The Joe Rogan Experience - #1756 - John Abramson

Episode Date: December 30, 2021

John Abramson, MD, is a Harvard Medical School Lecturer, national drug litigation expert, and author. His new book, "Sickening: How Big Pharma Broke American Health Care and How We Can Repair It," will be available on February 8.

Joe Rogan Podcast, check it out! The Joe Rogan Experience. Train by day, Joe Rogan Podcast by night, all day! Hello, John. Joe, pleasure to meet you. Thanks for doing this, man. So, this is obviously a subject that in this current era is very intriguing and very important for people. Big Pharma.

And this is the subject of your book. How Big Pharma. What is the heading? How Big Pharma Broke America? Is that what it is? I actually have a copy of it. Oh, good. Because it's not available.

I tried to get it. And they sent me copies of the audio book, but it's in these weird wave files and when you have to turn your screen off or it shuts off the sound. All right. There you go. Sickening. How Big Pharma broke American healthcare and how we can repair it. So how did they break American healthcare? What happened? How did it get so deep in? And how is it that we're one of only two countries on earth that allows pharmaceutical companies to advertise?

Well, let's start with that question. Yeah, let's do that. So the United States and New Zealand allowed drug companies to advertise. But New Zealand has very active oversight of its pharmaceutical program, active oversight of the evaluation of the efficacy of the drugs and whether the pricing of the drugs is reasonable. So it turns out that even though we in New Zealand allow drug advertising, New Zealand spends the least per person amongst developed countries, and we spend the most by far. So has there ever been a conversation, like whether it's publicly or privately, that you know of where they've tried to stop this? Is this one of those things that once it gets into play, once there is a law that allows pharmaceutical drug companies to sponsor or to advertise, are we doomed then?

Because then the amount of money that's involved in advertising, and when you see those brought to you by Pfizer, those CNN commercials, and when you see the, whether it's for allergy medications or antidepressants, the sheer volume of money that's involved, it seems like extracting that from our system would be very difficult to manage because they're going to fight tooth and claw to keep that in. Absolutely. So as best I understand it from the lawyers who do understand it, in our constitution, the advertising of prescription drugs falls under the free speech mandate of our Constitution. And some things you can control the advertising of, cigarettes and alcohol.

There's no beneficial use of those. They're not a – they can be recreational, but there's no absolute benefit to them. But with drugs, there is an absolute benefit. And because of that, they qualify as protected under the First Amendment. However, that said, the floodgates were opened, and it's clear that the drug company is going to spend as much advertising, however many billions of dollars they want, to make as much money as they can. But there's nothing that says that drug ads need to be allowed, that we need to allow them to be misleading. So you never see in a drug ad that you have to treat 323 people with trulicity for a year to prevent one cardiovascular event. They don't tell you that. They tell you trulicity for a year to prevent one cardiovascular event. They don't tell you

that. They tell you trulicity for diabetes prevents cardiovascular events in diabetics. But if they said you have to treat 323 people to get one better and the other 322 aren't going to have a cardiovascular benefit, then you'd be delivering information that people can use. then you'd be delivering information that people can use. And if you said that you can't play violins or have family picnics while you're reciting all the side effects, then people would listen to the side effects. So I think the key is that the drug companies know how to use the ads very skillful to manipulate people on an emotional level. And we don't have to settle for that. You want to advertise drugs? Okay. Let's decide what facts need to be told about this. Is this better than other therapies? Is this better than lifestyle intervention?

How much does it cost? How many people do you need to treat in order for one to get better? I think if that information were included in the ads, they'd be much less, the cost benefit of the ads would be reduced, or the benefit cost ratio would be reduced for the drug companies. And then they wouldn't advertise so much. But right now, they can make these ads that make anything look great and make people want them and make people go to their doctor and ask for them and they make a ton of money. Yeah, it just doesn't seem like it should have a place. Advertising in terms of the way they're advertising, not just showing something in a print form, like there is a new medication that stops the damages of high blood pressure,

or whatever it is. What they're doing is they have these theatrical representations of the most beautiful and wonderful life, where people are dancing in wheat fields and delivering picnic food while everybody laughs and cheers. That should be illegal. Right. I mean, it's manipulation.

They're clearly fucking with people's heads and they're using psychology. They're not doing it in a way where they're trying to objectively, coldly rely facts and have people see these facts and recognize that this has benefit to them. No, what they're doing is they're trying to get people excited about the possibility of living a life like they're seeing. When they're relaying these facts, they're doing it with music. They're doing it with joyous dancing. It's bullshit. It's really wrong because you're not selling a car.

If you want to do that to sell a car it doesn't bother me at all but you're doing something that you people who have health problems are really thinking that they're going to wind up like these people in this video they're really you're manipulating them to the point where you're getting them to bring things up to their doctor things about antidepressants or anti-anxiety medication or all kinds of stuff that people could just ask for. And it's just, it seems insane that of all the countries on earth, there's only two that allow it. And as you're saying, one that allows it pretty much unchecked. Right. That's exactly right. And I'm in total agreement with you, Joe. I don't think we're going to get rid of drug ads.

But I think we could make the drug ads. You could ensure that the drug ads leave people with an accurate understanding of what the benefit of the drug is going to be. But don't you think if you have any ads, there's going to be room for fuckery? drug is going to be. But don't you think if you have any ads, there's going to be room for fuckery? And there's going to be, I mean, if you have any ads and say, okay, well, no theatrical representations, they're going to go, whoa, okay. What about music? Can I have music? Like, what about the way people talk? Like when they say these side effects at the end, when they list off the side effects, it's crazy the way they're talking about death and suicide. You may have suicidal thoughts like, oh, what? Why is it like that? Right. And why is the dog wagging his tail? Why are you saying this while this lady's dancing? Like, you know, what?

Yeah, I'm totally with you. I just think that it's not going to happen that we get rid of them. But if we made them tell the truth, and if we did studies that looked at the messages that people actually take away from these drug ads and made sure that the messages were accurate, that it would be an improvement. So you're just being pragmatic. You're just saying, realistically, we're so far fucked, we're never going to remove these ads. It's worse than that. I think they're so baked into our constitution. The right to advertise is so baked into our constitution that it's not going to happen. But I do think that if you made the ads tell the truth about how the drug compares to other therapeutic approaches, how it compares to taking charge of your lifestyle, what the real cost is, not what your copay is, if you made the ads communicate an accurate picture of the role of that drug in therapeutics and the price, the relative price, that it wouldn't

be so bad. I agree 100% with you. It makes no sense. Doctors know how to read medical journals and they should be deciding what's good for people. We don't need the TV ad to tell us that. All that said, it ain't going away. So I think the energy ought to be to figure out how to deliver a constructive message. It seems like, but if you did have a constructive message and it was comprehensive, it would take, you'd need like a half an hour infomercial. It wouldn't necessarily fit inside a one-minute advertising. If you're talking about the benefit of different

lifestyle choices, if you're talking about diet and exercise and how it affects the way these things interact with the body and what's the actual cost, copay, if you have all those factors in, how are you going to squeeze that into a one-minute ad? Well, maybe you can't, but maybe it needs to be a two-minute ad. Maybe the law needs to be that you need a two-minute or a five-minute. Maybe make it as boring as possible so at the end of the day, they hate the drug. Now you're on the right page.

Yeah, yeah, yeah. But you could standardize it. This is how the drug compares to therapeutic alternatives. This is how it compares to lifestyle. This is how the drug compares to therapeutic alternatives. This is how it compares to lifestyle. This is what it costs. This is how many people you need to treat in order for one to benefit. You could make that standard. So just like the drug label that the FDA approves, it's standard. You know where to find stuff. So I think you and I share one common thought that we're not on one side or the other and that pharmaceutical

drugs have some amazing benefits and they've been incredible for mankind in so many different ways. The problem is unchecked capitalism, like unchecked profit, unchecked where you have so much money that you can influence the way things are regulated, you can influence the way things are promoted by health officials, where you just have full reign with your ability to distort information and to cover up the damaging and detrimental effects of these drugs. And that's where I think we agree about pharmaceutical companies, And that's where I think we agree about pharmaceutical companies, what they've done in terms of whether it's lying about studies, lying about the addictive properties of these drugs. It's been absolutely horrific.

But as well, some pharmaceutical drugs are amazing. Correct. Both things are true, right? Both things are true. And I think there are two important points to be made. One is, this may sound impolite, but the primary function of the drug companies is to make money for their investors. And we've got to get over the illusion that somehow their purpose is to serve our health. Their purpose is to make money. Their purpose is to serve our health.

Their purpose is to make money. And in our largely unregulated system, uniquely unregulated healthcare system, pharmaceutical system amongst developed countries, we allow the drug companies to control the information that flows to doctors and patients. And that's what has to change And that's what has to change. That's what has to change. And the amount of accountability that drug companies have. So like, you know, we've talked before about Pfizer and that, what was the one drug where they had the largest settlement ever with the largest penalty ever? Pfizer, it was an arthritis drug. And what did they do? Like, what was their, what was the, I want to say error, but what was

the lie? Like, what were they selling versus what was reality? So I can't tell you. I know, but I can't tell you. I spent about 10 years, a little more than 10 years in litigation as an expert in the national drug cases. And when I served as an expert, I got to see all the documents. So there would be like 20 million documents in a case. And I could see the science, and if I needed a statistician to do a reanalysis

of the primary data, I got that. I got to see how the marketing people strategize to exploit the science to create the most profit. I got to see how they marketed to doctors, how they wrote the articles in the medical journals. And I did that for, in the case of Pfizer, plaintiff's attorneys hired me to analyze the situation. So I wrote a report and it got submitted to the court. And Pfizer's behavior was, in my opinion, so outrageous that I picked up the phone and called the Department of Justice and said, I know a lot about this drug, but I can't tell you because I've signed a confidentiality agreement as an expert. So the Department of Justice and the FBI sent me a subpoena and said, you must come with your computer and tell us what they did wrong.

And I did. And that was the end of it. They keep their cards close to their chest. And six months later, I read in the newspaper that the Department of Justice had found the company had committed a felony and they were dealt the largest fine in U.S. history, the largest criminal fine in U.S. history. So I know what happened, but I can't tell you. You can't tell me because of the confidentiality. Yep. Wow. And this, well, we can read it, right?

We can, well. No. No? You can read what the Department of Justice, you can read the Department of Justice press release, and I would encourage anyone who thinks this story is too crazy to be true to just search Department of Justice and Baxter and they'll see the story that I just told. But none of the real data is available as far as like what they lied about and nothing? Nope. Nope.

Wow. Nada. So how is that possible? Nothing. Nope. Nope. Wow. Nada. So how is that possible? Is it some sort of a deal they had? They were going to pay the amount of the fine, this enormous, exorbitant amount. And in the deal, it was that the actual details of it would not be divulged? That's correct. And it's even more serious because the drug companies own the data from their clinical trials. It's so serious, Joe. When a drug company sponsors a clinical trial and they do the analyses and they write up a manuscript and they say what happened and they send it to a medical journal and it gets peer reviewed and doctors

are trained that they should read and trust peer reviewed articles that are well conducted. And that's how the system works. The peer reviewers and the editors of the medical journals don't get to see the data. They have to take the word of the drug companies that they've presented the data accurately and reasonably completely. And you only get to see it in litigation five years later when it doesn't matter because everyone's formed their opinion. That seems insane. It's insane. And doctors don't know this. They're taught there's this paradigm of evidence-based

medicine where good doctors practice evidence-based medicine, and that's based on the peer-reviewed articles published in medical journals and the clinical practice guidelines. And the doctors don't know that the peer reviewers didn't have access to the data and couldn't perform their independent analyses. And the experts who write the clinical practice guidelines don't have access to the data. So the data is only held by the pharmaceutical companies. They release their analysis of the data? Correct. And then the peer reviewers do everything based on the analysis of the data that was released by the pharmaceutical companies.

That's correct. That's insane. That's insane. And docs don't understand it. They don't understand that they're getting manipulated, that the control of the knowledge has been turned over to the drug companies. And the drug companies, they pay for, I think, 86% of the clinical trials. They design them. for I think 86% of the clinical trials, they design them.

