Dhru Purohit Show - #263: A Deep Dive on the Fraud, Deception, and Misdirection of Big Pharma with Dr. John Abramson

Episode Date: February 3, 2022

This episode is brought to you by BiOptimizers, InsideTracker, and Eight Sleep. The United States spends an excess of $1.5 trillion annually on health care compared to other wealthy countries—yet the amount of time that Americans live in good health ranks at 68th in the world. At the heart of the problem is Big Pharma, which funds most clinical trials and therefore controls the research agenda, withholds the real data from those trials as corporate secrets, and shapes most of the information relied upon by health care professionals. This week on The Dhru Purohit Podcast, Dhru sat down with Dr. John Abramson to talk about the inside story of how Big Pharma’s relentless pursuit of ever-higher profits corrupts medical knowledge—misleading doctors, misdirecting American health care, and harming our health. Dr. Abramson is the author of the new book, Sickening, and has been on the faculty of Harvard Medical School for twenty-five years, where he teaches health care policy. He also served as a family physician for 22 years, during which he was named a “top doctor” six times in local, state, and national surveys. He served as an unpaid consultant to the FBI and Department of Justice, including in a case that resulted in the largest criminal fine in U.S. history. He is also the author of Overdo$ed America: The Broken Promise of American Medicine.   In this episode, we dive into:  -Big Pharma’s best-kept secret (10:25) -The first trial of a drug company found guilty of fraud and racketeering (25:34)  -Insulin and the exploitation of diabetes (26:37)  -The core relationship between pharmaceutical companies and doctors (27:39)  -Understanding absolute risk vs. relative risk for pharmaceutical drugs (31:16) -How data manipulation led to excess deaths from the drug Vioxx (40:39) -Why pharmaceutical companies are able to skirt accountability (44:09)  -Where the budget for the FDA to oversee human products comes from (49:52) -Vaccines for children, boosters, political inputs, and FDA resignations (58:16) -What we can do to actually change the system (1:24:00)  This episode is brought to you by BiOptimizers, InsideTracker, and Eight Sleep. Magnesium Breakthrough from BiOptimizers really stands out from the other magnesium supplements out there. It contains 7 different forms of magnesium, which all have different functions in the body. There isn't anything else like it on the market. BiOptimizers is offering my community 10% off, just head over to magbreakthrough.com/dhru, with code DHRU10. InsideTracker provides detailed nutrition and lifestyle guidance based on your individual needs. Right now, they’re offering my podcast community 25% off. Just go to insidetracker.com/DHRU to get your discount code and try it out for yourself. Eight Sleep’s Pod Pro mattress is so smart that it adjusts your temperature and also gives you individualized recommendations on how to sleep better the next night. To get yours, go to eightsleep.com/dhru to check out the Pod Pro mattress or mattress cover and save $150 at checkout. Hosted on Acast. See acast.com/privacy for more information. Learn more about your ad choices. Visit megaphone.fm/adchoices

I think the drug companies would argue, well, their job is to sell product. It's not their problem about how many people have side effects and so forth. Well, that may be right or wrong, but if they're not going to do it, we need a way to do it. Because if doctors are going to prescribe drugs, they have to know what the real benefits are and what the real harms are. And they don't. Hi, everyone, Drew Prode here. Today, we're talking about how big pharma broke the American healthcare system using shady tactics, nefarious tactics, And there's nobody better than our guest today, Dr. John Abramson, to talk about this.

He's an expert litigator. He's got a lot to say on this topic. Stay tuned. Hi, everyone, Drew here. If you're a fan of the show, I'd love your help. My team and I have put together a brief survey to get your feedback on this podcast, help us source better sponsors that you actually want to hear from, learn a little bit more about you, and continue to provide you with free content.

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but InsideTracker makes their results easy to understand and even provides tips on how to use food first for optimal nutrition. Right now, InsideTracker is offering my podcast community, 25% off their system. Just go to inside tracker.com slash drew. That's D-H-R-U to get your discount code and try it out for yourself. That's inside tracker. I-N-S-I-D-E. Tracker. T-R-A-C-K-E-R-com back slash Drew. D-H-R-U for your 25% off. Welcome to the Drew Perot podcast. Each week we explore the inner workings of the brain and the body with one of the brightest minds in wellness, medicine, and mindset. This week's guest is Dr. John Abramson, and he has a lot to say about how big pharma, the medical industrial complex, broke our American healthcare system through often shady and nefarious tactics.

If you're curious about the subject, this episode is for you. A little bit about Dr. I'm sorry. Abramson. He's the author of the new book Sickening and has been on the faculty of Harvard Medical School for 25 years where he teaches health care policy. He's also served as a family physician for 22 years, during which he was named a top doctor six times in local, state, and national surveys. He served as an unpaid consultant to the FBI and the Department of Justice, including in a case that resulted in the largest criminal fine in the history of the United States. In addition to many academic articles and op-eds in the New Yorker, in the New York Times and other publications, he's the author of Overdosed America, The Broken Promises of American Medicine.

Dr. Abramson has appeared on the Today Show, CNN's American Morning, NPR's All Thing Considered, CBS's evening news, NBC Nightly, and many, many other media outlets. It's an honor and a pleasure to have him here on the podcast to talk about how we can push Big Pharma to stop letting their drive for profits impact our health care as a nation. Dr. John Abranson, welcome to the Drew Pro podcast. It's a pleasure and honor to have you here. I'm going to jump right in, and I'm going to be paraphrasing here. but you've shared that the American public and specifically America, and we'll talk about why America,

is playing a game with what I'm going to loosely define as big pharma. But unfortunately in that game, there's no referee to help make sure that the game is being played fairly. Number one, is that an accurate summary of what you've shared before? And number two, why is it that that's the case? Well, it is an accurate summary, but I want to make one small change. Please. I don't think the American public is playing the game. I think the American public would like to be as healthy as it could as efficiently as

you can achieve that goal. I think Big Pharma is playing a game where, their core business is to maximize their profits and return those profits to their investors. And what they're doing is creating the image that their purpose is to improve Americans' health. It's not. It's to maximize their profits. Along the way, they sometimes provide products that are incredibly important to our health. And we want to be very careful as we criticize Big Pharma, to throw out the baby with the bathwater and to understand that the whole realm of medical therapeutics of medical science is they it has to come through them. New therapeutics have to come

through them. So we don't want to reject all of big pharma. What we want to do is get a lot smarter about making the best of scientific medicine, taking the best of scientific medicine for ourselves and our families, and not subjecting ourselves to the excesses of the drug companies. Before we jump into your story and it's a fascinating one, and it'll lay the groundwork of everything that brought you to writing this new book that's out there, I want to talk a little bit about the foundation of where this misinformation at times, as you've said, sometimes there is fraud, sometimes there is misinformation, sometimes there is blatant data manipulation, not always, right?

Not always. But sometimes it's there. And the foundation of that, from my understanding of reading your book, starts with the presentation of the science around prescription drugs that are being researched in the journals that are published out there. So right now, a lot of people, including many doctors, and most doctors, you know, many doctors of my family and they're well-meaning people and they're doing the best that they can and they're trying to take after their patients. You're a physician yourself. You're a family physician for many years. They think that when a study is published in

a journal talking about the efficacy and the results of a particular drug, there's a core assumption that that data, that raw data has been looked at and reviewed by other parties separate to the drug company themselves. Tell us how that might be a limited view in terms of what's actually taking place and happening. Yep. It's a limited view, but it's certainly an understandable view that people and doctors assume that when articles are published in peer-reviewed journals, that the data have been reviewed for accuracy and reasonable completeness, and therefore are trustworthy and ought to be integrated into the doctor's repertoire of evidence-based therapeutics. The problem is that it doesn't work that way.

