Not Sickening Enough

a book review

Sickening by John Abramson, MD. Mariner Books, 2022, ISBN 978-1328957818

This book describes the top-to-bottom control over medical research and its dissemination exerted by large drug manufacturers. Of course, they have their own research staff, paid to test their patented drugs and make sure those tests come out favorably. In addition, they are the largest sponsors of research at all the major medical schools, their reprint purchases from medical journals supply 40% of total journal revenue, and they are the largest advertiser in mainstream media, newspapers and TV, assuring that the most influential purveyors of science news know where their bread is buttered.

Thus “science-based medicine” has become tilted toward science that is curated and supported by the companies that profit from a particular approach to medicine, and toward exaggerating the benefits and minimizing the risks from the most recent and most expensive medicines.

Sickening, yes. But the actual situation is even worse than the bleak picture Dr Abramson paints. Big Pharma is not just cheating us, their approach to medicine has had disastrous effects on public health in the West, especially the USA.

For example, why would anyone believe that the same companies that defrauded the FDA and paid billion dollar fines would be telling us the truth about safety trials of their vaccines?

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This book describes the scandalous state of healthcare in America, and traces the problems to financial domination by the pharmaceutical industry. The story is told with numbers. It’s a book only a statistician could love.

I’m a statistician. What’s my problem?

Limited hangout def : A piece of journalism that covers a scandal, often with breathless intensity, but focuses on lesser crimes, and thereby diverts readers’ attention from the worst excesses. See also controlled opposition.

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We call it “healthcare”, but of course this word ranks with “Ministry of Truth” and “Re-education center” as an Orwellian deception. So much can be done to protect our health, starting with exercise, social support, organic vegetables, and clean air. But “healthcare” in America has nothing to do with these things, and it’s all about waiting until you develop symptoms, then suppressing those symptoms in the most expensive way possible. The US ranks first in the world in high-tech medicine, first by a long shot in medical expense per capita, and 68th in healthy longevity.  

“Only about 20% of a population’s health is determined by medical care; most of the rest is determined by these external factors [including] interaction between individuals and their social, cultural, and physical environment.”  

40% comes from social factors and wealth disparities; 30% from diet, exercise, and individual behaviors; 10% from pollution and other environmental factors. A compelling theme of this book is that we spend an outsized portion of our national income on the 20% and have utterly neglected the other 80%.   

A generation ago, Dr Abramson was a pioneer in muckraking from the inner bowels of the Pharma industry. To a large extent, this book is based on research he did in the early 2000s when he served as consultant to plaintiffs and expert witness in court cases against drug companies. Missing is the story of how much worse the situation has become since then, with an explosive rise in deception during the COVID pandemic. 

In the intervening decades, Big Pharma has captured the regulators at FDA and CDC and has solidified its control over the mainstream media. Without these two institutions reliably in their camp, the great deceptions of 2020-22 could never have been accomplished.

Abramson barely mentions vaccines, but when he does so it is with the understanding that, of course, vaccines are safe, the best thing Western medicine has to offer, also the best tools we have for preventive medicine. This bias is my largest beef, and I will say more about it after describing what the book does well.

“The uniquely high revenue generated by prescription drugs in the United States creates a self-generating cycle. High prices create surplus funds, which are used, in part, for advertising and lobbying, which maintain the manufacturers’ control of the knowledge and pricing, which increases profits to fund the next round of even more expensive new drugs, and so on.” 

There you have it. The Pharma industry is so profitable that they can pay off the research institutions, the doctors, the regulatory agencies, and the Congress to maintain their profitability. Controlling the flow of medical knowledge is the linchpin of their business strategy, and they do it so well that most health professionals have no idea that what they read in the medical journals is high-falutin advertising copy.

“Under our current system, it is more profitable for large pharmaceutical companies to commit crimes and pay the fines than to obey the law.”