First, they decide what they're about, and they're about the things that are going to make money, obviously. They're not about the things that are going to make people healthy. They're not prioritized that way. But they design the studies. They figure out the doses. They figure out the conditions and exclusions of the people who are in the trials, and they do what they can to exercise their fiduciary responsibility to their shareholders, which is to make this thing

come out with data that's going to sell the drug. And then after they've done all of that, they own the data. How did that ever become the way that system is set up? What steps were not put into place to protect people from the kind of fraud that's possible when the pharmaceutical drug companies are the ones who are relaying the data in their interpretation of the data to the peer reviewers? How is that ever acceptable? I think we drifted into this situation. And what made it so important, so destructive to American health care is that we don't put a limit on what the drug companies can charge so that our prescription drugs, our brand name prescription drugs cost three and a half times

more than the same brand name prescription drugs in the other OECD countries, Organization of Economic Cooperation and Development. So we have a price that is making this manipulation of data, some people would say BS, the price drives, it creates an enormous incentive. And then we don't have what's called health technology assessments. So we have no governmental or quasi-governmental oversight that compares the value of new drugs in terms of the therapeutic value and the economic value to old drugs, to older drugs, older other available therapies that inform coverage decisions and inform physicians about how best to apply the new therapeutics. And we also don't allow, this one is just mind boggling, we don't allow government funded

cost effectiveness studies and we don't allow cost effectiveness studies to be used in government funded healthcare. So we've created this situation where the prices are sky high, where the knowledge is not being overseen, and where the cost effectiveness is not, the government is not allowing cost effectiveness to get into our dialogue in the way it should be. And we're essentially like playing a professional basketball game where the players are calling their own fouls. They're paid to win and they're calling their own fouls. players are calling their own fouls. They're paid to win and they're calling their own fouls. It's craziness. And that's why I wrote this book. I've been fortunate enough to be in this unique position as a family doctor for 20 years and then as an expert in litigation. And I

understand how this works. And the docs, they're trying hard. They're drowning in information and they're under more and more pressure. And it's just so they don't understand this. Were you aware of how twisted the system was before you started doing this litigation, before you started going over the peer-reviewed papers and finding out where they did? Were you aware of how the system was set up? It came in two stages. So after I finished my residency in family medicine, I did a Robert Wood Johnson fellowship for two years. And that was a wonderful training in epidemiology and research design and statistics. So that's where I got these skills that I came back and drew on. But family medicine is very hard in an academic environment.

The purpose of the fellowship was to train academics in family medicine to increase the prestige of family medicine, which seems like a good idea. But family medicine is very difficult in an academic environment because the family docs are low man on the totem pole in the hospital and all the specialists often don't treat them with the respect they deserve. And I decided that my calling was to go be a doctor in a smallish town. And I did that for 20 years. But I had this Robert Wood Johnson fellowship training always in the back of my mind. And as we got through the late 90s, it became clear that the drug companies were influencing what was in the journals. And then the drug, do you remember the drug Vioxx? It was an arthritis drug. I have a friend who had a stroke after taking Vioxx.

So, yeah, I got a letter from a mother whose child died, 17-year-old child died from taking Vioxx, eight samples of Vioxx. But Vioxx came along and there was an article in the New England Journal that Merck had sponsored and it said it was safe and was advantageous, not because it was any more effective, but because it reduced the risk of serious GI problems. And then there was another article in the New England Journal of Medicine that fessed up to cardiovascular problems. But the review article said, this may be due to the play of chance because there were only 70 events and such a small number of events is subject to statistical variation. And I knew that that was crazy because there were only 53 serious GI events, which was the whole reason for selling this $2 billion a year drug, was that it was safer on the GI tract and there were only 53 events it was an anti-inflammatory right it was like yeah exactly so the idea was

that that was better than non-steroidal anti-inflammatories exactly because it because it didn't upset the stomach the same way and this the science was elegant and it might have worked but it it didn't. And in changing that balance, it made the blood more likely to form clots. The physiology was a little more complicated than just stomach or no stomach. And is something like this, the issue is the size of the trial, because you could have 10 people and none of them can have a problem, but you could have 10,000 people and you could have quite a few problems. So you have to make this study as large as possible so you get all this biological variation between human beings where different things affect different people in different ways. That's part of it.

And you can have a study of 8,000 people where you leave out three heart attacks and you flip the statistics and claim that there's not a cardiovascular risk. Okay. So they just, it was fraud. It was fraud. And you couldn't tell the fraud from the article in the New England Journal. Merck had submitted this data to the New England Journal and they did what peer reviewers do, which is not have the data, but make sure that the article makes internal sense. They published the article. And then this review article came along, and they gave a little bit more insight into the cardiovascular problems, but they blew it off as the play of chance because there are only 70 events. And that was crazy.

And at that point, I was sitting in my office at lunchtime reading, taking a break between sessions, reading this article. And I said, that's it. I got to find out. I got to figure this out. There's something so wrong going on here that it's beyond my comprehension. JAMA two weeks later that had a footnote that led to an FDA website that had enough data to see that Merck had been fraudulent about the heart attacks. And when I saw that, I said, I'm going to leave practice and I'm going to figure this out. And I worked for two years on a book called Overdosed America. It was published in 2004 and it had the Vioxx story

in it. And a week after that book was published, Vioxx was pulled from the market. It wasn't my doing. Another study, Merck had done a second study that showed the same thing, that the risk of strokes and heart attacks and blood clots was doubled. And at that point, they had to pull it because they were hiding the data on this first study. Now the second study came along, and it was clear that the jig was up for them. And how long had they been prescribing and distributing Vioxx at that point? It came out in May of 99, and that was September of 2004. Wow. So between 20 and 25 million Americans had taken Vioxx. And between 40 and 60,000 Americans had died, died from the cardiovascular consequences of Vioxx.

In the same ballpark as the number of Americans who died in Vietnam. Died from taking this drug that was no more effective at treating arthritis or aches and pains than non-steroidal anti-inflammatories and caused 40,000 to 60,000 deaths. And what was the punishment for Merck? Merck, there were 27,000 plaintiffs in the, and they were awarded $4.7 billion. Merck sold $12 billion worth of IOCs in the four and a half years it was on the market. So they paid the plaintiffs $4.7 billion, and the Department of Justice fined them a little bit under a billion dollars. But nobody went to jail.

Well, not only that, they're still making profit. That's a profit. Excuse me. Vioxx, they probably made a small profit. They took in 12 billion. They had research and development costs and marketing costs and all, manufacturing costs. So a small profit of what, a billion dollars? Maybe they made a billion. Isn't that wild? You can make a billion dollars from lying. Joe, it's crazy. Even after being punished.

It's crazy. And Merck's chief scientist saw the data from that first study where the 300 hex were omitted. And there's an email that the Wall Street Journal published from March 9th, 2000, when they opened up the data on that. And the email, I'm paraphrasing, but the email said something like, it's a shame, but the cardiovascular effect is there. But the drug will do well and we will do well. Oh, God.

That's written down. It's written down. and no one goes to jail for that no he's i mean that that is insane i mean imagine any other thing that you do that's fraud that causes 40 000 deaths between 40 and 60 imagine any other thing any other thing that you would sell imagine if that was like oreo cookies or you know whatever it's unheard of it's unheard of and that's why it continues because there's not adequate oversight and there's no consequences there's there's consequences but there's slaps on the hand but yeah you know usually when the fines are announced by the department of justice the stock goes up because the shareholders are happy to have this burden off. It's interesting that both of those drugs, Vioxx and the other one – what's the other one? The one where Pfizer was awarded or they had the –

The biggest fine? Yeah, the biggest fine. Bextra. Bextra. And Bextra is also an anti-inflammatory? Yeah, it's the same class. It's a cousin of Vioxx. There's a lot of those out there.

There's a lot of dealing with inflammation. Inflammation is like a, it's very common to medicate against. Yes. I mean, people have aches and pains. Yeah. They have rheumatoid arthritis and they have aches and pains. So people take a lot of those drugs. The question is, how can you make them better than the generic drugs that cost next to nothing that you can get over the counter? So they exaggerated the GI problem. Suddenly, our physicians' knowledge landscape became dominated by all the people who were dying from GI bleeds.

by all the people who were dying from GI bleeds, and we had to switch those people from ordinary non-steroidals to Vioxx and Bextra and drugs like that. And so you can't tell us exactly what Pfizer did with Bextra, but it was enough to, it was $23 billion? No, no, $1.195 billion. Oh, Oh, okay. Fine. So that was the largest find ever? At that time. And this was, was there deaths involved with Bextra as well? You know, I'd have to refresh my memory and I might not be able to tell you even if I did. Okay.

But with Vioxx, we have the data on Vioxx because it did go to litigation in open court. And it's clear that they removed three heart attacks that were critical that flipped the statistics. that flipped the statistics and that's how they sold 12 billion dollars worth of a drug that more than doubled the risk of heart attack strokes and blood clots and these companies are obviously they don't get disbanded they don't get dissolved they're still in business and the same people are still running them in many cases and no one goes to jail. Correct. It's very rare for somebody to go to jail. And even when they plead guilty to a felony, it's often, I don't know why this happens, but the Department of Justice allows a subsidiary of the parent company to take the hit so that if there's another flagrant foul,

so that if there's another flagrant foul, the subsidiary gets, it's called disbarred, but prohibited or excluded from the Medicare program. The parent company doesn't even take the legal, doesn't get the legal foul counted against them. And so this has obviously all been set up by the pharmaceutical companies. They've arranged this somehow or another with the Justice Department or whoever's prosecuting them. No, that's going too far. That's going too far. No, but I mean as far as like these regulations, like how is it possible that they would allow them to have such egregious violations where people die and they also have all these safety nets in play to make sure that people don't go to jail

and make sure that the parent company doesn't get hit with the fire. I mean, that doesn't seem like it's not negotiated. It's going too far to assume or to assert. Like, what's going too far? It didn't happen that way organically. It didn't like, this seems like the best way to do it. This is going to protect American people the best. We're going to make it so that you don't get in trouble. Yeah. Joe, I'm not an expert at what happens at the level of the Department of Justice, but I have a lot of experience about what happens in civil litigation. Same drug, same situation, but civil litigation.

And a lot of times the plaintiff's lawyers will settle. They'll make a settlement and oftentimes bury the data, agree to bury the data in civil litigation. And I've been on the inside of some of those decisions. And the plaintiffs are representing the interest, the plaintiff's lawyers are representing the interests of the people who were injured, and they're trying to get the best deal for them. And it's hard to get a jury to understand this. Now, I did participate, I testified in a federal court, in a federal trial, where Pfizer, I apologize to Pfizer for their names coming up a lot. And they're all the same.

Hilarious. Yeah. So I'm sorry, Pfizer. Sorry, Pfizer. Sorry, Pfizer. Yeah. You do make boner pills. Do they work? Yeah, they're great. They make other stuff too, right? Pfizer makes a lot of good stuff.

Let's turn this into a drug ad right here. We're going. Okay, but go ahead. Pfizer. Kaiser Health Plan, the biggest HMO, sued Pfizer for fraudulently marketing Neurontin when Neurontin, Gapapentin, was still on patent. What is Neurontin? Neurontin had been approved for two uses. One was as a

second-line seizure drug, and one was for post-herpes zoster pain. Those were the two indications for which Neurontin was approved. And let me preface this by saying Neurontin is still the sixth most free, or gabapentin, is still the sixth most frequently prescribed drug in the United States. So a lot of insurance companies sued Pfizer for misrepresenting and marketing Neurontin off-label use for general pain, mostly some migraines, some bipolar disorder. But Kaiser was the only plaintiff that the judge who was overseeing this litigation allowed because Kaiser creates like a bottleneck through which information comes to doctors. So in the other insurers where doctors are getting information from all over the place, the attorneys couldn't prove that Pfizer's marketing had misled the doctors, but they had the opportunity to prove that it

had misled the doctors in the Kaiser health system to prescribe this drug. The short of it is that there was a six-week trial. I testified in it and would love to talk about that. But that Pfizer, the jury found that Pfizer had committed fraud and racketeering. It was the first RICO charge against a drug company. It's in civil litigation, so they're not going to RICO jail. The damages were tripled. But when the jury heard the story, and I got to explain it to him, I got to explain it to him sitting – standing at an easel next to the jury box as close as I am to you and explain one of the tricks that Pfizer used to mislead doctors. So occasionally it comes out. But again, nobody went to jail. What was the trick that Pfizer used to mislead doctors? So what they did, this actually is something that I wanted to talk to you about because it has to do with how you feel about hydroxychloroquine not being approved or not being embraced as a therapy for COVID.

for COVID. What Pfizer did to mislead doctors was there was a randomized controlled trial, and it was Neurontin against placebo for the treatment of diabetic painful neuropathy. And the guy who did the trial faxed them the results and said it doesn't look like Neurontin works. And Pfizer rejiggered the results so they instead of looking at the comparison between the change in pain level between Neurontin and the placebo group, which wasn't significant, they just looked at the pain level of the people who took the Neurontin and the pain level went the people who took the Neurontin. And the pain level went down from the beginning of the study to the end. But it went down in the placebo group almost as much. But when they just showed the Neurontin arm

of the randomized controlled trial, which is no longer a randomized controlled trial, they misled doctors and claimed that it was effective. So in hydroxychloroquine for COVID, to change the subject a little bit, people get better. And that's good when people get better. But it's like one arm of a randomized controlled trial. And I firmly believe that people who want to take hydroxychloroquine if they get covid should be allowed to take it and they should talk to their doctor and there should not be

this propaganda against it i my issue is with ivermectin oh i'm sorry yeah i apologize but no i'm not similar issue is it is it similar it's yeah issue. So people are going to get better. And whether there's a causal relationship or not is the question. Right. So if you take 20 people and put them on ivermectin and 19 of them get better, you can't conclude that the ivermectin played a causal relationship. I think you can surmise that the ivermectin didn't hurt them if they get better. And on the situation that you've talked about, is it okay to talk about this? Sure, yeah. Yeah.

