We’ve written a lot about the scientism of mainstream economics, both here and in ECONNED, and how these trappings have let the discipline continue to have a special seat at the policy table despite ample evidence of its failure. As bad as this is, it pales in comparison to the overt corruption of science at work in the drug arena. Although this issue comes to light from time to time, often in the context of litigation, the lay public is largely ignorant of how systematic and pervasive the efforts are to undermine good research practice in order to foist more, expensive, and sometimes dangerous drugs onto patients.
Ben Goldacre, a British doctor and science writer, provides a short overview of one of the worst scams practiced by Big Pharma: that of suppressing negative research, in a new piece at the Guardian (hat tip John l). This is the overview:
Drugs are tested by the people who manufacture them, in poorly designed trials, on hopelessly small numbers of weird, unrepresentative patients, and analysed using techniques that are flawed by design, in such a way that they exaggerate the benefits of treatments. Unsurprisingly, these trials tend to produce results that favour the manufacturer. When trials throw up results that companies don’t like, they are perfectly entitled to hide them from doctors and patients, so we only ever see a distorted picture of any drug’s true effects. Regulators see most of the trial data, but only from early on in a drug’s life, and even then they don’t give this data to doctors or patients, or even to other parts of government. This distorted evidence is then communicated and applied in a distorted fashion.
In their 40 years of practice after leaving medical school, doctors hear about what works ad hoc, from sales reps, colleagues and journals. But those colleagues can be in the pay of drug companies – often undisclosed – and the journals are, too. And so are the patient groups. And finally, academic papers, which everyone thinks of as objective, are often covertly planned and written by people who work directly for the companies, without disclosure. Sometimes whole academic journals are owned outright by one drug company. Aside from all this, for several of the most important and enduring problems in medicine, we have no idea what the best treatment is, because it’s not in anyone’s financial interest to conduct any trials at all.
And the consequences are devastating. Data scientist Cathy O’Neil earlier discussed one case, that of Vioxx:
Yesterday I caught a lecture at Columbia given by statistics professor David Madigan, who explained to us the story of Vioxx and Merck. It’s fascinating and I was lucky to get permission to retell it here…
Yet Madigan’s own data strongly suggests that Merck was well aware of the fatalities resulting from Vioxx, a blockbuster drug that earned them $2.4b in 2003, the year before it “voluntarily” pulled it from the market in September 2004. What you will read below shows that the company set up standard data protection and analysis plans which they later either revoked or didn’t follow through with, they gave the FDA misleading statistics to trick them into thinking the drug was safe, and set up a biased filter on an Alzheimer’s patient study to make the results look better. They hoodwinked the FDA and the New England Journal of Medicine and took advantage of the public trust which ultimately caused the deaths of thousands of people.
And “deaths of thousands of people” is no exaggeration. When Vioxx was taken off the market, the US death rate fell and experts attributed it to the Vioxx withdrawal.
Goldacre explains that the sort of abuse that occurred with Vioxx isn’t an anomaly. One of the biggest ways pharmaceutical companies deceive doctors (even the ones like Goldacre who have the skills and take the time to read medical research) is by presenting them only with cherry picked studies, those that show good efficacy and low/no adverse side effects. Perversely, regulators don’t insist that they receive the results of all clinical trials on a particular drug and make the results public. This deliberately misleading disclosure is even more troubling as some economists keep maintaining that patients need to become more informed medical consumers and decide which treatments to buy and not buy. Ahem, major drug companies already spend more on marketing than on reasearch and doctors themselves, including vigilant ones like Goldacre, are snookered. How is the dumb chump public supposed to make sense of all this if medical professionals can’t?
Goldacre stresses the active suppression of negative research and mentions in passing a second flaw: limited duration of safety and efficacy studies. Typically clinical trials are at most four months in duration. That is not sufficient to see if they work over the long term and similarly, have long term side effects. Both have proven to be major issues with psychoactive drugs. Many appear to provide short-term changes, but the brain’s chemistry often adjusts to counter the operation of the drug, leaving the patient more or less back to where he started from. That often leads doctors to prescribe even more drugs. Similarly, important side effects are often missed in the original clinical trails. The now well known libido-suppressing effects of SSRIs (selective seratonin uptake inhibitors, the most widely prescribed type of anti depressant) weren’t captured in the initial clinical trials, first because it took a little while for patients to recognize what was happening, and then they were embarrassed to discuss it with their doctors. More generally, while the FDA (and I assume other national drug regulators) have a regime for tracking longer-term effects, it is not well enforced.
The entire Goldacre piece is a must read, and here are the some important parts:
In 2010, researchers from Harvard and Toronto found all the trials looking at five major classes of drug – antidepressants, ulcer drugs and so on – then measured two key features: were they positive, and were they funded by industry? They found more than 500 trials in total: 85% of the industry-funded studies were positive, but only 50% of the government-funded trials were. In 2007, researchers looked at every published trial that set out to explore the benefits of a statin. These cholesterol-lowering drugs reduce your risk of having a heart attack and are prescribed in very large quantities. This study found 192 trials in total, either comparing one statin against another, or comparing a statin against a different kind of treatment. They found that industry-funded trials were 20 times more likely to give results favouring the test drug.
He then discusses that broader studies (ones that were not drug specific) had similar findings. He continues(emphasis mine):
It turns out that this pattern persists even when you move away from published academic papers and look instead at trial reports from academic conferences….
How does this happen? How do industry-sponsored trials almost always manage to get a positive result? Sometimes trials are flawed by design. You can compare your new drug with something you know to be rubbish – an existing drug at an inadequate dose, perhaps, or a placebo sugar pill that does almost nothing. You can choose your patients very carefully, so they are more likely to get better on your treatment. You can peek at the results halfway through, and stop your trial early if they look good. But after all these methodological quirks comes one very simple insult to the integrity of the data. Sometimes, drug companies conduct lots of trials, and when they see that the results are unflattering, they simply fail to publish them.
Because researchers are free to bury any result they please, patients are exposed to harm on a staggering scale throughout the whole of medicine. Doctors can have no idea about the true effects of the treatments they give. Does this drug really work best, or have I simply been deprived of half the data? No one can tell. Is this expensive drug worth the money, or has the data simply been massaged? No one can tell. Will this drug kill patients? Is there any evidence that it’s dangerous? No one can tell. This is a bizarre situation to arise in medicine, a discipline in which everything is supposed to be based on evidence.
