America’s Broken Health Care: Diagnosis and Prescription
re: cholesterol and statins
re: Medical Industrial Complex
Why is America so sick and getting sicker?
America’s Broken Health Care: Diagnosis and Prescription
February 2023, by John Abramson MD, MSc, Author of Sickening: How Big Pharma Broke American Health Care and How We Can Repair It @AMAZON
I developed a serious cardiac arrhythmia, ventricular tachycardia, seven years ago...
On the good side, I was fortunate to have the attention of two world-class doctors who spent six hours, one going inside my heart, the other coming through my chest wall to the outside of my heart, to map electrically the aberrant signals in my heart and to ablate them. Since then, I’ve not had a problem.
On the bad side, two days after the procedure, I was in the intensive care unit when a cardiologist came by on rounds. He advocates a wider use of cholesterol-lowering statin medications than I do, and he started to cite the literature about why I should be taking more cholesterol-lowering medicine than I already was. I asked him if he had read the studies underlying that literature, and of course he had. I then asked him if he understood that the endpoint of many of those studies wasn’t really appropriate to determine the benefit of statins, and he acknowledged there was some debate about that. Finally, I asked if he was aware that when peer-reviewed articles are published in medical journals—even the most reputable medical journals—the peer reviewers don’t have access to the actual data from the clinical trials being reviewed. And he answered, somewhat meekly, that yes, he was aware of that.
In other words, he was aware that his recommendation that I increase my use of statin drugs was based entirely on incompletely vetted commercially-sponsored and largely commercially-influenced medical journal articles. This gets to the heart of the problem of the commercial takeover of the medical knowledge that doctors believe in and implement.
But before continuing that thought, let me step back and explain why I begin from the assumption that U.S. health care is on the wrong track.
WIND: imagine you had such heart issues and were told you had better be on a statin forever thereafter. How many people would have the faintest clue of what a poor idea that is? That is, all the evidence suggests that statins are one huge gaslighting and psyops operation, with the evidence showing essentially zero benefit (infinite NNT) with all the nasty side effects up to and including triple the risk of diabetes mellitus.
Recommended: The Clot Thickens, by Dr Malcom Kendrick @AMAZON.
When it comes to a doctor like Peter Attia making tons of money from his high-end medical practice, none of the right questions are asked, not by him and not by Huberman—really sad to such stuff presented emphatically as “settled science” and completely lacking in assessing outcomes, the only thing that matters (besides the side effects). It’s a startling example of cognitive commitments leaving no room in the mind for doubt.
The evidence for the cholesterol hypothesis of atherosclerosis is swiss-cheesed with cognitive commitments, cognitive dissonance, and a dismal grade of “science” dominated by follow the money. Seventy years or so have failed to establish any causal link, with a constantly-changing series of claims, coupled with intentionally not studying key aspects (as just one example, the the role lipoprotein A, which is not amenable to Big Pharma meds). Competing theories are not just not studied, and anyone raising them becomes a pariah. There is nothing even science-like about the whole sordid affair.
BTW, compare the quality writing and reasoning above to the word salad and DEI/CRT civilization-destroying vomit spewing from disgraced Stanford Medicine (with a very few exceptions such as Jay Bhattacharya). The difference could not be more striking.
Dropping life expectancy, out-of-control costs, usurpation of science, the Medical-Industrial Complex...
The article continues:
An easy way to gauge the health of a country, and to compare the health of a country with that of other countries, is to look at average life expectancy... life expectancy in the U.S. has fallen further and further behind....
By 2019, prior to COVID, life expectancy in the U.S. had fallen relative to that in the other countries so much that 500,000 Americans were dying each year in excess of the death rates of the citizens of those other countries...
Now combine this with the fact that we in the U.S. are paying an enormous excess over those other countries on health care...
Which means that our health care system is broken and needs fixing.
