The American Way of Health; The Links Between Big Pharma, the Medical-Educational System, Agribusiness, and the Food Industry


The title of this blog series draws from Jessica Mitford’s The American Way of Death published in 1963. The description on Amazon.com gives a preview of the approach this post will take.
“Before the turn of the century, the American funeral was simple “to the point of starkness,” says Jessica Mitford, the acclaimed muckraking journalist who published this investigation of the country’s funeral business in 1963. That the country went on to develop a tendency for gross overspending on funerals Mitford puts down to the greed and ingenuity of undertakers, whom she regards as salesmen guilty of pressuring families into agreeing to their excessive standards for burial.” 
 

Part Three. How Agribusiness and the Food Industry Work Together to Sabotage the Health of the American People.
Agribusiness
There has been a documented decrease in the nutritional quality of foods in America. Although interest in this become more evident in the past decade or two the decrease has been going on according to some at least since the 1950s. Probably, there has been a slow progression even since the end of the 18th century, which took on rapid acceleration with the move to industrialized farming.
A writer to one of the columns in the ScientificAmerican “Earthtalk,” asked, “What’s the nutritional difference between the carrot I ate in 1970 and 180 today? I’ve heard that there’s very little nutrition left. Is that true?” While the answer explained that it would be overkill to say there’s very little nutrition in today’s carrots, “It is true that fruits and vegetables grown decades ago were much richer in vitamins and minerals in the varieties most of us get today.” The writer went on to identify the main culprit in the trend as soil depletion. Agribusiness reliance on intensive farming methods strip more and more nutrients in the soil which are no longer available in the food products. On top of this soil erosion continues to be a major problem in the farmland in the United States (and other countries as well).
A study published in the December 2004 issue of theJournal of the American College of Nutrition compared data between 1950 and 1999 from the U. S. Department of Agriculture and found that 43 different fruits and vegetables showed notable declines in the amount of vitamin C Vitamin B, iron, phosphorus, calcium and protein. Besides the focus on intensive farming the article noted that more and more agricultural practices focused on improving salability—for example the size the resistance to pass in the rate of growth—rather than nutrition. Putting it another way the driving force since at least the 1950s, and most likely for decades prior was not the health of the American people but the “bottom line” of gigantic farming companies—Agribusiness. Other studies have found similar drops in nutritional quality, for example, 12 fresh vegetables and fruits dropped in calcium level by 27% between 1975 in 1977. The iron levels in these products fell 37% and vitamin C levels dropped 30%. The same kind of nutrient data emerges from studies of British farming as well.
According to an article in Mother Earth News, the U.S. government’s involvement in this process did not help our health at all when by about 2004 the USDA decided for what many consider political reasons to claim that organic foods are not superior nutritionally or even safer than conventional foods. This even though there was evidence that, for example, organic eggs from free range hens had more vitamin E, folic acid, and B12 than intensively raised eggs from massive chicken raising operations. You might notice if you’re eating organic eggs that probably the yolks are bright orange, indicating high levels of carotene antioxidants. On the other hand, eggs produced in a factory operation yolks are much lighter unless the owners feed marigold flowers to the eggs to make the yolks brighter. Adding fertilizer high in nitrogen (often higher than is actually needed for nutrition) in the interest of promoting faster growth by forcing the vegetables to take out more water is not only not particularly healthy but it also means that were eating vegetables and paying more for them that have more water in them.
To further complicate the picture, there is a multiplicity of federal agencies involved in the U.S agriculture and food system, introducing a bureaucrat’s heaven of regulation.
Consumer Product Safety Commission
Federal Trade Commission
U.S. Department of Agriculture
U.S. Department of Commerce
U.S. Department of Defense
U.S. Department of Energy
U.S. Department of Health and Human Services
U.S. Department of Homeland Security
U.S. Department of Housing and Urban Development
U.S. Department of the Interior
U.S. Department of Justice
U.S. Department of Labor
U.S. Department of Transportation
U.S. Department of the Treasury
U.S. Environmental Protection Agency
As the Union of Concerned Scientists points out, the modern system of industrial agriculture now dominant United States is “characterized by large-scale monoculture, heavy use of chemical fertilizers and pesticides, and meat production in CAFOs (confined animal feeding operations).”  The costs in human health and safety, society and economy:
·       Toxic pesticides
·       Water pollution
·       Increasing antibiotic resistance
·       Farmland damage from soil depletion and soil erosion
·       Lost biodiversity
·       Society and our economy:
·       Loss of midsize farms
·       Runoff pollution from agriculture that damages areas hundreds of miles away resulting in added costs for remediation. 
FoodIndustry
Once upon a time a relatively honest U. S. Senate committee tried to do the right thing. In 1977 the committee on Nutrition and Human Needs, known as the McGovern committee, published a document titled Dietary Goals for The United States. This document was based on significant research that found coronary heart disease could be reversed by eating a plant-based diet. The intent of the publication was to encourage Americans to stop eating so much animal-based foods and to increase foods based on plants. The benefits had been known in medical circles for decades. Then what happened? According to what one Harvard university professor remembers “the meat, milk and egg producers were very upset.” The government, following heavy pressure from industry, not only removed the recommendation to decrease meat consumption but disbanded the senate nutrition committee completely. Supposedly several prominent senators lost their reelection bids because they supported the report. 
According to an article in the Food and Law Journal by Jeff Herman, “Saving U.S. Dietary Advice from Conflicts of Interest,” some years later—surprise, surprise—the U.S. Dietary Guidelines Advisory Committee turned out to have a number of members with financial ties to “everything from candy bar companies to entities like McDonald’s counsel on healthy lifestyles and Coca-Cola’s beverage Institute for health and wellness.” Falling in line with industry wishes in 2012, the American Dietetic Association changed its name to the Academy of Nutrition and Dietetics but kept on taking millions of dollars every year from processed junk food meat dairy soda and candy bar companies. By the way this Association or Academy is the one involved when you see “registered dietitians.” It is a closed circle, as you can see.
In closing this bittersweet tale, here are what one authority considers the top 11 biggest lies of the food industry (be sure to read the detailed explanations).
  1. Low-Fat or Fat-Free 
  2. Trans Fat-Free 
  3. Includes Whole Grains
  4. Gluten-Free
  5. Not That Much Sugar
  6. Calories Per Serving
  7.  Fruit-Flavored
  8. Small Amounts of Healthy This and That
  9. Calling Harmful Ingredients Something Else
  10. Low-Carb Junk Foods
  11. Zero Calorie Beverages
For the possible conspiracy enthusiasts among my readers . . .