On the situation you've talked about where you were derided for taking ivermectin, I think that's out of bounds. That's not fair. Well, the issue that was really bizarre was that I listed a laundry list of things that I took and they only focused on ivermectin. I talked about all sorts of things that are generally accepted to be effective, like monoclonal antibodies, which I'm now hearing. Now, I need to find out if this is true, but someone posted that. Here, i'll try to find

it because uh it was so weird that i couldn't believe it was true but that someone in the biden administration that they're trying to actively block the distribution of monoclonal antibodies and that someone from florida is uh accusing, accusing the Biden administration of doing that, which to me sounds insane. Well, we've got a – Here, the Florida Surgeon General says that Biden administration is actively preventing monoclonal antibody treatments. But they're saying that they're not effective with Omicron. But they're very effective with Delta. And a lot of

people still have Delta. It's not like Delta went away, but they're blocking the use of monoclonal antibodies. The suspicion is that the Florida Surgeon General sends terse letter to Health and Human Services concerning monoclonal antibodies. Dr. Joseph Ladapo says that state-facing life threatening shortage of treatment options. The idea is the primary concern is the reason why they're doing this is to encourage vaccination only as the only way to treat COVID is to get vaccinated. If you don't get vaccinated, you have no other options. If you do get COVID and you take monoclonal antibodies, they're extremely effective. What was bizarre to me was that I listed off Z-Pak, prednisone, monoclonal antibodies.

I talked about vitamin IV drips that I took, all these different things that I took, and I got better really quickly. But they focused only on ivermectin. And it became this thing that seemed to be a concentrated effort to demonize and mock this one type of treatment by connecting it to veterinary medicine. Yes. I'm completely with you. It was bizarre. Yeah. And motivated clearly also, you've got to think of how to be motivated by money because

that drug, ivermectin, is a generic drug. It's very cheap. You get it for like 30 cents a dose. Yeah. Yep. I can't deny that money played a role. I think that the control over the situation, wanting to be in control over the situation also plays a role. So the truth is that the NIH has not ruled one way or the other. They

looked at the data and they said there's not enough data to rule on whether ivermectin is helpful or not. If it were a brand name drug at this point, the drug company would do a study that was big enough to show that it's helpful or not. And the question would be over. And they are doing that with Pfizer has a new antiviral drug that they're going to release that's similar to what people say ivermectin does, whether that does or not, I don't know. Yeah. But that's getting back to our original discussion. When there's money involved, you can do the studies and you can make them big enough to make small differences statistically significant.

And you do that by manipulation. And occasionally you go to court. You do that by 96% of the research that's done in the United States, clinical research, is about drugs and devices. And most of that is paid for by the manufacturers. Drugs and devices? Medical devices. Artificial hips and pacemakers and the like. But the point that I'm making is that it's like the drunk looking for his keys under the streetlight, and he keeps looking, looking, looking,

and someone comes along and says, why do you keep looking there? And he says, that's because that's where the light is. The keys aren't there, but that's where the light is. That's where the money is. The money is in new therapeutics, so-called innovation, new therapeutics. It's not in looking about which drugs make you healthier. Right. It's not in generic repurposed medicine.

No, nobody's funding that. Right. So you're not getting an answer to the question that you have a right to have an answer to. Well, it's strange to me that monoclonal antibodies do have an emergency use authorization. The emergency use authorization, it seems to be that for whatever reason, that drug, these monoclonal antibodies, is being dismissed. It makes it more difficult to get. Whatever shenanigans are going on, it seems to be there's some sort of conspiring against the distribution of monoclonal antibodies. And I think it's got to be because of its effectiveness.

It may be because we can't test fast enough to make a decision. It exposes our deficiency on the testing side? Well, also, the vaccines were only... You can only get an emergency use authorization if there's no effective treatment. Well, if there's an effective treatment, like a wide distribution of monoclonal antibodies. I mean, according to Dr. Peter McCullough, who was on here, he said there's enough monoclonal antibodies. I mean, according to Dr. Peter McCullough, who was on here, he said there's enough monoclonal antibodies for every person in this country. He says it's

not a shortage of supply. It's a shortage of distribution. And he believes it's by design. Well, they're going to make a lot of money. Yeah. Regeneron would, off monoclonal antibodies. Yeah. Yeah. Yeah. Any of these new drugs, and I hope they're effective, it looks like some of them will be, beyond the monoclonal antibodies, right. Yeah, yeah. Any of these new drugs, and I hope they're effective. It looks like some of them will be beyond the monoclonal antibodies. Like the Pfizer antiviral. And Merck. And Merck as well.

We don't have all the data yet, but I hope they work. But they're going to make a ton of money. They're going to break our healthcare system because they only work when you treat people early in their disease. You can't wait until people get sick enough to need a $700 or $3,000 drug. You've got to treat everybody who gets sick in order to have the benefit. Right. But why would they stop monoclonal antibodies from being distributed? It seems like they can make money with those too, right? They can. Maybe there's more money elsewhere i i don't know i i don't know what's going on in that black box the only thing that makes sense to me is that monoclonal antibodies it doesn't seem to matter whether or not you've been vaccinated

like if you if you're sick and you get those for a lot of people that seems to do the trick and you get better maybe that's the problem no no get better. Maybe that's the problem. No, no. You don't think that's the problem? I think it's a problem if you can't get good therapeutics to people. That's not what I mean. I mean the problem they have with that, with monoclonal antibodies, in that you don't have to necessarily be vaccinated for them to be effective.

The whole idea, the binary approach has been everyone needs to get vaccinated. They keep saying it over and over again, even in light of Omicron, where it shows that it's a vaccine escape variant or the vaccines aren't effective with it, even though it's mild. I don't think you can say that yet. They haven't been saying it. No, it looks like people who are boosted have significant protection against Omicron from severe illness. But no one's getting severe illness from Omicron. There hasn't been a single death in the United States that's attributed to it. We're early.

Well, yeah, we're a month in. But there was one death in Texas that they initially had attributed to it, but they backed down from that. The person had pretty significant comorbidities. We're still early on that. I would stay tuned. I wouldn't make that judgment yet. But it's a month in? It's a month in, but the number of cases has been going up logarithmically. But if it was a month of Delta, we would have some pretty significant deaths. You can kind of assume that this is less, and this is what's been widely reported, that it's less virulent or less

damaging than Delta. Yes. And it's going to take two to four weeks in before you know what the real damage is. So that it may be that the extremely high volume, and we broke the record of cases in a day yesterday, it may be that it certainly looks like it's less virulent. But it may be that the higher number of cases is going to create real trouble. I don't know yet. Because of the strain of the healthcare system? Strain of the healthcare system and because we don't know yet how many people are going to get seriously ill. And whether the unvaccinated people are going to get more seriously ill than the vaccinated people. The data that I'm seeing suggests that that's true.

What data is this? It's from CDC. Is there data that you trust more than other data? Is there data that you think, in terms of different organizations that release data, that's more compromised, that is more objective? Yeah, it's hard. It's really hard. As painful as it may be, the CDC is going to have the broadest access to data. It doesn't mean it's all trustworthy. But you got to look at that data. What influences what their assertions are when the CDC releases data? I mean, what is influencing their choices? Are they purely independent? Are they not reliant on pharmaceutical drug companies or political entanglements in any way?

I'd only take it out of political entanglements. When we look at the FDA and ask the same question, you can see that 61% of the FDA's budget for human products is paid for by the drug companies. That seems like a lot. It's a lot. And it might seem like it might have some effect. Yeah, maybe. Yeah, just maybe. Yeah, a little bit. That's horrible. So that's not hard to connect those dots. I'm not sure about the influence on the CDC. So when you look at data, do you always have to take it and put it through a filter of, I wonder what's really going on here, and I wonder how much influence is being exerted on these results? Absolutely. And when you ask me, what do I rely on?

Is there a source I rely on? And the answer is you've got to look at all the data. And then you got to understand that virtually everyone who's publishing data has a bias. And so you got to try and subtract that out. I mean, there are people who are anti-vax and have a bias, and there are people who are pro-vax and have a bias. So it's hard. This is unfolding in real time. And you've got to kind of gestalt the whole situation. And much like when I was practicing family medicine, you often don't have all the facts you need to make a decision. You've got to kind of weigh what are the positives and negatives, what are the risks of just going one way than the other. And it may turn out that you called

it wrong, but you you got to make your best call in real time. Now, when you were practicing family medicine and you had to make these calls in terms of like medications that you prescribe for patients, how did you do it where you were at least reasonably assured that you were making the right call? Well, it changed over time. In the beginning, I trusted the literature. I was a hotshot, residency-completed, certified family physician who had done a two-year, essentially, MPH program. It was master science where I took the courses. And I thought I knew a whole lot about medicine. And as time went on, that was 1982

when I went into private practice. As time went on, it was clear that things were going off the rails. I remember I went to a continuing medical education lecture at our local hospital, so-called Grand Rounds at the local hospital. And that's the thing that good doctors do, is they go and you sort of get a sandwich and you talk to your friends and you get a lecture from a academic doc. And I went to a lecture, and the guy gave a lecture about a pain drug, and the pain drug had been withdrawn two days before.

He gave this lecture about why we should prescribe this pain drug, which had been withdrawn two days before. He gave this lecture about why we should prescribe this pain drug, which had been withdrawn because it was causing severe adverse effects. And I realized that he had signed his contract to get paid to give that lecture. So he was gonna give his lecture come hell or high water, even though the drug had been withdrawn. And at that point, the light went on

that this is a commercial proposition that we've got going, that the academics who are coming out to Beverly, Massachusetts to give us a lecture at the Beverly Hospital are getting paid to do that, and that we can't trust everything we see. And then from there, that was maybe mid-1980s. From there until 2001, when I saw that article in the New England Journal of Medicine, I, the awareness of the financial manipulation, the commercial manipulation of what we were basing our decisions on had become just overwhelming. And I couldn't practice. When did they start advertising drugs on television and in magazines? So it came in in phases. I think the first phase was 1987. Before that, it was known that you could,

but there was kind of a gentleman's agreement that you wouldn't. And then there was another step that had to do with decreasing the amount of information you had to deliver. And you could say, see our advertisement in Men's Magazine or Men's Health or whatever. And it was that second step that discharged responsibility for providing information to another source that opened the floodgates. So you have gone through a process of understanding the influence that money and the pharmaceutical drug companies have on the data and the way doctors perceive medications. Exactly. And it was two stages. One is a practicing family doc. And then I was fortunate enough to get on the inside of the data in litigation inside the pharmaceutical company's computers. And that's when I could really find out what the truth was now I was listening to this interview with Robert Kennedy jr. And

One of the things he said that really confused me and I wanted to ask you about this because I couldn't believe this is the whole story he was talking about when you describe something as being 100% effective. And what he was talking about was the trials for COVID vaccines. And that in one of the trials for COVID vaccines, where they had 22,000 people who took the vaccine, and 22,000 people who took a placebo, the people who took the vaccine, one person in that 22,000 had died of COVID. The people that took the placebo, two people had died of COVID. So because two people is double one people, they decided to say that it's 100% effective. That seems like

bullshit, right? Is that... I don't know what Robert Kennedy's looking at, but you cannot say that. That's ridiculous. If two people die and one out of 10,000, one person or another, there's no way that's statistically significant. Right. But is it possible that that's what they said and that they're manipulating data like they did with Vioxx or is he misinterpreting it? I can't believe that anybody beyond a high school education would have done that.