Prior to leaving office in 1961, President Eisenhower famously warned the nation about what he called the “military-industrial complex.” I suggest that we now have a medical-industrial complex that is sucking America’s wealth away from the other things that will make us healthier and create better lives for the American people.
Ask yourself, what ought to be the primary goal of American health care? To my mind it is this: to maintain and improve individual and population health most effectively and efficiently. And if that is correct, there are two critical questions we all need to ask: (1) Why are we failing so miserably to achieve this goal? and (2) Why are doctors and other health care professionals willing to go along with this dysfunctional system?
One of the fundamental reasons for the disparity between the health of Americans and the health of people in other wealthy developed countries is that our medical-industrial complex has taken control over what doctors and the public accept as medical knowledge. This is something that has evolved over time.
Back in 1981... Derek Bok, the president of Harvard University, said in Harvard Magazine that year that the university’s reliance on industry funding for research was causing “an uneasy sense that programs to exploit [i.e., make money from] technological development are likely to confuse the university’s central commitment to the pursuit of knowledge.”...
Along the same lines, a 1982 article in the journal Science, “The Academic-Industrial Complex,” pointed out that universities that had been pursuing knowledge for its social and scientific value had been suddenly drawn into the marketplace and were pursuing knowledge for commercial value. We today have grown accustomed to an environment where it’s normal for professors at medical schools to have commercial relationships. But it wasn’t always that way, and it doesn’t have to be that way in the future.
...In litigation involving Pfizer—although Pfizer is no different than other drug companies in this respect—internal Pfizer documents stated in stark language that “Pfizer-sponsored studies belong to Pfizer, not to any individual,” and that the “Purpose of data [from those studies] is to support, directly or indirectly, marketing of our product.” Not to ensure that the drugs will make people healthier or improve quality of life—or to ensure that they will do no harm—but to support the company’s marketing...
... In 24 percent of clinical trial agreements, the sponsor (meaning the drug company) “may include its own statistical analysis in manuscripts [i.e., journal articles].” And even more outrageously, 50 percent of clinical trial agreements allow the sponsor to “write up the results for publication and the investigators may review the manuscript and suggest revisions.” In other words, 50 percent of the contracts that academic medical centers make with drug companies allow the drug companies to ghostwrite the articles. The researchers who are the named authors of the articles have the right to suggest revisions but not to make actual corrections or edits. This is not academic freedom. Nor is it an arrangement in which medical science is going to serve the interest of the American people.
...It is irresponsible for medical journals not to require transparency from the drug companies—but it makes perfect business sense when we understand their financial dependence on those companies.
WIND: follow the money; the amounts are huge. I am not optimistic about a fix. Powerful interests have tentacles everywhere.
This sums it up well:
We in the U.S. are spending 96 percent of our biomedical research money on medical drugs and devices, and only four percent on how to make the population healthier and how to deliver health care more efficiently and effectively. Put another way, the U.S. spends $116 billion on researching new drugs and devices—which comprise only 13 percent of total health care costs—but only $5 billion on research concerning the remaining 87 percent of health care costs. Why? Because the drug companies’ job is to maximize the money they return to their investors, and the highest return on research investment is not going to be from studying and promoting healthy diets and lifestyles. The money is in selling drugs and devices. This leads to a tremendous epidemiological imbalance in the information coming down to doctors.
...In the case of Trulicity, it turns out that you have to treat 327 people for approximately three years in order to prevent one non-fatal heart event. And treating just those 327 people over that time period would cost the public $2.7 million. Wouldn’t knowing these numbers make a difference to a doctor deciding whether to prescribe the drug? Or to a patient deciding whether to request the drug? And this is leaving aside the possible negative side effects—and the “number needed to harm” for each of them—which clinical trials often fail to monitor and more often fail to report in journal articles.
...Big Pharma is comprised of for-profit companies. The job of for-profit companies is to maximize returns to their investors. Accusing drug companies of being greedy is like accusing zebras of having stripes. They are doing their job, and we’re not going to change them...