The American Way of Health; The Links Between Big Pharma, the Medical-Educational System, Agribusiness, and the Food Industry

Part Two. Wooing New Graduates of Medical Schools and Practicing Physicians

 In this post the number of similar articles in both popular and medical literature is copious and the length threatens to grow excessive. For this reason, I encourage the reader to treat the linked articles not just as academic citations, but as further recommended reading. Beyond this, it hardly seems necessary to do more than let a small sampling of words from reports and exposés speak for themselves. The samples are presented in chronological order.

The Truth About the Drug Companies: How They Deceive Us and What to Do About It. (Book, 2005)

 

Dr. Marcia Angell, of the Harvard Medical School, wrote The Truth About the Drug Companies: How They Deceive Us and What to Do About I in 2005. Angell joined the editorial staff of The New England Journal of Medicine (NEJM) in 1979. She served as interim Editor-in-Chief after the resignation of the former editor over a controversy. She was a finalist for the permanent post of Editor-in-Chief, but withdrew as a candidate explaining she was retiring to write a book on alternative medicine.
In the January 15, 2009 issue of The New York Review of Booksshe wrote an article titled, DrugCompanies & Doctors: A Story of Corruption.” A single paragraph best sums up her writing. “It is simply no longer possible to believe much of the clinical research that is published, or to rely on the judgment of trusted physicians or authoritative medical guidelines. I take no pleasure in this conclusion, which I reached slowly and reluctantly over my two decades as an editor of The New England Journal of Medicine.
$$$$$$$$$$$$$$$$
HarvardMedical School in Ethics Quandary (March 2, 2009) [Just One School’s Example]
 The students argue, for example, that Harvard should be embarrassed by the F grade it recently received from the American Medical Student Association, a national group that rates how well medical schools monitor and control drug industry money. . . . Under the school’s disclosure rules, about 1,600 of 8,900 professors and lecturers have reported to the dean that they or a family member had a financial interest in a business related to their teaching, research or clinical care. The reports show 149 with financial ties to Pfizerand 130 with Merck.”
If you think things may have improved since 2009, see “The Pharmaceutical Industry’s Role in U.S. Medical Education” below.