I can't believe it either. But is there room for fuckery where they could manipulate data to say something like that? They do manipulate data. And generally it has to do with presenting relative risk reduction and absolute risk reduction. So in the case, let's say you got the story that Robert Kennedy relayed correct, that your numbers are correct. So the relative risk reduction would be 50%. You've got two people on one side and one person on the other. You've reduced the risk of mortality

by 50%. You wouldn't say 100% effective. No. The relative risk is 50%, which is equally outrageous claim. The absolute risk reduction is 1 out of 10,000, 0.01%. And a lot of times the relative risk reduction will be presented when the real information that people need is the absolute risk reduction. Yeah, that's the problem with both sides, right? risk reduction. Yeah, that's the problem with both sides, right? It's the problem with both these pharmaceutical companies to distort information, but also the people that distort what the pharmaceutical drug companies are saying to make it seem more outrageous.

And that's what I'm concerned with when I keep hearing people repeating what he said and he was on the Jimmy Dmy door show and that that's where i listened to that particular assertion see if you can find that um maybe there's a clip where robert kennedy jr is describing how they labeled the covid vaccine as a hundred percent effective i know i listened to it on j Dore Show, but I listened to it. I was like, that, I have to talk to John about this. I'm like, there's no way that's real. Let's see.

Is it possible that there's that much shenanigans going on that they would say something like that? No, it's ridiculous. Nobody who had any training at all in the health professions would believe that it was 100% effective. So that's nonsense. It's just so unlikely.

Well, if it was, because they never, didn't they say it was in the high 80s? They didn't even say it was 100% effective when they first released the vaccine. Yeah, high 80s. I've seen 91% before the antibody levels went. Would they be able to say 100% effective at reducing death? I've seen 91% before the antibody levels went up. Would they be able to say 100% effective at reducing death? Only if there were no deaths. Right.

Right. If there's one death versus two, that's not 100%. That's not 100%. Right. That's what I'm saying. Yeah. There's so much to sort through, especially when you're someone like me who doesn't have an education in this and you're just trying to read these studies and listen to people talk and trying to figure out what's what. There's a lot of noise. There's a lot of noise. And a lot of the noise is distracting us from the real issues. We got real trouble in the

United States. For the past two years, about 1,300 people a day have died of COVID. That's bad. We can talk about things we could do or should do, whatever. That's bad. For the four years before the COVID pandemic, that many people were dying in the United States because our health and health care are so inferior to the other wealthy countries. so inferior to the other wealthy countries. 1,300 people a day dying because our age-adjusted mortality rate, which allows you to compare different countries of different ages, is so much worse than the average of 10 wealthy countries. and our healthy life expectancy has gone down from 38th in the world in 2000 to 68th in the world in 2019. We rank 68th in the world in healthy life expectancy.

Our health, the health of Americans is just abominable compared to the other wealthy countries. And for this, for this health, you know, devastating health situation, we're spending an extra $1.5 trillion a year. We're spending 7% more of our GDP on healthcare than the other wealthy countries are. And 7% times a GDP of $22 trillion is $1.5 trillion a year. So whatever you think of President Biden's Build Back Better plan, and I'm not getting into politics here, but it's $1.5 trillion, $1.7 trillion over 10 years that he's arguing for. And this is 10 times that much money that we're pissing away each year while Americans' health ranks 68th in the world. This is a disaster.

It's ruining our country. We can't go on like this. Now, what is the best country when it comes to health care? France is good. The best changes a little bit, but there's France, the UK is good, Japan does well, Switzerland does well. And what do they do different than what we do other than some of them have socialized medicine? Well, let's take that apart a little bit. But what they do differently is what I'm writing about in Sickening. What they do is they oversee the integrity of the medical knowledge that reaches doctors. They can't control the journals.

They can't control that problem with peer reviewers not having the data. But they can do governmental or quasi-governmental, it's called health technology assessment, where they determine the medical value of new drugs and the economic value of new drugs, and make recommendations about covering new drugs. And they also control the price of drugs, because with our allowing drugs to be three and a half, brand name drugs to be three and a half times more expensive than in the other developed countries, we're creating such an incentive

to distort the medical knowledge. So we've got a Wild West situation where the drug companies pay PR people and the lobbyists to create this illusion that their innovation is our only hope for a long and healthy life, when that's rarely true. In terms of new drugs, new molecular entities that are approved, about one out of four is actually an improvement over a previous drug. But in the United States, we don't know that because there's no oversight. In the other countries, they're evaluating it. So when, for example, insulin analogs come along and replace human recombinant insulin, and they start to jack up the price, and there's no evidence that it's better for type 2 diabetics

who use 80% of the insulin in the United States. There's no evidence that it's better. Doctors are bombarded with marketing materials that say you've got to give your type 2 diabetics insulin analogs because it's more physiologic and it reproduces natural insulin function. And in the other countries that have health technology assessment, they're saying there's no evidence that it's superior to recombinant human insulin. So use that first. If your patient fails on recombinant human insulin, if they have idiosyncratic problems with low blood sugar or anything else,

you can use it as a second-line drug, but not a first-line drug. But we're essentially playing this game without, it's like professional athletes not having umpires. Now, when you said 68th, United States ranks 68th. 68th. And that is for overall health? Yeah. Healthy life expectancy is probably the best single measure of the overall health. It's how many years you live in good health. So if you live to be 86 and you had kidney disease for the last six years that compromised the quality of your life for 50%, then your healthy life expectancy would be 83. So it integrates longevity with the time you spend in good health. And do they calculate the factors involved in that?

Like how many of the factors are calculated? Is it obesity? Is it drugs, like recreational drugs, nicotine, alcohol? Like what are the factors that lead us to be so poorly represented there? Right. So one of the issues that I'm sure you've heard of is the diseases of despair that Professors Deaton and Case, Professor Angus Deaton is a Nobel Prize winner, and his wife is a professor at Princeton as well. They wrote a book about diseases of despair and how non-college educated white Americans are having an epidemic of drug overdoses and suicides and liver disease. And that it has to do with the economic context

that the wages and quality of life are not as high, that people's expectations about how their lives are going to unfold and having families and living independently and owning a house have gone down. And that all that adds up to these diseases of despair causing 100 deaths out of 100,000 white Americans, and they chose ages between 50 and 54, but you could take any age group.

But the important fact here, that's true and that's awful. But the increased death rate in that group is not 100 per 100,000, but 400 per 100,000. And the other 300 deaths have to do with cardiovascular disease and diabetes and all the things that die of. But those folks are exposed to the social pressures that are compromising their health. This is a long answer to your short question. But so my opinion, what I tell you as a medical fact, I stand by. My opinion on this is that since 1980, the United States has had a radical growth in economic inequality. That essentially, the share of the income pie has been so distorted to the wealthy that it's like the average family living at the median income level of $55,000

with 2.6 people in their household. If they were getting the same share of the income pie that they got in 1980 as they are now, they would have $20,000 more a year. But as it stands now, that $20,000 is transferred from people who are working hard and trying to keep their kids in clothes and pay their bills to the top 1%. So it's like the working people in America are donating $20,000 per family to the top 1%. And that's having a disastrous effect. This is kind of an interesting sidetrack, right? Because now we're talking about economics. But is there a way that that could be switched?

Is there a way that that could be somehow or another re-diverted? Absolutely. What would that way be? Absolutely. If the economy is such that companies on their own are suppressing the wages of working people and transferring that money to the wealthy people, you simply do it with tax policy. If you can't do it pre-tax, you can do it with tax policy. And how would you do that? You would give them a tax break or you would tax the rich more? What would you do? You'd pull some of that money back.

And you could do it with tax credits. You could do it with tax rates. You could do it with inheritance taxes. The problem people have with taxes, whether this is accurate or not, is that no one trusts the government to do well with that money. No one trusts the bureaucracy and the nonsense and red tape that's involved in our overbloated government to the point where they're like, yeah, I'd be more than happy to give them extra money because I know they're going to do with it very good things. I agree. And what we got, we got because we don't trust the government.

And how we get to some middle ground on this, I hope you're smart enough to figure it out, because I'm not. No, definitely not. But we've got to get to a middle ground. The working people in the United States are getting a raw deal. To achieve some sort of a better state with unions? Absolutely. The union membership is down by two-thirds. And some of the laws that are passed about right to work and so forth have made it harder for unions to hold their grip. But in 1952, we had the professors Deaton and Case that I referred to a minute ago from Princeton. They coined the term blue-collar aristocracy, that in the post-war years, in the 35 years after World War II, the blue-collar Americans were living well. They were making a fair wage. They were getting, as our

economy grew after World War II, blue collar workers were getting their fair share. And the economist John Kenneth Galbraith attributed this to the countervailing power of government. So you've got business on one hand, trying to make money, and in those years, business had a broader definition of their primary responsibility. It wasn't just to make money. It was to be responsible in the community and take care of their workers and their consumers. Now it's to make money. But Galbraith identified this countervailing power of the government when there was a balance. And we don't have that balance.

That's what's gone. When in 1980, when President – 1981 when President Reagan was inaugurated and he said government is not the solution. It's the problem. And the libertarian economists were given great sway. Libertarian economists were given great sway. We moved towards this anti-regulation, free market eth labor that's ever existed in the history of the earth. Wow. We're out there.

And I agree with your reservations, Joe. I'm not happy. I don't think anyone's happy with the government, right, left, or center. We got a problem. But you need some referee in this to represent the public's interest. And we don't have one right now. We don't have one. And what we've got is social media that is making money from inflaming the extremes and drowning out the center that's trying to get to reasonable solutions.

Yeah. Whether it's by design or not, whether it's just human nature that's sort of filtered through this medium of social media, which is a strange medium, right? And it's one we're not accustomed to. We don't have any history in it. And it's being used by the vast majority of people. And it's being used through algorithms which favor what is more inflammatory, what people gravitate towards, what's going to get your eyeballs and get your clicks. And we're really not designed, we don't have the discipline to handle it. We're not designed emotionally or intellectually to be able to mitigate the influence of this

stuff. It's very confusing for people. I am total agreement. So is there maybe, maybe there could be a way where companies could make it a very public part of their policy that they pay great wages and that they take care of their workers and that they do this because they recognize that they also have a, and that they take care of their workers, and that they do this because they recognize that they also have a responsibility to do well for the community and not just make money, but do this and proclaim it publicly in a way that people would gravitate

towards their business as opposed to a business that's purely gross capitalism where they don't give a shit about the workers. They're just trying to make the most amount of money every year for their shareholders. I agree. And in order to make that transition, you've got to make the private equity investors and the stock investors and the institutional investors happy along the way because they want to see every last dime that you can squeeze out of the proposition. And if they don't get it from that company, they'll get it from another company. If they don't get it from that company, they'll get it from another company. If they don't get it from those managers, they'll get new managers. So in sickening,

we get to the same place in healthcare. How the hell do we fix this? I can tell you what's wrong, but how the hell do we fix it? And we fix it with exactly the solution that you've proposed, that the constituencies that are affected need to move into positions of power in society. So we've got the constituencies are the doctors who are not getting good information.

They think they are, but they're not. the doctor's got to understand that this is a very serious problem and that they're trusted to be learned intermediaries to apply medical science in the service of the patients, and they can't do it under these circumstances. And we've got businesses, non-healthcare-related businesses, that are paying a fortune for their healthcare and losing their competitiveness, and they should be in on this. And most of all, we've got consumers who want the best health. But in order for each of those constituencies to become competent political activists, they've got to understand what's going on. And right now they don't. They don't. And this term of diseases of despair is very accurate right like if

you look at like west virginia and you look at these places where you have these pill like tremendous pill problems yeah this is this is what's going on there's these people that really don't have anything to look forward to and this is what alleviates some of their horrible feeling is to just get drugged up. And the drug companies were very willing to make a buck doing it. Yeah. Have you ever seen the documentary, The OxyContin Express? No. It was on Vanguard.

And it was essentially they showed that Florida had created this situation where they would have these pain management centers that were essentially just pill mills. The pain management center was connected to a pharmacy that only had pills. They only served opiates. So you would go to this pain management center. You go to the doctor and you say, doctor, my back is killing me. The doctor said, well, you needed some OxyContin, son. And they would write you a prescription. You would literally go right next door and they would have the pills for you.