Over the last 40 years or so, research has been taken over. Control of research has been taken over largely by the commercial interests. The data that are produced are owned by the sponsors of the research, which are usually the drug companies that make those drugs. And when clinical trial results are written up and submitted to journals, even the most prestigious journals. What's submitted is only the manuscript itself that has a very brief data summary in it. But the peer reviewers and the editors of the medical journals don't get to see the actual data from the clinical trial.

That remains the property of the drug company and the analyses that are based on that data are shown. but the peer reviewers and the medical journal editors don't have enough information to recreate those analyses on their own. So the basic principle of science, that the findings are independently vetted and that they're reproducible, are violated on a routine basis. Doctors don't understand this, that peer reviewed doesn't mean that there was access to the whole database just to what the drug company and the authors chose. to submit in the manuscript. And to make this worse, even for the clinical practice guidelines

that establish the standards of care that good doctors are supposed to follow, the experts who write those clinical guidelines don't have access to the underlying data. So they too have to trust the interpretation of the data that was submitted to the medical journals for publication. I mean, when I heard that and when I read your book, I knew that sometimes that might be the case. I know that there were some questions. There is a gentleman named Peter Doshi, who's at the University of Maryland, who writes a lot about this topic. And the British Journal of Medicine had written about this topic a little bit in terms of raw data in the context of the early vaccine development with COVID-19 and making sure that people had action. to it. They weren't saying that they're against vaccines. They're just saying, hey, we would

like the public to have the access to the raw data. But I didn't know that that was the case pretty much what I'm hearing from you is that it's always the case. Is it ever not the case that when it comes to these big pharmaceutical drugs that are being the studies that are being published around them? Is this pretty much the de facto case all the time? Yes, it is. peer reviewers can request additional data, but they rarely do. And there's nowhere near the resources available to get patient-level data, which is the basic clinical, the raw clinical trial results. There's nowhere near the expertise available within the medical journals to turn that

raw data into independent analyses. In fact, just before we started this podcast, I was on the phone with an editor from the British Medical Journal who's going to do a bookstore talk with me. And we were talking about a situation that I got into with the British Medical Journal where I published, I was the lead author of an article about cholesterol lowering statins. And we were making the argument that even based on the data that was available, the benefits were being exaggerated. And it turned into a huge kerfuffle with a demand for retraction.

that was unanimously rejected. It was a real, it was a problem. It mostly stayed on the other side of the pond. It didn't get here. But the British Medical Journal, coming out of that, they, editors realizing that the people who wrote the guidelines didn't have the real data, wrote to 32 of the lead authors of statin trials, the major statin trials that had been done and said, look, the guidelines are being written,

not based on access to the real data, but just based on access to the published articles. And we can't possibly be recommending this drug that is recommended for half of American adults between age 40 and 75. We can't possibly be making these recommendations based on non-transparent data. So please, you 32 lead investigators, please send us the data so that we can have an independent analysis and issue guidelines that are based on the real data. And after a year of repeated writing and calling, only seven of those lead authors even responded to the BMJ's request for data. Wow.

That was in 2015, and there it lay. The BMJ wrote this. they couldn't have been clearer in their editorial. They said, look, you can give us the data and we'll analyze it, or you can get dragged kicking and screaming into the realm of transparency. So far, they haven't gotten dragged in. It's incredible when you realize the extent to what I would call a de facto system. You know, nobody wanted it to really be this way, but somehow we ended up in this position

where fraud, data manipulation, and profits became the primary driver, but it's so systemic and it's so entrenched that we all just accept it as normal. Tell us when you started to realize in your hero's journey that something was a mess and when you started to ask for and eventually become an expert witness when it came to people, that were looking under the hood to see what was really going on with these drug trials. Right. So there was a moment when it happened. I was in my family practice office. I was working hard in a small town, being a family doc, and I was teaching at Harvard at the time, as I am now. And I read a review article in the New England Journal of Medicine that about the drug, Viox,

an anti-inflammatory drug. Do you remember the Vioxx? It came out. Yeah. Okay. So I was reading a review article. If you could give a little bit of a summary for those that might be listening that aren't familiar, when did it come out and just a little bit of context? Yeah. So Vioxx came out in May of 1999. And its purported advantage was that it's an anti-inflammatory drug, no more effective than a leave or Motrin or any of the over-the-counter anti-inflammatory drugs. But it's purported advantage was that it's gentler on the stomach. It causes few serious GI side effects. And that was their marketing schick. And they turned Merck, it's Merck's drug. They turned it into a major blockbuster. It was selling $2 billion a year in the United States. Problem is that there were serious cardiovascular complications. The drug more than doubles the risk of heart attack, stroke, and serious blood clots in comparison to naproxin or leave.

But the article that was published in the New England Journal in 2000 didn't include that fact. It didn't include that safety data. That here we have a drug that's no more effective. We're claiming it causes fewer GI problems, but we're not telling you that your risk of serious cardiovascular events will go up 2.38 fold. And later, that article came out in the New England Journal in November of 2000. And then there was a review article in the New England Journal about Cox 2 inhibitors, the class that Vioxx is a member of. And there was language in it that said it more than doubles the risk of cardiovascular events, but this may just be due to the play a chance because there were fewer than 70 events in the whole study. And I had done a fellowship

in research design and epidemiology, and I'm pretty good with numbers. And I remembered that there were only 53 total serious GI events. So they were making the case that this drug should be a blockbuster drug based on its GI safety when its cardiovascular harm was far greater, but blowing it off as the play a chance. And at that point, I knew that there was something dreadfully wrong with the way the New England Journal was allowing this information to be presented. And it was at that point that I decided I was going to leave my practice and write a book and figure this out. So I left and two years later, overdosed America came out. I had the Vioxx story in it. Vioxx got pulled a week after my book came.

out. It was not directly because of my book. Another study that Merck did confirmed the doubling the risk of heart attacks and strokes, and Merck obviously couldn't hide it anymore, and my book was out there. And suddenly I was on the Today Show and all over the TV. And at that point, lawyers started to see me, the lawyers who were running the national litigation against the drug companies. And that's when I started my journey as an expert in litigate. Now, when you became an expert witness in that trial, and since then you've been part of other trials that have been there, one of the things that you've shared is that in some instances where these companies have had incredibly large fines and penalties, but very importantly, nobody's gone to jail. We'll talk about that in a second. even though there's been thousands of deaths attributed to some of these misrepresentation of drugs that are out there. So going back to my point is that when you were part of these trials,

you actually got a chance to see what no other journals and no other people outside of the pharmaceutical industry were seeing. You got a chance to see essentially what I'm calling raw data. Is that the right term? Even more than raw data. I got to see. I got to see, what was on the hard drives of the corporate executives and scientists who had been involved in the drug in question. So we actually got to query the hard drives, 20 million documents in many of these cases. And I could put together what happened. And not only could I put it together working as a plaintiff's expert, but the only place where peer review really happens is in litigation. where one side hires experts to do analyses and the other side hires experts to do analyses,

and you have it out in a courtroom. And you have to tell the truth. As an expert, if I didn't tell the truth, if I had a biased analysis, it would be exposed by the drug company, and it would be a humiliation and a professional... Suicide. Yes. Exactly. So for 10 years, I lived inside those corporate computers, and I was privileged to see what's really going on. And for all the Americans out there who say, you know, I got this sense that the drug companies are playing with me and they're manipulating my doctor. And I wish I could know what was going on. I got to know what was going on. And the thing is, you can talk about themes as a whole. But if you can talk about themes as a whole, but if you can

could set the record straight, you are not allowed to talk about any one of those specific cases. Is that true? And why is that true if it is? It's not completely true. It's almost completely true. In order to get access to the corporate computers, one has to sign a confidentiality agreement. And that's legit. I mean, there's no reason why a drug company should open up its computers to me and let me go blabbing to the press about their private matters. So the confidentiality part of this, I think, is legit. What happens is when a case goes to open trial, then all the information that's been submitted to the court becomes accessible and public.

