Do insurance companies invest in pharmaceutical companies, either directly or indirectly? Are they allowed to?

Um, th- that's a very good question.

Uh, they don't.

Uh, and, um, one of the ways to break industry's lock on this is just to start making drugs, uh, effectively.

California's getting into the insulin business.

Um, and this craziness of the $300 per vial insulin, um, uh, is going, uh, uh, the truth i- a- and now you're gonna take the $300 vial, and you're gonna cap the cost at $35 a month for consumers.

The truth is that it costs much less than $35 to make.

... actually what works.

You know, consult your doctor, but what's your thoughts?

M- my thoughts are that you need to consider that.

That's in the secondary prevention or maybe a little higher up in the secondary prevention, uh, category.

And there is a finite chance that the statin can help.

Um, it's certainly less than 50/50.

It's somewhere around, um, 30, uh, maybe it's 20, 1 out of 20 people over five years.

Somewhere in there.

Uh, uh, what are your thoughts on, it's the, that it's, one is, is seeing it directly and one is seeing it through the lens of, uh, a adulterated, uh, system?

To keep the pharmaceutical industry happy because they're going to work at when they get out.

The researchers need to do it because they wanna be researchers, and they've gotta play ball with them.

So we have this nexus of market failure, and we have no way to straighten it out.

You need to have government straighten these things out, uh, s- straighten out a market failure.

So the successful healthcare reform must include restoring epidemiological balance to the medical research agenda.

It must include that.

That was a very powerful presentation and, and one of the reasons why you're one of my favorites.

Thank you.

Okay.

Uh, I, I'm 76.

Um, I did throw caution to the wind in 2002.

I left my practice.

I had a very nice practice.

I was chair of family medicine at Lahey Clinic, and a lecturer at Harvard Medical School in healthcare policy, um, or in primary care at that point.

I, I left that practice because I u- I, I understood how much the journals, in, in this case it was The New England Journal on the drug Vioxx, were being, um, misled by the drug companies, and that it was a national emergency.

H- wh- what, what's the, what's your vision for how that would work?

So the problem here is that only about one out of three or one out of five new drugs is clinically superior, meaningfully superior to older drugs.

Um, the problem is that in the United States, docs don't have access to a health technology organization that will tell them, explain to them which drugs actually add benefit and which ones don't.

And this wonderful study that was published in JAMA show that they separated a group of, I think, 135 drugs, new drugs, into high added benefit and low added benefit.

And what they found is that the drug companies spent three times more marketing their, uh, uh, marketing their low added clinical benefit drugs.

They spent three times more marketing the low efficacy drugs compared to the high efficacy drugs.

And when they create marketing, they know what they're doing, they know how they spend their money, they spend it wisely, and they generate sales.

Overnight oats, uh, with chia and with flax and, and, and with berries and oatmeal and, and a few nuts of, of walnuts and so forth that were there.

And one of the things that we look at is, well, what are some of the ways that oatmeal can actually lower, right, your cholesterol? We understand that oatmeal's amazing.

It actually binds to those bile acids.

Remember I told you that cholesterol goes into making bile acids? So because the oatmeal binds to the bile acids, it makes your body absorb more cholesterol to make bile acids, and that's where the value of the, the oatmeal comes into play.

Now, I'm not talking about the instant oatmeal.

I'm talking about the stuff that makes you chew a little bit, the steel cut, the regular oatmeal.

So we wrote this letter to, uh, JAMA.

We wrote it in August when the, um, uh, initial, uh, papers came out, and it was not published until February 12th, two months ago.

February 12th, 2025.

So, um, this is now stale news, and our letter is gonna have very little effect, I think, on how people think about this.

But let me read it to you 'cause it covers what we think is going on.

So, to the editor, recent study reported that utilizing the predictive, pre- utilizing the predicting risk of cardiovascular disease events, the prevent equations, developed by the American Heart Association and the Ame- American College of Cardiology for calculating cardiovascular risk would lead to millions fewer US residents at low risk of heart disease being recommended for statins.