And they also did not have a digital database. So you could go to Jamie and get a prescription from Jamie and then leave him and then go to another doctor, Mike, right down the street and get a prescription from him. And you could do it all day long. And people were doing this. And then they were selling these pills on the OxyContin Express that drove it straight up into Kentucky and Ohio and wherever the highway took it. And they were seeing how there was a direct chain of events where these people were going to these pill mills, stockpiling all these pills, and then they were selling them into these other states and making a lot of money. Right.

So you see the synergy between the folks whose lives aren't working out the way they wanted to and they're miserable. And maybe they're miserable because of back pain or maybe they're miserable because life doesn't have the meaning they hoped it did. And you have the drug company, which is telling doctors that they've got a new product that's less addictive, it's so much less addictive that you can treat non-cancer pain

and not get into trouble with it. Then it lasts 12 hours, but they know it doesn't last 12 hours. And when it wears off before 12 hours, they tell the doctors to increase the dose because that means they're not taking enough, not that their drug doesn't last 12 hours. Right. And that it can't be abused and people are crushing it and putting it in a straw and shooting it up and so forth.

So you've got the drug company that's an actor and you've got the social circumstances where people are hurting, whether it's medical hurting or spiritual hurting or whatever you want to call it. And it's just a recipe for disaster. And without the appropriate oversight of the drugs, the spigot's turned on. And that's, in this country, it's been one of the most egregious offenses by the pharmaceutical drug companies is distorting the data on the addictive properties of opiates. Absolutely. Absolutely. It's a scary thing when you find out how many people. There was a statistic that was just revealed, just released rather, that from people 18 to 49, fentanyl was the number one cause of death.

100,000 people died in this country from fentanyl that are ages 18 to 49, extremely potent opiate, and most of it recreational, right? Most of it is like from cut. All of it. Yeah. It's hard. I don't know if it's 100,000. I think it's 100,000 deaths total, and fentanyl is a major proportion of those 100,000 deaths. Oh, that's horrible. I don't know if it's 100,000. I think it's 100,000 deaths total. Yes. And fentanyl is a major proportion of those 100,000 deaths.

Oh, that's not what I thought. I thought I saw that they were literally attributing 100,000 deaths. It could be. They were saying it's the number one cause of death between people age 18 to 49, which is insane that we're not hearing about this because it's such a large number of people. This should be something that's on the news every day it should be something that terrifies folks yeah say it again it's the way he said oh so what is the nut the actual number the way the headline reads is so the drug overdose death top a hundred thousand annually for the first time driven by fentanyl oh so it's all kinds

of drug overdoses but drug overdoses are the number one cause of death between people 18 to 49. But Joe, here's the problem. Drug overdoses are the number one cause of death, but that accounts for only a quarter of the excess deaths in that age group. What are the other three quarters? The other three quarters are the cardiovascular disease, diabetes, cancer. And that's the problem is that we do such a poor job in the United States of preventing preventable disease. We're last amongst developed countries in preventing preventable disease. Does that have to do with our diet? I mean, it has to have some sort of an impact.

Absolutely. These other countries, I mean, I'm not totally familiar with France and what their food choices are like, but do they rely as heavily on fast food as we do? I don't think so, but it's easy to... I think we can get a quick and dirty answer by the rate of obesity. 40% of Americans are obese, and that's way above any other developed country. And we're going to be at 50% within the next 10 years or so. So it's a whole way of life. And it's – I know about health care.

I know what is wrong with health care. I know what is wrong with healthcare. I know what the drug companies do. But it's the food industry and it's every industry. And I totally understand when you say, but government screws up and they get bossy and they overstep their authority. It's true, but you need a referee. The center doesn't hold here right we need to get a center that holds so so that we get common values so that we could talk about our shared and common values instead of what what uh splits us apart right the question right from the watchman who's going to watch the watchman yeah The thing about the government stepping in and being this regulatory body that oversees it is like we actually need someone to oversee them as well. I wish someone could think of how to do it.

But we need to recreate the center with authority so that you can't make a whole bunch of money selling fat food to poor people and you can't make a whole bunch of money lying about your drugs and getting them covered by Medicare or private insurance. It doesn't work. The center is not holding. And we're paying a price. Our country – I mean the divisions in this country are predictable and it's because the center doesn't hold. Yeah, that's, it's pretty, it's confusing and it's also, it's disheartening because you look at this and you go, there's no clear way out of this. There's no like real clear path where we just pass this law or elect this person and all

of our problems are going to go away. These are compounding problems that seem to be getting worse every year. Yes. And I love this conversation. It's been broad. We've got a little bit away from my area of expertise. No, but I'm glad you expressed yourself in that way because I think you made some really good points. Well, thanks. But in health care, I know how we can do it. We've got a case in point. And when the constituencies that are coming out on the short end learn, they need to learn about what's going on and then become – they can't be politically active until they understand what's going on. And I am hoping that the six years I dedicated to writing this book will help people to understand

that the healthcare that they're getting, which we believe is the best in the world, is the worst among the wealthy nations. We're getting ripped off. It's a way to transfer wealth to the wealthy, and Americans are paying the price, and we've got to wake up and take control of it. That's the case with the healthcare.

That's the case essentially with everything you're talking about. Yes, yes. It's a transfer of wealth issue as much as it is a healthcare issue. Yes, exactly. But we cannot make progress until people understand the problem, and that's what I've dedicated myself to. That's the contribution that I can make. Well, the hopeful aspect of your book is this part and how we can repair it.

Correct. So it's how Big Pharma broke American health care and how we can repair it. So how can we repair it? How we can repair it is by the constituencies that are affected becoming knowledgeable and politically active. If the consumers who want to be healthy, and instead of putting their hope in Adjahelm to reverse Alzheimer's disease when there's no evidence that it does that. If the consumers would understand that 80% of their health comes from how they live their lives and 80%, 80%, 80%.

And now some of that has to do with social context that people who live in disadvantaged circumstances can't just turn around. They can't just decide to go jogging five times a week. So it also has to do with inequality. We've got to address that. But consumers say, look, we're not getting a fair deal. We're paying a fortune for our health care. Our wages aren't going up because so much money is going to health care. And our out-of-pocket costs are out of sight. We're not going to take it anymore. And that doesn't mean settling for a government program that says the copay for insulin will only be $35 because that's just shifting. That's just having the government pick up the money. That doesn't help to contain the costs. It makes it

better for somebody who needs insulin, but it doesn't help to contain the costs. It makes it better for somebody who needs insulin, but it doesn't help to contain the costs or rationalize the use of insulin, insulin analogs and human recombinant insulin. So the consumers need to represent their interests, and their interests are to live the longest, healthiest lives they can. It's not to get the most expensive medicines. It's not to invest so much money in medical innovation that we can't invest in social services. It's to live the longest, healthiest lives that we can. Business, fair business people who want to run an honest business, pay their employees a decent wage and make an honorable product, they're getting ripped off. And they need to get into this in some kind of buyer's trust to control the price of the new drugs. Say,

we're big enough now, so we're just not going to buy your new drug at that price. So how are drug prices regulated currently? Like say if Pfizer comes out with this new medication that's an antiviral medication for COVID, how do they decide how much each pill costs? Right. So the way they decide that is they get together and they decide how can they maximize the amount of money they make? And that's a price. The equation is price times volume. If you charge a billion dollars per pill, you're not going to sell many and you're not going to make much money. But they will price their drug to determine how much money they're going to make, to maximize the money they're going to make. And so they have to realize that if you make it too

expensive, everyone can't afford it. So you have to make it just expensive enough so that they can maximize their profit and the most amount of people can afford it? No, that's too kind because it's not a real market like that because most of the drug is paid for by insurance. So people, it's not Adam Smith's economy where you go and buy the bread or the beer from the one who's selling quality products for a fair price. The consumer is only worried about the copay, or most consumers are only worried about the copay. So what you do is you get a pharmaceutical benefits manager, a middleman, and you say to them, we'll give you a rebate, which really means kickback. We'll give you a sizable rebate.

If you place this drug that doesn't have therapeutic advantage over less effective drugs higher in the formulary so it has a lower cop copay, will give you, the PBM manager, a rebate. So it's this whole other level of chicanery that's going on. So the drug company is thinking about how are they going to get their drug. It's not, how do we price this so consumers can afford it so we sell a high volume. It's how do we get this drug marketed to PBMs, pharmaceutical benefits managers, so that they'll let us give them a rebate and have an advantageous tiering. The thing that's missing in this equation is nobody's saying, wait a minute, there's a ceiling on this. This drug is not worth this. So that the end result is that between two-thirds and three-quarters of global pharmaceutical profits come from the United States.

Wow. Two-thirds to three-quarters. Oh, my God. That's crazy. It's crazy. And it gets crazier because when the Democrats passed, it was H.R. 3, the Democrats in the House passed the drug Medicare negotiation bill in 2019 that they would negotiate the price of 25 to 50 of the most revenue-consuming drugs. drugs. And the CBO said that that would cost $456 billion in pharmaceutical profits over the next 10 years. And the pharmaceutical company went into this spasm of saying, this is going to be a nuclear winter for drug innovation, and you're not going to get the drugs that you need to be healthy. Meanwhile, the drug companies, instead of $456 billion in 10 years, had just spent $577 billion in cash buying back their own stock to jack up their stock prices between 2016 and 2020. So they're out there saying, if you control our drug prices, you won't have any more

innovative drugs, and they're buying back their stock. And since 2020, they have another $500 billion in cash that they're going to use to buy startup companies and inflate the price of the new drugs that are coming online. There's so many layers of fuckery that you have to pay attention to with all this stuff. There is. I've laid it out. You want to know how much fuckery there is? I know how much fuckery there is. And it's in that book. And you don't need to know all these facts, $577 billion and $456 billion. You don't need to know those. But what you do need to know is that the drug

company is in the business of making money. And they do it very well. And they will continue to do it ever better until they're stopped. And we might as well stop them sooner rather than later. And we need the drug companies. We need them to commercialize medical science. I'm not for socializing this. I think we need a market. But for all those folks out there who are afraid of what I'm saying because I'm going to destroy the market, the market's going to get destroyed if this keeps going. And if you believe in the market, you better get it to work. Milton Friedman, the conservative economist, wrote in 1962, he wrote a book called Capitalism and Freedom. And he said there's only three legitimate functions of government.

To preserve law and order, to enforce private contracts, and number three is to ensure that private markets work. Law and order, enforce contracts, ensure that markets work. Law and order, enforce contracts, ensure that markets work. That was very radical at the time. We're failing on all three. We're not enforcing law and order when the drug companies commit fraud and felonies and whatnot. They pay their price, take their slap on the hand and move along. So is the fear that if you punish Pfizer more robustly or more fairly, as a lot of people

would think, that they're going to go under and they're not going to make medicine anymore and then people are going to die or their quality of life is going to deteriorate because there's not going to be the innovation, the medical innovation that leads to these pharmaceutical drugs they need? That's what Pfizer would like you to believe. But there's no reason that that's true. There's plenty of money to be made, honestly. But if Pfizer really wanted to be a responsible corporation,

they would say, let's have health technology assessment so our drugs are tested fairly and are used appropriately. And if the medical journals wanted to be responsible players in this nexus, they would say, let's insist that the data from the clinical trials is available to the peer reviewers. to the peer reviewers. So in the case of Vioxx, let's say this, let's just say a for instance, or what do you think would happen? What if when that went down, a bunch of people went to jail, all the people that knew the data, I mean, they went to jail for 25, 30 years. What if the company got stripped of all of its assets? What if all that money was funneled to the victims? What if they made a public display of real punitive damages? Do you think that would have changed the way the pharmaceutical drugs operate in this country, the way the pharmaceutical companies operate? 100%.

So that could have, just one case like that, a very large public case like Vioxx, where you said up to 60,000 people died because of fraud. Right. That could have changed the course. Absolutely. Absolutely, it would have changed behavior. And if the people who masterminded the OxyContin scandal were at risk not just of losing their last $8 billion or whatever it is, but going to jail. That too would change it.

But we've got this sort of system where it's somehow you use a term that was like an agreement, but somehow this isn't working properly. Yeah, there's too much shenanigans. There's not consequences. There's not what Milton Friedman said, is that the government needs to make sure that law and order is maintained, that private markets work. Now, when you see the way the system is established currently with pharmaceutical drug companies, with just the whole medical industry, and you see the future, where do you think it's going? Like, is it going to continue to deteriorate?

