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Conflicts, Corruption, Medicine, and Me Part 1

At my age, it’s humbling to recognize how easily I can be manipulated. It is small comfort to know I am neither the first nor is it rare among my profession.  Still, as a physician in my 44th year of practice, the events of the past several years have had a profound effect on the way I think of the care I have been rendering.

The CDC and NIH manipulated the government and the willing press into supporting incredibly corrupt behavior.  Prestigious medical journals such as the Lancet suspended their usual stringent review processes to publish fraudulent data.  The regulatory agencies, and Big Pharma acting in concert, punished non-doctrinaire opinions.  They manipulated our academic institutions by the issuance and withholding of grant money.  

It is beginning to sink in that the vaccines were untested, were minimally helpful, and are likely, to an extent, unsafe, especially for the young.  The lack of acceptance of the new bivalent injection, I think, confirms a new public wariness.  Likewise, there has been a pronounced lack of enthusiasm for pediatric inoculation.

But for me, there have been much broader revelations.

I looked back and wondered about my entire career.  Was everything a lie?  Were there medications, perfectly adequate, that I was convinced to discontinue in favor of newly patented and expensive medications, with less well understood safety profiles?  

How many of the other articles that I had read over the years were corrupt documents, meant to bolster the profits of the pharmaceutical industry?  Just how badly have I been manipulated?

Unethical behavior has its roots in the Garden of Eden. But it was more recent manipulations that ensnared me. It happened when I was 3 years old.

In December 1953, the CEOs of America’s leading tobacco companies cast aside competitive rancor and gathered at New York City’s Plaza Hotel. An emergent body of science published in elite medical journals had cast doubt on the safety of cigarettes and threatened to destroy a half-century of corporate success.

Joining them at the Plaza was John W. Hill, the president of America’s top public relations firm, Hill & Knowlton. Hill had closely studied Edward Bernays, whose work on propaganda in the 1920s and 1930s defined common techniques to manipulate popular opinion.

Instead of ignoring or denigrating new data that found tobacco dangerous, Hill proposed the opposite: embrace science, trumpet new data, and demand more, not less research.  Follow the science.

Critically, tobacco companies would then control the science. Tobacco companies would fund the research which allowed them to harness academic scientists. These corporations hired academics as advisors or speakers, appointed them to boards, funded university research, supported vanity journals, and provided academic scholars with ghostwritten manuscripts to which they could add their names and publish in peer-reviewed journals with little or no effort.

While pretending the goal was science, tobacco companies repurposed research for public relations. To control. By controlling the research agenda and the scientific process, tobacco companies could manage journalists even better than in the past. Instead of manipulating journalists to fight on their side of a public debate, companies would create the debate and then harness the media to publicize it for them. 

The Tobacco Industry Research Committee (TIRC) was formed and practiced aggressive outreach to authors, editors, scientists, and other opinion makers. They presented journalists with contacts of “independent” skeptics to ensure accurate journalistic balance. They controlled the conversation.

Did it work?

When tobacco hired the Hill PR firm in 1954, the industry sold 369 billion cigarettes. By 1961, companies sold 488 billion cigarettes, and per capita cigarette use rose from 3,344 annually to 4,025, the highest in American history.

Were scientist, academic institutions, governmental agencies, or politicians concerned with the conflict of interest? Not so much. These were the very bodies receiving millions of dollars. When the Surgeon General established an advisory committee on smoking and health in 1963, the tobacco industry was allowed to nominate and reject committee members. 

Why am I telling you this story?

It is because the pharmaceutical industry has repurposed tobacco’s campaign of co-opting academics and influencing government agencies to sell drugs. It is because this practice impacts our patient care decisions and the cost of health care in the United States. It isn’t so much “follow the science” as it is “follow the money.”

It is because integrity and trust has been lost from vital government organizations. Organizations we need to be able to trust. It is because our health care system is broken and needs fixing.

(to be continued)

Tim Powell MD

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