’s Top 5 Threats To Science In Medicine - December 24th, 2009 [December 24th, 2009]
- Buteyko Breathing Technique – Nothing to Hyperventilate About - December 26th, 2009 [December 26th, 2009]
- The Graston Technique – Inducing Microtrauma with Instruments - December 29th, 2009 [December 29th, 2009]
- The “pharma shill” gambit - December 29th, 2009 [December 29th, 2009]
- Ginkgo biloba – No Effect - December 30th, 2009 [December 30th, 2009]
- Oppose “Big Floss”; practice alternative dentistry - January 1st, 2010 [January 1st, 2010]
- Causation and Hill’s Criteria - January 3rd, 2010 [January 3rd, 2010]
- The life cycle of translational research - January 10th, 2010 [January 10th, 2010]
- The anti-vaccine movement strikes back against Dr. Paul Offit - January 10th, 2010 [January 10th, 2010]
- Osteoporosis Drugs: Good Medicine or Big Pharma Scam? - January 10th, 2010 [January 10th, 2010]
- Acupuncture for Hot Flashes - January 10th, 2010 [January 10th, 2010]
- The case for neonatal circumcision - January 10th, 2010 [January 10th, 2010]
- A victory for science-based medicine - January 10th, 2010 [January 10th, 2010]
- James Ray and testosterone replacement therapy (TRT) - January 10th, 2010 [January 10th, 2010]
- The Water Cure: Another Example of Self Deception and the “Lone Genius” - January 12th, 2010 [January 12th, 2010]
- Be careful what you wish for, Dr. Dossey, you just might get it - January 13th, 2010 [January 13th, 2010]
- You. You. Who are you calling a You You? - January 15th, 2010 [January 15th, 2010]
- The War on Salt - January 16th, 2010 [January 16th, 2010]
- Is breech vaginal delivery safe? - January 16th, 2010 [January 16th, 2010]