In case after case, Abramson describes how companies have been convicted of defrauding the FDA and other corporate crimes. Humans are jailed if they are convicted of such crimes; but for  companies the equivalent of jail would be putting the company in receivership or forbidding the company to do business for a period of years. This never happens. Instead the companies pay fines which are always a fraction of the profits they reap from the very fraud they have committed. Thus “crime pays” if you’re a drug company.

“We can’t be in the business of policing every piece of data we put out.”
— Editor of the New England Journal

The most prestigious medical journals have become the least reliable. Precisely because of the respect they command, they have been targeted by the drug companies for capture. When an article is published that demonstrates the benefits of a new drug, the manufacturer will buy hundreds of reprints, which salesmen then distribute to doctors in their offices. Journals have become addicted to sales of reprints. Britain’s best-respected journal, The Lancet, gets 40% of gross revenue from selling reprints to drug companies, while the Journal of the American Medical Association and New England Journal of Medicine (JAMA and NEJM) refuse to reveal their revenue from reprints. 

Summary

Chapter 1 revisits Abramson’s old haunting ground and reminds us of medicine’s most famous scandal: Vioxx. Merck had been one of the most highly-regarded companies in America before its executives made an economic decision to (statistically) kill tens of thousands of its customers, so long as the lawsuits were costing less than the profit margin. 

Chapter 2 is about the epilepsy drug Neurontin, which was repurposed and illegally marketed for pain control. (It is legal for physicians to prescribe any drug off-label, but it is not legal for the manufacturers to talk to doctors about off-label applications.) “There is no other drug being used to treat so many different conditions with so little benefit.”

In the older cases of Merck’s Vioxx and Pfizer’s Neurontin, Abramson did the right thing, and patiently pored through the data from company trials of the drugs, demonstrating that the data told a different story from the companies’ summaries to the FDA. But in the case of Pfizer and Moderna’s clinical trials for their mRNA vaccines, the data were even more damning, yet Dr Abramson does not review them. In fact, he scolds the companies for charging so much for their vaccines that they are unaffordable in Third World countries. But there is good evidence that the mRNA vaccines are doing more harm than good.

For example, when you read that the Pfizer trials showed they are 95% effective, you might be excused for thinking that 20 people died in the placebo group for every 1 person who died in the group that got the vaccine. The truth, from Pfizer’s own data table, is that more people died in the vaccinated group than the placebo group [FDA doc, p 23]. Wouldn’t you think that this vaccine should be dead in the water the moment that this information was known? But FDA found excuses to ignore this most significant of all indicators, and sleep-walked to fast-track emergency authorization of the vaccine.  

The theme of Chapter 3 is that statin drugs lower risk of heart attacks for those who have already had one, but are being marketed to a great many more people who are judged to be “at risk”. Certainly, statin drugs are among the most over-prescribed in history, but I would like to see Abramson address the deeper controversy about their mode of action. Usually, they are prescribed to lower cholesterol levels in the blood, but many medical researchers today believe that the link between cholesterol an CV risk has been discredited. The alternative view is that the benefit of statins comes exclusively from their anti-inflammatory effect. If this is true, then inflammation can be lowered far more safely and with fewer side effects by natural herbs (curcumin), omega 3s, and NSAIDs.

Chapter 4 is about insulin. Until reading it, I didn’t know that most insulin sold today is not natural insulin but a synthetic protein, slightly modified from human insulin, that arguably provides improved performance for some Type 1 diabetes, and inarguably costs hundreds of times as much. Many diabetics can’t afford the more expensive drug and don’t know about the less expensive version, so they scale back dosage to save money and they pay with their health. I wonder if synthetic insulin doesn’t cause other long-term health problems as well. The corporate motive to “improve” on human insulin is that natural hormones cannot be patented, so they must compete on price. But insulin is literally billions of years old and has multiple metabolic functions, including regulation of lifespan in yeast cells and lab worms and humans, too. Yes, insulin has a direct impact on aging itself. Before we modify a hormone that has co-evolved with diverse aspects of our metabolism, we should be doing whole-life studies to establish long-term benefits. Synthetic insulin has been improved based on short-term, narrowly-focused studies that demonstrate marginal improvement in control of blood sugar only.

