American Thought Leaders - How Overdiagnosis Turns Healthy People Into Patients | Alan Cassels

Episode Date: December 24, 2025

“We get a lot of inappropriate over-prescribing for almost everything,” says drug policy researcher and journalist Alan Cassels.Cassels is the co-author of “Selling Sickness: How the World’s Biggest Pharmaceutical Companies Are Turning Us All Into Patients.”For Cassels, it was one disease in particular—osteoporosis—that changed his entire view of medicine.Based on changing definitions of the disease, large swaths of Americans could suddenly be declared sick and in urgent need of drug treatment.They “medicalized normal aging of basically the entire female population. Overnight,” he says.In our interview, we discuss the influence of the pharmaceutical industry on overdiagnoses and prescriptions, and how the criteria for many diseases can be expanded arbitrarily.“When you look closely at the quality of prescribing, a lot of times, the decision-making is not really driven by evidence. It’s driven mostly by … marketing, biases, influence from thought leaders, and influence from guidelines, medical guidelines themselves, which are often appallingly biased,” he says.Many doctors, Cassels says, know little about the adverse effects of the many drugs they prescribe to their patients.We also dive into the connection between psychiatric drug prescriptions and violence, how psychiatry labels normal behaviors as abnormal, and how exaggerated statistics are used to sell theories of disease and drug treatments.Views expressed in this video are opinions of the host and the guest, and do not necessarily reflect the views of The Epoch Times.

We know that the rate of effects are much greater than 1%. Right. So you're promoting this drug on the basis of a misleading reduction. We still see this today. In this episode, I sit down with Alan Castles, a health policy researcher, an author of Selling Sickness. He highlights the risk and adverse effects of antipsychotics and antidepressants, including violent behavior.

And oftentimes when these violent attacks happen, Nobody is sitting down and asking what kind of drugs was the person taking and what kind of prescribing were they, you know, experiencing. How are medical conditions exaggerated to drive increased drug prescriptions? What used to be considered to be autistic behavior, there might be, say, 15 to 20 different symptoms. If the child exhibits 10 of them, they might be considered to have autism. Now they only have to exhibit six of them.

Castles warns against fear-based marketing and encourages careful consideration of prescriptions, especially for chronic conditions. Stop allowing yourself to be made afraid by those who are selling treatments. If you're facing the sharp end of a prescription pad, you have time to think about it. This is American Thought Leaders, and I'm Yanya Kellogg. Alan Castles, such a pleasure to have you on American Thought Leaders. It's great to be here.

So what's the answer to the question? Are we looking in the right place for answers to violent attacks? So when you think about violent attacks, you think of people who have psychiatric problems, for example, and oftentimes when they investigate it, they look at the kind of psychiatric care, a person might be under. What they're not questioning though

is the quality of the prescribing that goes into a lot of psychiatric care. And in fact, we know that one of the main adverse effects related to psychiatric drugs, I'm speaking broadly here, but specifically say antipsychotics or antidepressants, is violent, behavior, suicide, homicide. These are all known dangers to these drugs. And oftentimes when these violent attacks happens, this as we had in Canada where a person drove a vehicle into a group of

people having a street festival, when they examine this, nobody is sitting down and asking, what kind of drugs was the person taking and what kind of prescribing were they, you know, experiencing. And I think that's probably the first place you should look. And oftentimes, again, overlooked altogether because people will assume that if whatever psychiatric care they're under it must be sort of guideline care and and approved but really we have to step back and say look we're probably causing a lot of the psychiatric outbursts by the kinds of prescribing that we do now is this because of rare effects that maybe even some of the doctors might not be aware of or is that

What is the reason? Well, doctors lack of cognition around adverse effects related drugs is well known. I mean, this has been well studied. Physicians don't learn about the adverse effects of drugs largely because they're not exposed to that through a lot of the marketing that they get. And of course, a lot of the information

that physicians get around drugs comes from the hands of the pharmaceutical companies. And they're not exactly promoting the adverse effects of their drugs. Is there some way to quantify how big a problem is, like how often the drugs might have been responsible or partially responsible in situations where that hasn't been looked at? Yeah, it's a good question.