And this data is withheld from everyone in medicine, from top to bottom. Nice, for example, is the National Institute for Health and Clinical Excellence, created by the British government to conduct careful, unbiased summaries of all the evidence on new treatments. It is unable either to identify or to access data on a drug’s effectiveness that’s been withheld by researchers or companies: Nice has no more legal right to that data than you or I do, even though it is making decisions about effectiveness, and cost-effectiveness, on behalf of the NHS, for millions of people.
In any sensible world, when researchers are conducting trials on a new tablet for a drug company, for example, we’d expect universal contracts, making it clear that all researchers are obliged to publish their results, and that industry sponsors – which have a huge interest in positive results – must have no control over the data. But, despite everything we know about industry-funded research being systematically biased, this does not happen. In fact, the opposite is true: it is entirely normal for researchers and academics conducting industry-funded trials to sign contracts subjecting them to gagging clauses that forbid them to publish, discuss or analyse data from their trials without the permission of the funder.
This is such a secretive and shameful situation that even trying to document it in public can be a fraught business. In 2006, a paper was published in the Journal of the American Medical Association (Jama), one of the biggest medical journals in the world, describing how common it was for researchers doing industry-funded trials to have these kinds of constraints placed on their right to publish the results. The study was conducted by the Nordic Cochrane Centre and it looked at all the trials given approval to go ahead in Copenhagen and Frederiksberg. (If you’re wondering why these two cities were chosen, it was simply a matter of practicality: the researchers applied elsewhere without success, and were specifically refused access to data in the UK.) These trials were overwhelmingly sponsored by the pharmaceutical industry (98%) and the rules governing the management of the results tell a story that walks the now familiar line between frightening and absurd.
For 16 of the 44 trials, the sponsoring company got to see the data as it accumulated, and in a further 16 it had the right to stop the trial at any time, for any reason. This means that a company can see if a trial is going against it, and can interfere as it progresses, distorting the results. Even if the study was allowed to finish, the data could still be suppressed: there were constraints on publication rights in 40 of the 44 trials, and in half of them the contracts specifically stated that the sponsor either owned the data outright (what about the patients, you might say?), or needed to approve the final publication, or both. None of these restrictions was mentioned in any of the published papers.
When the paper describing this situation was published in Jama, Lif, the Danish pharmaceutical industry association, responded by announcing, in the Journal of the Danish Medical Association, that it was “both shaken and enraged about the criticism, that could not be recognised”. It demanded an investigation of the scientists, though it failed to say by whom or of what. Lif then wrote to the Danish Committee on Scientific Dishonesty, accusing the Cochrane researchers of scientific misconduct. We can’t see the letter, but the researchers say the allegations were extremely serious – they were accused of deliberately distorting the data – but vague, and without documents or evidence to back them up.
Nonetheless, the investigation went on for a year. Peter Gøtzsche, director of the Cochrane Centre, told the British Medical Journal that only Lif’s third letter, 10 months into this process, made specific allegations that could be investigated by the committee. Two months after that, the charges were dismissed. The Cochrane researchers had done nothing wrong. But before they were cleared, Lif copied the letters alleging scientific dishonesty to the hospital where four of them worked, and to the management organisation running that hospital, and sent similar letters to the Danish medical association, the ministry of health, the ministry of science and so on. Gøtzsche and his colleagues felt “intimidated and harassed” by Lif’s behaviour. Lif continued to insist that the researchers were guilty of misconduct even after the investigation was completed.
So get this: doctors that revealed not the content of any of the work they did, but some of the key features of the research contracts, were harassed, with the clear intent of getting them fired and damaging their reputations.
Goldacre also has a long discussion of “off label” uses of drugs, and GlaxoSmithKline presented studies that showed paroxetine, an anti-depressant, was effective in children, even though if you included the studies they hid, you would have to conclude that its efficacy was not proven. And because this was an off label use, GSK didn’t have to report about the side effects, namely, increased risk of suicide. Goldacre writes:
How is it possible that our systems for getting data from companies are so poor, they can simply withhold vitally important information showing that a drug is not only ineffective, but actively dangerous? Because the regulations contain ridiculous loopholes, and it’s dismal to see how GSK cheerfully exploited them: when the investigation was published in 2008, it concluded that what the company had done – withholding important data about safety and effectiveness that doctors and patients clearly needed to see – was plainly unethical, and put children around the world at risk; but our laws are so weak that GSK could not be charged with any crime.
Again, please read the entire article and circulate it widely. The way to start to attack this is to demand more transparency, say by requiring any drug company that gets NIH funding to make all its drug research contracts and studies public. A credible threat is the only way to force this miscreant industry to begin to behave responsibly.
Excellent article, Yves!
This is another example of how, “finance” distorts “markets.” And, I’m using quotes around both finance and markets– finance is discussed daily, but I just want you all to stop and consider the field of research as a market, because I think it shows quite nicely the limit of contemporary capitalism.
The fact is, that most of the significant scientific and technological discoveries are the result of being in the right place at the right time. I personally, would even go further and say, that revolutionary scientific discoveries are by their very nature subversive. Now consider, the current system of incentives (supply/ demand), which is supposed to drive scientific and technological development: these can only bind researchers closer to the /existing/ system.
In effect, we have compromised researchers most valuable characteristic– their independence and impartiality. And at a time, in which their work is arguably more important than it has ever been for the survival of our way of life.
Talking heads, “Crosseyed and painless”
The island of doubt-It’s like the taste of medicine
Working by hindsight-Got the message from the oxygen
Making a list-Find the cost of opportunity
Doing it right-Facts are useless in emergencies
Facts are simple and facts are straight
Facts are lazy and facts are late
Facts all come with points of view…
Just this week you have shone the spotlight on Big Agri, now Big Pharma … while the corruption at the core of Big Banks has been in focus for some time. I’m waiting for Insurance, and Media/Marketing/Advertising to hit the stage. By the time this historic cycle is over we will have figured out that 90% of GDP is comprised of products and services that have no moral reason to exist.
Well, what about big Tech, Apple, Google, etc.?
But you are right, we are living in a hall of mirrors.
Add GE’s nuclear reactors and you have the four horsemen that can destroy our food, health, environment, soil, and economy.
Imagine what corporate profits would look like if we actually had non-captured regulators doing their jobs. I suspect the profits of the entire pharma industry, which hasn’t produced a legitimate blockbuster drug in years, would be wiped out. So would the profits of many other parasites on the health care system and escalating health care costs, like United Healthcare, Wellpoint, etc. With honest accounting and a ban on deceptive practices, profits of the financial services industry would be drastically reduced or wiped out. Likewise for the defense industry. The for profit education industry would be out of business if not for taxpayer loans to students pursuing mostly near worthless degrees. Break up oligopolies in the telecommunications industry and create some competition and most of the profits in that industry would disappear.