Do you think there's some hope that we will have some common sense regulations that are put into place to try to move this into a more beneficial direction? Or do you think people are just going to continue to make as much money as they possibly can, extract it from the system at their own personal gain to the detriment of all of us? I think it's the latter. I mean, look at the vaccines. Pfizer is going to sell $36 billion of vaccine in a year. The previous highest selling drug in the world was $20 billion. And what was that? That was Humira.

That's another story we could talk about another time. I'll come back. But they're going to make $36 billion. They're going to make $65 billion in two years. They're going to make $36 billion. They're going to make $65 billion in two years. Now, they're going to make that money with most of their doses being sold in the first world. They and Moderna both declined to actively participate in creating the development of the capacity to manufacture drugs in underdeveloped countries.

drugs in underdeveloped countries. So in May of 2021, the IMF, the World Bank, the World Trade Organization, and the World Health Organization got together and said, we need $50 billion right now to get vaccines to the third world. And we need to get 40% vaccination rate in the third world before the end of 2021, which we're now at, or we're going to have $9 trillion in economic losses from COVID spreading and from variants that emerge out of under-vaccinated countries. emerge out of under-vaccinated countries. Now, there were 17 individuals at that point who had made $50 billion from the vaccines. 17 people made the $50 billion. But nobody came forward with the $50 billion. It didn't happen. And now we see Omicron coming back to bite us. Could Omicron have been prevented if the $50 billion appeared and this program of global vaccination were underway? I can't promise that. But maybe the

next one, I don't know what the next Greek letter after Omicron is. No, don't. I don't either. But the next one maybe would be prevented. But there's no indication at all that the drug companies are serious about getting into this. Well, there was also an issue where the drug companies did not want to release the patents to construct these mRNA vaccines. So they didn't want to make it so that they're available for people to make in other countries. And they were trying to say that they didn't have the technology or the ability to. That's precisely right. And it was even to say that they didn't have the technology or the ability to or – That's precisely right.

And it was even worse than that. Pfizer, to their credit, was honest. And they said, no way. It's dangerous to give that out, to give that information out. Moderna didn't quite tell the truth. They said, yeah, we'll give the patent out. We're good global citizens. And they offered to release their patent, but they didn't make any effort to help any country with the know-how that's necessary to put the patent into action and build a plant to manufacture the drugs.

So Pfizer said it's dangerous for them financially? Is that what they said? That was the whole quote from the CEO. That it's just dangerous? It's a dangerous idea. Huh. I assume that he was referring to it will decrease innovation down the line because we won't make so much money that we won't be able to innovate. But that's just my assumption. Now, what do you make of places like Africa where they only have like 6% vaccination rate?

Yeah. But they have less cases there than anywhere. I don't know what's going on, but I don't think it's stable. A lot of people have antibodies in Africa, and it's unclear because those cases were never reported. It's an unknown. It's a very interesting mystery. were never reported. It's an unknown. It's a very interesting mystery. But I would not count my chickens on that one because I think you're going to have a huge population of vulnerable people. And without them being vaccinated and with all those doses going to the first world for first

dollar, it's like we're building this huge swimming pool and we've created for ourselves a no peeing zone in the swimming pool. And we think we're going this huge swimming pool, and we've created for ourselves a no-peeing zone in the swimming pool, and we think we're going to be just dandy because we are allowed to swim in the no-peeing zone, and we're going to get dirty. Now, the ivermectin proponents and hydroxychloroquine proponents, they point to that as the wide distribution of ivermectin in Africa because of river blindness and dengue and yellow fever, and that it's a very cheap, generic drug that's commonly distributed. They also say that in India, as far as Uttar Pradesh, like how they have essentially eliminated COVID. What do you think about that? Well, first, let me say that I've said a lot of bad things about drug companies.

Merck was the most respected drug company for seven years in a row, starting in 1987. And during that run, the CEO, ivermectin away to the areas of Africa that were at risk of river blindness. And you got to tip your hat. Times have changed. The next CEO was a master of business, not a scientist, and we got Vioxx is how radically things changed. But for river blindness, I believe you just give two pills a year. So it's pretty unlikely that a population taking two ivermectin tablets a year would be protected. But the idea was not that. The idea was that ivermectin is prevalent there and that they were giving out ivermectin to people like in prophylaxis. I know they did that in India. I'm not sure.

Supposedly they're doing that in Japan as well. It's confusing because the thing about the ivermectin proponents is they are, I'm trying to say this charitably, they're as culty as the people that think that everybody should get triple, quadruple boosted. Yes. Like they, on both sides, there there's this binary view of things. I've heard people say that ivermectin is great for even curing issues that the vaccine injuries have, like vaccine injuries, like things that the vaccine has done, take ivermectin for that too. Is there data on that? I don't think so, but this is a very easy problem to solve.

I mean, you've got a natural experiment. Usually you say for better or worse, but for worse, Africa has a very low vaccination rate. I think it's 8%, up from 6% to 8%, but a very low vaccination rate. You could go in there and do a randomized controlled trial where you gave 100,000 people ivermectin at whatever interval the proponents think would be effective and give another 100,000 people a placebo and you'd have your answer pretty quickly. But it's not being done. Well, there are randomized controlled trials that are currently being done, right? Isn't there one in, was it North Carolina or South Carolina now?

I think there's... I think the answer is yes. The NIH is on the record, to their credit, of saying that there's not enough evidence to say it does not work and there's not enough evidence to say it does work. So that's certainly an invitation for somebody to fund a study. Yeah. The problem is, even if they did fund it, like you were saying before that these studies, the vast majority of them are funded by these pharmaceutical companies.

Why would they do that for a study for a drug that's generic? That would be a good role for government, wouldn't it? Yeah. Yeah. It would be a good role for government. But again, the entanglement between money, politics, the pharmaceutical drug companies and the influence that they have and lobbyists, there's so much to fucking clean up. I have a little more faith. I think I have a little more faith than you do. I think if there were a government-funded study, if the NIH said, we're going to fund a study, a massive study, and it's an ethical study

because we don't know whether ivermectin works or not, sometimes you can't do it. I mean, you can't give monoclonal antibody or a placebo because monoclonal antibodies work. But this would be an ethical study because we genuinely don't know the answer to the question. It's a very simple study to do. And if that study were done by the government, funded by the government, I think you'd get an honest answer. Let me give you an example. There was a government-funded study called the Diabetes Prevention Program done in the 1990s. They took people at very high risk of diabetes, so-called pre-diabetics, and they randomized

them to a control group, to a group that got treated with the diabetes drug metformin, or to an exercise group. And you couldn't mask the exercise group, but everybody got a placebo pill. So the question was not, does this drug, which was on patent at the time, does this drug help to prevent diabetes, high-risk people from developing diabetes? It wasn't that. It was, what's the best way to prevent diabetes? Nothing, metforminin or lifestyle. And it turned out that lifestyle was the winner by far. Really? Yeah. Lifestyle had a 58% efficacy rate of preventing diabetes. Metformin had, I think, 39%. Lifestyle was significantly better than metformin.

Now, the results of that study were fairly reported. They weren't implemented so well. We went on to develop these fantastically expensive diabetes drugs instead of programs to get people to make the lifestyle changes that that study showed you can get people to make and they're effective at preventing diabetes. Now, what are the steps they take to get people to make lifestyle choices? diabetes. Now, what are the steps they take to get people to make lifestyle choices? It's common sense stuff. One-on-one counseling. You come back frequently. As a family doc, this was one of my favorite things to do, to try and get people to make change. And I always,

my program was, I would say, look, lifestyle is the best way to fix what you got. And here's a program that's easy and will gradually get into the exercise so you don't get an athletic injury. And why don't you come back in a month and tell me how you're doing? And I knew when they came back in a month that nine out of 10 of them would not have done a frigging thing. But I knew that. That's part of the therapy. That's not a failure. Now we got a good discussion going. Okay. What did you learn that was preventing you from doing it? Now let's keep going. And that works. It works on one out of 10. No, no, no. That's what, no, Joe, that's what this diabetes prevention program study showed. This is a randomized controlled trial. So you essentially imparted motivation into these people? It wasn't I personally. In my patients, no, I got them

to understand what their resistance was and to confront their resistance. How'd you do that? Every person's different. Right. So you're kind of acting like a psychologist then that way. Well, I would like to say family doctor, but you can see. Right, but you're talking about the psychological aspect of motivation. What stops people is procrastination, laziness, and then self-sabotage. Their feeling of not being told what to do by their father, being beaten up by their brother, whatever it is. But yeah, one-on-one, it was pretty successful. But the point is not that I claim to be a good behavior modification guy, but that in this randomized controlled trial,

where people were randomly assigned to go to these counselors and have these sessions, I forget, one every fourth week or something, and then they tapered down and then they turned into group sessions, that it worked. They lost weight, they started exercising, and they prevented diabetes. It works. I think the idea that it doesn't work and doctors can't motivate people to change, I think that's drug company, to change. I think that's drug company, your word that ends in E-R-Y. You said it already. No.

You said it earlier. Did I? Yeah, you said it. All right. We're going to call you out on that. Just a slip. I think that- I'm a bad influencer. Yeah. I think that's the healthcare systems controlling things and trying to make more money on it.

Well, I don't know if I agree with you on that, because I think it's just, there's a problem with human nature. And I've been around fitness and involved in martial arts most of my life. And there's always been an issue getting people motivated. There's always been an issue with people self-sabotaging. There's always been an issue with discipline. It's a very difficult thing for people to acquire discipline. And that's one of the reasons why people like David Goggins or Cameron Haynes or these like incredibly disciplined people that talk about it are so appreciated because the motivation of listening to a guy like Goggins talk about discipline, it actually, you can impart some of it or rubs off on some people and get you to throw your sneakers on and go for a run.

It really will get someone to sign up at a gym and maybe get some of those first baby steps going and develop some sort of a habit. But it's very difficult. It's one of the most difficult things to do to motivate people that are sedentary into changing the way they live their life. It is. But again, this is a randomized controlled trial. You know, I think most of the science we see is commercially motivated and it's biased and so forth. This was a

randomized controlled trial and these people lost I think 10 pounds and sustained it and they exercised five times a week and sustained it. The difference in there though is that these random, this trial, these people are part of a trial and they're also recognizing that, you know, they're getting a wake up call because they're pre-diabetic. So they're realizing like, hey, do I love my children? Do I want to see them grow up? Do I love my parents? Do I want to be around them? Yeah, you have to do something like this.

The time is now and you're also now a part of a trial. So there's a thing where you're in a group and, you know, you sign up for it. Now you're part of this thing with a lot of other people and they're giving you these steps and you start taking them and then you see positive results. Right. A lot of people are pretty diabetic. I mean, sometimes I hear the number even in the above 50 million Americans. Is it really that high? Yeah, I think so. But if it's being in a trial, I think you raise a good point. But maybe we should put everyone in a trial. Maybe that's what the social science says.

I think everyone should belong to some sort of an organization like a local community gym that has exercise programs and classes and things like that, that would help a lot. And I think if there's something that we could do, you know, there's this, people are, they hate the concept of socialism and I understand why, but if there was anything that I think that we could benefit from, like our taxes go to things that we all agree are important that aid the community. That is a socialist thing, like the fire department. It has nothing to do with how much money you make. The fire department is there to put out fires.

Your taxes go to the fire department. Everybody agrees that's a good thing. I think there would be extreme benefit if that same sort of thing was in place for nutrition and the same sort of thing was in place for exercise. That was a part of being a part of this community. You have access to healthy food. Part of being a part of this community is you have access to the gym. As far as all the other luxuries and all the things that people want, televisions and cars. You've got to work for that. But just the basic necessities of life, nutrition, and to enhance your experience as a person, exercise and education,

and especially exercise in terms of like a group dynamic because then it gets everybody motivated because you're doing it with a bunch of other people in class. I couldn't agree with you more. And we're talking about recreating the center here. And the fourth chapter in that book is called Insulin Inc., Inc. like incorporated. And what I show is that you could do that program that you're talking about. The CDC has funded a small program.

It has 15,000 people in it. And it's working through YMCAs and through community organizations. It's working. So you say, well, we don't have the money for it. It costs $20 billion a year to do that for everybody who needs it. Well, it happens to be that we're wasting about that much money by giving insulin analogs instead of human recombinant insulin to type 2 diabetics. And if we just spent that money rationally in helping people to straighten out their lives and exercise and prevent the disease and feel better, we'd be a much better society.