I don't think it's been adequately studied, but I think if you talk to the experts that are well-versed in sort of the adverse effects of psychiatric drugs, they would say most of the time you can draw conclusions by looking at the drugs that person's being prescribed. So maybe dig into that a little because what you're describing is not something that's obvious. Yeah, it's not obvious, but let's put it this way. We assume as consumers, as patients, that when we're presented to a physician with a particular disease, that the decision-making around your condition and how to treat it in terms of some kind of therapy or drug that you might get is evidence-based. It's based on a physician's careful, you know, assessment of the science and assessment of your disease.

Though when you look closely at the quality of prescribing, a lot of times that decision making is not really driven by evidence. It's driven mostly by sometimes marketing, by biases, influence from thought leaders, and influence from guidelines, medical guidelines themselves, which are often appallingly biased. I'll give you an example. So someone who presents with high blood sugar, you know, might be a precursor to pre-diabetes or diabetes. Physician will assume that because the guidelines, and this is the level at which you should start taking some kind of treatment to alter your blood sugars,

without knowing that the people who wrote the guidelines are heavily funded by the pharmaceutical companies. And in fact, the Canadian guidelines, the conflicts of interest of the authors of the guidelines, of the guidelines fills up 15 or 20 pages. So what's clear to us who independently look at this kind of thing is that the pharmaceutical companies are very good at putting their own people on guideline committees, and that's why we end up in a situation

where we get a lot of inappropriate and over-prescribing for almost everything. Now, with that particular scenario, I recall some instance, and maybe it was a different drug, but where the level, of blood sugar was moved to something lower, right? You would not believe how often they move the goalposts. Give you an example, probably the best example is not blood sugar, it's blood pressure, okay? So 20 years ago, if you came in and your doctor said

your blood pressure is 150 over 90, they would say, it's a little on the high site, no problem. You know, maybe you should exercise some more, reduce the salt in your diet. Today, now over time, that 150 over 90 has been lower, to 140 to 130 and now it's around 120 well when you lower the level at which you start treating someone or telling someone that they're ill or potentially ill from high blood pressure you expand the massive pool of people that become patients and this is one of the the key things

behind disease mong green when you change the definitions of what the disease is you expand the pool they never changed the definitions that that reduce the size of the pool because again the pharmaceutical companies are very, very involved in the writing of the guidelines. But we document that in selling sickness, how just by lowering, say, the level at which we would consider high cholesterol to be a condition, overnight they would expand the number of Americans who would be treated for cholesterol lowering drugs by 25 million people, just by changing the definition. So, I mean, you're describing, I think, a very powerful incentive structure to do precisely

that. Exactly. I mean, the incentives are all in the direction of the pharmaceutical companies and for those who are funded by the pharmaceutical companies, including the patient groups and specialty societies and so on. Absolutely. But what's kind of missing from this situation is that you don't have enough people perhaps like me who are critiquing this and saying, just hang on a second. You just move the goalpost. You're not actually expanding the number of people who are going to be considered well, you're expanding the group of people who are considered sick, so you're actually creating illness. You're creating a sense of ill ease amongst the population when you start telling people your blood pressure needs to be at this level, otherwise you're unhealthy.

And this idea that telling people that they're not healthy when they otherwise are is really the essence of disease mongering. This is something that I've written quite a bit of us. And this is your term, I think you coined the term disease mongering. I wrote the book. Yes. So I wrote a funny little book called The ABCs of Disease Mungering because I wanted to describe in 26 letters how we see this kind of creation and marketing of illness from cradle to grave, from babies to people who are at the end of their lives, where normal, just human changes in physiology and your life as you age becomes another reason for which another drug. might be prescribed. So, you know, yeah, you're right, there's, there's definitely a campaign, shall we say, to get more and more of us to become, to be ill. So one thing comes to mind. In the U.S., there's been a lot of discussion about autism rates growing, you know, in a way that's,