So, um, how can we trust the, you know, even, um, these companies, uh, so how, how can we trust that these companies, if we, if we make it so that they have to show us the clinical trial data, that they won't doctor up the clinical trial da- the tr- the clinical trial data?

Well, that's a, yeah, that's an excellent question.

So what can we do about it? Well, first of all, we have to get rid of ingesting the things that have a lot of plastic, and that would be, uh, seafood.

And, uh, I did check into my omega-3 supplement that was algae-based to find out if it had plastic, and the answer is yes.

And so we have polluted the planet to the point where whatever's coming out of the ocean, um, ought to be somehow filtered if it's possible.

Um, but it really is a struggle.

Okay, so, um, so that's the, the fish issue.

How about choles- how about eggs? Uh, eggs are often touted as a good source of protein, and they s- and they say, yes, you're, uh...

Commercial marketing and medical, and let me translate that.

That means the marketing department of the drug company needs to be involved in all data dissemination efforts.

The marketing part of the drug company needs to be involved in all aspects of data dissemination.

Now, let me show you how this plays out in the real world.

This is real, uh, data from the drug Paxil.

Uh, excuse me, Paxlovid.

Yeah

... uh, I'll give a brief answer.

Um, there's an excellent example of that.

There was a study called The Diabetes Prevention Program study.

It was publicly funded, uh, done in the '90s.

I think it was published in 2002.

And it took people who were at high risk of developing diabetes, and it randomized them to three groups.

Dr. Abramson?

Only seven of those 27 researchers even took the time to respond to the request for the data.

And the BMJ editors say in stark language here, listen to how strong they are, from 2015, the statin saga forces us to confront the deep flaws in our current system for evaluating medicines and guiding clinical decisions.

These are strong words and the BMJ is a major journal.

You would think that this would change things.

In particular, how can it be right to recommend mass treatment of healthy people without independent review of patient level data, especially the data on adverse effects? The statin trialists have huge potential.

The trialists who control this data have huge potential and they have a choice They can take the lead on transparency.

So is the knowledge reasonably accurate and complete? And now, as shocking as the previous data was about the comparative performance and cost of American healthcare, this I think is really, really far more disturbing in my mind, how what is taken for knowledge and what directs our healthcare has been so captured by commercial interests.

So if we, this is a, let me, before we get into that.

In 1991, 81% of research, medical research was done by universities and nonprofit centers.

They controlled the research.

They largely designed the research.

They had owned the data.

There are some groups trying to undo the coziness between the guideline writers and the drug companies.

They haven't been very successful, in my opinion.

So again, a little bit more about guidelines.

They sound objective.

They're often written by paid insiders.

And really, no guideline will say, don't use this drug.

And it's a very scary thought.

So Steve, I was involved in litigation around Neurontin, gabapentin, which was approved by the FDA as a secondary anti-seizure drug and for the treatment of post herpes neuralgia after you get shingles for the neuropathic pain after that can last for months and is very severe.

And it was approved for no other causes of pain.

And I had all the data and this is one of the rare cases that went to trial so I can talk about it.

Kaiser Health Plan sued Pfizer And the bottom line is that the jury found that Pfizer had committed fraud and racketeering in lying or being fraudulent, let's use the right language, about presenting its information in the medical journals.

And my report is accessible online and many of the exhibits are accessible.

And we showed not just that Pfizer knew that its drug, Neurontin, wasn't effective for neuropathic pain.

I mean, they They get a large amount of money from companies, unfortunately.

So Jim and Harriet Rosenberg and Nick Jewell and I, we reanalyzed this data and we had a paper published in the British Medical Journal.

And our conclusions were that lifestyle factors, including lack of exercise, tobacco use and unhealthy diet account for about 80% of cardiovascular disease, 80%.

This is the headline of the story.

If you want to prevent heart disease for yourself, your family, your loved ones, your parents, 80% of the risk is what you do about your own healthy habits.

