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Rapid response to:

Editorials

Judging the benefits and harms of medicines

BMJ 2017; 357 doi: https://doi.org/10.1136/bmj.j3129 (Published 30 June 2017) Cite this as: BMJ 2017;357:j3129

Rapid Response:

MEDICINES AND VACCINES HARMS: Could International Fraud Unearthed In Ghana Be Happening Elsewhere?

MEDICINES AND VACCINES HARMS: COULD INTERNATIONAL FRAUD UNEARTHED IN GHANA BE HAPPENING ELSEWHERE?
Re: Judging the benefits and harms of medicines doi.org/10.1136/bmj.j3129

I congratulate Joe Freer, Fiona Godlee [1] and Kamran Abbasi [2] for encouraging discussion on medicines and vaccines side-effects. Could the unmasked international fraud that caused untold harm in Ghana [3] not be occurring worldwide?

DEFINITION OF FRAUD

“Crime of obtaining money or some other benefit by deliberate deception” [4]. It is by this definition that this [3] and other events need to be assessed. An Italian, a Lebanese, and a Ghanaian arranged to supply Ampicillin to Ghana’s Ministry of Health. The Italian flew in tens of thousands of empty red/black capsules labelled 500 mg. The two expatriates used the Ghanaian’s factory to put just 10 mg of the antibiotic in each capsule, adding enough chalk and kokonte (cassava powder) to fill it up. How I discovered the names of the culprits, how the Lebanese promised to build me 2 houses in Accra if I kept quiet, how I reported them to the then Commissioner for Health, how when he began to investigate he was moved to the Ministry of Agriculture - all described in BMJ http://oW.ly/Dq8g30dSHe0 [3]. Ward rounds made me distrust Ministry of Health antibiotics. Front-page splash in GHANAIAN TIMES Friday March 16 1984 read “POWDERED MAIZE IN AMPICILLIN CAPSULES: Five arrested in Kumasi and Accra”. [5]

Fraud details in countries differ. Dr J K Anand made the correct diagnosis: “A fraud has been perpetuated by one or more individuals …” [6] looking at the “Missing data at a cost of $2 bn” [2 7]. What happened in Ghana was “crude fraud” [3] but what BMJ Editors highlight is “smooth fraud” whose global effect exceeds my country’s monstrosity by far. This CORRUPTION stinks Tafracher! [8].

WHY NOT CALL A SPADE A SPADE?

Describe something as “scientific” and probity is assumed. Are we right in that assumption? [9 10 11]. How many of Professor John Tooke’s 12000 Academy of Medical Sciences Fellows [12] have read that remarkable article by Professor Lord S Zuckerman OM FRS MA DSc LLD MD FRCP FRCS, entitled “Pride and Prejudice in Science”? [13] Reading that convinced me scientific liars and lying scientists exist.

BMJ Editor Richard Smith in his book The Trouble with Medical Journals [14] states that medical journals have become "creatures of the drug industry", rife with fraudulent research and packed with articles ghost written by pharmaceutical companies. In a 2014 interview with New Scientist he suggested criminalization of research fraud [15].

BUT TERMINOLOGY COULD HIDE WRONGDOERS

Take the frequent use of phrases like “reputation of science is at stake”, and “poor science”, and “imperfections in the evidence base”, and “inadequate evidence”, and “gaps in vaccine science”. How, O how do I identify from these phrases the kind of fraudulent researcher Lord Zuckerman describes whether regarding Statins, or Thalidomide, or Tamiflu, or Tranquilizers in pregnancy, or Opiates, or Hydroxyurea? Is there no way of identifying researchers who give science a bad name? Must scientists making mistakes take refuge in something called “poor science” that “will correct itself” [16]?

TAIL WAGGING THE DOG PHENOMENON IN MEDICAL PRACTICE

Has minority opinion (the tail) not sometimes worked its way into Global bodies like WHO, UNESCO, WORLD BANK, CDC to prescribe “Official Policy” for the majority (the dog) resulting in disaster? How else do we explain WHO Director-General apologising for Sierra Leone losing 11,000 people to Ebola? [17] Or reversing earlier endorsement of Tamiflu (Oseltamivir)? [7]. Why did experts differ so much that Dr Fiona Godlee demanded “an independent review” on Statins? [18] Front page Daily Telegraph August 1 “Statins ‘needlessly doled out to millions’” [19], and DAILY EXPRESS July 14 2017 “STATINS: NEW HEALTH ALERT – Study says heart pills do you more harm than good” [20].