So to that extent, I can talk about it. In the first section of my book, I talk about four drugs or classes. of drugs. Viox is one. Neurontin or gabapentin is another. And in that chapter, I describe the court case that happened in federal district court where Pfizer, the manufacturer of Neurontin, now gabapentin, generic, was found guilty by a jury of having committed fraud and racketeering violations. This was the first trial in which a drug company had been found guilty of racketeering. i.e. anti-organized crime or anti-mafia laws, having violated RICO, the RICO Act. The third chapter is about statins, and I talk about the bona fide effect of statins, the extent to which

they're helpful and the extent to which their help is limited and the extent to which side effects aren't known. And then the fourth chapter is on insulin. And I was not involved in litigation in insulin, but the story about creating an imperative for doctors to prescribe the most expensive insulins, the insulin analogs for people with type 2 diabetes is an amazing story of the manipulation of physicians' understanding of what quality care is. The bottom line is that we're wasting about $20 billion a year by treating almost all of our type 2 diabetics with insulin analogs that cost about $5,200 a year instead of the previous generation of bioengineered insulin, which is recombin human insulin, which is just as effective for people with type 2 diabetes.

So we're wasting about $20 billion a year, and that $20 billion would essentially pay for the community-based lifestyle improvement programs that would prevent about half of the diabetes in the United States. Let's talk about the core relationship between pharmaceutical companies and our doctors, right? We all have doctors, knock on wood. I know a lot of people don't have access to medical care, and we'll chat a little bit about that at the end of the podcast around your solutions that you've proposed inside of the book. Let's talk about the core relationship between medical companies and doctors.

How would you explain that relationship to somebody who may not be familiar with it? Yes. And this is a very important subject to talk about because people assume that a key component of the control that drug companies have over doctors' opinions have to do with the doctors receiving money or gifts or some kind of benefit. And that's not the truth. There are some doctors who take a lot of money from the drug companies, and they play ball with the drug companies.

Their side of the story would be that this is the most effective way to get good products out to the public. I generally see it otherwise. Excuse me. But the key that holds doctors in the thrall of the drug company influence is that they are taught that the legitimate sources of information that good doctors trust are the sources of information that the drug companies know how to deliver their information through. So more specifically, doctors are taught that evidence-based medicine is that's the criteria of being a good doctor. And evidence-based medicine means that you practice according to the findings of clinical trials that are published in peer-reviewed journals and that are of high quality, and that you follow the clinical practice guidelines that are issued by nonprofit organizations or governmental organizations.

That's evidence-based medicine. That's the absolute foundation of what doctors are taught is their obligation to their patients to provide good medical care. What they don't know is that evidence-based medicine has been largely taken over by the commercial interests. And their own view of that evidence is that they own the data, that the purpose of the data is to support their marketing, not to be given out to individuals to do independent analysis, but to support their marketing. And the bottom line is that no matter what kind of candy frosting you put on it, the drug company's job is to make money, to maximize their return on investment for their investors. And they're going to use all of these channels, and we can talk about all of them,

but they're going to use all of these channels to convince physicians that, quality medicine is the kind of medicine that's going to maximize their profits. Let's talk about some of those channels and let's talk about some of the trickery associated with these channels that are there. I'd love you to start off with one, maybe even coming back to the journal and the journals and the relationship there, but one of the things we didn't touch on is that in addition to the peer reviewers not having accurate. to the data that actually went into the findings. They only have access to the pharmaceutical company's interpretation.

There's other ways of finagling data to make a drug sound more efficacious than it actually really is. Can you maybe talk about some of those examples, like the difference between absolute risk and relative risk or any other ones that might be present? Sure. Sure. So the difference between absolute risk and relative risk, let's look at the effectiveness of statins in protecting people at low risk of cardiovascular disease from heart attack and stroke. So the data, this is not based on primary data. This is based on the interpretation of data that's published shows that there's maybe a 20% relative risk reduction of cardiovascular. cardiovascular events. So you say, gee, I'd like to reduce my risk of cardiovascular events. I'm a healthy

person. I haven't had a heart attack or stroke. I'm not in a high risk group. But if I could reduce my risk of heart attack by 20% relative risk compared to people who didn't take the drug, then that's a good thing. But the absolute risk is how much you're reducing the chance of somebody who takes the drug from having a cardiovascular event compared to somebody who doesn't take the drug. And the absolute risk reduction is about 1% or less, which means that for low-risk people, you have to treat between 100 and 140 people with statins for a year in order to prevent a non-fatal heart attack or stroke. Now, that doesn't say whether that's a good thing or a bad thing. And as a former family doc, I would say that the right way to approach this is to tell the patient in front of me.

Look, you're at low risk of heart disease. And if I treat between 100 and 140 people like you for a year with a statin, one will benefit. And we don't know how many are going to have side effects because the side effects aren't really measured. that's not the drug company's interest to document side effects. So can you pause on that real quick? The side effects aren't measured and it's not in the drug company's entrance to measure side effects. I know I'm taking you on a tangent, but a lot of people would think that I thought that's

actually what drug companies do, that they measure the side effects. One would hope. But a study that was published in JAMA, Journal of American Medical Association, showed that out of 41 studies, randomized controlled studies of statins, Only one study actually called people up and asked them if they were having muscle symptoms. Just one study out of 40. So we don't know how many people have side effects. The drug companies and the people who work for them have defined muscle symptoms in such a restrictive and drastic way that very few people have that problem,

that you have such muscle inflammation that you're going to threaten the life of your kidneys. And, you know, there's a, it's called rhabdomyelysis. It's a drastic condition. That's very rare, thank God. But they don't take the trouble to prospectively inquire about the incidence of side effects. So we just plain don't know what the side effects are. These drugs have been on the market since 1987. And we don't know what the side effects are.

and we don't know how the benefit of taking a statin compares the benefit of healthy lifestyle modification counseling. That study's never been done either. So this just highlights what we're talking about before, Drew, that the purpose of the research is to sell drugs, is to create information, air quotes around information, to sell drugs, to convince doctors and consumers that the drug is in their interest. It's not to find out how best to prevent heart disease. It's not how best to make a preventive program that's prioritized on the most effective approach. It's to sell product. And you could argue, and I think the drug companies would argue, well, their job is to sell product. It's not their problem about how many people have side effects and so forth.

Well, that may be right or wrong, but if they're not going to do it, we need a way to do it. Because if doctors are going to prescribe drugs, they have to know what the real benefits are and what the real harms are. And they don't. You know, the challenge is it's not just that they don't. It's that they think that they do. They do. That's exactly right. That's the large message that I'm getting from your book. It's not just that, okay, I also am an entrepreneur.

I have businesses that are set up to ideally both look after, you know, people, profits, planet. You know, those are things that we consider. But it's my objective in those companies to make money. And everybody knows that. And I think that most people, especially here in America, although it's very different in other countries and we want to chat about that, why is it, you know, different in America compared to other countries and how does advertising play into that? Most people would understand, okay, great, drug companies are going to make money. They're going to make money, but they're providing such a service, and especially we're in that context right now in all things COVID with the therapeutics and the vaccines.

They're providing such a service and they have such an expertise that, fine, we're happy with them making a lot of profits because there's only so many organizations, people, or groups on the planet that can actually undertake this. But the missing piece that's there is that goodwill that's given to pharmaceutical companies comes along with this misunderstanding that people have, which is that fine, I'm totally happy with you making all the money in the world. But I know that you are looking out for our safety and I know that you're making the world a better place with your medicines.

And I know you're going to make sure that you keep in mind total harms, that the risk for taking this medication and all, interventions have a risk outweighs, sorry, the reward for taking this medication outweighs the risk of this medication. And what I'm getting from your book is that the risk sometimes is completely either swept under the rug, manipulated, or in a generous situation, a little bit of a don't ask, don't tell. We're not going to investigate it. So we don't, we're not put into place where we have to report it. Right.