$$$$$$$$$$$$$$$$
How Corrupted Drug Companies Deceive and Manipulate Your Doctor (May 18, 2010)
After pointing out how heavily the National Institute of Health (NIH), the second-highest funder of drugs studies, is influenced by pharmaceutical money, this articles lists and explains in detail the biases found in medical journals. Since reading medical literature would seem to be an important part of a medical education, understanding these biases seems important. [The blog reader is encouraged to read the details of each of these items below plus what is likely to happen to any doctor who speaks out about them.]
Bias #1: Unwanted Results Are Not Published
Bias #2: Bad Results Are Submitted as Good
Bias #3: A Favorable Study Is Submitted Multiple Times
Bias #4: Follow-Up Reviews Done by Biased Experts
Bias #5: Ghostwriting
Bias #6: Journal Bias
Bias #7: Drug Companies Masquerading as Educators  
$$$$$$$$$$$$$$$$

Getting ‘Em Early: Pharma Reps Give Gifts to Most Medical Students (February 26, 2013)

 

. . . . more than half of medical students end up receiving gifts from pharmaceutical representatives by the end of their fourth year, according to an upcoming study.” 
$$$$$$$$$$$$$$$$
BigPharma Influencing Med Students and Doctors (November 6, 2014)

The collaboration between industry and academics is needed, but when does legitimate financing cross over into biased teaching, manipulated medical journals and untrustworthy prescriptions?” This article says that happens when the partnership between the two puts consumers in danger.
“In 2006, the New England Journal of Medicine, known as the best medical journal in the world, published a report that compared three diabetes drugs.” Their conclusion was that GlaxoSmithKline’s new drug Avandia was the best. Not one mentioned at the time was that all of the authors of this report (11) got money from GlaxoSmithKline or any possible safety concerns. Four of them actually worked for that company. “100,000 patients suffered heart attacks blamed on Avandia.” Lawsuits are still being processed.
$$$$$$$$$$$$$$$$

The Pharmaceutical Industry’s Role in U.S. Medical Education (April 3, 2016)
The Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure stated that “diuretics and beta-blockers are the preferred choice for initial hypertension drug therapy” in 1993. From 1992 to 1995, diuretic prescriptions dropped by 50% and beta-blockers by 40%. Calcium channel prescriptions increased by 13%. Care to take a guess why this was? Perhaps because the pharmaceutical industry put $14 billion into marketing a new type of drugs, calcium channel blockers. Although these were described as “heavily-promoted, expensive, newly developed hypertension treatment” by 2001, one of the calcium Channel blockers, Norvasc,was among the top 5 selling drugs of any kind worldwide.
Medical students are prime targets for the pharmaceutical industry. “Medical students’ exposure to pharmaceutical marketing begins early, growing in frequency throughout their training.” Through gifts like free meals, textbooks and even drug samples, drug companies implant their message. “Forty to 100 percent of medical students reportexposure to the pharmaceutical industry, with clinical students being more likely than preclinical students to report exposure. The number of students recalling over 20 exposures to marketing rose from 33.3percent to nearly 72 percent as students entered their clinical training.”  

Next: Part Three. Agribusiness and the Food Industry.


The American Way of Health; The Links Between Big Pharma, the Medical-Educational System, Agribusiness, and the Food Industry


The title of this blog series draws from Jessica Mitford’s The American Way of Death published in 1963. The description on Amazon.comgives a preview of the approach this post will take.

“Before the turn of the century, the American funeral was simple “to the point of starkness,” says Jessica Mitford, the acclaimed muckraking journalist who published this investigation of the country’s funeral business in 1963. That the country went on to develop a tendency for gross overspending on funerals Mitford puts down to the greed and ingenuity of undertakers, whom she regards as salesmen guilty of pressuring families into agreeing to their excessive standards for burial.” 

Part One: Big Pharma (aka the Pharmaceutical Industry)

As it might be viewed by those who have fallen victim to the American way of profiting from drug sales, the growth of pharmaceutical companies can be viewed either as an example of unintended consequences or the result of intelligent design by a global conspiracy.