frankly, shocking when you look at these graphs. Now, what's very curious about this is that I think it's actually kind of industry that's saying this is a function of, precisely what we've just been describing of the goalpost being moved, so now we're just over-diagnosing autism a lot more. Well, absolutely. We have, it used to be, for example. But this is a curious

situation because I think it's the industry that's saying that, whereas it's the people who are, like yourself, like activists, are saying the opposite. No, that this is actually a real shift. Well, on this point around autism, same with the attention deficit disorder. I would agree with that where they have changed the goalposts. and what used to be considered to be autistic behavior or, say, on the spectrum, 15 or 20 years ago,

there might be, say, 15 to 20 different symptoms. And of this checklist of symptoms, if the child exhibits 10 of them, for example, they might be considered to have autism. Well, they've changed that over time, so now they only have to exhibit six of them or four of them. And so, again, when you do that, you're expanding the pool of people who, begin to take this label and perhaps to be accepted for treatment for it and as you know there's a whole industry around autism at the same time you have to ask yourself is there actual things in medicine or in society that might be causing neurodevelopment problems in children and that's

when you start looking at things like drugs or perhaps vaccines right just putting that out there that those things need to be adequately studied in order to be able to determine what is actually causing this apparent rise in autism or ADHD. So basically you're saying that both things can be very much true that there is a there could be a rise in these neurodevelopmental issues but and at the same time autism itself could be over diagnosed because it serves the interest of people who want to provide drugs around that. Absolutely and you know you hear anecdotes of parents who want a diagnosis for their child because that's going to get them special care

or extra extra help in school and so on. You certainly see that in the area of ADHD where it actually comes as a relief to some parents that, oh, my goodness, my son now has ADHD and therefore is eligible for some extra help or in school. Explain to me, you kind of describe this almost like, you know, assistance, I guess this disease mongering

is a systemic thing. It's something that's almost done in every area. Give me some examples where we see that. Well, again, it's a cradle-de-grade phenomenon. Maybe start from the closer to the end of people's lives. And this is something that I became aware of 30 years ago, and when I started becoming aware of this one disease, and to see to which the industry had infiltrated itself

into the definition of the disease, it changed my whole view of medicine. And that was osteoporosis. And, you know, in the early 90s, a major pharmaceutical company in the U.S. created a new drug to treat this condition osteoporosis, which at that point wasn't very well understood. In fact, there wasn't really an agreed upon definition. There was a meeting convened at the World Health Organization. And at that meeting, there were, you know, officials, there were endocrinologists and others.

And representatives from pharmaceutical companies that were making drugs. that were going to treat this condition and there they set the definition at a certain level of bone density so this is the the density of your bones as you age they said it at a certain level in a way that you would have diagnosed something like 50% of the female population over 70 with having this condition they set the definition that way and basically said overnight that this this portion of the population that has bone density below this has now has this condition called osteoporosis, or if it's close to that, they might have something that is pre-ostoporosis or known as osteopenia. And what you ended up doing is you medicalize normal aging of the basically entire female population overnight. That drug became a blockbuster drug prescribed widely the company that was marketing that bought bone density testing equipment and distributed through all of clinics and hospitals throughout the the US and basically overnight created a condition that is a normal part of aging and really it's

basically medicalized one's bones that has gone on to be extremely controversial because that drug you know after time when you get millions of people taking a drug that's when you start seeing the major problems severe problems with swallowing and esophageal burning and and and really over the long term and this is cruel and ironic at the same time that those drugs are the they're called the bisphosphonates drugs and those in that class of drugs found that um over time it actually makes people's bones more brittle so more prone to being to breaking i mean admittedly elderly people falling breaking a hip can be a quite serious problem oftentimes that can lead to you know disability nursing homes

and sort of the beginning of the end of a person's life absolutely you want to do it you can to reduce the sort of problems of broken bones and elderly people but preventing falls should be the should be the focus not using a drug that's going to alter the chemical composition of your bones which ends up becoming something that made your bones more brittle again that was a that was from start to finish I would say a pharmaceutical industry construct and now they've gone on they've moved on to other classes of drugs but still I have friends of mine who would be my age in their 50s and 60s they're on a bicycle they fall off they break their wrist or their skiing or they're an accident

they get sent to their doctor the first thing they do they'll send them for a bone density test and they'll say oh you have pre-Austrioporosis it drives me crazy because they are they are using the broken bone is a pretext for explaining to a person that they now have this disease and they possibly could be a candidate for a drug. I mean, this is, forgive me, I'm going to play advocate to the devil here a little bit, but some people have low bone density and probably need some kind of help, but it's never the drug that will be helpful for this in your view. Well, it depends.