But these industries and others have bought both political parties, so this is the system we have and will continue to have.
I spent 8 years in academic medicine. You simply have no idea how corrupt it is from top to bottom. Like so many other areas of human endeavor, it’s all about the money. Research grant money is skimmed by the university. 50% off the top is not uncommon. So someone with big drug grants is a “producer” and gets a bigger salary, nice office, etc.
Then come the lectures. You get all-expenses-paid trips to nice places plus a fat honorarium.
This all goes away if you piss off the drug companies, so you have to publish positive things and the lectures have to be infomercials. I have often thought that these people should wear patches on their white coats like race car drivers wear, showing who sponsors them.
One time I was invited to speak at a symposium. I had never had a drug company grant so I was rather naive about how the game was played. I’m still not sure why I was invited to speak, other than one or or two minor things I’d written. I literally saw some of the biggest names in my field read from scripts prepared by the drug company, following along with the slides. The audience had no idea that these were scripted performances.
I was also given a script and slides. When I told them I had my own lecture and slides and insisted on using them it caused a huge stink. Initially there was anxiety over the loss of control over the dog and pony show – fears that were well-founded. It turned ugly when they realized that what I intended to say totally trashed the message of one of the scripted lectures.
I stuck to my guns. When the time came for the panel discussion the guy running the symposium – one of the biggest names in the specialty – did everything he could to make me look bad. It didn’t work and I kind of enjoyed getting him to lose his cool. People were coming up to me during breaks and asking me WTF was going on. I guess there was enough of that feedback that they told the jerk to back off because the second day he was a pussycat.
I left academics a year later. Even if I could stand being around the whores they would have made sure I never published another article since the whores at the top are the ones on the editorial boards. I have no regrets: an honest day’s work treating patients beats anything I experienced during 8 years as a professor.
A lot of the most famous doctors in academics are also some of the worst clinicians. They got famous by marching in the Bullshit Parade, not by performing great acts of healing. Many of them would be unable to function in a typical clinical setting.
Great post! I think many of us in the major institutions of this country who have eyes to see can see the rampant corruption everywhere. I was a gov’t IT consultant and saw similar problems not just with IT but throughout gov’t. Offices that did nothing, stunning redundancies and fiefdoms, takeover of big corporate consulting firms each getting plum contracts often duplicating systems. Even the firm I worked for resisted innovation because it would reduce billable hours. And don’t get me started with the whole lobbying/PR/Congressional staff series of revolving doors or the fact the major media is spoon fed by PR companies (yes I worked in that area as well).
To put it simply, there is no hope for our major institutions. They will get worse because the incentives are all perverse. We need to just fuggedaboutit and start building our own networks of honest professionals and businesses and get down to the long and patient construction of new institutions within the ruins of the old. I think we are in that transition period. Sadly, it is only the right that really gets it but they are run by PR firms like one I worked for. Also, in case no one recognizes it, many popular blogs are partially controlled by young bloggers paying off big student loans who work for certain PR firms in and around K Street. Money is very seductive.
I used to own a company that did sales, marketing and product development research for a small and (largely) ethical mfr. specializing in innovative animal nutrition products. I was tipped to participate in a private-public committee to discuss the regulation of such products. My fellow committee members were state regulators, two FDA officials, and a few reps for large, well-known animal nutrition firms.
I learned first-hand how the big firms enjoyed an inside track with regulators, how pathetically ignorant the state regulators were about the natural substances they were itching to rule out of existence, and how duplicitous FDA types could be in protecting their careers and corporate relationships.
In private conversations with the FDA officials, I was highly amused to discover that they both fed our products to their animals and enjoyed the results! Back in the committee room, of course, they returned to their inside-the-Beltway coded methods of disparagement in oh-so-reasonable terms.
I also learned (from my own motivations) how manufacturers could easily be sucked into the game as long as it could be played to protect their own interests. Not long after this experience I quit the field entirely, disgusted with the cut-throat and dishonest tactics of my competitors, with marketing in general and the grow-or-die imperative, and, most importantly, with myself for succumbing to it all.
….My tiny glimpse of the tortuously wound guts of the scandal this outstanding post describes.
Great posts! I find it the most valuable to hear “insider” stories, which corroborate the message and show the extent of corruption described in this piece.
Yes, there is no hope for our major institutions. And we have to ask… why? What is it about this period of history when these large scale institutions seemed to have over-ripened and rotted so much? One thought is that the growth in scale of these institutions has outstripped some check-and-balance – maybe their incentive to communicate honestly, and the the resulting corruption is ultimately self destructive.
Tip O’Neill once said “All politics is local”. By that standard, the larger the scope of government or corporate reach, the more prone it is to losing touch.
thank you or saying what I’ve always thought.
I got out of academic medicine pretty early but returned to acedemia to pursue yet another degree.
The whole medical system is rigged,pharma rules the roost and doctors are oblivious to it.
I spent much of my recent graduate studies investigating nd writing about the revolving door big pharma has with those at the FDA, CDC and NIH as well as the federal advisory committees, it’s downright shameful.
Yet another outstanding piece Yves …
You are truly one of the very few shinning lights of honesty, integrity and courage left in a dark sea of corruption …
A doctor I respect advises you should never take a drug which has been on the market for less than a year. My approach is to limit myself to very old drugs (ten years or more). Part of the problem is an unrealistic public belief in drug ‘cures’. The oldest medical axiom says ‘the body heals itself’. In general, drugs only supress symptoms. Their problems are magnified by interactions which were never tested. You need courage to resist the blandishments of the medical industry. Its practitioners are always so handsome, so reasonable. They make you feel like a fool when you reject their advice, and the doctors practice defensively: it doesn’t matter if you die, but it does matter if they get sued for letting you die without exposure to the latest drug cure.
Re: Dearime: Or another way insist that only generic drugs be prescribed for you. That is another way to get the extended trial, and have a better idea what the consequences of taking the drug are. Of course many of the commentors here are right fee for service creates the incentive to look for sickness so the medical system can be paid to treat it.
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I came across this in WKPD.
“Metformin … is the first-line drug of choice for the treatment of type 2 diabetes … the only antidiabetic drug that has been conclusively shown to prevent the cardiovascular complications of diabetes.
… in 1957 … the first clinical trial of metformin as a treatment for diabetes. It was introduced to the United Kingdom in 1958, Canada in 1972, and the United States in 1995.”
Why did the UK use it within one year of the successful (French) trial while the US waited a further thirty-seven years?
