Highly Profitable Conflicts of Interest

“Putting together my next talk on undisclosed conflicts of interest. Authors of ‘my’ go to textbook of medicine ‘funded’ in excess of $11 million without declaration. Makes practicing tricky when you lose trust in your education foundations. #TipOfIceberg”
~ Gary Fettke

We wonder why doctors coming out of medical school lack basic knowledge of treatments that don’t depend upon profitable drugs and invasive procedures. The majority of medical interns fresh out of school get about half the questions wrong on nutrition. Would you turn to someone for authoritative expertise who is as likely to be wrong as to be right in the advice they give you?

That is exactly what is happening when you ask most doctors about diet or about many issues related to diet. For example, look at the sorry state of affairs in the knowledge about cholesterol and statins. It’s standard practice for doctors to recommend statins to patients who, according to research, would not benefit from them. And so there is overprescription of statins, a class of drugs that has worrisome side effects such as neurocognitive decline (your brain needs cholesterol). This is also found with other medical practices that are continued even when doctors know they are ineffective in most cases.

The shocking part is that they’re being well funded to be this ignorant. Drug companies spend more money on advertising than on research and spend more money on influencing doctors than on advertising (they also spend money on influencing nurses, as with pharmacists, who will influence both patients and doctors; and there is the funding that goes to patient organizations).

Such ignorance among doctors doesn’t come naturally or cheaply. It requires systematic planning of a propaganda campaign that goes straight to the most ‘respectable’ gatekeepers of knowledge, such as writers in the textbook industry. This crisis extends into medical research itself, as many researchers follow this same pattern of undeclared conflicts of interest (many of those researchers, by the way, work in universities where they also teach the each new generation of doctors). This could explain at least some of why we are also experiencing a replication crisis in medical research with nutritional studies being one of the worst areas.

So, what exactly is all that money buying? And what is so dark and disturbing that these medical authorities, in not declaring it, are afraid others will find out?

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Undisclosed conflicts of interest among biomedical textbook authors
by Brian J. Piper et al

Background: Textbooks are a formative resource for health care providers during their education and are also an enduring reference for pathophysiology and treatment. Unlike the primary literature and clinical guidelines, biomedical textbook authors do not typically disclose potential financial conflicts of interest (pCoIs). The objective of this study was to evaluate whether the authors of textbooks used in the training of physicians, pharmacists, and dentists had appreciable undisclosed pCoIs in the form of patents or compensation received from pharmaceutical or biotechnology companies.

Methods: The most recent editions of six medical textbooks, Harrison’s Principles of Internal Medicine (HarPIM), Katzung and Trevor’s Basic and Clinical Pharmacology (KatBCP), the American Osteopathic Association’s Foundations of Osteopathic Medicine (AOAFOM), Remington: The Science and Practice of Pharmacy (RemSPP), Koda-Kimble and Young’s Applied Therapeutics (KKYAT), and Yagiela’s Pharmacology and Therapeutics for Dentistry (YagPTD), were selected after consulting biomedical educators for evaluation. Author names (N = 1,152, 29.2% female) were submitted to databases to examine patents (Google Scholar) and compensation (ProPublica’s Dollars for Docs [PDD]).

Results: Authors were listed as inventors on 677 patents (maximum/author = 23), with three-quarters (74.9%) to HarPIM authors. Females were significantly underrepresented among patent holders. The PDD 2009–2013 database revealed receipt of US$13.2 million, the majority to (83.9%) to HarPIM. The maximum compensation per author was $869,413. The PDD 2014 database identified receipt of $6.8 million, with 50.4% of eligible authors receiving compensation. The maximum compensation received by a single author was $560,021. Cardiovascular authors were most likely to have a PDD entry and neurologic disorders authors were least likely.

Conclusion: An appreciable subset of biomedical authors have patents and have received remuneration from medical product companies and this information is not disclosed to readers. These findings indicate that full transparency of financial pCoI should become a standard practice among the authors of biomedical educational materials.