So what is the problem that we're trying to solve here? there is a whole range of different bone densities. A lot of people live perfectly well and quite healthily with low bone density. It's not something that it's kind of like developing gray hair and wrinkles. Eventually, your bone density will change over time and it will become lower than it was when you're in your 30s. I mean, that was the other problem with the bone density measurement is that they were comparing women in their 70s to women in their 30s.

And then they were pointing them and said, well, they have low. low bone density. Well, they have lower bone density than they did when they were young, active, and probably in the prime of their life. So, yes, so is there a problem with people having low bone density? If people are repeatedly falling and breaking bones, yes, that can be a problem. But I could be wrong, but I don't believe there's any drug in the world that's going to prevent someone from breaking a bone if they fall. So the idea that this drug will somehow prevent, breaks when people fall, that is untrue? It's totally untrue because, I mean, even when they, okay, I'll give you an example of how

crazy this was. They marketed this drug, and the drug was called Phosphamax. It was called Allendronate. The trade name was Phosphamax, generic it means a lendronate. They marketed as reducing hip fractures by 50%. And I know, because I've used the ads that the company ran. in major medical journals, I've used these ads in presentations that I've done on this very topic. And they show a person, an elderly woman bent over and it's signed 50% reduction

hip fractures. My question is, when somebody gives you a number like that, well, how many hip fractures were there in the placebo group? I mean, the women in the group, and there were more than 3,000 women in this trial that had low bone density. They were defined as having osteoporosis. They had had previous fractures. They have low bone density. So, high risk how many of these high risk women in the course of four years would have a hip fracture well the answer was out of two about two percent two out of a hundred well how many had a hip fracture if they took the drug well it was one out of a hundred so when you go from two out of a hundred down to one out of a hundred that's a 50 percent drop and so the 50 percent was marketed to

patients to doctors to specialists and when people went away thinking, this drug is miraculous. It's going to reduce our rate of hip fracture by 50%. This is what I, this is kind of what turned me into an activist when I saw the misuse of those numbers and how misleading that would be for my mother or my grandmother thinking that they're going to have a massive effect when there's a 1% difference. Well, and it's also probably not statistically significant at all. Well, I mean, it's not clinically significant.

I mean, statistics is a whole. another game but but but they they would have determined that it was perhaps statistically significant that you had fewer uh hip fractures in the in the bisphosphonate group but the same time is that meaning is that meaningful to have a 1% difference what's how does that compare to the rate of adverse effects and we know that the rate of adverse effects are much greater than 1% right so you're promoting this drug on the basis of a misleading reduction and this happens all the time we saw We still see this today. You remember the 95% during COVID.

A hundred percent. It's the difference between relative risk and absolute risk. Absolutely. Yeah. It's just, that's shocking. I mean, this is a very widely prescribed, or was, I don't know what the status is, but I know because I discussed it with my mom at one point, right? These are very commonly used.

Yeah. Yeah. How many situations like this are there? Well, in my book about disease, we're going to have 26 examples. But yeah, this kind of, say, using exaggerated statistics to sell theories of disease and drug treatments is ubiquitous. It's everywhere. Before we continue, tell me a little bit about what you were doing when you said you got,

you became radicalized, you became an activist. How did you get into all this? Oh, so I went back to university. I was the naval officer. I went through military college, and I served in the Navy for 12 years. And then I went back to university, and I started studying a master's program in public administration. And I got asked at the time if I would be interested in working on a project studying pharmaceutical policy in British Columbia. And it sounded really interesting, yes.