FRAUD NOT ALWAYS TO BLAME

“The Lancet”, wrote Sarah Knapton, “argued that thousands of people had been misled into stopping their medication after two articles appeared in the BMJ questioning their use and warning of side-effects” [21]. Two editorial giants disagreeing on Statins? There was no suggestion that any editorial palms had been greased. Indeed, one Lancet Editorial “Corruption in health care costs lives” criticised “aggressive marketing strategy by pharmaceutical companies” [22]. We know that equally brilliant experts can look at facts differently, and I gave the example of Dr Jeffrey Sachs and Professor C J Peters whose emphases on tropical public health priorities differ. [3 23. 24].

TRIBAL RUMOURS, CONSPIRACY THEORIES, CONSPIRACY FACTS [25-30]

Threats immediately provoke rumours as when on July 8 2002 one UN Official at the Barcelona AIDS Conference said (BBC’s WORLD AT ONE) that any country’s Leader failing to heed “Official Policy” should be “kicked out” [31], rumours intensified: POPULATION CONTROL is what most “Official Policy” is about - mandatory vaccinations [26], use of Artesunate-Amodiaquine for malaria [32], medicated bed nets (“What’s wrong with present nets? These Imperialists are killing babies with chest problems from medicated nets”), azoospermia in African young men caused by “spermicidal vitamins” [25 26], “Pressure from UK to legislate that men marry men and women marry women is for population control”. When vaccination for HIV was mooted people exclaimed: “Are they going to prick us with needles so we can do what we like?” [26]. Speak Tribal Language to collect grassroots opinion and you will find “Official Policy”-Vaccinology perceived as big business to kill many birds with one spicule-stone for POPULATION CONTROL. [25 26 33-36]

WHAT THEN SHALL WE DO?

“Intelligent Openness” [37] does not exist in a post-truth world [38-40]. Deception requires “Intelligent Coverup”. The serious concerns of parents and doctors who have seen damage caused by medicines and vaccines must prevail over “Official Policy” from WHO, NICE, NIH, CDC, EUROPEAN COMMUNITY. Vigilance is required as when Ghana Academy of Arts & Sciences advised Parliament NOT to allow Ebola Virus Vaccine Trials in our Ebola-free country. [41 42]. Protest is mounting against mandatory vaccinations worldwide [43 44]. Why should coercive tails continue to wag docile dogs?

Competing Interests: Self-Appointed Spokesman for Africa on Clinical Epidemiology [45 46], Public Health [47 48], and African Anthropogenetics [49 50 51].

Email: felix@konotey-ahulu.com Twitter@profkonoteayhul www.sicklecell.md

Felix I D Konotey-Ahulu FGA MD(Lond) FRCP(Lond) FRCP(Glasg) DTMH(L’;pool) FGCP

Kwegyir Aggrey Distinguished Professor of Human Genetics, University of Cape Coast, Ghana and Former Consultant Physician Genetic Counsellor in Sickle Cell and Other Haemoglobinopathies, Korle Bu Teaching Hospital, Accra, Ghana and 9 Harley Street London W1G 9AL.

References

1 Freer Joe, Godlee Fiona. Judging the benefits and harms of medicines. BMJ 2017; 357: j3129 https://doi.org/10.1136/bmj.j3129 (30 June 2017)

2 Abbasi Kamran. The missing data that cost $20 bn. BMJ 2014: 358

3 Konotey-Ahulu FID. Who should pharmacovigilate in developing countries? http://oW.ly/Dq8g30d5He0 Rapid Response 14 September 2007 to BMJ Editorial by Pirmohamed M, Atuah KN, Dodoo ANO, Winstanley P. Pharmacovigilance in developing countries. BMJ 2007; 335: 462

4 ENCARTA World English Dictionary. Fraud is the crime of obtaining money or some other benefit by deliberate deception. A BLOOMSBURY REFERENCE BOOK. Bloomsbury Publishing Plc 1999, London page 741.

5 GHANAIAN TIMES. Powdered Maize in Ampicillin Capsules. In Konotey-Ahulu FID What Is AIDS? Tetteh-A’Domeno Company, Watford, England 1989, Figure 5.6, page 75. ISBN: 0 9515442 0 9

6 Anand JK. “A fraud has been perpetuated …” Rapid Response 14 July 2017 to Mark H Ebell’s “deliberately withheld data” in WHO downgrades status of Oseltamivir BMJ 2017: 358: j3266 (12 July 2017) [Reference 7] and Kamran Abbasi’s “Missing billions” [Reference 2].