Now, for people at low risk of cardiovascular disease, and that's 10% risk over the next five years because the British Medical Journal obviously is written in the UK, But if we go less than 20% risk over the next 10 years, statins do not reduce the overall risk of death or serious illness.

I want to say that again.

So when I was in medical school in the 70s, it was, in my opinion, shameful when I heard that a professor was taking money from a drug company to do research.

That didn't seem right.

It seemed like a total conflict of interest.

That was in the early 70s.

But that flipped completely so that the article in the Journal of Science, Academic Industrial Complex, was written in 1982, published in 1982.

And this article says scientists who 10 years ago would have stubbed their academic noses at industrial money, and 72 is when I went into medical school, now eagerly seek it out.

It's not really a process that's designed to provide the best available evidence.

So the prestigious journals, the more prestigious the journal, the more attractive they are to the drug companies to submit their randomized controlled trials because when the companies buy the reprints from the journals and have their drug reps hand them out, it looks like the doctor who you were describing, Steve, who's a hardworking, dedicated doc, when he or she receives the reprint and it says New England Journal or Lancet or whatever, that's supposed to be the truth.

But as Jim was saying, there's an enormous financial conflict of interest so that it's hard to get this data.

But one study showed that for the Lancet in 2005, I think, 41% of the Lancet's income came from selling reprints of the clinical trials that it published back to the manufacturers so the drug reps could hand them out to the doctors.

And the editor of the British Medical Journal, when he stepped down, Dr. Smith said, it took me 25 years to figure out what was going on, but this, he didn't use this word, but it's basically a racket where the journals publish these commercially important articles, and then they make a significant percentage of their money selling the reprints back to the drug companies.

No, definitely not.

Yeah, I was a family doc until I understood what was happening with Vioxx back in 2001.

Vioxx was an arthritis drug that was supposedly... advantageous because it was gentler on the stomach and safer.

This is the population for women that we were just talking about and similar populations of men.

Unfortunately, our analysis is imperfect because these trials are not solely primary prevention.

Eight and a half percent of the patients in these primary prevention studies already have evidence of occlusive vascular disease.

Furthermore, many of the patients, in some studies more than half of the patients, have a 10 year risk of heart disease over 20%.

And though experts generally agree that if your 10 year risk is over 20%, you should be treated like somebody who already has heart disease and you should be on statins.

And there was, because the patient level data as it showed in that iceberg slide, because that patient level data is not submitted to the journals when the articles are published.

Longevity has actually gone down since 2014.

And it was going down slightly even before COVID hit.

Now, this is really critically important because there was a huge natural experiment in 2014.

Obamacare came in.

And Obamacare led to about half of the uninsured Americans getting health care coverage.

This has been a major issue.

So it's a sad situation, but it's the truth and it's the way it's been set up.

And it's been hard to discuss these things.

And so thanks to you, Steve, for allowing us to bring these issues out that aren't covered well or are covered up well in our news and in our information sources.

I think the biggest way that the drug companies to pick up on what Jim said about the funding of the trials and the control of the design of the trials and the financial relationships with the researchers and the universities, All that's true and very important.

In my opinion, at the core of the problem is that the drug companies own the data from the trials, and they're very clear about it.

I showed a slide from Pfizer in my first lecture on Monday, last Monday, that showed that Pfizer says openly that they own the data, they control the data, that all the studies have to be run through the marketing departments so that they'll be able to capitalize on the information that's produced.

But the most shocking thing for me is that the data are not shared with peer reviewers or medical journals.

Since this is one of the main themes of your books, can you elaborate on the implications of pharmaceutical companies owning the raw data from their clinical trials? Their job

So I'm looking forward to everything you have to say.

And I'm going to be careful to leave enough time for discussion so that we can make up for some of the time we missed on the last lecture as

Thanks.

All right.

So I want to, Michael, I want to thank you.

Special thanks to John Papadopoulos and to Steve Shore for organizing this.

this conference, which is essential in getting health information out that otherwise is very difficult to access.

And that's why I participate in this because it's an opportunity to communicate serious issues about healthcare that are otherwise very difficult to put together.