And don't compare the new, higher price drug to older therapies. Don't do that. So the key point here is, let's take the ethical entrepreneur who's going to try to maximize profits by delivering a product that has the value that it's claimed to have. We don't have that part in the pharmaceutical business. So essentially what we have is the commercial interests of producing the knowledge without adequate oversight of the integrity of the knowledge. It's as if we were trying to play a professional football game without referees. And that might not go so well as we get to the playoffs and these guys are paid to win and that's their job.

You need referees. And what's happened in the United States is the referees have been taken out of this. So there's not an independent way to assess the medical value of the drug, the medical efficacy of the drug, and the economic value of the drug. So the drug companies basically have no obstructions to their maximizing profits at the public's expense. And people say they're greedy. It's their job to be greedy. It's like criticizing a zebra for having stripes. They're supposed to make money.

And what we need to do as consumers and as health care professionals is understand that they're going to make as much money as they can. That's what they do. Now, we need some structures in place to ensure that the public's interest is protected in this endeavor. Now, before we talk about the structures and there's a lot of them inside of the book, there's more groundwork to be laid. And one of those things is that so far we've been talking about.

profits. And we've been talking about a little bit of accessibility, right? Drug prices going up and using new therapeutics when old generic drugs would be just as good, just as good and way cheaper and maybe potentially even have a lower side effects profile, drugs that have been around for a really long time. But separate from the price component, there's also this component that we're talking about real deaths taking place. Can you give us an example of how some of this trickery or data manipulation led to excess deaths in the population? So the two most striking examples are we go back to Vioxx, the anti-inflammatory drug we

were starting about at the beginning of the podcast. This drug did not provide better pain relief and was significant. significantly more dangerous than the older, cheaper alternatives because the cardiovascular risks outweighed the GI benefits. And it turns out that between 40 and 60,000 Americans died from taking Vioxx. So this is approximately the number of Americans who died in the Vietnam War died from taking Vioxx. When you hear that number, 40 to 60,000

individuals died from taking a drug and you look up any other situations you mentioned the Vietnam War I'm going to have to go on Wikipedia and look for other instances where you've had that population of people separate from war separate from a nuclear bomb Hiroshima other things like that radioactive fallout there's not going to be many instances again separate from war where you have that quantity of people dying as a result of what was found to be pure fraud in the instance of Vioxx. Correct. And it gets even worse than that.

There was an article in the Wall Street Journal that published an email that was written by the head scientist on the Vioxx study. The day that the data were unblinded for Merck, it was in March of 2000. And the email said, I'm paraphrasing, it's a shame that the cardiovascular events are there, meaning he knew that there was a significant increase in the risk of cardiovascular events. He said, it's a shame that the cardiovascular events are there, but the drug will do well and we will do well. we will do well. No criminal charges. He's a prestigious scientist even now. No personal responsibility. When you look at that, no criminal charges, and it's not just in the case of Vioxx, but this has happened a few times.

And there are parallels to other industries, you know, some of what happened maybe in the banking during the Great Recession. I'm sure there's other industries as well too. But pharmaceutical industry and the healthcare industry and medicine is unique in a way that, yes, it's devastating to know that when people lose money, that's like super devastating in the case of banking. In this instance, again, we're talking about deaths. We're talking about people literally dying as a result of manipulation and tributation and trickery. When you look at the system that allows that to take place, what do you think are some of the core factors that are at play that allow pharmaceutical industries to continue to skirt accountability separate from the fines that they pay? And again, they have huge pockets and they make a

lot of money on these products. So the fines is kind of like the equivalent of a speeding ticket for us. Yeah. But what allows them to skirt additional accountability? What are the factors that are at play? We may want to go back and talk about it, but Vioxx was back in 2000. So OxyContin story is even more devastating with the number of deaths that resulted from OxyContin and getting people addicted to drugs that later turned them out to the street. And then the fentanyl came along and we have a real disaster there.

But I think the chief element of this continuing, you're absolutely right that the financial penalties amount to a slap on the hand and they're not enough of a disincentive to break the law. But we see two phenomena that must be changed. One is that when these companies plead guilty, even to felonies with the Department of Justice and pay billions, billion-dollar fines or more, they're often allowed to let a subsidiary take the plea so that the parent company doesn't take the plea and they don't get the first strike against them in terms of getting what's called disbarred from Medicare, not being allowed to sell drugs to Medicare. So it's absurd to let a subsidiary take the plea when you've got a parent company that was overseeing the project.

That's number one. Number two is that executives don't go to jail. And if we go back to the Vioxx story or we go to the OxyContin story, and we see that misleading and fraudulent marketing led to tens or hundreds of thousands of deaths in the case of OxyContin. And it was a willful act on the part of the individuals in the drug company. and they don't go to jail, then that's behavior's not going to stop. It's not going to stop. If a neighborhood guy passes a $20, a counterfeit $20 bill in the neighborhood corner store, they're subject to arrest, they're subject to God knows what.

But here we have executives who know what they're doing, who are responsible for enormous amounts of money, being ill-gotten profits and harming people and they don't go to jail. And that's, I think, one of the core problems that we have with maintaining integrity in drug company research and sales marketing. How much do things like a revolving door between pharmaceutical companies and governmental agencies, or deep lobbying pockets, bipartisan lobbying pockets

where pharmaceutical companies are often the largest contributor to political campaigns, both for Democrats and Republicans here in the United States. How much do those things play in or not play in to no criminal accountability,

in your opinion? I think they play in, sometimes indirectly through political pressure, sometimes more directly through lobbying and so forth. But we're at a point where the drug companies have so much money. They're so profitable. They have so much money. They have so much cash on hand.

They can spend so much on public relations and media relations and advertising. It's like a seesaw where there's too much weight on one side. And you can't get the seesaw balanced. You can't go back and forth because there's so much weight on one side. side. And that's where we are at this point. And that's the economic term for that is market failure. And market failure does not correct itself when there's too much weight on one side of the seesaw. And I think that's an important point here because I'm going to give a little bit of a preview to what we'll be talking about in a few minutes is that we need referees in this field.

And there are examples. You know, there's always a back. balance that's there in terms of governmental intervention, right? You want that Goldilocks zone, not too little and not too much. Right. Exactly. When we look at other countries around the world, which we'll talk about in a minute, there's plenty of other goods that I want to cover before that time. There are much better examples of how other countries like the United Kingdom and France and other countries manage their relationship with their pharmaceutical companies to not only keep costs down, but to actually improve the overall level of mortality rates and the lifespan of the population that's there. So there are examples that are out there

in the world that we can at least learn from and try to figure out a way to make it uniquely American. And I have a bunch of questions on that. Before we get into that, one of the interesting things that I learned from reading your book, and it's fascinating. And please, anybody who's interested in this topic, which I hope is everybody who's paying attention to this podcast, please pick up the book. The link is in the show notes. One of the things that I learned is that people often say, okay, well, the pharmaceutical industry, sure, they're driven by profit. And yes, there are bad actors or bad apples that are out there every so often. But largely it's good. And even sometimes when they get out of control,

we at least have the FDA to look out for us. Now, one of the things that I learned from your book is that a huge percentage of the budget for looking at therapeutics and drugs for the FDA actually comes directly from the pharmaceutical industry. Is that accurate? And what percentage of the budget or total amount of dollars contributes into the FDA budget from pharmaceuticals? It is accurate, true. And the percentage of the budget of the FDA to oversee human products is 61% of that budget

it comes from the drug industry and device industry. 61%. That's more than the majority, which would be 50% or more. What influence, again, we're speculating here, but if there would be anybody to ask, it'd be you. You're the guy, right? Harvard background, expert litigator, been involved with many of the biggest, you know,

more recent trickery that's happened around some of the pharmaceutical industry, what influence does that have when 61% of the budget is coming from the group that you're supposed to be watching as the watchdog? Right. So there's explicit influence, like establishing timelines that the FDA has to meet in terms of approving new drugs or they lose money. so that there's explicit influence and there's implicit influence. And the implicit influence is a feeling that you get from within the FDA