For example, in 1900, Pfizer, now one of the largest pharmaceutical, filed an official certificate of incorporation in the state of New Jersey, with authorized capital of $2 million divided into 20,000 shares of $100 each. In 2008, Pfizer had sales of $20.5 billion. The real value of that $2 million in 2008 dollars would be $137 million, but the sales alone in 2008 were 145 times that number. The latest revenue figures for Pfizer were $51.6 billion. How, you might ask, did a company become so big over the past century? It certainly is not just inflation!
The beginning of the answer lies in a particular action of the United States Government. In 1940, Pfizer was one of the smaller existing drug companies in America. Then came the war years. In 1941, the government contracted with a number of drug companies to produce penicillin for soldiers. Of these companies, Pfizer was the only one that used fermentation technology. Investing millions of dollars, Pfizer’s senior management put their own assets as Pfizer stockholders at stake to buy the equipment and facilities needed for the novel process of deep-tank fermentation. In just four months, Pfizer was producing five times more penicillin than originally anticipated.
Compare the growth in sales and net income from 1940 to 1950 for two of the companies involved in penicillin manufacture (Source: Moody’s Stock Survey 1947-1950):
Pfizer Inc.:
Merck & Co., Inc.
Sales (Million)
Sales (Million)
1940 – $7.0
1940 – $23.8
1941 – $10.3
1941 – $39.6
1942 – $11.4
1942 – $43.5
1943 – $16.7
1943 – $57.9
1944 – $24.4
1944 – $52.8
1945 – $27.5
1945 – $55.6
1946 – $43.6
1946 – $61.5
1947 – $39.2
1947 – $68.3
1948 – $47.7
1948 – $72.9
1949 – $47.5
1949 – $73.6
1950 – $60.8
1950 – $94.1
Net Income (Million)
Net Income (Million)
Pfizer, Inc.
Merck & Co., Inc.
1940 – $1.1
1940 – $2.5
1941 – $1.1
1941 – $3.2
1942 – $1.3
1942 – $2.8
1943 – $1.8
1943 – $3.6
1944 – $2.3
1944 – $2.2
1945 – $1.8
1945 – $2.3
1946 – $10.6
1946 – $6.0
1947 – $9.3
1947 – $6.3
1948 – $9.6
1948 – $8.5
1949 – $7.8
1949 – $7.0
1950 – $9.9
1950 – $11.3
Penicillin gave drug companies the start, but it took a lot more for them to get to the current level of income and profits. Some things that helped were spending millions of dollars on lobbying, getting useful control of the agencies that set threshold standards for specific diseases such as diabetes, wooing new graduates of medical schools and practicing physicians to prescribe their products and literally inventing new diseases.
Pfizer and Merck are not alone in these practices; these companies are used only as examples. The largest company, Johnson & Johnson, spends twice as much on sales and marketing (including lobbying) than on Research and Development—$17.5 billion compared to $8.2 billion.
Sales in billions USD for top pharmaceutical companies in the US (2004-2008)
Company
2004
2005
2006
2007
2008
Pfizer
31.1
27.3
26.8
23.6
20.5
GSK
19.1
20.2
22.2
20.7
18.4
AstraZeneca
11.5
12.7
14.7
15.5
16.3
Johnson & Johnson
16.7
16
16.1
16.3
16
Merck
15.3
15.4
16.7
17.6
15.5
Amgen
9.6
11.9
14.5
14.3
13.4
Hoffman-La Roche
6.2
8.2
10.4
12.4
13.1
Novartis
11.5
12.9
13.9
13.9
12.4
Lilly
8.2
8.7
9.2
10.3
11.4
Sanofi-Aventis
10.2
11.2
11
10.9
11
Total, Top 10
139.4
144.5
155.5
155.5
148
Total, US Market
239.9
253.9
276.5
287.6
291.5
Source: Standard & Poor’s Industry Surveys Healthcare 2009: Pharmaceuticals
Lobbying
What does it take to make an industry like pharmaceuticals successful given government regulation (Food & Drug Industry)?  In one word, MONEY.
Control the Standards for Disease Treatment
1.      The U.S. Preventive Services Task Force (USPSTF)

As self-described on their Web site, the USPSTF is an independent, volunteer panel of national experts in prevention and evidence-based medicine. The Task Force “works to improve the health of all Americans by making evidence-based recommendationsabout clinical preventive services such as screenings, counseling services, and preventive medications.” Supposedly free of influence by commercial interests, each member must disclose any such involvement. These reviewed by task force chairs and a determination made as to what restrictions should be placed on the members’ eligibility in specific actions. Three levels of disclosures (potential conflicts) exist—Level 1, 2, or 3, described on the USPSTF site (Emphasis in bold below added by this blog poster):

Level 1 disclosures include nonfinancial disclosures that would not affect the judgment of a Task Force member. These disclosures do not require any action.