Chapter 5 is mostly about income disparities being the deep cause of bad health in America. Amen. I wish he had fingered our dysfunctional economy as being the reason for most antidepressant prescriptions.

In Chapter 6, he tells the story of a meta-analysis review of relevant data on the antiviral drug Tamiflu, signed by the prestigious and once independent Cochrane Collaboration. The review was modified after discovery that the most compelling evidence in its database was provided by the manufacturer, Hoffman-Laroche, data which had never been peer reviewed and never made public before the “review article” was written. The revised article found that Tamiflu had minimal benefit, and no impact on severe outcomes or deaths, but this revision came only after US  Homeland Security had purchased a $1.3 billion stockpile of the drug for emergency use.

Since 1975, the Federal office of Health Technology Assessment provided independent evaluation of what was working and what was cost effective. Under the Clinton Administration, HTA was defunded. To save money. There was, at one time, a Federal Clearing House, a project of the Agency for Healthcare Research and Quality that vetted healthcare information. AHRQ was shuttered during the Trump Administration. To save money. 

In Chapter 7, Abramson lays out the story of Prilosec’s replacement by Nexium, which is in fact no more effective than Prilosec, but which enabled Pfizer to effectively extend patent rights on a bestselling drug. What he doesn’t say is that both Prilosec and Nexium are deeply flawed strategies for countering stomach acid reflux (GERD). Both products are Proton Pump Inhibitors, which act by interfering with the body’s acid-generating mechanism. But the stomach requires acid to digest food, and the body chemistry quickly learns to compensate. People taking a PPI drug adapt to it by upregulating the enzymes that produce acid; the result is that PPIs are highly addictive, as discontinuation of use results in a painful surge of excess stomach acid. Older and cheaper antacid strategies don’t have this problem.

Chapter 8 is theoretical: Why we can’t rely on the free market to fix our problems. Why aren’t honest drug companies producing better products able to crowd out the parasites? The reason involves control of information that doctors and consumers need to make medical decisions. 

Chapter 9 is about Obamacare. He describes how the bill faced stalwart opposition in Congress, and in the end it achieved an increase in percentage of insured Americans from 80% to 88%. But passage was possible only because both Big Pharma and Big Insurance were solidly behind the bill; and this, in turn, was because the Obamacare plan posed no public competition for private healthcare, regulation of the industry was not included, and bargaining for price breaks on drugs was explicitly forbidden. Obamacare added to the profitability of both the insurance industry and for-profit hospitals. In the story that Abramson tells, the President fought valiantly for the “public option” that might have held down costs, but in the end the combined political clout of the drug and insurance industries defeated the reforms he had promised during his campaign. I’m not so sure that Obama was not in on the fix from the beginning.

Chapters 10 and 11 describe the political conditions that maintain our state of high prices and low quality research. I think Abramson is correct in focusing on data transparency as the key reform that is needed. The central cause of dysfunction in our medical system is that we rely on for-profit corporations to summarize for us the science that supports the benefits of their own products, while raw data remains proprietary. This is not madness, it is fraud. Abramson rallies us into the coalition that will be necessary to break the stranglehold that Pharma has on government. He has more faith in America’s democracy than I have, but I hope he’s right.

Quibbles and suggestions: 

He mentions in passing the advantage of polyunsaturated fats for lowering cholesterol. This is badly out of date. I assume that the reference slipped through Abramson’s careful editorial pen because it was part of a quote that was intended for other purposes. Nevertheless, it should be flagged for readers so they don’t take it as a recommendation to increase intake of polyunsaturated fats. Recently Dr Mercola has inveighed against polyunsaturated fats.