So I signed up for that. And even though I was headed for the Foreign Service, I ended up becoming a drug policy. researcher and never went into the foreign service. But it was one of the first studies that I was asked to work on was developing a guide for consumers around osteoporosis. And that's when I started to read and understand what a massive amount of misleading information was out there. And then I took that and I said, well, does this happen in other areas?

And then I started looking and started working with people that were experts in hypertension, which is high blood pressure. It's very similar kinds of things in terms of the manipulation in the use of statistics in order to increase the sort of appeal of drug therapy, the appeal of it. And even discovering to the degree to which doctors are misled

by the marketing materials that they are exposed to. And this really kind of shocked me because I thought, you know, like most people, We believe that the decisions made about the drugs that we get every day are mostly science-based and are based on a good understanding of the potential benefits and the potential harms. And I discover over time that is almost that kind of paradigm doesn't exist in the real world. The paradigm that does exist is that there are many decisions that go into making prescribing decisions

and the marketing of both the disease and the treatment are a major part of it. There's other things. I mean, we can't discount the idea of patient demand, where people are exposed to information from their neighbors, from advertising. From the U.S. from advertising. Drug advertising and start seeing their own, they start seeing their own body through the lens of drug ads

and think that if they only have, that drug their life would be better you know so so physicians respond to patient demands we know this this has been well studied yeah how does this apply to psychiatric medications yeah well so in in psychiatric medicine again the same sort of things apply but what is probably the most damaging about the i would say what the world of psychiatry is the labeling of of behaviors that are generally within this uh what would used to be within the range of normal so you have boys who are exuberant they've got lots of energy they're told to sit down shut up do your work and it's like that's not kind of how boys learn

and that's not how boys operate but so it's very foreign for a lot of and i'm saying boys but happens to girls as well to be jammed into a classroom and been told to um sit down and pay attention where then they'd rather be running around and boys learn kinetically through movement and And but a boy who's very disruptive and speaks up is going to make it difficult for all the other children to learn. And therefore, there is a lot of pressure on doing something to prevent that boy's behavior from becoming disruptive for everyone. And that sometimes leads the road to a diagnosis and a drug, whether it's, you know, your son has some level of attention deficit disorder. and might be helped by a drug. So the problem, and there's many problems in this pair,

the problem is that we're creating social situations and we treat them as medical situations, right? I'll give you another example. It could also be lack of discipline, right? Absolutely. It could be the child comes from a situation at home where there's poverty, neglect, abuse, all kinds of things which might be affecting this child's behavior.

It's not that they have a brain disease. They're probably reacting normally to whatever stimuli they're getting. Just to touch on this, I don't want to cut off your thought, but just to touch on this a little more, I mean, there's been a change in the educational system where discipline isn't as valued, right? Like that isn't taught. It's like systemically not taught at a level say it would have been

some decades ago. Right. Right. So that you can imagine a whole lot more people would benefit from such discipline being ADHD and then prescribed with drugs as a solution. Right. Or people modeling self-discipline and saying self-discipline is actually a very good thing, right? Yes. Totally agree. But back, just to one other example, and it has to do actually with ADHD. We did a study in British Columbia now more than 20 years ago, and this was published in the Canadian Medical Association Journal. We looked at all of the children in

British Columbia, we have a province-wide database. You know, there's hundreds of thousands of children in elementary school. And we looked at the prescribing of stimulants, drugs for ADHD, and we broke it down by the birth month. You say, what do you mean by that? Well, we broke it down into two cohorts. The kids that were born between January and June and the kids that were born between July and December. And we found that the kids born in the latter half of the year, so the younger kids in the class had a 40% higher rate of ADHD drug use than the kids born in the beginning part of the year. We're like, what's going on here? There's no difference in brain disease or mental disorder in younger children versus older children. No, the kids are less mature,

possibly less able to follow things when they're that much younger. Because, you know, a kid born in December is almost a year younger than the kid born in January, right? And they're all in the same classroom. So when this study came out, I was asked by a reporter what's going on here and I said point blank, we are treating a social situation as a medical one. And that's simply wrong. You're not benefiting the younger children in a classroom. When you take them and say to them a certain percentage of them, you have now a brain disease because you can't sit still and pay attention in the classroom. You just said something very powerful, this idea. You said it twice now. with the idea of treating a social situation as a medical one yeah people identify with a certain