7 Ebell Mark H. WHO downgrades status of Oseltamivir: Important lessons from the Tamiflu story. https://doi.org/10.1136/bmj.j3266 BMJ 12 July 2017; 358:doi.10.1136/bmj.j3266

8 Konotey-Ahulu FID. Tafracher – http://bit.ly/2bRQ7B1 Invaluable Ghanaian devulgarizing word. BMJ Personal View 1(5953): 329 8 February 1975.

9 Dyer Clare. Journal agrees to retract paper after university found study was never done. BMJ 2013; 347:155 http://dx.doi.org/10.1136/bmj.f5500
September 5 2013

10 Eales L-J, Nye KE, Pinching AJ. Group specific component and AIDS. Erroneous data. Lancet 1988; i: 936

11 Konotey-Ahulu FID. Sickle Cell and Altitude. BMJ 1972; 2: 231-232
“If evidence obtained from my country cannot be scientific it should at least be true”

12 Tooke J. Enhancing the use of scientific evidence to judge the potential harms and benefits of medicines. Academy of Medical Science Report. 2017 http://acmedsci.ac.uk/policy/how-can-we-all-best-use-evidence

13 Zuckerman, S. Pride and Prejudice in Science. Aerospace Medicine 1974; 45: 638-647. [Also republished in Ghana Medical Journal 1975; 14: 52-60]

14 Smith Richard. The Trouble with Medical Journals. Royal Society of Medicine Press, London, 266 pages. ISBN 1-85315-5673-6

15 Smith Richard "It's time to criminalize serious scientific misconduct", in Interview with Nuwer R. New Scientist, 2986: 27 (15 September 2014).

16 Krumholz Harlan M. Statins evidence: when answers also raise questions. Sharing data is more likely to settle the debate than another review. BMJ 2016; 354:i1463 (doi:10.1136/bmj.i4963)

17 WHO Apology: Maria Cheng – The Associated Press: “WHO admits it botched early attempt to stop disease. Health Agency says response to recognize potential Ebola’s explosive spread too slow”. October 17 2014.

18 Godlee F. Statins: We need an independent review. BMJ 2016; 354: j4992 http://www.bmj.com/content/354/bmj.j4992

19 Bodkin Henry. Statins “needlessly doled out to millions”. Daily Telegraph Front Page August 1 2017

20 Sheldrick Giles. Statins: New Health Alert. Daily Express Front Page July 14 2007.

21 Knapton Sarah. End statins controversy with government review. Daily Telegraph. Friday September 2015, page 1

22 Lancet Editorial. Corruption in health care costs lives. Lancet 2006, February 11-17, page 447.

23 Sachs JD. A new global effort to control malaria. Science 2002; 298: 112-124.

24 Peters CJ. Hurrying towards disaster? Special Centennial Edition of PAHO, Washington DC, pp 14-20. [1902-2002]

25 Konotey-Ahulu, FID. What is AIDS? Tetteh-A'Domeno Company, Watford, England, 1989, 227 pages ISBN: 0 9515442 Reprinted 1996.

26 Konotey-Ahulu FID. AIDS in Africa: Wake-up call and need for paradigm shift. BMJ Rapid Response (3 April 2003) to Didier Fassin and Helen Schneider on Politics of AIDS in South Africa, beyond the controversies BMJ 2003; 326: 295-297 http://bit.ly/1EB71LS

27 Clinton President W J. Apology on behalf of the American Government to survivors of the Tuskegee Syphilis Experiment victims. Worldwide Radio & Television. May 16 1997.

28 Konotey-Ahulu FID. President Obama apologizes over Guatemala syphilis study: International cooperative research in jeopardy. BMJ Rapid response October 17 2010. www.bmj.com/content/341/bmj.c5494.full/reply#bmj_el_243183

29 Muller-Hill Berno. Murderous Science: Elimination by Scientific Selection of Jews, Gypsies, and Others – Germany 1933-1945 [Translated from German by G R Fraser] Oxford University Press, 1988.

30 Thairu Kihumbu. The African & The AIDS Holocaust: A Historical and Medical Perspective. Phoenix Publishers Ltd. Nairobi, Kenya 2003. ISBN 9966 47 1847.

31 BBC July 8 2002 WORLD AT ONE names UN Official who said any country’s leader who failed to obey “Official Policy” should be “kicked out”.

32 Amofah G. Furore over Artesunate-Amodiaquine. Daily Graphic Accra 2006, Monday May 15, page 23.

33 Konotey-Ahulu FID. AIDS in Africa. Lancet 2002; 360 (9343): 1424 Nov 2. In response to “vaccine development in the developing world” in Weidle PJ, Mastro TD, Alison DG, Nkengasong J, Machara D.HIV/AIDS treatment and HIV vaccines for Africa.