Is it right that Ivermectin needs only one dose a year to prevent river blindness? This study from 2014 that twice yearly works much better. Still, this is impressive testimony to a Nobel prizewinning drug that has had enormous benefits for people whose environments routinely expose them to parasites. Abramson doesn’t mention the propaganda war that disparaged of Ivermectin as “horse paste” during the COVID pandemic. In reality, dozens of clinical trials and observational studies have indicated that IVM is the best preventive and probably the best treatment we know for COVID (see also). The story of Uttar Pradesh in India is eye-opening.

Abramson notes several times that life expectancy in the US has improved in recent decades. He fails to mention that the increase is almost entirely for men. In 1980, men’s lifespans were 8 years shorter than womens’. Now, men have nearly caught up, while women’s lifespans have barely improved. Surely, neglect of research on women’s health is a scandal in its own right. 

Why doesn’t he explore the relationship of insurance companies to the problem? Insurance companies’ financial interest is opposite to the interest of drug companies, and they have used their market power to demand discounted drug prices. But they have rarely gone to bat for the health of their patients, doing their own research to determine which drugs are actually benefiting their customers’ health and reimbursing those at a higher rate than more questionable drugs. 

He might have told the story of antidepressants, sold based symptoms that reflect patients’ despair about the state of American culture and the economic pressures that come from wealth disparity. Two generations of Americans have grown up numbing themselves in response to problems that are far larger than their individual depression. He might have told how frequently side effects of drugs are treated with more drugs, which have their own side effects in an escalating, profitable spiral that is devastating to patients’ health and lucrative for the medical establishment.

Why are vaccines a sacred cow, untouchable in the press?

It is a remarkable public relations coup. The Pharma industry has surpassed Big Tobacco as the #1 industry hated by the American public. But this same public believes that vaccines are life-saving preventatives, and never questions their safety. The vaccines, of course, are sold and tested largely by the same companies that they hate, and the public never connects the dots. Why should we think that companies that have repeatedly been convicted of criminal fraud would honestly report the benefits and the risks of their vaccines?

The truth is that some vaccines have saved hundreds of millions of lives, while others are actually doing more harm than good. Vaccines have general, long-term effects on the immune system, and these can either increase or decrease risk of diseases other than the one for which the vaccine was targeted. (Refer to the work of Christine Stabell Benn.) Vaccines have communal as well as individual benefits, but they also have communal costs; so discussion of any particular vaccine must be nuanced, taking account of wide-ranging social factors. This analysis is never, never done — not by the press nor the epidemiologists nor the journals, certainly not by the FDA. Instead, the world is divided into pro-vax and anti-vax. The latter are disparaged as “enemies of science”. One of the Orwellian triumphs of the vaccine industry is that anyone who asks for vaccines to submit to the same testing regimen as every other drug category is tarred as an “anti-vaxxer”. 

There are five reasons why Big Pharma is so jealously protecting its fiefdom, marketing vaccines without public or regulatory opposition.

1. Childhood vaccines are actually mandated by most states for school children, guaranteeing a market among people who don’t even have any present health problems.

2. Vaccine manufacturers enjoy legal immunity and cannot be sued in America when their products cause harm in vaccinated people.

3. Vaccines bypass most tests for safety and efficacy. In “placebo-controlled” trials for vaccines on the childhood schedule, the “placebo” is usually a previously approved vaccine, rather than a harmless saline solution. This practice has masked an escalating spectrum of side effects, growing as the number of vaccines expands.

4. Childhood vaccine injuries, mostly unrecognized as such, feed a pipeline of lifelong customers for other drugs, especially stimulants and antidepressants. 

5. As a result, vaccines were already the most profitable sector of any drug company’s portfolio before vaccine profits went through the roof in 2021.

I won’t pretend to any comprehensive history of vaccines and their discontents, but I want to tell two stories with which I have some personal familiarity.