diagnosis that becomes part of their identity and they they meet others online and this is part of who they are they're grasping on to explanations of why they think a certain way or why they act a certain way and i think for some people having a diagnosis brings them a lot of comfort allows them to join the tribe, if you will. But, you know, most of us will go through all kinds of stuff when we're growing up. You know, the ups and downs and the normal ups and downs of puberty and development and so on. But to take those normal ups and downs, say that that is a medical condition and then applying whatever pharmaceutical treatment or whatever that you can't, it seems to me completely.

backwards that you know we should as consumers we should push back against that because we have to recognize that everyone goes through the normal ups and downs of development and that you will get through it and I wish parents and and young people just had more confidence that you know you're going to get through whatever it is you're not going to have to resort to to claiming a diagnosis which you're going to carry around for the rest of your life I mean I think The harm that we do in applying labels to people is pretty serious and can be long-lasting. You tell a young rambunctious boy that he's got somehow a mental deficit, and he's going to carry that possibly for the rest of his life.

You've damaged him. You haven't provided any advance for this child. You have damaged him by telling him he's deficient. It's the same with, you know, if you're telling someone, oh, you have generalized anxiety disorder. No, you're anxious about something that you're going to get through. But to telling someone that they have suddenly this medical sounding condition is extremely damaging. Well, and even in social media, I've been observing this phenomenon. There's almost like a valorization of certain medical conditions.

Like people kind of celebrate, as you said, like being part about the club or part of the group or whatever. Like it becomes this identity. What I'm thinking right now, right, is just how bizarre it was. would be right that we create we basically assign a label to someone that isn't warranted that presumes a medical condition and people with that label all get together to celebrate the fact that they have that label yeah i mean it's kind of a mess yes it is an absolute mess but it's also very damaging you know there is a study and i have to tell you this because this is something that will affect everyone at some point in their life one of the most common things that

a physician will do to you when you go for a visit is to have your blood pressure checked right and you know a certain percentage of us are going to be on the high side right however it's defined i won't give you a number because it keeps changing we'll say you've got high blood pressure they did a study in uh in a in a steel mill in Hamilton Ontario back in the in the early 80s and this study basically took all of these steel workers and measured their blood pressure. Some of them, they told the workers that they had high blood pressure, and maybe they should consider seeing their doctor and getting treated. The others, they didn't tell them. So they had a cohort, both had some level of high blood pressure, however it was defined at the time. The people who

were told that they had high blood pressure, did they do better, so they track them and they look in the long term, did they do better in terms of job performance, life satisfaction, happiness, things like that? No, actually, the people who are given the label did worse. The people who weren't told that they had high blood pressure, they had to do something about it actually did better. So this to me is really good evidence that when you apply a label to someone, you can be causing harm. Well, and because of this, I mean, the term is placebo effect, right? The point is that and the effect that the doctor has in terms of influencing you to believe something. which is apparently huge.

It is. Yeah, and the placebo effect, you know, it's well known. We use it in clinical research all the time because we want to determine what is the difference between the similar types of patients, some of them who are given an active drug and some who are given the sort of sugar pill or an inert drug because the differences in whatever outcome should be the differences caused by that treatment. That's why we use the placebo effect. You know, it's quite interesting when you look at research around antidepressants, you know,

the people who get placebos do very well as well. So when they track people over time who are given placebos in antidepressant trials, they improve and the person in the drug improves. And the person who drug improves a little, however, it's defined by a little bit more. why the drug gets approved, but both patients because they're given treatment, perhaps because they're given some attention, they improve. Except that in many cases the placebo doesn't have the side effects, except from studies I've seen, which I found absolutely fascinating, that if the patients know about the potential