34 Konotey-Ahulu FID. Konotey-Ahulu FID. Averting a malaria disaster. Lancet 1999; 354: 258. July 17.

35 Konotey-Ahulu FID. Ebola viewed through HIV/AIDS spectacles – What Africans think. BMJ Rapid Response. August 7 2015 www.bmj.com/351/bmj.h4142/rr-0 to Zosia Kmietowicz: Ebola vaccine trial results “extremely promising” says WHO. BMJ 351: h4192 July 31 2015.

36 Lancet Annotations. The Biological Bomb. Lancet 1968 March 20; 1: 465 Lord Ritchie-Calder - “Public health in reverse: While one group of scientists is devoting its energies to prevent diseases, another is devising man-made epidemics”.

37 Tooke J. Judging the benefits and harms of medicines. Rapid Response 14 July 2017 to Joe Freer and Fiona Godlee www.bmj.com/content/357/bmj.j3129

38 Konotey-Ahulu FID. AIDS in Africa: Misinformation and Disinformation. Lancet 1987; 2(8552): 206-208 July 25

39 McCartney Margaret. Evidence in a post-truth world. BMJ 2016: 355: i6363 (Nov 28 2016) https://doi.org/10.1136/bmj.i6363

40 Konotey-Ahulu FID Evidence in a post-truth world: Scientists' Misinformation and Disinformation 19 December 2016 http://bit.ly/2igdDg2

41 Konotey-Ahulu FID. Ebola and Ethics: “Are vaccine trials going on somewhere in Africa?” www.bmj.com/content/350//bmj.h2105/rr-5 BMJ Rapid Response June 2 2015

42 Konotey-Ahulu FID. Ebola and Ethics: Ghana Academy of Arts and Sciences and Ghana Government Suspend Ebola Virus Vaccine Trials. BMJ Rapid Response www.bmj.com/content/350/bmj.h2105/rr-7

43 Day Michael. Doctor and MPs in Italy are assaulted after vaccination law is passed. 358:doi 10.1136/bmj.j3721

44 Scheibner Viera. “Presently, vaccination proponents are pushing for more and more mandatory vaccinations in many countries. Re: Peter Doshi “US Government ..” (Rapid Response July 13 2017)

45 Konotey-Ahulu FID. An African on AIDS in Africa. (Guest Editorial). The AIDS Letter - Royal Society of Medicine 1989, No 11, Feb/March 1989, pp 1-3.
http://www.konotey-ahulu.com/aidsinafrica/konoteyahulu/art1_cvref113.htm

46 Konotey-Ahulu FID. Clinical epidemiology, not sero-epidemiology is the answer to Africa’s AIDS problem. BMJ 1987; 294: 1593-1594. June 20.

47 Konotey-Ahulu FID. Public Health in less developed countries. Lancet 356 (9243): 1769-1770

48 Konotey-Ahulu FID. Combating malaria: Try public health measures in Africa too. BMJ 2009; 338: b 1971 www.bmj.com/cgi/section_pdf/338/may20_3/b1971.pdf

49 Konotey-Ahulu FID. The Human Diversity Project: Cogitations of an African Native. In POLITICS AND THE LIFE SCIENCES, September 1999, Vol 18(2), pp 317-322.

50 Konotey-Ahulu FID. Sequencing genome of 1000 volunteers: Why do this anonymously? http://bit.ly/1CZRIAT African J Health Sciences 2011; 18:37-52 www.ajhsjournal.or.ke/admin/current/914vpjkSBOS.pdf

51 Konotey-Ahulu FID. Male procreative superiority index (MPSI): The missing co-efficient in African anthropogenetics. BMJ 1980; 281(6256): 1700-1702 doi:10.1136/bmj.281.6256. www.bmj.com/cgi/reprint/281/6256/1700.pdf

Competing interests: Self-Appointed Spokesman for Africa on Clinical Epidemiology [45 46], Public Health [47 48], and African Anthropogenetics [49 50 51].

08 August 2017
Felix ID Konotey-Ahulu
Kwegyir Aggrey Distinguished Professor of Human Genetics, University of Cape Coast, Ghana
Former Consultant Physician Genetic Counsellor in Sickle Cell and Other Haemoglobinopathies, Korle Bu Teaching Hospital, Accra Ghana and 9 Harley Street, London W1G 1AA
14 Imperial Way Hemel Hempstead, Herts, HP3 9FJ.