But as it unfolds, big pharma controls so much of how doctors think the best way to treat diabetics is, control so much of how doctors think the best way to treat diabetics is that they're taking that $20 billion and they're spending it on insulin that is more expensive, like 11 times more expensive than is necessary. Now, I don't understand this insulin thing. So how did that get through? How did this narrative that this one type of insulin was superior get through even though it's far more exorbitant. Right. So you got to go back to 1982. In the 70s, genetic engineering was coming

along. The scientific infrastructure for genetic engineering of drugs was coming along. And once they figured out how to insert human DNA code into E. coli bacteria or yeast or whatever the organism they wanted to use was, once they figured that out, they wanted a drug. And the obvious drug was insulin because people who have diabetes were using insulin that came from cattle and pigs. And it was a pretty easy cell to say, look, this bioengineered insulin is pure and creates less immunologic reaction. And it had a sort of prima facie logic to it. So it was a pretty easy cell to get doctors to believe that replacing the animal insulin with recombinant human insulin, which is exactly like human insulin, amino acid for amino acid, that was a pretty easy

sell. And more than 90% of the insulin prescriptions flipped over very quickly when that drug came out in 19, when bioengineered insulin came out in 1982. Unfortunately, there was no evidence that it was superior to animal insulin. And the Cochrane reviews that came out afterwards said no difference. No difference. Not at all, just more expensive. More expensive.

It sounds cooler because it's genetically engineered. Yeah, and we control the price. There aren't many companies that make insulin, so the price is sort of cartelish. The next cell was much harder. So they did the human recombinant insulin, and that cost like $21 a vial or something. This is not very expensive. It was a lot more expensive than the animal insulin, but not very expensive.

So the innovators said, well, now what do we do? We got this insulin and it's cheap. And now how are we going to make another buck to make our investors happy? And in 1996, they came up with these insulin analogs that are just slightly changed and amino acid or two are changed. And supposedly they more closely mimic the actual natural secretion of insulin in the body. That was a challenge. And that's one of the most fun stories that I discovered while I was writing this book. I didn't know about this before I was writing this book and kind of backed into this story about how the manufacturers, to get back to the question you asked, the manufacturers about how the manufacturers, to get back to the question you asked,

the manufacturers manipulated the standards that the doctors were held to, and they created an artificially tight control of insulin to lower the blood sugars beyond what medical science showed was beneficial, but they could claim that the insulin analogs could get you down there more safely with less hypoglycemia. Am I making sense? Yes, yes. Okay. So they sold this. They hired an advertising firm, and they sold the standard of getting hemoglobin A1c down to seven, that that was good control, even though there wasn't evidence of medical benefit. And that's how it happened. That standard, that became standard insulin care. And the manufacturers created bonus programs if doctors had a certain percentage of their patients controlled like that. And then nonprofit

organizations like the National Committee for Quality Assurance adopted that standard and they certify outpatient healthcare providers as being high quality and they defined that as a high quality issue to have a standard of a hemoglobin A1c of seven or less. There was no evidence. There was no evidence. And then a study came out in the New England Journal that showed that diabetics who were more tightly controlled had a higher risk of dying, published in the New England Journal. That didn't change anything. And it hasn't changed until 2018, 19, 20. It's been that image in doctors that high-quality medicine means treating your type 2 diabetics with insulin analogs. Instead of $21 a vial, we're talking about $330 a vial at the peak, that that's standard medical care. Meanwhile,

we're not doing the exercise program that you know would not only prevent diabetes, but heart disease and stroke and everything else, and people would be happier, and their families would be better, and the community would be better. And that's what's happening. That's how we got here. And when you extrapolate, when you look at where we're at, and then you go to 10 years from now, 20 years from now, it seems like the direction we're on, this is only going to be worse. It's only going to get more entangled. That's correct. Unless we make a vast, very dynamic course correction. It doesn't appear that we're going to. I mean, now it's going to get worse. It's going to be accelerated because these drugs, the vaccines and the drugs for COVID are going to be effective, I hope. But why should a company be allowed to charge a government $25 for a vaccine

when it costs them about $3 to make, and much of the technology was done by the NIH anyway? Why should we allow that to go on? Why should Pfizer be selling $65 billion worth of vaccine when their profit margin, one of the stock analysts said their profit margin after the first year or two is going to be 60 or 80 percent? So why is that? What kind of deals have been made? Because they spend so much in lobbying and so much in political contributions and they're nonpartisan in their political, bipartisan in their political contributions. The Democrats get paid and the Republicans get paid. And we're in this charade. We almost had an opportunity to have

some effect controlling drug prices. And we came up with this plan to limit the price of insulin, the copay for insulin for $35 when you're using the wrong insulin. Just get some experts together and decide which insulin you should use. And this is obviously just one drug. I'm sure there's probably countless other versions of this. Yeah, this is a particularly egregious story because there's only three major manufacturers of insulin. So they could really act as a cartel in bringing their prices up. And this animal insulin, how is that extracted? They crush up the pancreas. So you kill animals and take their pancreas? No, no, the animals are killed.

They're in the slaughterhouse. The pancreas is already there. So is it pigs? Yeah, pigs and cows. Pigs and cows. Yeah. Because that means obviously there's ethical issues with that too, right? As far as people who are vegans who don't want to be using.

I'm all for drug development. There should be options. It's great to have options. And I think we should have more than one drug available. But what you're saying makes a lot of sense that there's no evidence that this is beneficial. It's superior. But yet they've sold this to people based on no science and for extreme amounts of profit. Yes.

That's a good summary. That's not good. None of this is good, John. It's not good. When you wrote this book while you're writing this, is there any moment where you're – because I'm looking at this book and I'm hearing you talk and there's an incredible amount of data that you have to go over when you're doing something like this. Does it ever fill you with despair? No, no. It was a challenge to figure it out. And what I ended up with, I could have written a long book. I could have

written a 900 page book like Robert Kennedy. It would have been a lot easier. It would have taken me one or two years instead of six years. It's harder to edit it? It's hard to tell your story in short. And to make it digestible. Digestible, but tell the story. But I got to a breakthrough in this book when I figured out what's really happening is that there's a nexus of influence. I don't want to use the word conspiracy, but the drug companies are working with the journals and selling them back reprints or buying back reprints of the articles. And the journals part of the deal is not to ask for the data. And the academic medical centers are working with the drug companies and giving them more control than you would think academics would give to private industry

because they're making money. The institutions are making money and the researchers are making money. and the researchers are making money. And the physician societies, the professional organizations, are getting paid by drug companies. They're taking drug company money. They, in large part, oversee the guidelines that are made. So that we've got this nexus of confluent interest

that's feeding at the trough of drug company money. And that's called market failure. And market failure doesn't correct itself. You need government. You need to break this up. It's like a trust buster. It's like breaking up Microsoft. The market failure is so comprehensive that it's got all the parties' impression

of how medicine should be run in the United States going in their direction. And we need an umpire. If I gave you magic powers, I give you you could fix everything. Like, John, you have the best ideas. I'm the king of the world. Do whatever you want. How do you fix this?

So first you make data transparent pre-publication once an article is published the cows are out of the barn that seems simple and then not only that that seems like no one can argue against that right but that but the journals don't have an interest in doing that how so because their gig is to sell the a big part of their gig is to sell the reprints back to the drug company. So would the solution to that be the government funds the journals so that the journals don't operate on profit? I think that's a step too far. I don't think you have to go there. There's an intermediate step.

When a drug company does a clinical trial, they do what's called – they get all the patient forms and truckloads of data and they put them on electric – they digitize it. And then they produce what's called a clinical study report that it doesn't have the raw data in it but it has all the data tabulated. It's like 3,000 pages. And they do that. And as I got along in litigation, I got pretty good at reading these clinical study reports. I could, you know, in maybe 10 hours or 20 hours, I could figure out what happened, what didn't happen. And occasionally needed to go back

and have a statistician get the primary data. But what I'm saying is that there's no reason in the world why medical journals wouldn't require the clinical study report to be submitted with a manuscript for publication. No reason in the world. And if the ordinary peer reviewers who aren't adept yet at going over those things, they could hire statisticians that were. They've already been done. There's very little redaction that's necessary, but let them redact if there's some commercial process or something. It's a no-brainer. They exist. I mean, that's what makes it even crazier. So you can fix that with clinical study reports, and then you can request the individual patient data if you need to.

You could fix the professional societies and say, okay, docs, you want to have a society, don't take drug company money. Boy, how hard is that though? Because you have to substitute that money then, right? If someone already has this incentive and they're making this profit, how do you get them to abandon that profit for the greater good of mankind when they figure it you know you have that diffusion of responsibility aspect of it because there's so many doctors and so much money and there's like i'm not helping anything i'm not hurting anything that's right that's what they think yes but let's break down the function of those professional

societies and let's figure out how to fund them. Doctors are making good salaries. Maybe they could pitch in some money. Maybe you could have a match plan with the government. I don't know. The problem with the idea of good salaries is even really wealthy people want more money. You know what I'm saying? Guys like Jeff Bezos and Bill Gates, they still want more money. They have hundreds of billions of dollars together at least, and they still want more money. This is a thing that people do. They have hundreds of billions of dollars together at least, and they still want more money. This is a thing that people do. They never just go, I'm good. So doctors are the same way. And if they're making this money from these pharmaceutical companies- Well, most of them are not making money. They may take some lunch and they may take a trip now and

then, but they're not making, most of the doctors are not making big money. Most of the doctors is just incentivized by other methods. Because the drug companies have taken over what they think is evidence-based medicine. Most of them are trying to be good docs. And they're just naive to the influence that the drug companies have on these journals like you were perhaps in the 80s? Yes. That's exactly right. That's scary because that means that they think that they're acting in good faith and that they're doing a good job and they're using evidence-based medicine. And in fact, they're getting manipulated.

That's exactly right. That's terrifying. It's terrifying. And that is because of the journals. The journals are playing a role.. The journals are playing a role. The professional societies are playing a role. The pharmaceutical drug companies are clearly playing a role. That should be, in your opinion, well, in my opinion, that should be illegal.

Do you agree with that? That should be regulated. What's the VAT? In terms of like, well, the VAT being the hiding of the data and showing their assessment of the data to peer review. Yes. That seems crazy. It seems crazy. And there's an organization called the International Committee of Medical Journal Editors that's in a perfect position to just say stop it. We'll all stop it together so no journal is disadvantaged by demanding the data and they won't do it.

How much of an impact do you think that would have? I mean it seems like this manipulation of data in order to ensure profits is a part of their business model. It's a part of the way they act and operate. And a lot of this is because of this constant growth paradigm where every year, and this is what scares me about these current years because of the amount of money that's being generated by the vaccines. How do you tell them? Like what if COVID goes away and there's no need for these vaccines anymore? How do they recreate these golden years of profit?

They don't. So what do they say to their shareholders? When the shareholders are like, hey, why are the profits down so low? What's going on with the stock? Like, this is a real problem with money being integrated into healthcare, right? It is.

I don't think it's, I'm not sure it's that much of a problem. This is a windfall profits for COVID. But they're sitting on $500 billion right now. That money is probably going to be used, at least in large part, to buy drugs in development by smaller pharmaceutical companies, startups, and companies that are funded by the NIH to do research. But they'll be finding other targets to aim drugs at. And I think that's where you get Adjahelm, the story. Have you talked about that on a podcast?

No. What is that? That's a good story. Excuse me. Adjahelm is a drug for Alzheimer's disease that got approved a few months ago, despite the fact that the FDA advisory committee voted 10 not to approve it, 1 to abstain, and the FDA approved it anyway. And the reason why the 10 voted not to approve it is because the studies show that it did not have a clinically meaningful benefit. It decreases amyloid plaque in the brain, which is associated, not necessarily causal, but associated with the onset of Alzheimer's disease and progression of Alzheimer's disease. So this drug decreases the accumulation of the amyloid plaque. But it doesn't make a significant improvement in clinical

status. And it has about a 33% incidence of brain side effects, brain swelling, brain bleeding. Swear to God. And they approved this. I can't make this up. And the FDA approved this? The FDA approved it. Why'd they do that? It's a story that's unfolding. They did a backdoor move where the FDA said they weren't going to approve it because it hadn't shown efficacy. And there was some back channel communication between FDA and one of the people in Biogen, executives in Biogen, which is the manufacturer, and they came up with this scheme to have it approved on a, I don't know if it was emergency use or, accelerated approval, accelerated approval, because there was no other therapy for the disease. But it was, it was just, they made it up. So three of the advisory committee members quit.