No patent on metformin, other than some manufacturing process patents, of which the (apparently) last had expired by 1995. If they don’t own the patent, drug companies have exactly zero interest in the drug, no matter how good it is. Without a drug company to pursue approval, FDA will hardly ever get around to doing anything about it, no matter how good it is. In this way, patent law coupled with corrupt regulation works to drive useless, and often dangerous, “innovation” – a worser mousetrap.
My former boss (clinician) blew the whistle on Vioxx and was ostracised for many years (and is finally lauded). Colleagues (at Bristol Uni) published a fantastic test for pulication bias – the inverse funnel test – one of the most cited papers in medicine. For a given drug, clinical trial estimates of effectiveness should be widely dispersed for small sample sizes and should converge on the true effectiveness rate as the sample size increases – hence the inverse funnel of treatment effects. Half the funnel is “missing” for a number of drugs – you can guess which half! Great demonstration of when pharma is suppressing the trials that didn’t show effectiveness.
Wow, that is brilliant.
Can you provide a link to the paper, or to a longer layperson friendly write up?
Perhaps it is this one:
Egger (1997) “Bias in meta-analysis detected by a simple, graphical test”
Having worked as a patent attorney in pharma for many years, I am not too suprised. The investment risk is just too great for companies not to get tempted to embellish their research to the point of putting lipstick on a pig. I have argued for years that pharmaceutical research should be funded publicly with full publich access of the research and development. Given the economic risks and incentives, the public is too vulnerable to the beer goggles that most executives wear when they have to evaluate research on research programs their careers are tied to. The pharmaceutical companies should be only in the business of bidding on production.
I was under the impression that that was how it started out. That the NIH did the research and then contracted with Pharma to produce the medicine.
Nope. The NIH does do drug research, but the lion’s share of the work is done in the pharmaceutical houses.
But a lot of basic and not so basic research is FUNDED by NIH, no?
Most of the basic research is NIH funded.
Claritin is a successful marketing based drug, in that the trial studies found it was, “as effective as the placebo.”
A worthless compound that brings in 100’s of millions; at least it does no harm.
Beware that “placebos” for phase two trial or trials looking for adverse events often use toxic substances and non-disclosed substanes as the placebos, at least in the vaccine development world they do. And, the FDA let’s them.
can you imagine and undisclosed biologic listed as the placebo when looking at the rotavirus vaccine’s risk of intucusssption. THe placebo and vaccine group both had high rates but they were equal so the newer vaccine passed. (the previous vaccine was known to cause the problem). often, previous vaccines are used as the “placebos” in these trials.
What I read in some book about overtreatment in the medical system is that claritin actually is</em effective…BUT not at the doses that are non-sedating. Since the whole point of the drug is to be non-sedating (otherwise you could just take diphenhydramine, aka Benadryl), the drug is useless.
“The drug doesn’t work, but the side effects are bitchen!”
Great slogan! Made my life a little better….
Thank you for this important post. One way to, penetrate this topic is to pick out an orphan compound/drug that is promising, but has no commercial value and follow its progress or demise over a period of years. Another useful approach is to find a reality based, medical research, Journo who is not a cheerleader for an industry such as Nicholas Wade at NYT on anything related to genetics. Compare a standard media report on a medical “breakthrough” with a more sober report such as one you might find on a dedicated support foundation website who generally want results that do not kill the patient. Do not be intimated by medical research journals. I like the ones that report results on more than 15,000 patients. Caveat emptor. Check out what the capable critics say just like you would do at NC. These topics are directly related to the Negligent Macro-Micro Economics/Financial Malfeasance posts. The settlements over Big Pharma disasters are quite similar to Big Bank fraud settlements – no admission of liability, waiver of all claims, known and unknown, of course.
This has been going on for some time. Almost 3 decades ago, researchers were able to genetically engineer insulin production from E. coli bacteria. There was no NEED for an alternative insulin (then or now), but the “discovery” was remarkable. Successful marketing, data subversion, insider support at FDA have rendered synthetic insulin (and, now, insulin-like products) as the ONLY tool available for Type 1 diabetics. The research that garnered approval relied on a mere 8 trials, with a total of less than 1000 participants, and now, U.S. diabetics have no freedom of choice of insulin products.
Conveniently, T1 diabetics do not have advocates looking for negative consequences. After all, the disease is multi-faceted and patients have UNIQUE responses to both disease and treatment–any significant ‘adverse events’ can be attributed to the disease, the non-compliant or unique patient–NEVER to the favored ‘insulin du jour’.
As an outside observer, I maintain that Eli Lilly’s successful marketing ploy for an unneeded, unwanted and dangerous product provided the roadmap that BigPharma members employe (and expand on) to this day. Way to go, Lilly! How’d that free license from Banting & Best work out for you . . . and how did you repay society?
Although I am not a Christian I must admit that St. Paul was right: “The love of money is the root of all evil”. It is interesting to note that our “Christian” right doesn’t seem to embrace that particular C
No: the love of power is even worse.
Money IS power.
The Christian right has embraced power and money as a means to the end, the end is to force their dogma on everyone and create the perfect Christian state where any deviation from their authoritarian structure is severly punished.
In other words, they are extremists that have lost touch with the very principles of their religion. They subscribe, but they’ve never actually read any of the issues.
They read the back issues. Like Leviticus.
Yet, they can’t quote a single thing Jesus actually said. It amazes me that they can read the bible and just ignore every last thing Jesus said like it wasn’t even there.
They are much more attracted to the sin and punishment parts of the bible. Which, I think, says a great deal.
I venture to say that most of what you call the Christian right are the equivalent of the pharisees of Jesus’ day. That said, as a Christian, I can fully agree with most of what you say about the Christian right…
Dr. Dean Baker (CEPR.NET) points out that the monopoly granted to the pharmaceutical industry by our government predicts and guarantees their malevolent behavior. And Dr. Baker also estimates that our monopoly drug patent system costs Americans $250 billion dollars more per year more than other safer and more efficient pharmaceutical delivery systems.
I spent a couple of years on a contract within the Global Marketing department of a big pharma company. Their function was to run clinical trials. That clinical trials were run by the marketing department tells you a lot of what you need to know. The moral compass of the environment was set to good=making money and therefore success=positive trials. The folks who worked there were for the most part good people who genuinely wanted to help society, but worked in an environment where they were rewarded for getting the drugs approved. Management’s role was to keep them believing that these are the same thing.
The clinical trials were run by the marketing department? Are you serious? I’m not in that field, but had learned that marketing gets very involved in “following” the trials. That the trials are actual run By the Mktg. Dept. is rather jaw-dropping.