that the drug company is their partner. And I can give you an example of that. The drug Adjahelm, the very expensive Alzheimer's drug that was approved by the FDA against the almost unanimous advice of its, advisory committee, and it created quite a brouha. The doctor who is in charge of the center of the FDA that approves new drugs said after the three doctors resigned from the advisory committee and the press picked it up and it became public that the science that the FDA relied on to approve this drug didn't support the approval of the drug. The doctor who's in charge

of that part of the FDA said, we can contain this kind of emotionalism, her word, not mine, emotionalism in advisory committee meetings by taking away the restriction that advisory committee members can't have financial ties to the drug company. If we allow advisory committee members to have financial ties to the drug companies, we won't see such emotional reactions. The emotional reaction was that the drug doesn't provide a significant clinical benefit and 33% more people have brain swelling and symptoms from brain swelling and brain bleeding. That's the emotionalism. But the point I'm making here is that this doc who's in charge of the division of the FDA that approves new drugs, who had, I think, a 16-year career with Farmer before she came to the FDA,

thought that we could obviate the problem of such a rebellion by an advisory committee just by letting more people get paid by the drug companies who come in and advise us. It's crazy to think that that was the explanation that took place. And for anybody that's not familiar, this was originally touted as sort of this miracle drug for Alzheimer's, right, even though the efficacy was incredibly low. And in some instances, people went backwards. And not to mention that, preemptive. many groups around the country were saying that we're not going to cover this medication

because the cost, and you'll maybe know the more accurate number, but I think the range of taking the medication every year was somewhere around $30,000 to $50,000 a year. $56,000 a year, which very easily on its own could have bankrupt certain medical insurances. And there was all sorts of implications in terms of what would this mean for Medicare. And in one of the interpretations that I saw that was from the, a group that was writing about this said that, well, maybe the FDA approved it because they don't want to discourage future Alzheimer's drugs from taking place. But when you look at it as a whole, and the impact on people's budgets, and the number one reason still to this day, a lot of people

don't know this, but the number one reason for bankruptcy in America is still health insurance bills, right? Health insurance bills, medical bills, medical bills. That's the number one reason for bankruptcy and you have this drug that doesn't do much and you have top advisors of the FDA resigning. I'm surprised it didn't get more attention for people to look at. This is kind of crazy. We cannot let this continue. Otherwise, we're going to be bankrupt as a country and we're going to continue to become worse off in our health. This episode is brought to you by eight sleep. There is nothing worse than restlessness, nasty night sweats and constant tossing and turning when you just want some restful deep sleep. But did you know that studies actually show that our body

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sleep fitness today. I have to ask you, and I want to have you have the opportunity to, you know, be able to go on record for this. You know, you've been very clear about your, you know, your support for COVID-19 vaccines. And on this episode, on this podcast, we've had many people come on and have different discussions. and we have many nuanced discussions that are there. One area that feels very similar to the Alzheimer's drug that we were just talking about is that there was a group of FDA vaccine safety scientists who were reviewing the data

around boosters for kids. And in this instance, there was a very similar situation where, again, they didn't go on record and say, but many people who are familiar with FDA, and people that run in the same circles as those individuals saw something very interesting. When the political pressure came, and again, political pressure can come from all sides. It's always going to be there, right? That's why a lot of your recommendations in this book are actually great recommendations because they help us go beyond politics, right?

That's an important thing to be able to do. But you had multiple individuals, I believe it was two, who resigned because the efficacy around boosters that were being pushed for kids and young adults just didn't seem to cross their threshold of cost-benefit analysis. In the modern context where there's so much praise, and again, pharmaceutical companies do great things. There's fantastic therapeutics and, you know, a lot of people like yourself do feel very, you know, that the vaccines have been a major, contributor. And I do feel that same way specifically for people that have been at risk. But I want to ask you in the context of this world today, and it's very hard when anytime

you're talking about vaccines, because immediately people want to put you in a bucket that you're for, you're against, you're this, you're that. But I'm asking you for your nuanced thoughts. Do you see some of the same political influence that's happening? And is those instances with kids and boosters a parallel? Or is it not a parallel to some of the themes that you've talked about in your book. Great question. And let me just say, Drew, you get an A-plus. You're a good student of this stuff. And thank you for bringing what you bring to this conversation. What we're seeing with the vaccines is there are several issues, particularly what you're referring to now, the issue of boosters and kids. We're seeing, this is my subjective.

opinion now. We're seeing an over-enthusiasm about the vaccines so that people who believe that the vaccines are going to be more helpful than harmful, I think are sometimes getting out over their skis and projecting what they believe the data will show as opposed to what the data actually does show. And I think that's a terrible disservice. I mean, I respect people who hope that the vaccines are more effective and that using them broadly will work better, that's their opinion, and that's fine, and God bless them, we need optimists to push back the boundaries of our knowledge. But I don't think that it's fair for experts to read beyond the data in public because of their enthusiasm of what they think future data will show. And we've gotten into that problem. I am

As you said, I am not an anti-vaxxer. I believe that the vaccines are very effective. There are some complex issues with children. If I had young children, I would get them vaccinated. We can have a debate about that. And I certainly don't believe in mandates for children. But that said, I think public officials have a duty not to overread the data, even if they believe their over-reading will have an overall beneficial effect in society.

And I think we've gotten some very honorable people have been not incorrectly criticized by the anti-vax faction for going too far in reading data that doesn't, presenting data that doesn't yet exist. I think the beauty about reading your book is that, you know, there's that age old quote. And it says, you know, history doesn't repeat itself, but it often rhymes. And when we understand that, we understand that there are motivations that can lead to profit an agenda being the primary driver. of decision-making, whether that comes from a drug company, whether it comes from policy. That's the nature of the game. And we also understand without oversight, absolute power corrupts absolutely. And when you walk away and you study that history of what's happened before, and I would say that most people, including well-intentioned medical doctors, I've been on this

podcast many times saying that being South Asian, I have many, family members that are medical doctors. I grew up in that system and they're all great people that are just trying to do their best. They often don't know about this history as well. They're just trying to survive medical schools, survive residences, survive their fellowship and just be there and provide care to people in the best way that they can. And in a way, starting from medical school, they're indoctrinated that the drug companies are fully on their side without much attention to the fact that they have their own motivations. And while they deliver important therapeutics, there are some times that they get out of

control. And there's that baseline arrangement that has to bring questioning and open-mindedness and that we at least have to be able to have a discussion. I want to ask you, as you started right about this and coming from an academic institution like Harvard, how much pushback and blowback and questioning did you get from your peers that are in the medical space and how much open-mindedness is there for doctors themselves to start questioning the data that they're getting from the journals and the drug companies? Yeah, that's a really good question, Drew.

And I think the answer is that the ether in the academic medical centers tends to be permeated by a working with the commercial interests. So the academic medical centers have been brought into the commercial enterprise. It started back in 1980, I think, with what was called the Bidol Act, where federally funded research, going to nonprofit organizations could be patented by the nonprofit organizations and turned into profitable enterprises. So you could privatize the financial value of the research that had been federally funded. So that brought academic medical centers into the commercial realm. And at the same time that was happening, the drug companies, the academic medical centers were doing 80% of drug company research. They were playing a role in designing the studies.