They said, we're not going to work. We're not going to do this for you anymore. And there are two parts of that story that are just, three parts that are just mind boggling. One is the price of this drug, which is shown to have significant harm and no benefit, is $58,000 a year. $58,000 a year. It was projected. It hasn't taken off. It was a bridge too far. But it was projected to increase the total cost of Medicare Part D by 150%, single-handedly. It was approved. Number two is that a survey was done of Americans who heard about the Agile Helm issue, and 60% of Americans believed that it worked, even though there was no evidence that it worked.

This is really scary. What is this based on? What is their 60% based on? Where did they get the information from? It was probably press releases from the company about reducing amyloid plaques. And maybe some news reports? Yeah, it came through the media.

And the press releases, so they were reported on MSNBC or what have you? I can't say that for a fact. Some networks, some sort of media. Yeah, NPR covered it, actually. And NPR covered it in a favorable light? Well, they reported a true fact, which is that it reduces amyloid. But they didn't pick up that there are 27 studies that have been done that the FDA wrote a memo about of drugs that reduced amyloid, but they didn't pick up that there are 27 studies that have been done that the FDA wrote

a memo about of drugs that reduced amyloid, and none of them improved Alzheimer's. And they also didn't talk about the, was it 33% of the adverse side effects? Right. That's a lot. Yeah. It's actually 41%, but you correct it down to 33% because 8% in the control group had side effects. So I'm trying to be fair here. That's so nice of you. Thank you. It's so crazy, man. It's like that's the problem that we really worry about when it comes to pharmaceutical drug companies, that they're going to do things

like this. And they're going to use their influence to push stuff like that through. And they're going to do it because they are a profit generating machine. And that's what scares me about the amount of power and money that they've amassed during the COVID years. Correct. Correct. And political influence. A lot of political influence. Also, their social status has changed.

They've gone from being, in many people's eyes, a pariah because of things like Vioxx, because of the opioid epidemic, to being a savior of a public health crisis. That's exactly right. Six months before COVID was heard of, the drug industry stood at the bottom of 25 industries in terms of public approval. The lowest it had ever scored since 2001 since they've been doing the statistics. And suddenly, after the vaccines came out, Moderna and Pfizer are in the top 10 most respected corporations. That's wild.

That is wild. When you look at their history, I mean, you know, they're serial abusers. The problem, people say that drug companies are too greedy and blah, blah. The problem is that their job is to make money. That's what their job is and they do it. And if the American people and the American government let them do it, shame on us. So clearly there has to be some sort of course correction, but how do you do that when these pharmaceutical drug companies have so much influence? They don't want to do this. They're going to resist this tooth and claw. So how do you do this? They're going to claim that they can't innovate if you take a dime away from them. They'll spend nine cents proving that that's not

true. The way you do it is in the last chapter of the book. You've got to build this coalition. It's almost all Americans are getting ripped off and harmed and physically harmed, economically harmed and physically harmed by what's going on. And if democracy is going to work, we've got to be able to make progress. Democracy is a sham. If we can't make progress on this, which is so obvious, then how are we going to govern ourselves? It's a good question. Especially when it's such a large part of our life. You know, medicine and health care and being able to go to the doctor and find some sort of a viable solution to whatever your health issue is for you or your family. It's a huge part of our lives. Absolutely. And trust your doctor. I mean, just trusting your doctor,

it has a lot of health benefit to trust. If you have a doctor you trust. And now people look at me and say, wait a minute, you're throwing a wrench in all this and you're getting people not to trust their doctor. And, you know, I guess it's true a little bit, but let's move to a higher state here. Well, I think you have sympathy for the doctor's position as well because you were in that shoe once. I was. Yeah. Yeah. Well, this is bleak. I was hoping that maybe you had some sort of impossible solution to this that would be easy to implement. Well, I do and you do too, which is 80% of our health is determined by how we live our lives.

I think that's a very important message. And let's take responsibility for ourselves and the people we love. Yeah. And yeah, I've thought about ways other than having healthy people come on the podcast and influence people and sort of motivate people. I've thought of ways that I could contribute to that. And I'm not exactly sure other than like opening up a chain of gyms and making it free for people. I've thought of ways that I could contribute to that and I'm not exactly sure other than like opening up a chain of gyms and making it free for people. I don't know what else I could do to sort of inspire people to do things. Maybe put together some sort of an online program that's free where it allows people to check in with other people that are in the same sort of situation and motivate them to participate

and have readily available classes and things you could follow along online in a free form, like a YouTube type deal? Yep. So the CDC has this project going on with local YMCAs and other such institutions. And they had 15,000 people in it, and I don't know how many are in it now. And they're getting good results. I think if you and other people like you who are social influencers, who understand that individual responsibility

is just so important here, worked with that program, that maybe together you could make, you could get something done. Yeah, that might not be a bad idea. Just something has to be done other than just some people are motivated and some people are, you know, they're self-starters and they get going. And I think we have to – I think most people are at least partially aware of how much of a benefit it would make to their life if they exercised and took care of themselves. I don't think people are aware of that number, the 80 percent, that 80 percent of your health is how you live your life.

Yeah. It's not the next drug innovation. Yeah. The next drug innovation may help some people. Some of the new drugs are fabulous. You know, the drugs that contain HIV AIDS and drugs that contain hepatitis C. Sure, yeah.

And I think history is gonna show that the vaccines fit in that category. Maybe they won't. It could be wrong. We don't know the end of this story. But some drugs work. Out of all the drugs that are approved, one out of eight are actually new drugs and the rest are reformulations and extended care. But one out of eight are actually new molecular entities, they're called. But only one quarter of those actually have been shown to be a meaningful clinical advance over other drugs.

So three quarters of the new molecular entities that are approved have not been shown to be a meaningful improvement over the older drugs. And they're just pushing these for profit. For profit. Do you get concerned at all about the reports of myocarditis and pericarditis and the adverse side effects of the vaccines as reported by VAERS and anecdotal reports from people who either know people that have had bad side effects or what have you? Well, the truth is you got this on my radar screen with your interview with Dr. Gupta. Well, the truth is you got this on my radar screen with your interview with Dr. Gupta. And I did the best research I could

and I found that, do you have that slide? I think it's the first slide in the slides that I brought. Jamie's gonna find the slide, here we go. Well, maybe it's the second slide. That's it. So the top line, I'll explain Israel data below afterwards. But this is data from the CDC. And it's looking at boys aged 12 to 17 and 18 to 24.

And this is per million kids who are vaccinated. 17 and 18 to 24. And this is per million kids who are vaccinated. So by CDC's data, you prevent 5,712,000 cases. You prevent 215 hospitalizations and 530. You prevent that many 71 and 127 ICU admissions, which are serious, and two deaths in the younger age group and three in the older. The VAERS data says that the risk of myocarditis in that same population is 56 to 69 for the younger kids and 45 to 56. The VAERS data, I wanted to corroborate because that's voluntary reporting. So there's Israeli data that was published in the New England Journal. And Israel has a good data system for their national health system. So the Israeli data, I trust. And the Israeli data came out and said out of this million people in each age group, 151 will develop myocarditis and 109 in the older group.

So why is the Israeli data so much higher than what the VAERS has put out? Is it under-reporting on the VAERS side? It's probably under-reporting. It's a cockamamie. I mean, we know, most Americans know what a computer is. We could computerize this data set. Right. And then we could find out if kids were admitted to the hospital with myocarditis. We'd know that. And we only know about hospital admissions. We don't know about people that have shortness of breath and chronic fatigue and issues that are associated with myocarditis where people don't get treated or don't get medical treatment or don't get diagnosed. Don't get diagnosed.

Don't get diagnosed. So that's an issue that I can't address. But on that slide, the point that I wanted to make is that myocarditis is a significant issue. And if the CDC data is correct, not about myocarditis, but about the benefits, that the benefits don't outweigh the harms of myocarditis, but they're not that far away.

They're maybe half as much. They maybe nullify half. Can we look at that slide again, go over the... So if we looked at hospitalizations prevented, you're preventing more hospitalizations than you're causing myocarditis. And the myocarditis in the kids tends to be not disastrous. Well, how do we know that? That's from the Israeli data. They had 129 people.

Right, but we don't have long-term studies on that. We don't. No, that's fair. That's absolutely fair. That's where myocarditis is the issue, right? I was reading this thing about myocarditis, about when people develop the type of myocarditis that they've had from vaccine injuries, a significant swelling of the heart tissue, that over time, this could be a significant issue in their life? The answer is we don't know. We can't know. Time has not gone by. And the reason why I made that slide is to say, A, you are raising the issue is really important and it ain't over. It should be

considered. So if you ask me, which I was hoping you wouldn't, if you ask me do I think kids should get vaccinated, I think my response would be that at this point in time, it looks like in the future we're going to say that it was better to get vaccinated than not. Even for children? To 12, to age 12. But here's the thing about these children, when you're saying deaths and hospitalizations, but deaths in particular, they're all with comorbidities. And many of these comorbidities are lifestyle related, right? Many of these comorbidities are kids that are grossly obese or that have all sorts of health problems that

are associated with that 80% that you talked about, the way they live their lives and the food they take in. Yes. That seems like an easier prevention and then you avoid the possible, even though it's a small number, if you're dealing with healthy children, that's what's so scary. Because if you're dealing with healthy children that seem to be getting myocarditis, a lot of them, I was watching this video on TikTok that was removed for whatever reason because it had millions and millions of views. But it was a 14-year-old boy that was in the hospital who was talking about his case of myocarditis, and they deleted the video.

It was a personal account of a kid who got vaccinated. The thing is, if it's affecting healthy people that aren't at risk from COVID, like the number of kids that are at risk from dying of COVID is fairly small, right? Correct. 800 kids have died. And those kids, the vast majority of them have comorbidities. I haven't seen that data, but I believe it's the data that I saw was that they can't account for, I don't know what the number is, but very, very few kids have died that didn't have something significantly wrong with them. So that's what scares people. The idea of vaccinating a child that's not at risk, that's a healthy child because you've mandated this for all children. Yeah, I'm not saying mandate.

Right. Absolutely not. But that seems to come up with this. And this is what I'm concerned with is the influence that the pharmaceutical drug companies have with this extreme desire to earn profits. Well, obviously, there's a whole segment of our country that you could vaccinate and extract enormous amounts of profit from. That segment is children. And the way to really get that to go is to mandate it. Now, they're mandating it in California. They're trying to mandate it. I think they backed off of it because of lawsuits. They were trying to mandate it for school. Like,

you have to get vaccinated to go to public schools, which seems in my mind to be kind of fucking insane because you're not mandating health, you're not mandating dietary choices, you're not mandating exercise, you're not mandating this 80% of how you live your life, which could affect so much of the quality of life for these kids for the future. You're not doing that, but you're saying that they have to take this pharmaceutical drug.

I can't argue with you, Joe. I think the right thing to do is to give the parents the best information you can get to them and let them make a decision. And then also make sure that the parents are actually getting the best information. Right. But if I haven't made you depressed enough yet, yeah, this one's bad. So I was saying earlier that 1,300 Americans die every day because our health and health care is so inferior to the other developed countries. 16,000 kids die every year in our country above the death rates in the other developed countries.

In excess, 16,000 children die a year. An excess 16,000 children die a year. Some of it's guns, some of it's traffic accidents, and some of it's general health. But it's an appalling number. You and I, you got me into the myocarditis issue. It's a fascinating issue. I don't think it's black and white. I think it's open and more information will come along. But 16,000 extra American children dying every single year.

There's nothing gray about that. It's horrific. And I think we've raised so many issues in this that I think people are going to have to dissect this and take notes and go through your book, of course, which is not out yet. It'll be out February 8th. And it's called Sickening, How Big Pharma Broke American Healthcare and How We Can Repair It. Anything else to add to this, John? No, thank you for the opportunity. My pleasure. And thank you for all your hard work and putting this together it's much much appreciated and you know I think slowly over time with conversations like this with you and with people reading your book and getting the kind of information that you work so hard to put out we're gonna get a better sense of what's going

on because I think it's very hard for people as it was you know for you being a you know a young doctor and learning this kind of the hard way and piecing it together. And I really, really appreciate that you did that. So thank you very much. Thank you, sir. Go get it, folks. It'll be out February 8th, and I will put this on my Instagram.

Let everybody know. Thank you, John. Thank you very much. All right. Bye, everybody. you