Level 2 disclosures include financial disclosures of $1,000 or less and nonfinancial disclosures that are relevant to a topic but not anticipated to affect the judgment of the Task Force member for that topic. These disclosures are announced at the Task Force meeting, but do not limit the Task Force member’s participation in the topic process.
Level 3 disclosures include financial disclosures of a larger amount and significant nonfinancial disclosures that may affect the Task Force member’s view on the topic. Actions for Level 3 disclosures vary according to the nature of the conflict, and may include preventing the member from serving as lead of a topic or on the workgroup of a topic, preventing the member from serving as a primary spokesperson for a topic, or preventing the member from taking part in all topic activities. As all new Task Force members are reviewed for conflicts prior to joining the Task Force, Level 3 disclosures are extremely rare. 
Examples of Level Three Disclosures on the part of some current USPSTF members:
·        Kirsten Bibbins-Domingo:
·        Topic(s): Statin Use for the Primary Prevention of Cardiovascular Disease in Adults, Screening for Lipid Disorders in Children and Adolescents
·        Date of Disclosure:May 2015
·        Action: Dr. Bibbins-Domingo will not participate in the topic workgroup but may discuss and vote on the topic.
·        Francisco Garcia:
·        Topic(s): Screening for Cervical Cancer
·        Date of Disclosure:March 2016 
·        Action: Dr. Garcia will not participate in the topic workgroup. He may discuss the topic during topic deliberations but will be recused from voting.
·        Michael P. Pignone:
·        Topic(s): Aspirin Use for the Primary Prevention of Cardiovascular Disease and Colorectal Cancer
·        Date of Disclosure:January 2014
·        Action: Dr. Pignone may participate in the topic workgroup but will not be the primary lead. He may discuss and vote on the topic.
Readers may draw their own conclusions about panel objectivity.

2.     Health-Related Societies
Example: Diabetes and the American Diabetes Association
A reporton an article in the British MedicalJournalhad the following to say about diabetes and politics. Until the late 1990s, what is now called “pre-diabetes” was known as “impaired glucose tolerance.” Surprisingly, some 30 percent of those who failed the first test for this condition ended with perfectly normal results on a repeat.
The World Health Organization (WHO) lowered the criteria for diabetes in 1999. A year before this, the American Diabetes Association (ADA) recommended a similar reduction. Now you were diabetic with a fasting blood glucose level greater than or equal to 126 mg/dL (milligrams per deciliter). What before was simply an intermediate level was now called “impaired fasting glucose.” You fell in this category with a fasting blood glucose level of 110-125 mg/dL.
Then, in 2003, the ADA lowered the impaired level to 100 mg/dL. No other agency followed that step. Some experts noted the expansion at least doubled the number in the impaired category. Always seeking to improve health (even if in the process the drug companies got richer and the health organizations gained influence, a new test, HemoglobinA1c arrived in 2009.  Instead of an immediate read of current glucose level, HbA1c measured the effect over approximately the most recent three months, although somewhat weighted to the past two weeks. Now WHO said people with levels of HbA1c greater than 6.5 percent were diabetic. The intermediate or pre-diabetes level became 6.0 percent. More diabetic customers!
Finally, within a year, the ADA on its own, with no support from any other group, dropped the threshold for pre-diabetes to 5.7 percent. As a result of these changes, based on the ADA definitions, about one-third of adults between 20 and 65 are pre-diabetic and half of the adults older than 65 are in that category. We are talking about a potential market of more than 86 million people for treatment with a drug like Metformin that might prevent an unknown number of cases of Type 2 diabetes from developing! 
But, as authors John S Yudkin and Victor M Montori explain in depth, “a pre-diabetes diagnosis offers little value.” As previous research showed, half of people identified with “impaired glucose tolerance” and about two-thirds of people identified with “impaired fasting glucose” will not be diabetic 10 years later.  It seems that borderline HbA1c levels are no better at predicting who will and who won’t develop diabetes.
By this point, an announcement on an ADAWeb page headlined “Long-term Follow-up of Diabetes Prevention Program Shows Continued Reduction in Diabetes Development,” June 16, 2014should come as no surprise. The content notes that, “the study’s two interventions, a lifestyle program designed to reduce weight and increase activity levels and the diabetes medicine metformin (emphasis mine), decreased the development of type 2 diabetes.

Of course, significant beneficiaries of the new recommendations are the pharmaceutical companies. Their potential market suddenly got a lot larger. As one onlinesource notes, “It’s a good time to be a diabetes drug maker. The top 10 companies producing diabetes meds raked in about $62 billion in global sales in 2014, up 5.1% from the previous year. This is according to a report from data analytics firm GlobalData which says Novo Nordisk ($NVO), Sanofi ($SNY) and Merck ($MRK) lead the pack, posting solid gains for their products as they compete for a piece of a rapidly growing market.”
Just for metformin alone (and there are other similar drugs), 2013 salesby Merck and Bristol-Myers Squibb totaled $498 million. But wait! There is now research the metformin may extend life in non-diabetics! An entire new market! Although metformin is now remarkably cheap—as little as $.29/pill from online pharmacies, if you sell enough of anything, no matter how cheap, you can make a lot of money.

Next: Part Two. Wooing New Graduates of Medical Schools and Practicing Physicians