They owned the data. They analyzed the data and published. In 1991, 80% of the research was coming through academic medical centers. And by 2004, only 26% was. There was this enormous change in control of the research. So the drug companies took the research back, hired private research companies to do the research, contracted with academic physicians to be authors on the articles. But essentially, control of the trials was taken from the academic medical centers and delivered to the commercial sponsors of the research. And what didn't happen, all this could, in a well-functioning market, all this could happen, except that as this transition to the privatization of the creation of knowledge, as we went through this transition, we needed to put up

guardrails to make sure we were ensuring the integrity of the research and the epidemiological balance of the research so that the public was going to get value for its research investment. And we didn't get the guardrails. We got the privatization of the research and the distribution of the knowledge, but we didn't get the guardrails that the public needs to prevent profiteering activity to compromise the medical care that Americans get. So if I'm understanding you correctly, it's that there's all this research that's happening that's being funded by the government. Now, we need to take that research and we have to turn it into a product that can reach

the public. And so there was those arrangements that were made that private groups could do that. They could leverage some of the research that was there, but there was never the question of how do we make sure that at the end of the day, people are getting healthier and in a way that isn't going to bankrupt us. That's exactly right. And if I could make the link, let's look at Moderna, the company that makes the one of the two companies that makes the MRNA vaccine for COVID. moderna took federally funded research and commercialized it and made a vaccine very quickly that was very effective they've priced it at somewhere around 20, $25 per shot in the first world and it costs about $3 to manufacture so they moderna has taken this publicly funded knowledge and priestly funded knowledge and privatized the commercial benefit and charged inordinate prices that give them inordinate profits.

And the key part of this is that in doing all that, the government did not impose an obligation to make sure that Moderna did its share to get the underdeveloped world population vaccinated so that we've got this wonderful vaccine. technological miracle vaccine. But when we leave Africa 9% immunized, they're going to breed more variants that are going to come back and cause disease in the United States. So they're greed in selling drugs at first world prices, prioritizing sales of drugs in the first world, and not prioritizing sales of drugs in the third world, ensures that these variants, the last when Omicron came from South Africa, which is a very low vaccination rate. Their profit model subverts the public benefit of their wonderful product. Yeah, there's a lot of layers there in that discussion. On the topic of Moderna, when Pfizer and Moderna, only bring it up because

you mentioned, when they launched the initial vaccines that were there, because again, we were reliant on their interpretation. It was a really good original article by Dr. Peter Doshi, I'll link to it in the show notes in the British Medical Journal, who wrote an essay talking about, we just kind of have to trust that the interpretation of this data is accurate. Now, I don't have the exact numbers, but the efficacy initially that was touted around vaccines, and this isn't a pro or or this is not a pro or anti-vax component, you've mentioned exactly where you stand on it. And people who have heard my podcast before know all the nuanced conversations that we've had. And what I'm asking specifically here,

is that when the efficacy was brought up, which we're relying on the pharmaceutical companies, just like every other drug. It's not any exception for the vaccines. The same sort of story and themes that are happening inside of your book that you talk about with other drugs are there for the vaccines as well. And we were hearing things like 91% efficacy, 95% efficacy, 99% advocacy. Then when we had real world data in almost every instance, that efficacy number went down, whether it was run by different governments or whether, I don't know if the pharmaceutical companies themselves ran some of that data.

But when we had real world data of how the vaccine actually did, again, in the real world with people taking it, that number went down massively. and that was the relative risk. The absolute risk in many instances also dropped massively as well. Now, don't you think at this point in time, well, actually, let me phrase it, at this point in time, taking your ideas and thoughts from the book and knowing that, let's say somebody believes, as you do, that we need to get the rest of the world vaccinated, wouldn't we also want to know what the actual data shows and open up the books so that people can

decide what version of the vaccine will work best as we want to take it around the world? Is there some aspect that I'm missing in trying to extrapolate some of the examples in your book out to the current standpoint of where we are in the pandemic and with the vaccines and many countries around the world, Australia and Canada, still relying heavily on mandates for their population. Yes. You described the situation well. The one thing that we have to be careful about is when we talk about vaccine efficacy, you have to specify whether it's efficacy at preventing infection or efficacy at preventing serious illness or death, so that the efficacy for preventing infection has gone down dramatically. and especially for the Omicron variant. So that now the data shows that people who are unvaccinated have double the risk of getting infected with Omicron than people who are vaccinated. And just a quick question on that.

Is the contributing, is that drug company data or are you relying on a or is that independent nation state data, whether it's from the United States? Yeah, good question. data. And some people would say, hey, they're in bed with the drug companies, and sometimes they're too close. We can't do better. We don't have a national system of data collection. We have to rely on that. Let's assume it's approximately right. And history will show whether they were right or wrong. They can't get too far off track. So you reduce the risk, a fully vaccinated person and boosted, has a 50% reduction in the risk of getting infected, but they have a 95% reduction in the risk of dying from Omicron.

And that, I believe that data stands. It may be somewhat inflated because people who have other comorbidities may be more likely not to be vaccinated. So maybe it's not 95%, maybe it's 75%, but there's some effect there that's large in reducing your risk of dying from Omicron. And I think the beautiful thing is that as I think it was under the Obama administration, you know, he said, I want to make precision medicine a priority. And as we go into the future and coming from the background of, you know, our medical clinic

in Massachusetts, as well as a lot of the doctors that come on this podcast, they typically fall into the world of precision medicine. And in the world of precision medicine or functional medicine, a big part of the understanding of therapeutics, which there are life-saving vaccines that are out there, there's life-saving medications that are out there, you know, thank God to all the people that are part of the drug companies that created these things. And on the flip side, as you've outlined in your book, there's a lot of fraud and there's a lot of trickery where things are exaggerated, when we start to leverage precision medicine for understanding how different groups respond to different treatments based on their underlining health challenges, we can clearly state that,

hey, the vaccines are fantastic for this group of people. And hey, this other group of people, it's up to you, right? Here's the data we have. Here's the transparent data. Make your own decision that's there. In the instance of kids, you had mentioned that if you had kids, young kids, you'd get them vaccinated. You know, we've had other people on the podcast that are shared. hey, in Germany, when they've done the data from a national level looking at healthy kids, again, healthy kids. You know, we've had about 800 total deaths of kids since the beginning of the pandemic. That's under the age of 18.

Most of those instances have been kids with comorbidities. Great. Let's put all of our resources, just like we were talking about supporting other countries, to make sure no variants came out. Let's look after the most vulnerable. Let's look after the most challenged. Let's look after them and there might be another risk reward for other groups. But whether or not people agree with that or not, and you're the expert in this field,

I'm not. What I did feel really excited about after reading your book was people can make better decisions, including policy decisions and be more transparent with the public when all the data is available. When all the data is available, especially to the peer reviewers who are looking at these clinical trials in the case of Vioxx and the other drugs that are mentioned, it is just going to lead to better decision making. And I believe when there's more transparency, there's less polarization, right? One would hope. That's the hope. That's the hope. Yeah, that's a key. Polarization is a health risk in its own right. Just we ought to talk about that. But let me go back to you're addressing

the precision medicine issue because that's very important. People who are obese, people who have diabetes, people who have heart disease are at much greater risk of serious consequences from COVID. And I agree with you, if we were designing a program to get the best effect for people to prevent people subgroups from getting COVID, we would go directly to those high-risk people with comorbidities and elderly people. There's no question. There is another dimension, and it's not determinative of how we approach this, but the other dimension is the public health dimension, which is not individual health, not whether it's going to help me or that obese guy over there, but whether by increasing the vaccination rate, and this is relevant to kids, we're going to decrease the transmission of disease to teachers, to grandparents and so forth. And we have to consider that. It doesn't tell you you should lean one way or the other, but you do have to consider it as another dimension. Absolutely. And I think there's somebody, if you're not familiar with him, you know, he's really, you know, I follow a lot of COVID moderates, right?

Most of my family is vaccinated and some have been boosted like my parents. Others have not because they're in the lower risk category. My brother-in-law's cardiologist, you know, we want to have just open discussions that are there. One of my favorite COVID moderates is a gentleman named Dr. Vinae Prasad. And one of the things that he talks about is that when we're looking at spread and whether or not any therapeutic in this instance we're talking about vaccines, we actually want to make sure that the randomized control trial that's being set up is looking at that versus, you know, these arbitrary antibody markers.