The childhood vaccine schedule

Dr Paul Thomas is a pediatrician in Portland Oregon. His practice is rooted in standard Western medicine, but he believes in informed consent. So every time a child comes up for a scheduled vaccine, he explains in detail to the parent the trial results, the pros and the cons, the benefits and the risks as far as they can be known from the medical literature. As a result, his patients have become a diverse sample of vaccination status, with some accepting the full vaccine schedule and some others having no vaccines at all, and most of his patients selective about which vaccines they accept. A few years ago, he worked with statistician James Lyons-Weiler to study the histories of these patients over 10 years of follow-up. How did the fully vaccinated, the less vaccinated, and the unvaccinated fare in the subsequent years of their childhood?

They wrote up their study and published it (2020) in the International Journal of Environmental Research and Public Health. In every measure of health, the unvaccinated children did better. One sixth as many allergies and anemias. One fourth as many asthmas and colds. Zero cases of ADHD among 561 unvaccinated children; nationally, the rate of ADHD is 9.4%. The article presents a graph demonstrating a positive relationship between the number of vaccinations a child receives and the number of future medical problems s/he experiences.

Fig caption: The horizontal axis divides Dr Thomas’s juvenile patients into 20 groups from the least to the most vaccinations received. The vertical axis is the normalized number of office visits. Green bars show that the number of routine check-ups was about the same across the board. Red bars show that showing up in the office to deal with fevers of any kind was much more common among the heavily vaccinated.

It is well-known that vaccines have long-lasting effects on the immune system, affecting susceptibility to multiple diseases, but the mix of benefits and risks is impossible to predict without a study of this kind. Remarkably, this is the first such study ever attempted published. Had no one ever asked the question, “are vaccinated children better off overall?” Or had they asked the question and didn’t like the answer they found?

Immediately after publication, the Oregon Medical Board suspended Dr Thomas’s license on an emergency basis, without a hearing. The journal received complaints. The publication was “irresponsible” because it would encourage vaccine hesitancy. The study was “misleading” in unspecified ways. A year later, the journal retracted the article without explanation to the authors. 

And so we don’t know whether the extensive vaccine schedule now recommended (often mandated) for children is doing more good than harm. We don’t know because someone doesn’t want us to know. 

Suppression of COVID treatments to clear the way for vaccines

I consider this story to be the most egregious scandal in the history of medical publishing. It unfolded almost two years before publication of Sickening, yet it was nowhere mentioned in the book. 

Hydroxychloroquine (HCQ) is a drug with multiple uses and a well-established safety profile. It is taken daily by millions of people who have Lupus, and hundreds of millions more who live in areas where malaria is prevalent. HCQ was used successfully in China to treat the first SARS outbreak in 2003. It works by opening cell walls to allow zinc ions to enter; zinc strongly suppresses the replication of respiratory viruses, including SARS and SARS-CoV-2.

During the spring of 2020, many small studies were being conducted around the world to see if early treatment with HCQ and zinc could keep patients out of the hospital. Then, in May, a major study appeared in the British journal The Lancet. (A companion article appeared in New England Journal of Medicine.) The authors compiled hospital records from six continents, with 100,000 patients who received HCQ and those who did not. In this huge sample of COVID patients, those treated with HCQ were dying at twice the rate of those who did not. The results were so compelling that dozens of smaller studies around the world were discontinued. It would not be ethical to expose COVID patients to HCQ under the circumstances.

But this was the opposite of what had been found previously in smaller studies. Other medical researchers, reading the article, wanted to check the calculations. They asked for the database of patients and outcomes. Weeks passed, and the authors of the Lancet study could not produce the database. Quietly, without announcement or apology, the study was retracted, along with the companion in NEJM. 

The story came out: the database had been presented to high-profile academic doctors at Harvard and Stanford by a small Chicago company called Surgisphere. The doctors were excited to have such an extensive database to work from, and they failed to ask even the most obvious questions. Surgisphere had no relationship with dozens of hospitals around the world. The patients in the database were not real people. The data had been fabricated from whole cloth. 

But the damage had been done. HCQ studies had been shut down, and the drug had been tainted as dangerous and ineffective, a reputation which has survived to this day. 