This article really hits home for me. When I was nine years old (now I’m 24) I was prescribed antidepressants. After taking the medicine, I developed severe OCD and suicidal tenancies. Now that I’m older, I’ve seen pharmaceutical reps pushing and hassling busy docs, how these companies recruit pretty people from college campuses, and how many doctors have disdain for these companies.
Now I try to live a medicine/drug free life and feel generally better (though that might be the effects of vegetarianism and no alcohol confounding my results.)
Doing without medicine must be really good for you if it outweighs even the baleful effects of not eating fish or drinking beer.
Keith, the fact that you had an adverse reaction is in no way an indictment of the medication or proof that you are better off without medication. Shit happens and people have idiosyncratic reactions that can’t be foreseen.
As Mark Twain said, “The cat, having sat upon a hot stove lid, will not sit upon a hot stove lid again. But he won’t sit upon a cold stove lid, either.”
There might be meds that can help you but having sat on the hot lid you won’t sit on the cold one. I tell my patients that sometimes you just have to kiss some frogs before you find a prince. For some strange reason I have a lot of frog-themed gifts from patients.
Hi Keith, good on you mate!
I’ve posted (1st half of) this information in the past here at NC, but here and now seems most apropos.
“Anatomy of an Epidemic”
I am also alcohol, caffeine and meat free and take NO drugs. Took nothing after 2 hip replacements. I DO take a lot of carefully chosen supplements. I have been to the base of Mt Everest 8 times, walk 10-30 miles a week and just turned 70.
Amazing–congrats that is inspiring.
Not long before he died, my father the doctor said to me, “I’ve come to the conclusion that the secret to a long and healthy life is to have as little as possible to do with doctors.” Nuff said.
heh, .. look at my nickname ;-)
Here’s how you know Yves has no clinical trial experience. Check with your academic degress in clinical trials. The George Washington University, for example, has a master’s degree program. So do some other academic insitutions in the United States. Most clinical trials have a Data Safety Monitoring Board (DSMB) or an Independent Data Safety Monitoring committee (IDSMC). They look at the data collected during a clinical trial subjects and decide whether the trial continues or is terminated early. In other words, if your trial product is not more effective than the drug already on the market,your clinical trial stops early. If can’t build a better mousetrap, you can’t go to market. So that’s a whole other piece of information Yves needs to get educated about, rather than just committing sins of omission.
Yes, and the results of these early termination trials is not published, while the data from the other “positive” trials goes through. In other words if you run enough small sample trials, and you have the DSMB and ISDMC filtering out the non-positive trials for you, you can get anything approved. The DSMBs and ISDMCs are enablers. So your statement that if you don’t build a better mousetrap you can’t go to market is untrue. They are collaborators in suppressing data that’s unfavorable to the trial sponsor. Oh, and guess who gets to set the data standard for early termination for lack of efficacy? The DSMB? No – the sponsor!
Whoever is paying to troll this blog should ask for their money back.
No kidding. Pretty pathetic attempt.
Yes its great when these “experts’ brag about their pill working better than a placebo–a sugar pill. Wow works better than a sugar pill!
Wins teh internetz!
So Sam how long have you worked in Pharma?
Big Pharma is “committing sins of omission” when they prevent publication of unfavorable results.
Citations, please. I’ve never heard that and, in fact, heard the opposite: that one of the problems is that indeed drugs are not required to be tested against others in the same class to measure comparative efficacy.
It’s not just that in many cases the drugs of the last 15-20 years either do not work or achieve no better effects than the previous generation of drugs.
Also, they often work *worse* in that many have more side effects which, in turn, necessitate more palliative medications to temper those side-effects.
Talk to nurses in any metropolitan hospital and they will bend your ear on this subject.
Echoing Liberal’s query. I thought that one of the “features” of drug development testing (at least in the US) was precisely that PharmaCo’s are NOT required to test their compounds against existing drugs, which would provide the more useful (and economically sound) data (than testing against placebo).
Hence several lost decades of pharma research with few discernable breakthroughs but the advent of many, many “me-too” drugs (for all intents and purposes useless except to prop up PharmaCo revenue streams).
Goldacre has, over the last couple of years or so, been running a regular column in the Guardian in which he tracks down the wrongdoings of the peddlers of a variety of ‘non-evidence based’ approaches to ailments. It is good to see him – at last – turning to examine the more apparently respectable forms, discovering, to his surprise, that they are little better than the various woo-merchants that he most usually pursues. But he is following a well-trodden path. Ralph Nader, for example, has been pointing to malpractice in the halls of Big Pharma for some years – here’s a recent example : http://dandelionsalad.wordpress.com/2010/12/27/pharmaceutical-industry-fraud-by-ralph-nader/ and anyone who keeps an eye, as I unfortunately have to do, on the practices surrounding the developement and marketing of psychotropes, will have read Whitaker and been appalled : http://www.cctvcambridge.org/node/23807
The thing is that what Goldacre here acknowledges has been in the public domain for decades, and yet little or nothing has been done about it. From the scandal of Thalidomide to the recent shameless pushing of so-called anti-depressants, the pattern is the same: a short moment of moral outrage, and then a collapse into business as usual. And ‘business as usual’ is perhaps the key : if Big Pharma were to be brought to heel, what might we not ask of the other sectors of the economy dominated by conscienceless oligopolies? Best to nod, wink, and let it pass.
At the end of this article in the Guardian was a note that it had been excerpted from a soon to be released (in the U.K.) book, titled “Bad Pharma: How Drug Companies Mislead Doctors and Harm Patients”. I checked Amazon and it is scheduled for U.S. release on January 8. He also has written a book titled “Bad Science: Quacks, Hacks, and Big Pharma Flacks”. I’ve put both in my shopping cart.
thank you for posting this Robert Whitaker video/interview (~25min long?) that i will now watch — notice upthread, i posted a similar one from April 2010 which aired on C-SPAN — “Anatomy of an Epidemic”; more detailed i would presume, since the presentation is ~90mins.
“The thing is that what Goldacre here acknowledges has been in the public domain for decades, and yet little or nothing has been done about it.”
Yes, much of this has been part of the alternate medicine scene for decades. But that’s often what keeps it out of most people’s lives, the perception of the nutrition/herbal/energy/traditional medical viewpoint as serious woo-woo fit only for rural Bible thumpers and pot-heavy dirt squirrels.
The stance that large corporations make health decisions for purely financial reasons is an unquestioned axiom in that alternate scene. However, that makes that assertion suspect, as the source has been slanged out of hand time out of mind. Now, it’s an uphill battle to get serious people to accept paranoia as perfectly true.