side effect, some of them can still get the side effect on placebo. Absolutely, absolutely. The power of suggestion is extremely effective, right, in the sense of people are highly suggestible people are easily did not easy but many people could be easily hypnotized because you know we're very uh we're very suggestible there's a whole other round to explore with you another time yeah um differences between can the canadian and the american situation yeah well american medicine is is is as you know on steroids um it's a very we we live in a very commercial culture public health for the most part I mean in terms of where compared to other countries the US has a system which is very fractured it's very

private and you allow certain things in the US that you don't allow in other countries and one example is drug advertising so you see if you're exposed to television or possibly the internet there there are a lot of drug ads and a lot of times these drugs are for very rare and and sometimes unheard of conditions and the the powerful effect of a drug ad on consumers it works in two ways one is that there's the suggestion that a person might be ill and could benefit from a treatment the pharmaceutical industry would defend that and say oh we're just doing disease awareness advertising okay well sure well grant that that might be helpful for some people but generally you're you're you're increasing the pool of people

who are exposed to disease mongering there's that happening but the same time when you allow that amount of of pharmaceutical advertising to influence the media you find that the media does not really um they they cannot do the kind of hard-hitting journalism that you want to see uh because of the influence of the advertisers. And people would say, well, what do you mean? We've, you know, major journals like the Wall Street Journal or the New York Times, they get drug ads, but also they have critiques.

Critiques. Yeah. I would say that if you had no drug advertising or no influence of the pharmaceutical industry on the editorial decisions of any news outlet, you would see a whole different range of reporting. Look what happened during COVID. virtually those who are dissidents or those scientists who are questioning a lot of the public

health measures including vaccines were censored, not allowed to give their opinions in a lot of the mainstream medical or mainstream media organizations. And so the influence of the drug advertising in the U.S. is quite pernicious, not only in disease mongry, but also in influencing editorial decisions around what kind of critiques Americans get. So I did this little experiment with friends of mine a few months. I went to a reunion of a bunch of old Navy buddies, right? So these are guys, we're in our 60s, successful businessmen, some are doctors, some are lawyers, businessmen, and so on.

And I asked them, I get in a small group, because they asked me, what do you do for a living? And I said, did you guys ever heard of the term Vioxx? And they said, well, what's that? Vioxx. I said, have you ever heard of the Vietnam War? Oh yeah, of course you've heard of the Vietnam War. Well, did you know that Vioxx, which was a major pharmaceutical in the early 2000s that was taken by hundreds of thousands of Americans, killed 60,000 Americans in three years from excess heart attacks and strokes? The Vietnam War took 12 years of American involvement to kill about 60,000 Americans.

So Vioxed did, in three years, what took the Viet Cong 12 years in terms of killing Americans. And what was so astonishing about this is that this has been the, this is probably the most, the biggest drug disaster, probably in our lifetime.

And these guys hadn't ever heard of it. Right, and you're asking yourself, why is that? Educated. How could it be? Exactly. Educated, well-read, people

had never heard of what it's considered would be considered in my world. I hadn't heard of it until the last five years when I, yeah. To be the biggest drug disaster. So how is it that we can take something that has had such a profound effect on mortality from a drug

and then bury it in a way that no one has ever heard of it? It's amazing. It is amazing. It is amazing. and I think it's very telling what you're describing because that's not a it's not a there's no there isn't any contention around it even it's very it's it's universally agreed upon to be reality exactly just like the mortality the death count in in the Vietnam War I use this comparison I gave a lecture in in Sweden

a few months ago and I used this comparison because Viox and Vietnam both start with V that's what they have in common but what do they really have in common they have a death count that on one hand is highly recognized and had a major influence in American foreign policy the other is virtually unheard of by even very educated people and how much and why don't you tell me how much impact it has had on US and Canadian drug policy well I would say that the that there was a lot of talk about how we should tighten regulation around around drug discovery and drug marketing and and drug approval.

But I would argue that those changes are not noticeable. We have a system in which most people who have looked at this would argue that the drugs that we approved by the FDA have been sometimes inadequately tested, perhaps not tested in the right population or too short periods of time, or the company took the data and hids part of it or published only the more favorable things. I mean, there's a million ways to bias clinical research. But you need a regulator that is strong enough to challenge the pharmaceutical companies and say, look, that's not good enough. If this drug is going to be taken by millions of Americans, we need good data to prove that it's going to be safe.