It gets worse. Subsequent studies of HCQ were designed to fail. They were limited to hospitalized patients, in late stages of the disease when the virus is already gone. Toxic dosages were given to test subjects, causing heart complications and deaths that were completely avoidable. The low dose of HCQ would have worked just fine in early stage COVID. 

HCQ was deliberately discredited. In most of the 50 states, pharmacists are forbidden from dispensing it for COVID, or else they think they are forbidden, which has the same effect. The measure of this crime is that HCQ and zinc, used early, would likely have saved millions of COVID patients from hospitalization and death worldwide, extrapolating from some of the honest studies.

The reason for suppressing HCQ and Ivermectin was not just that they are cheap, out-of-patent alternatives. FDA’s rules for emergency authorization say that a vaccine can only be considered for emergency use if no available treatments exist. HCQ (and later IVM) threatened the vaccine strategy that had been determined in advance, with tens of billions of dollars invested.

Afterword

Abramson recounts the late-breaking story of FDA approval of the Alzheimer’s drug Aduhelm, despite the fact that its own advisors had found the drug had no clinical benefit and serious side effects. There is no longer any daylight between FDA and the industries that it was created to regulate. Exactly the same dynamic is underway with approval of the mRNA vaccines. The vaccines’ efficacy plummets after a few months, while the number of deaths reported after mRNA vaccination has been 90 times greater than the worst previous vaccine (Shingrix). These vaccines were based on an entirely new, speculative technology, and rushed to market with zero long-term testing, yet the FDA ignored all precedents, ignored the company’s own data, made no pretense of risk/benefit analysis, and approved the vaccines for every age group. What does Abramson have to say about this? The vaccines “saved countless lives and prevented enormous suffering.”

The bottom line

Dr Abramson does a good job describing the inflation of drug costs and the importance of data transparency. I think he seriously underestimates the harm that has been done to America’s health by a medical system centered on patented drugs.

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I can end this review on an upbeat note by retelling my own experience with hospitals, doctors, and the medical establishment. I had almost no such experience until this time last year, partly because I distrusted what Western medicine had to offer, partly because I was both lucky and careful, and had no chronic health issues into my 70s. But last July, the front end of my bicycle had a date with a speeding truck, and I immediately had an opportunity to sample the best that Western medicine has to offer, namely trauma medicine. 

My ambulance hit the ER mid-afternoon and I was given a 20% chance of living through the night. Not only did the surgeons save my life with intensive, simultaneous attention to a dozen places where I was bleeding (internally and externally) faster than they could transfuse blood into me; they also were preparing to rebuild my shattered and lacerated left leg, even as they gave me low odds of ever living to enjoy it. 

They did a lot of things right, stopping the bleeding, putting rods and screws in both legs, repairing my shattered pelvis with a rod and a second titanium pubic bone, tying off a vein that was too badly damaged to repair. 

I was flat on my back, unable to roll over in bed for three months. One year later, I am swimming and bicycling almost at the level of a year ago. My yoga practice is coming back, and I am hiking in the woods more comfortably each day, so far without the balance and dexterity that I used to have. I can’t jump or run, but I am building in that direction and I haven’t given up. Given my age and the severity of my injuries, I am an outlier in the rate and extent of my recovery. Given the kind of collision that sent me to the hospital, it is a miracle that I lived, let alone that my brain and spine were not injured.

Perhaps of interest, I refused all pain medication in the hospital, with the exception of ibuprofen on a handful of nights. I believe, but can’t prove, that pain medication slows recovery.

“How many people have to receive a given drug in order to save one life?” This number is called the “number needed to treat,” or NNT. For metformin and the best drugs we have that treat chronic disease, this number is in the range NNT=30. In other words, 29 people will have all the side effects of the drug and no benefit so that we can save 1 life. For preventive statins and the most questionable drugs in common use, NNT can be over 1,000. 

For the treatment I received last July, NNT=1.