Two medical website you can trust:
If the regulators (are they NIH?) are solely and discretely responsible for determining whether a drug company has met its clinical-trial burden, and therefore solely responsible for allowing a drug to go to market, it seems like that is the place to force strict discipline. My first reaction is that they must all be corrupt, so transparency won’t be very transparent. WTF – it’s just like the banking debacle. Pharma can produce all the theater it wants, but if it can’t get passed the regulators it will go out of business. It is too bad that regulators themselves need watching. But the alternative is this mess. And not only are drugs given a free pass, the companies are heavily subsidized. We could use a revolution in medicine but we are far from understanding genetic based medicine. It’s probably being sabotaged.
Since this is science based, why can’t be have a panel of computers play a part in review and regulation?
I suggested a solution based on independent scientific trials instead of gov’t asking companies to carry out clinical trials but my post did not get through (?).
“If the regulators (are they NIH?) …”
I’m pretty sure it’s the FCC. But I’m not going to waste my beautiful mind looking it up.
Susan, the regulator that is charged with reviewing animal (Initial Drug Application) and clinical (New Drug Application) data collected in studies and trials for a new pharma product is the FDA. FDA, after review, and with the assistance of an Advisory Committee (composed mostly of doctors/researchers from the private sector who are supposed to disclose conflicts, yeah right) then decides whether the data proves up a safety/efficacy balance justifying sale of the drug to the market. FDA also in theory monitors “post marketing surveillance” by the Pharma Co. (i.e., what are the efficacy and toxicity numbers once large numbers of patients are taking the drug.)
Here’s the problem: FDA makes its review of data that is submitted by the pharma company. FDA has no way of knowing if pharma company is omitting/deleting/”massaging” data in its applications (which are in the main the IND and NDA, see above). In short, the data that the Regulator (FDA) reviews is only as good as the integrity of the submitting entity (the pharma co. that wants to get its drug to market ASAP).
So, in a nutshell, it is in some ways naive to suppose that FDA acts as an effective gatekeeper of efficacious/safe drugs entering the market. (And this is before you even account for the revolving-door and business ties of FDA staff.)
That said, there are many many dedicated people at FDA (with the public’s interest at heart and intelligent) and no doubt also in Pharma (?). Problem is, their existence is unlikely to prevent incomplete or false disclosures of data to FDA.
I’m a vet and a diabetic. My VA doctor says I have high cholestrol above 150, keeps pushing statins at me. I’ve read the dangers and refuse to take them. He tried to send me to a special diabetes doctor just because I requested glucose tablets for often recurring low blood sugar episodes, he said I could’nt get them unless I saw this doctor. I thought all diabetics needed them. I wrote to VA and they changed the policy, yet this doctor seems vengefull and won’t prescribe the amount I need and then only with no refills. Great VA medical care huh!
We are expected to take it as gospel that aggressively managing a condition is an unqualified good. To sell these treatments they have to sell the fact that you have a disease (and downplay or simply ignore the risk to benefit ratio of treatment). I’m not sure how this article got published, but it really shines a light on how patients are “created”: http://seattletimes.com/news/health/suddenlysick/
Also this: As a a patient you are not a person but a “profile” made up of various numbers to be plugged into treatment guidelines. Whether the treatment fits into the context of your life is of little concern. Your life is to be rearranged to make the treatment fit.
Alan O, I suggest you read a book by Dr. Gilbert Welch titled Overdiagnosed. It includes a section on high cholesterol and statins, which includes a chart showing the risk of a heart attack doesn’t increase significantly until the total cholesterol score is 260 or above. Heart attack risk is also higher at cholesterol levels BELOW 160, so if anything you probably are much closer to having low cholesterol than high. A doctor pushing somebody with cholesterol of 150 to take statins to lower their cholesterol is absurd.
For those of us with chronic diseases, I think we have to do enough reading and be strong enough to question our doctors and find new ones if necessary.
Second the rec for this book as well as Rethinking Aging by Dr. Nortin Hadler.
Agreed. The Welch book is excellent, and I’ve read most of the other one you mention.
Stroke risk is also higher at low cholesterol levels. A buddy who has cholesterol of 120 points that out.
Do yourself a favor and research dietary diabetes cures. Diabetes is an “environmental” condition resulting from eating things that your body cannot use as fuel. There are individuals on the internet who have cured their own diabetes using sound, but rarely publicized, eating plans that restore the body’s natural functions.
You will be surprised at how wrong some of the things you thought you knew about nutrition actually are. And just to convince you how heavily invested TPTB are in maintaining a population of diabetic “customers,” some who have published this information on their own websites are being threatened with prosecution for practicing medicine without a license.
Google paleo diet.
Thats a load of shit. Diabetes cannot be “cured”. Technically, any time a persons blood sugar reaches a certain high level, they are said to be in a “diabetic” state..Then a 20 year old college athlete who is “diabetic” from getting drunk and eating a whole birthday cake can be “cured” by going to bed and sleeping it off…that individual was not actually diabetic..Carry that a step further to those people whos blood sugar is chronically high because they over-eat – usually diet can “cure” the diabetes of those individuals but thier condition was primarilly obesity, and not diabetes. Type 1 diabetes cannot be cured.Ever. Type 2 diabetes that develops becasue of age, and lifetime of bad diet, alcholism or bad hereditary luck – cannot be “cured”..it must be treated. And it is fatal, ultimately.
Type II diabetes can be cured with a 21-day water only fast.
I think the claim that Type 2 can “often” be cured is probably nonsense, but IIRC there is a small percentage of cases were radical changes in exercise and diet can reverse it. But I could be wrong about that.
depends on what one means by ‘cured’. (type 2) diabetes is diagnosed after something like 2-3 high blood sugar tests or failure of a glucose tolerance test.
but the reasons for running high blood sugar reasons are many. having a fever, being on bed rest/inactivity, certain drugs, various stressors (including sometimes, paradoxically, *not* eating) etc. will raise your blood sugar. being overweight/generally inactive will too.
if by ‘cured’ one means returning to a typically normal blood sugar readings without the use of medications, this is quite possible and not uncommon. losing weight & increasing activity are the usual means.
if by ‘cured’ one means that once diagnosed as diabetic, the label is removed from one’s medical charts and medical personnel stop viewing you as “diabetic” — that’s a different matter.
the average joe sees ‘diabetes’ as a disease that, once diagnosed, you ‘have’ for life — like heart disease. but it’s not quite like that.
if you’re able to maintain normal blood sugars without medication, are you still “diabetic” even though at one time in your life you had three high blood sugars in a row or failed a glucose tolerance test?
i’d say no. others may differ.
