The Truth About the Drug Companies: How they deceive us and what to do about it
BMJ 2004; 329 doi: https://doi.org/10.1136/bmj.329.7470.862 (Published 07 October 2004) Cite this as: BMJ 2004;329:862
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Of all the words of Dr. Pawelski one statement struck me:
"Whether a patient would benefit from adjuvant therapy depends on two
things: (1) whether the tumor is "destined" to come back in the first
place and (2) whether the tumor is sensitive to drugs which might be used
to keep it from coming back."
He seems to be mixing science with the nebulous shenanigans of
destiny.
If the tumour is destined to come back, meaning if the patient was meant
to die sooner than expected, then any hope resting with adjuvant therapy
or any other interventional strategy must have scant chance of success..
My personal observation has been, over now more than 3 decades, that
not much has changed in the outcome of most cancers, chemotherapy
notwithstanding.
As much as it hurts and shames us (thinking of the trillions spent on
"cancer research/looking for a cure") we need to stand up and say openly
that our current approach to the most dreaded disease of modern times is
all wrong.
It is totally idiotic in my view to keep searching for new chemo
drugs or regimens or for bigger and better radiation dispensers. Even
cutting out the tumour is nothing more than a rather primitive measure.
I realise we do not have any real answers, answers that any patient
ought to be able to expect from Modern Medicine, so it won't do to discard
the tried and shaky methods cut, burn and poison. Yet.
Over many years, there have been "healers" who dabbled in the
treatment of cancer, they were hounded mercilessly and many deserved to
be. However, those who achieved definitive results were hounded even more,
jailed and eliminated if at all possible.
The most recent case was that of Dr. John Holt, a highly qualified
Australian doctor who achieved a 25-30 % cure rate in terminal and very
advanced cancers. While conventional medicine cannot equal this it did not
stop its leaders from shutting him down. At least they did it in style and
behind closed doors.
What we need in this world is a fresh approach for cancer which would
put much emphasis on the prevention of those cancers that our way of life
causes. Which amounts to about 90 % I would say.
Perhaps Prince Charles could spare some time?
Competing interests:
None declared
Competing interests: No competing interests
The needed change in the "war on cancer" will not be on the types of
drugs being developed, but on the understanding of the drugs we have.
There are already over 100 different therapeutic drug regimens out there,
and 400 are in the pipeline. Any one or combination of them can help
cancer patients. The system is overloaded with drugs and under loaded with
wisdom and expertise for using them.
There are many cancer drug regimens, all of which have approximately
the same probability of working. The tumors of different patients have
different responses to chemotherapy. Tumors grow and spread in different
ways and their response to treatment depends on these unique
characteristics. The amount of chemotherapy that each patient can tolerate
varies considerably from patient to patient. It requires individualized
treatment based on testing the individual properties of each patient's
cancer.
Under this approach, scientists study how an individual's cancerous
cells respond to drugs. Doctors have learned that even when the disease is
the same type, different patients' tumors respond differently to
chemotherapeutic drugs. More and more physicians and patients are turning
to "individualized therapies" to treat cancers, not just "targeted
therapies." Without individualized testing, it's difficult to determine
which drugs are best for patients who don't respond to standard therapies.
Herceptin is only for the estimated 20% of breast cancer women at
risk for recurrence. However, Gene Expression Assays are panels of markers
that can predict the likelihood of cancer recurrence in various
populations. By testing the gene expression markers of a patient,
oncologists can identify those patients unlikely to benefit from
chemotherapy from those that would, saving the other 80% of cancer
patients the added expense, suffering and even death from having to take
chemotherapy.
What a cancer patient would like ideally, is to know whether they
would benefit from adjuvant chemotherapy. If so, which active drugs have
the highest probability of working, which Chemotherapy Sensitivity and
Resistance Assays can test for drug activity against a tumor, and what
drugs are relatively non-toxic in a given patient , which Pharmacogenomic
Testing can identify.
Whether a patient would benefit from adjuvant therapy depends on two
things: (1) whether the tumor is "destined" to come back in the first
place and (2) whether the tumor is sensitive to drugs which might be used
to keep it from coming back.
The gene expression markers (assays) actually can be calibrated to
provide information both about the possibility of recurrence and also
chemosensitivity. The problem is dissecting one from the other. Studies to
date have just looked at whether people had a recurrence.
You can identify gene expression patterns (via assays) which
correlate with this. But it can be hard and even impossible to tell what
exactly you are measuring: is it intrinsic aggressiveness of the tumor?
sensitivity to adriamycin? sensitivity to cyclophosphamide? sensitivity to
taxol? sensitivity to tamoxifen? You find a gene expression panel which
correlates with something, but picking apart the pieces is hard.