So do we actually know that this is reducing the risk of spread that's there? But I want to pivot from here because we didn't have you on the. podcast to talk about this, you know, and again, I love to have people on here who have an important lesson in history to teach us, but not only that, they have solutions, they have ideas. And one of my favorite things that you brought up in this podcast a little earlier was that we have to understand, you know, sometimes in the health world. Now, this is criticism towards the health and wellness world, is that we think people just need to get healthy. If they just, lost weight, then they'd be much less likely to get COVID or cardiovascular disease or diabetes.

And when you're somebody who's living at the poverty line, you know, or close to it, and you're working multiple jobs to survive, you don't have any time to research, to let alone listen to this podcast. Not to mention, you most likely live nearby a food desert. So there's no healthy food around you. Maybe you're used to getting your groceries from a 7-Eleven or a dollar store nearby, which was primarily filled with processed foods and carbohydrates that contribute to these underlining challenges that are there. And there's no support system. And it's in our interest as a society to be thinking about what can we do for those individuals to actually support them to help all of us get healthier as a nation. And you mentioned this idea earlier,

which was if we actually just switched from using one type of insulin to another type of insulin, the cost savings alone, those $20 billion, if I have the number accurate from what I remember from what you mentioned, would be enough to invest into health coaching, maybe hospital pharmacies, F-A-R-M-A-C-Y, which are being tested in various hospital systems where your doctor literally gives you a prescription and says, hey, I'm going to give you a prescription for eating whole foods. By the way, it's going to be subsidized or given to you for free. And it also includes in some instances health coaching, as I mentioned, or cleaning classes, because a lot of people actually don't know how to cook or even do the basic preparation around that. To me, that's exciting.

That's exciting that we can take the cost savings that come from getting people off of all these fancy drugs that are talked about in the trials that maybe have generic or lower cost options that are there. And other countries are doing this, by the way. They have a much more protections as you talk about in your book. And we can actually start to implement change on a population-based level. When I heard you share that earlier in the interview, I'm like, that seems like an absolute no-brainer. Yeah, I think to get to the big picture here, we've been talking about the particular instances where the drug companies have created a misrepresentation or buried side effects or whatever. But what's really happening is that almost all the research is about new drugs and devices. And almost all that doctors believe they know about how to practice best medicine has to do with new devices, new drugs, the latest. What's happened in the United States is this exaggerated belief in medical, biomedical innovation, has sucked away money from our addressing the social determinants of health so that that

person who's living on the border of poverty in a food desert with fast food outlets around them can't even go for a run because it may be too dangerous to go out his or her door and go run a couple of miles or even walk a couple of miles. So what's happened is the United States, the ratio of spending on health care to social care is reversed in the United States from most of the other wealthy countries. We're pulling all this money into health care, and it comes out of our social care.

And somehow we've got to figure out a way to move back towards a balance between spending on health care to understand when innovation is more about money than it is about health and to recapture some of those funds to go into social programs so people can follow the rock-solid advice that you're giving them about how to optimize your health. What are some of the other solutions? You know, the last part of the book is focused on what do we need to do? What do we need to do to actually change the system? And you being very much a realist who just wants to implement change, one of the important things

you said is that we can't just blow up the entire system. We can't tell a zebra not to be a zebra, right? We have to work within the boundaries. So what does that look like? And what are some of the things that you're proposing that could help us change the system for the better? Yeah. So the situation we have right now in American health care is that democracy is not

working. Our health care statistics are awful. 1,300 Americans die every day, more than died, on average, the first two years of the COVID pandemic. Before the COVID pandemic, 1,300 Americans were dying every day in excess of the citizens of other wealthy countries because our health care system performed so poorly. And for that poor performance, which has earned us a rank of 68th in the world in healthy life expectancy, we're spending an extra trillion and a half dollars every year on health care. And 80% of Americans understand that we pay too much for our drugs. And they understand that the drug companies are more interested in profits than they are in improving our health. They understand that. So we've got a failure

of democracy. And the way to address this failure of democracy is through, public education and coalition building. Because there are three coalitions that need to get to, three constituencies that need to get together to make change, to overcome the political and economic power of the drug companies and other health care industries. We've got doctors who, for the most part, like the doctors in your family, are trying their best to do the right thing for their patients and don't understand that they don't have access to good information and that the information they have, even if it were transparent, is not epidemiologically balanced to optimize the health of Americans. So doctors need to understand that they're not

getting good information and they can't do the job that is the existential basis of their life work. They can't do it without good information. Constituency number one. Constituency number two is the businesses that are purchasing health care for their employees, the non-healthcare-related businesses, where they're wasting so much money, it compromises their competitiveness, it compromises their profitability, it compromises their ability to market on a global basis because the other countries aren't paying nearly as much for health care. So we've got the doctors who need information. We've got the non-health care related purchasers who could form into a large purchasing cooperative, large enough to say we're not buying your drugs if you don't give us the

data. We're not going to buy a product when we can't have the information to evaluate that product. That doesn't seem like a radical proposition. And the third constituency is the American people who know that they're getting ripped off by the drug companies, who know that they're held bills are unmanageable. And what do they want? They want to be healthy. They want their families to be healthy. And they want to stop having to pay this health surcharge that comes to about $4,500 per person per year because our health care is so much more expensive than other countries. So we've got three huge constituencies that aren't natural partners. But they've got to come together because the interest of each of those constituencies merges into this revision of the way we produce and distribute

knowledge and deciding how much money is the right amount of money to be spending on health care and how much money is the right amount of money to be spending on the social determinants of health, which are responsible for about 80% of our health, as opposed to health care, which is responsible for 20% of our health. Now, I think that that's a fundamental challenge to our democracy. If we cannot get that done, if the drug companies distributing money to Republicans and Democrats and paying money for public relations and having influence in the FDA and so forth, if that overwhelms the public's interest and the doctor's interest and the purchase interest in getting the right drugs to the right people for a fair price, then we can't

really call ourselves a democracy anymore. We're not functioning in response to the will of the people. What are some of the best examples in the world of countries that are at least a little closer to this? Not that there's countries that out there, nobody's perfect, everybody's working on trying to figure out how to work within their system. But what can we learn from some of our allies elsewhere in the world who rank much higher on that world health score where the U.S. ranks 68. Yeah, right. So there are a couple of, a few things that make the United States unique in this process.

Number one is we don't have a formal mechanism of health technology assessment. So there's no place where doctors can turn and say, what do independent experts who have access to the data, say, is the most effective and efficient way for me to treat my patient. So its health technology assessment is number one. Number two is cost-effectiveness research, and though it may be hard to believe it is illegal for the federal government to fund cost-effectiveness research, and it is illegal for federally funded guidelines to integrate the difference in cost into the recommendation. and therapy. And when you say illegal, when was that set up and who set it up that way?

Gee, I don't know when it was. I don't know the answer to that, but many years, many years. It sounds nefarious. Was it something that was originally well-intentioned and it got out of control? Like, why would that even be the case? I can't make up a good intention for that. Okay, no worries. I think it represents industry influence. Okay. So, for example, the United States Preventive Screening Task Force is independent, non-commercially related guidelines that are funded by the government, but they're quasi-independent, quasi-governmental organization.