So there's an example just recently with the flu vaccine about the sort of over 65 cohort being the data set being left out here in the U.S. Oh yeah, I mean, that's one of a number of problems with vaccine, with flu vaccine research. I mean, one of the biggest problems is that when they look at meta-analysis, so meta-analysis, not just, you don't cherry-pick studies. If you want to look at the flu vaccine, you have to look at all the studies, positive and negative, you put them together into a systematic review, and then you come out to what we hope is the best answer, whether the flu has benefit.

When they do that with the flu shot, they find no benefit in the cohorts to which it's most marketed, and that would be elderly people. Middle-aged working people, almost no effect of these annual flu campaigns. And I've studied this, I've looked at this over the years. You know, what's an interesting comparison

is when you look at those jurisdictions that have high coverage, is a higher proportion of their population, population getting the annual flu shot compared to those jurisdictions that have low coverage we'll say you know some states in the u.s you would have more than 50 possibly 60 percent of the population the working age population getting their annual flu shot some states you might have 30 percent well that's quite a difference right what would you expect those states with the low flu shot coverage would have a massive flu influenza problem more deaths etc when they do these

interstate comparison, there's no difference. So you ask yourself, so let me get this straight. Even though you had high coverage in this state, you have had no impact on the rate of flu, influenza like illness or hospitalizations or deaths related to flu. Right, so what you're doing is you're running a campaign that's spending a fair bit of money,

driving a certain amount of fear amongst people, thinking that if they don't get their annual flu shot, they're going to get the flu and die. And then you're showing no impact of that spending of that money. Almost unbelievable. Yeah, I mean, so this is one of my themes and that is if we keep spending money on low-value care, when I say low-value care, that would be things like flu shots for relatively healthy people. You know, that would be perhaps ADHD drugs for rambunctious children.

You know, osteoporosis drugs are people who have normal bone density for their age. you know, treatment of high blood pressure or someone who has generally normal or within a normal range of blood pressure. When you treat people unnecessarily, then you're wasting money that you could be using on things that are actually really important, right? Sure. And you're also, you know, by inference, harming people that might not need to be harmed. Yeah, and you're not just harming them sort of medically or physically. You're harming them financially. I mean, some of the biggest scandals in medicine have to do with people who do have very serious diseases, say cancers, terminal cancers, and they prescribe drugs that we know are going to accelerate the cancer instead of reduce it. And those drugs cost hundreds of thousands of dollars.

So you're not only influencing having no effect, perhaps on the length or the quality of a person's life, but you're also bankrupt. them financially and and I think that's unconscionable that we allow that in this country that people say at the end of their lives become bankrupt because they're desperate but they're being prescribed or treatments which don't increase the value or the or the quality or the length of their lives that's uh I mean this is a whole another thing to unpack here perhaps I'll have to I'll have to invite you back to to discuss that this has been an unbelievable conversation in some cases literally.

A final thought is to be finished? Yeah, you know, I think a lot about what should people do. And that's not an easy answer to what should people do. I don't really like to tell people what to do. But if I could live one piece of advice to most people is that stop allowing yourself to be made afraid by those who are selling treatments. Stop allowing yourself to be influenced by those who are selling you theories of disease and drugs at the same time. And I think that we have to become much better healthy skeptics. We have to think if someone's coming at you with a prescription pad, you know that

there's something behind that. And whether it's real or relevant to your life, you have to sit back and think about things. And I would also say that most of the time, if you're you're facing the sharp end of a prescription pad, you have time to think about it. Most of the time, not always, most of the time, decisions around whether you start a chronic drug for a chronic disease is not an emergency situation. You have time to do some research. Maybe watch a few of your programs. You have time to do a little bit of research. And so don't feel like, you know, the sale ends tomorrow. You have to get on board now. You have time to stop and think. Well, Alan Castles, it's such a pleasure to have had you on.

Thank you for having me. Thank you all for joining Alan Castles and me on this episode of American Thought Leaders. I'm your host, Yanya Kellick.