Up to Auckland

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Our journey from Wanganui back to Auckland... Caution some pictures may offendNotre trajet de Wanganui a Auckland attention certaines photo sont de type pornographique

Surviving on Indian Roads Tips for the uninitiated The real truth behind Indian Traffic rules Or How I am learning to stay alive whilst dying a million deaths

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I have only been riding my new Enfield 350cc motorcycle a couple of days now in Bhubaneswar and thought I should write down these thoughts before I become just another participant in this web of conspiracy against every lsquoofficialrsquo traffic ordinance ever written into law The latter is bound to happen to me indeed it must for there to be any chance of survival out there at all you su

Timisoara Day 2

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Friday I met up with two friends individually. Monika worksd at the McD and is studying to be a psychologistfamily conselor. She and her boyfriend are going to be carnies in the States this summer.She got me a daypass on the transit system and took me on a tour of several parks a few churches some of her favorite markets and shops. We dropped by her apartment and when I couldn't set up the time

Australia East Coast Brisbane and The Gold Coast Surfers Paradise

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Hello allAs promised here is my essay about Brisbane and The Gold Coast Again GilliesColes family you may want to pay particular attention to this for Hannah and Anthony details RAINBOW BEACH to BRISBANESunday 18th AprilWe got up just in time for breakfast it was free and then got ready for our 10am bus to Brisbane. I was VERY excited about getting to Brisbane as I would see Hannah and An

Iao Valley State Park Maui

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Iao Valley State park is a short drive up the road from dry dusty central Maui and very quickly you are in rain forest. A large rock formation is called the Ioa needle. This is the site of an historic battle where King Kamehameha defeated the warriors of Maui and the rivers ran red with blood. Now it is a peaceful albeit foggy and damp park with walking trails and rivers. Just down the roa

Fun in the sun

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We have sadly departed from the Smith family and we left them in Cusco while we hopped on the Andean Express and headed off to visit Puno. The train ride was the best one that we have had yet the seats were quite luxurious and there were some live entertainment. It was nice to have the freedom to move around during our ten hour ride into puno as well as a bathroom to use whenever needed. Th

Tours in China

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April 22 2010Our day began at 330 am. Sadie was up and bright eyed. We needless to say were not. But we rallied and Ethan took her for a walk around 530 and found things coming to life slowly on the streets. We saw a horse drawn flat bed and quite a few dogs out for their morning walks. Our favorite corner store provided some milk to start the day out right. After another huge breakfast wi

In Dublin’s Fair City….

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Blog Day 30.Woke at about 7.30. I took a pill could see the writing on the wall as far as noise was concerned. Poor Roly had a very poor night. I woke at one stage at about 3.00am to loud caterwauling from some drunken yob. Just got back to sleep when the street cleaning vehicles came up and went down again very noisily Went cautiously down to breakfast. No cards for good service here girls

Panama Canal Crossing and into the Pacific

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After leaving the San Blas it was full steam ahead so to speak as far as organising our transit through the Panama Canal and onwards into the Pacific. Fortunately the guys of Ghost were a bit ahead of us and had arranged for Stanley the Agent to meet us at Shelter Bay Marina and he was the agent we were going to use to help us organise customs and immigrations into and out of Panama as well as a

kbbbq

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all right so were couch surfing rather driveway surfing in wilmington. tonight we are headed to a kick ball cook out travis's house. bound to be some jabby's there so our spirits are up. the missile is a wreck inside and the toilet couldnt smell worse but we are as happy as can be our plans are starting to solidify. but as per usual all bets are off the moment we light up the missile.

Forever England

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Today I felt a curious but not unpleasant sensation rippling through my nervous system. I was initially worried. It turned out not to be heatstroke. It wasnrsquot mild food poisoning or the early onset of dementia. Had someone spiked my drink last night with something toxic yet euphoric Eventually with some degree of surprise I diagnosed it as a benign bout of patriotism. Today St Georger

Final day in Taupo

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Following another restless night we both wake up with a mixture of feelings. We are ready to move on sad o be leaving Taupo and worried about the cancelled flights to the UK due to the Icelandic Volcano We have been told this could last up to 2 weeks we are due to fly in 8 daysOn that note Rob decides to lighten the mood by suggesting we walk to the bungy site however once we arrive he is

Demonizing “Big Pharma”

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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.


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