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Failure of Nutritional Knowledge in Science and Practice
Flawed Scientific Research
Clearing Away the Rubbish
Cold War Silencing of Science
Eliminating Dietary Dissent
Dietary Dictocrats of EAT-Lancet
Monsanto is Safe and Good, Says Monsanto

Race Realism and Racialized Medicine

I came across the passage below (pp. 143-145) which brings up one of the most important problems. I came across this in the essay “Evolutionary Versus Racial Medicine: Why It Matters” by Joseph L. Graves, Jr. It is from the collection Race and the Genetic Revolution: Science, Myth, and Culture:

Thus far, health disparity research and literature has not incorporated the full evolutionary medical approach. Generally, when biology is addressed as a cause of disparity and the focus has been on genetic differences that exist between reputed racial/ethnic groups, the evidence supporting the connection has been tenuous.5 The logical errors concerning genetic causality result from either ignoring or misunderstanding evolutionary genetics. The lack of training in evolutionary biology among medical researchers and practitioners accounts for this oversight.6 In particular, biomedical scientists often confuse the existence of geographically based genetic variation as proof of the existence of biological races. They also incorrectly assume that genetic differences in loci associated with complex diseases between populations is one of the causes of health disparity.7

[ . . . ] Despite the fact that most physicians practice medicine as if biological races are clearly defined in modern humans, there are few scientists or physicians who can or are willing to construct an argument to support racial medicine. The modern medical literature still utilizes nineteenth-century anthropological categories in group studies. For example, a recent search of Entrez Pubmed (conducted on January 6, 2010) utilizing the term “race” returned 114,305 articles from the human biomedical literature. More specifically, searches on Caucasian, Mongoloid, and Negroid race returned 52,846, 22,667, and 38,792 citations, respectively. While one can still debate the utility of the term “race” in the human biomedical literature, almost no one defends the idea that nineteenth-century racial categories are legitimate or that these (Caucasian, Mongoloid, or Negroid) are of much use in twenty-first-century research.

This touches upon a similar point I previously came across in a context that had nothing to do with race and racialized medicine.

It’s not just that most medical research about race is problematic. In general, medical research is one of the most problematic fields of research. It’s not just that most medical researchers and practitioners lack training in evolutionary biology. Most of them also lack training in research methodology and analysis. Anyone can do research and many doctors are interested in doing research, but it isn’t their field of expertise. Because of this, medical research is often of a lower quality and so less reliable.

We know so little about genetics. Considering what we do know, there appears to be many people doing research who don’t even understand that small amount. Medical researchers are still using obsolete racial terms from centuries ago, really?

The context for this is race realism which reminds me of capitalist realism. The two seem to go together. Both offer a pessimism about human nature, whether seen as humans constrained to their genetics or to their greed. This kind of false pragmatism is the most dangerous thing our society faces. It blinds us to the larger reality that surrounds us. It precludes new possibilities and unconsidered solutions.

When researchers think ideologically instead of scientifically, the entire scientific method is undermined. This racial realism isn’t reality. It is an ideology about reality. The racial ideology is being used as an assumption upon which to base research instead of a hypothesis to be tested. This makes it inevitable that the ideological results sought are found. By dividing the data according to a social construct, those social constructs are reified. This is how structural racism operates.

Race realists believe genetics causes and contributes to not just race but IQ, poverty, violence, mental illness, and just about every other aspect of society. All problems are the inevitable results of inborn traits. It is a genetic determinism that often goes hand in hand with a cultural determinism, ethnicity being the connection between the two. With this worldview, there is very little to be done about any problem other than keep the genetically inferior people out of our communities and out of our country. Build walls and gated communities.

There is no room for compassion and hope in such a reactionary worldview. There are no solutions, just damage control.

The Unimagined: Capitalism and Crappiness

It’s All Your Fault, You Fat Loser!

A Dangerous Pragmatism