My additional possibly helpful information would be to listen to Gary Null podcasts, and now again (finally!), Live on http://wpfwfm.org:8000/wpfw_64 (direct link to add into your favorite Media Streamer/Player – it’s a Washington DC pacifica network?) every weekday at 3pm EST, and recent podcasts can be listened to from/at the site listed below — He is a dietary nutritionist/expert, been doing this since the ’70s, and also has his own network and site; http://prn.fm (should take you to the ProgressiveRadioNetwork – hardly no commercials or adverts) – which hosts his personal show, and many other shows, and…he pays for it *all* SOLELY from his own pocket (he manufactures and sells holistic foods, made according to extremely high standards – completely and utterly *organic* only, through and through).
Speaking of which, to add to the GMO/GE fight, i found recently this site; http://responsibletechnology.org/about. I really hope Prop. 53(?) passes in California, since we *need* GMO labelling!, so we can boycott the crap out of it ;-) (70%, if not more, of all items in your typical supermarket contain atleast some form of GMOs!)
Oh, and two other quick things, the WPFW broadcasts are usually podcasted later that night, available on PRN.fm
Olive Oil (and even Rapeseed oil) is the great arbiter for anyone with high bad cholesterol, though you seem to be just fine in that area, long-chained fatty mono-unsaturated fats (like those i just mentioned) helps kill bad cholesterol ..reminds me of Lorenzos Oil (the movie, with Nick Nolte and Susan Sarandon …sad, ..but with an amazing story leading to resolve). Almost all other Vegetable-derived Oils are poly-saturated; http://en.wikipedia.org/wiki/Olive_Oil#Health_benefits_attributed_to_fat_composition …well the chart/table of oils there also shows the relationships between various oils.
Careful of Canola Oil, since from what i learned, IIRC, the top 3 GMO foodstuffs on the market are Corn, Soy, (and all their derivatives) and Canola Oil — go Organic Only! Recent studies are showing extremely harmful health effects from GMOs (Genetically Modified Organisms). Guess who is pushing it all and attempting to keep labelling of it *off* the products we buy? Yep – Monsanto, DOW, DuPont, Pepsi, etc, etc …
Dr. forced me to obtain a mamogram per year to get birth control pills. She would not give me a prescription unless I did it. I quit the Doc instead as I realized she MADE MONEY REFERRING PATIENTS to be irridiated.
Another Dr. was visibly upset at me when I explained to her that I did not plan on having kids…. you know, interrupting HER profit stream.
Moved to another Country = no problems or major push to have yearly outside tests (for profit not health). They found annual mamograms could increase the chance of cancer and discouraged it … go figure.
USA is corrupt. We the people need to become more involved and STAND UP.
“They got famous by marching in the Bullshit Parade, not by performing great acts…”
I would venture just about every sector of our society has been infected by this disease.
I know I’ve seen it over and over again in business – the most successful guys in the corner office couldn’t manage their way out of a paper bag or solve even the simplest problems, but they’re the first in line to the Boss with everyone else’s accomplishments pawned off as their own. And the Boss is such an authoritarian he listens to this crap as Revealed Wisdom time and again.
Makes me want to just open my own shop instead of listening to them for even one more day.
I think that Katt Williams said it all best (“Drugs in America”):
Makes you wonder about the faith we have in vaccinations for our little ones.
I am currently struggling to get my girlfriend’s llfe back after a horror of Cipro – (ciprofloxacin) – poisoning
• cartilage destruction in back, hands, and arms
• inability to walk uphill, or climb stairs
• inability see clearly
• dry eyes, mouth and skin;
• ringing in his ears
• uncontrollable shaking
• gastro-intestinal debility leading to multiple operations & chronic diarrhea
• burning pain in his eyes, legs and feet;
• tingling in his hands and feet;
• heart palpitations – I was in the ER August 2012 for heart issues
• muscle spasms in the arms, chest, back
• brain fog
• loss of memory
• loss of balance – almost unable to stand up without holding on
• loss of energy – I used to climb to 18,000’ in the Andes
AND this explains the many fibromyalgia like symptoms for which she experiences. See the site CIPRO IS POISON! Some are suggesting “Gulf War Syndrome” is, in fact, an anti-biotic poisoning reaction. Extensive antibiotic treatment in bout the only thing common to everyone who shipped out.
Look, all drugs are poisonous if given in the wrong quantities, or to people who are unlucky enough to be those who react badly.
I’m pretty sure that the fluoroquinolone antibiotics are a very useful class of drugs, WITH THE CAVEAT that there are definitely individuals who can have adverse reactions. Thus, older more mainline antibiotics should be tried first. From what I’ve read, there are a lot of docs who won’t do that and just prescribe a fluoroquinolone.
Given all of the above it’s interesting that New Jersey (home of big pharma) is attempting to create laws which prevent people from opting out of genetic tests as well as vaccinations for their children.
While I believe many vaccines are safe, some of the new ones may have fewer benefits. The mandatory genetic testing of all parents and their children in New Jersey is bizarre and a clear cut attempt at genetic profiling.
So now Pfizer and Merck have paid off the politicians to mandate all vaccinations in New Jersey. No doubt the genetic profiles will be used to help pharma’s research.
You might post this in the links section Yves.
Yves, you and your blog do a great job of reporting to us amateurs. Thank you.
I’m no doctor, but I see the same symptom undermining both politics and medicine — greed.
Agreed, and the commentariat is on target and firing for effect. NC at best!
As has been pointed out, all the low hanging fruit in pharmacological research was picked decades ago. There have been very few unambiguously efficacious new medicines without significant serious side effects in the last 20 or so years.
In any sane world, pharmacological research and testing would be wholly publicly financed and the resulting medicines would be generic and free for anyone to produce worldwide from day one. The existing pharma industry could concentrate on still profitable but unessential market sectors like wrinkle creams and boner pills and still make plenty of profits without pretending they are interested in treating serious illnesses. As a side effect of this approach research could be concentrated on medicines that actually treat underlying causes rather than manage symptoms by putting patients on treatments that never end — drugs the current system has little or no economic incentive to produce. There’s no profit in curing people. Profits come from when you can sell them pills for decades without curing them. From the economic perspective of big pharma, the worst possible outcome is curing people, who will then no longer require your product.
I couldn’t agree more. After nearly 30 years in the medical industry I can confirm it is corrupt from top to bottom. Perhaps the most tragic example being the cancer industry.
Another industry treating we the people like marks,to be exploited,even if it kills us…..