You can begin to do this if you combine gene expression studies with
cell culture studies. Use the cell culture as the gold standard to define
the difference between sensitivity and resistance. Then see which pattern
correlates with which for individual tumors and individual drugs. It can
theoretically be done (and certainly will be done, over time), but it's
not easy.
And then you come to the 1,000 pound gorilla of a question: What
effect will the different individual drugs have in combination in
different, individual tumors? This is where cell culture assays will
always be able to provide uniquely valuable information. But it's not one
versus the other. The best thing is to combine these different tests in
ways which make the most sense. One month's worth of herceptin + avastin
costs $8000. That's without any docetaxel and blood cell growth factors
and anti-emetics. If nothing else, we can't afford too much trial and
error treatment.
Sources:
Human Genome Project Information:
http://www.ornl.gov/sci/techresources/Human_Genome/medicine/pharma.shtml
Human Tumor Assay Journal: http://www.weisenthal.org/
ACGT, Inc.: http://www.acgtinc.com/gene_expression.htm
Competing interests:
None declared
Competing interests: No competing interests
Readers who want a flavour of Marcia Angell's excellent book, but who
might not wish to go to the lengths of buying it, may like to know that an
article which is in effect a synopsis of the book was published (by the
same author) in the New York Review of Books, July 15, 2004. The title is
'The Truth About the Drug Companies', and the full text is freely
available online at: http:www.nybooks.com/articles/17244.
Competing interests:
None declared
Competing interests: No competing interests
Dr Blaj may be correct but only if he/she realizes that what the rep
says is at best a partial truth. The rep is presenting a one-sided
argument for the drug, in a message crafted by marketing professionals and
honed in focus groups and by other methods to maximize sales, not to fully
disclose the pros and cons - Vioxx comes to mind.
The goal of the rep is to establish a personal relationdship with you
and to convey a message that makes you feel good about prescribing his
product.
We would do as well if we paid for our own educations about
pharmaceuticals and the reps found more productive work.
Competing interests:
None declared
Competing interests: No competing interests
Come on, people! Some of us view the drug reps as pests or plagues!
Fortunately they are only human beings who just happen to earn a living
like anyone of us in this ever competitive market place. To bluntly
refuse listening to their views is akin to avoiding using internet search
engines simply because one may stumble across, say, pornographic sites!
Does it matter where the information comes from? I guess it matters in
the end but what really matters is our informed judgement based on a
healthy balance between the pros and cons. I think I am not wrong if I
say that drug companies, drug reps, etc are just a medium or shall I say
'tools' in the clinician's hand for as long as the clinician works in the
best interest of the patient. As a corollary, it would probably be
unethical to withold the treatment with a new scientifically-tested drug
if for instance one has a competent and informed patient who has tried
everything so far to no avail.
Competing interests:
a networking dinner from time to time
Competing interests: No competing interests
food, flattery, friendship, free samples, all lead to fraud.
6 steps to avoid the latter.
(1)always show great scepticism to their claims,
(2)always be non-committal,
(3)always consult good, and latest texts,
(4)never beleive the reprints, pamphlets, brochures that are doled out by
them,
(5)never prescribe a new drug till it is time-tested.usual time it takes
for fatal/serious/alarming side effects to appear is a couple of years. if
you are lucky it may be earlier. don't rush in where angels fear to tread.
be patient as nothing will be lost, as you are not the saviour of mankind
as they will try to convince you of,
(6)lastly always imagine yourselves taking the drugs you have prescribed
for others and see if you feel comfortable!
Competing interests:
None declared
Competing interests: No competing interests
The drug companies and the boycott of new theories and new treatments
On the other hand the vested interests from Drug companies can harden
the boycott of new theories and treatments. An example is the myogenic
theory of myocardial infarction with its compatible prevention and
treatment of acute coronary syndromes by cardiac glycosides, continuously
suppressed in medical publications and discussions. So, the myogenic
theory is still hidden from doctors and general public since its
development in 1972 (1, 2).
1. A New Explanation Strengthen an Old Remedy and Shed Light to the
Coronary Heart Disease Enigma. ICP, April 7, 2006 at
http://www.infarctcombat.org/media/040506.html
2. “Two Heart Disease Theories, Same Therapeutic Treatment” by
Carlos Monteiro with comments by Dr. Thomas Cowan, Fourfold Healing
Newsletter of November/December/05
http://www.fourfoldhealing.com/NL%20NovDec%202005.htm and bibliography at
http://www.infarctcombat.org/FH2005-ref.html
Competing interests:
None declared
Competing interests: No competing interests