They are not allowed, and they are amongst the most trusted guidelines. They're not allowed to consider cost. So when we look at screening for colorectal cancer, which is important. Colonoscopy is recommended along with other less invasive and far less expensive forms of screening for colorectal cancer, some of which have to do with stool tests where you just test your stool for blood or genetic markers. The USPSTF, United States Preventive Screening Task Force, doesn't prioritize those screening

methods from the ones that cost $4,000 to the one that costs $4,000 to the one that costs, wants the cost $100 or $400. They don't. So people who are looking at those guidelines think, hey, they're all equal. I think colonoscopy is probably better, so I'm going to get that. You can't contain, there's no way to practice efficient medicine when you can't consider cost. So we've got health technology assessment. We've got cost effectiveness assessment.

and then we need a legal system that we talked about this in the beginning of the podcast that meets out penalties that will be a disincentive to bad behavior so that you need financial penalties for corporations and perhaps individuals within corporations and people who perpetrate fraud and harm people ought to be held responsible. The same way a petty criminal would be held responsible. I think those measures would go a long way. Transparency, health technology assessment, cost effectiveness, and a way to have penalties that are commensurate with the crime would go a long way to bringing the United States back toward the median of the other wealthy countries. And one other thing I want to mention is that we're the only country that allows the drug companies to change.

what they want for brand-name drugs that they have a monopoly on. And that not only raises the prices so that our prescription drugs, our brand-name prescription drugs, cost three-and-a-half times more than the other OECD countries' drugs do, but it creates an incentive to do this malfeasant marketing to exaggerate the benefits of the drugs because it's so much, bad information is so much more valuable in the United States. So it turns out that between two-thirds, and three quarters of the profits, global profits of the drug companies, come from the United States. And it's a crazy situation. It is crazy. And it can seem sometimes daunting, but one thing I always try to remember is that when the will of the people starts to build up, and often that

happens in a perfect storm. And I think we're in one of those perfect storms where people are getting sicker than ever, our life expectancy is going down. A big part of that being overdoses that are directly related to prescription drugs is a part of it. And which the drug companies obviously played a major role in that process. So our life expectancy is going down. For the folks in certain subcategories whose life expectancy is going up, their health span is going down. They're being diagnosed with more chronic diseases. They have more codimidities when they die. And the beautiful thing, though, that's happening is that they're one silver lining of some of the polarization that I see that we're in right now, right?

I always try to look at the silver lining in some aspect, even though there's many problems with the polarization, is I think that part of the polarization is a result of the free flow of information and the questioning of where does trust lie and where does trust not lie. There's going to be the bad that comes along with that, which is genuine misinformation, politically motivated, you know, hit jobs and other things like that. And then there's some of the good, which is maybe a, you know, a smaller percentage, but it's there, which is open discussions like this. So more people are having honest discussions to see you on the Joe Rogan podcast.

And to get introduced to you from my friend, Sean Stevenson, who has his own podcast, I don't know if even our audiences, if it wasn't for your work and hats off and kudos to you for writing this book and dedicating your life and your work to this message, we would have not known the extent of this. It's available in plain sight, but it takes somebody to truly do the storytelling and put it together. And we're lucky that it's somebody like you that has the pedigree that you do because you're more bulletproof than maybe somebody else. who may not have the track record and the history that you do. So I think that part of the polarization is coming from the free flow of information. There's some bad with that and there's some good with that that's happening. And all of those factors are leading to this perfect storm where people are fed up. They're dying early.

They're sicker than ever. And also I think that there's politicians, this new wave of politicians who are like, none of this is working for anybody. we're all going to go bankrupt as a country if we don't do something different. So now that we're in this perfect storm, it's really up to us, all as listeners of this podcast, to say, whatever constituency you're part of that you described earlier, are you willing to speak up? So if people want to be a part of this, if they want to speak up, in addition to picking up your book, it's a fantastic read, you know, give a copy to a friend, what actually can we do?

because it can feel so overwhelming that it's like, do I really actually make any contribution to making a difference with this big fat mess that we're in? Yeah, exactly. And one thing, after you read your book, please give it to your doctor to read. Because the doctors have to read it. And they're not going to read it unless their patients ask them and make them read it. That's a great suggestion is that if you have a doctor, you have a good relationship with them, in a gentle and well-meaning way, hey, right?

Actually, let me ask you, if somebody was looking for a script, right? Because there's this sort of interesting relationship sometimes that people have with their doctor. Doctors don't like to be, you know, necessarily always, you know, told what to do. I don't think anybody likes to be told what to do, but especially in their domain of expertise. And there's that old quote that says, it's hard to get a man, of course, a woman, too. it's hard to get anyone to question something when their salary is dependent on it. Right. So if somebody was looking for a script to present your book and a copy of it to their doctor, you being a family physician, how would have you wanted somebody to say, hey, check out this book?

You've said it. I think I would want somebody to say, hey, this is an interesting book. This guy's got real credentials. He's brought information to the FBI and the Department of Justice, and he's been vetted in the federal courts, and he teaches at Harvard, and he's not a crazy. So will you just read this book and see what you make of it? Just give them a listen and see what you think. And I think they'll be captivated.

I think I'm speaking the language that they understand if we can just get them to it. Now, one more concept before we quit. Please, please. Because what you've described is, that we need to rebuild the medical commons. It's been destroyed. It's been destroyed by profiteering.

It's been destroyed by polarization. Vax, anti-vax, we're going at each other. And we forget that in the middle of these polar arguments, we've got this huge amount of territory that we share in common, where we want our families to be healthy. and we want our society to be health-oriented, to promote health, and where the quality of our lives will improve. And that commons, where we all live better lives, is going to include most of the people in America. And I think that if we're going to recover from this, we've got to understand that

being on one of the two polarities and arguing that you've got to be right in your you're not going to accept anything but full acceptance of your position is can destroy our country. It's a time that we've got to come together. And the health care issue is a great team building exercise because we all have the same agenda. We want to be healthy and we want our families to be healthy. So if we could get this idea that it doesn't matter whether you're Republican or Democrat or left or right or progressive or conservative, none of that matters. we share so many values and we're missing out on that. It's an important reminder.

And I think that as part of that reminder, I'll add in one more layer, which is that let's talk about it all. But you can do it in a way that is open-minded, kind, and without this idea of tribalism, that I am going to vote, agree, and fall in line with whatever my camp says before. I consider another idea. Like the Buddha said, you know, it's the middle path. And there's so many great ideas, you know, there's many people that are listening to this podcast who are on a prescription drug that made a massive difference in their life, right? Whether it was being on an SSRI for a temporary period of time that helped them stabilize

when they're going through a very difficult, you know, or challenging situation, whether it's, I mean, we could go on and on and on that's out there. And there's people that are listening that have themselves or a family member. My father is on a statin. I've had many conversations with him. And I've sent him some of the things that people in England like Dr. Asim Mahotra, who's talked a lot about satins and other things saying, hey, you know, we just want to weigh the pros and cons to look at total harm and see for your risk category

of what's there. So there's people that owe their life to pharmaceutical companies, doctors, and the medical system. And there's also people who have, and it doesn't get as much attention, passed away, been harmed or are being misled by the industry. And everything in life is going to be that way. We just need to have open conversations and create systems so that we can help the larger population navigate through the middle.

You know, celebrate people when amazing technologies are developed and companies and reward them financially. I'm a big believer in that. And then also penalize people for going outside of the boundaries of what we described to be decency and humanity when it comes to bringing therapeutics to the marketplace. And nobody's done a better job than you in presenting the case for both of those aspects, Dr. Abramson. And I want to thank you for coming on the podcast and being willing to,

share your journey and and I'm just thankful that it's you who's talking about this because I think a whole new classification of people that were open-minded but needed the right person with the right background and and the right motivations, which is not any allegiance to any one particular group or camp, just looking out for the, you know, the citizens that are out there, they needed that person to be the person to bring the story. I hope that your book gets turned into a podcast series or, you know, a documentary or a docu-series. You know, I have some contacts at Netflix. I'm going to send them this book and say, I don't know, I think this needs to be like some sort of docuseries on Netflix.

This is all to say, I just want to thank you for your work, Dr. Abramson, and just appreciate you coming on the podcast to share all the beautiful findings that you found and why it's so important to have these discussions. Well, Drew, I want to thank you for the opportunity to share these ideas with you and your view. and listeners. It's a coalition between guys like you and geeks like me that'll get this information out and make a difference. The book is out there, the sickening, how big pharma broke American health care and how we can repair it. It's out in hardcover. We have a link to it in the show notes. Please buy a copy. And in a kind and open-minded and a gentle way, give a copy to your doctor and ask them to check it out. Dr. Abramson, thank you again for being. on here, super appreciate you. Likewise. Thank you.