A great bill moyers episode on big pharma and the prescription drug benefit pushed thru during the bush years…..it was about the court cases between the state of Maine and big pharma over drug prices and negotiations.Maine wanted to use the bloc of drug purchases it makes thru it’s medicaid money,as a means to negotiate for better prices.the big companies didn’t want this to happen.in the state supreme court, the state won the right to negotiate for all of its purchases together,which meant it had greater clout and a better bargaining position….big pharma didn’t like that decision.they took it to the federal supreme court…the state of Maine won again…..now the precedent was set for states to use block purchases to get better deals on drugs…. And the federal gov’t was in a similar position with the money it spends for Medicare drugs…at the time this federal purchasing would amount to 52% of the drug market annually.this would have given them extreme leverage in getting better prices and bringing costs down.in one year, the state of Maine saved 25 million dollars in drug purchases when it used its clout….
Well, the big pharma companies started contributing money to everyone in Washington and every state,republican and democratic…..and we got the BIG deal the republicans made on behalf of all Americans for the federal gov’t to provide drug coverages, the federal drug prescription deal for Medicare….that specifically PROHIBITED the gov’t from negotiating for better prices.
There are issues like …..pick one…..
Cholesterol drugs that in the best case scenarios improve levels by 4-6 %,yet have a laundry list of side effects,as opposed to the Mediterranean diet improves levels by 25%.
Then there is the war against medical marijuana,the drug that could be virtually free, with minimal if any side effects……that works so well for so many people, and has a record of thousands of years…..talk about a product that would hurt the pharma industries bottom line….yet could save America’s….
And so many others….
From PQS above: “I know I’ve seen it over and over again in business – the most successful guys in the corner office couldn’t manage their way out of a paper bag or solve even the simplest problems, but they’re the first in line to the Boss with everyone else’s accomplishments pawned off as their own. And the Boss is such an authoritarian he listens to this crap as Revealed Wisdom time and again.”
Man, this happens all over the world, and when it isn’t pure greed pushing it (mostly at the top) it is the mediocre bureaucrat’s (corporate and state) mindset that drives it: not only the need to put some food on the table, but also to enjoy the perks of an upper middle class life at all costs. Ames at exiledonline once recommended Trifonov’s “House on the Embankment” as the best (fictional) self-portrait of one the gray men without whom the machinery of evil such as big Pharma’s would grind to a halt.
Happily my own experience has been limited to watching some thousand dollar a day consultant try to get his ideas across to some outsourced idiot a million miles away via a ‘net conference call with a neo-Liberalized audio quality. Undoing the waste caused by out-sourcing by piling on quality man-hours made useless by a petty greed that thinks one can carry on serious business through a walkie-talkie.
The president of my college fraternity had a good theory about curing illness.
Whenever he felt himself getting sick, he’d get totally hammered on alcohol and smoke a lot of reefer.
His medical theory was, “The germs will just leave my body, to get away from all the alcohol and reefer.”
I think it worked pretty well. I bet if they ran some tests it would even work in the lab. And If they put people at a beach resort and gave them free drinks and reefer, they probably wouldn’t get sick very often, besides the hangover. And if you also gave them free women and free food and free houses up on stilts like Gaugin lived in in the Marqesas, nobody would ever get sick. It makes you wonder. haha ahahah
A continuing series on NC should be–American Racket of the Week.
Don’t forget the major NYT piece written after 80,000 leaked documents showed the FDA was spying on it’s staff, firing and intimidating scientists for refusing to rig outcomes.
for further information, go here:
Might as well point (again) at that wonderful Bloomberg Finance piece “Big Pharma’s Shameful Secret” (ad 2005)…
As Led Zep were fond of singing… the song remains the same :-/
One of the problems with these Big Pharma scandals is that more and more people, instead of adopting a more cautious, scientific approach, turn to “alternative” treatments.
Have you ever tried to explain the utter nonsense of homeopathy, eg, to people who regularly take that kind of stuff? You cannot use evidence, because “evidence is obviously manipulated by Big Pharma”.
More generally, science is being discredited by the market, by Big Pharma, Big Oil (climate warming), Big Tobacco, etc. When a new study comes out, the first question everyone asks is “hey, who funded this, aren’t they trying to trick us”? In a sense, it’s a good thing, but it often borders on paranoia.
More and more people are turning to “alternative” treatments because the drugs don’t work! I just completed a paper on Mauve Factor and I’m in the process of running double blind RCTs to see if zinc and b6 is affective as nutrient therapy for people with depressive symptoms. This research has all been done before pre-1975 by orthomolecular psychiatrists. Hoffer made amazing progress with nutrient therapy for schizophrenia. However, why did it fade into oblivion and why has it suddenly become popular again? Why was it quashed?? People are starting to think for themselves and this is a snow ball effect. People are sick of scary side effects, and trying to find the right balance of meds (especially in Mental Health). People want natural. And, it would cost about $5 to get your vitamins :D
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Emergency Reimbursement Benefits
Receive up to $500 emergency cash for Emergency Room or Trama Center treatment received due to injury in a
covered accident. Includes but not limited to cost for:
1. Cast or Splints
2. Lab Work
3. Nursing Service
6. Doctor Care
Daily Hospital Benefit
$54,750 Hospital cash benefits. You will receive $150 per day beginning the first day you are hospitalized as a
result of a covered accident for up to 365 consecutive days.
Accidental Death Benefit
As a member, you may enroll, free of charge, in one of three all accident AD&D coverage’s to suit your needs:
1. You, as named member, up to $50,000; or
2. You and your spouse, up to $25,000 each, plus job retraining is available for surviving spouse in many
3. You for up to $30,000, your spouse for up to $15,000, and your children up to $3,500 each. Optional benefits
include job retraining for surviving spouse, continuing child care and continuing education support.
Coverage election form must be completed and returned to home office before coverage goes into effect.
Coverage provided by Zurich Insurance Company of North America. See certificate of participation for details.
Travel Assistance Program
The named member receives the Travel Assist Program which assists worldwide with issues such as:
1. Medical Evacuation
2. Medical Repatriation
3. Non-Medical Repatriation
4. Return of Remains
5. Visit to Hospital
6. Return of Child
7. Return of Companion
Coverage provided by Zurich Insurance Company of North America. See Travel Assist Description of Coverage for
MATRIX REWARD INCOME
This is a summary of services, please see service contract for exact details.
*In NY coverage is for service provided through our dispatch center only.
**This benefit is not available in NY.
***Bond benefits are not available in CA and NY.
****In NY benefit pays directly to our Provider Attorney for services up to the limit specified.
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