John Abramson – Overdosed America, The Broken Promise of American Medicine

Jonathan: Hey everyone Jonathan Bailor back with another bonus Smarter Science of Slim podcast. Today is nothing sort of a blockbuster show. A hard hitting subject from an awesome, awesome man, author, professor, and doctor, something that I know got to get home for all of us if not personally, someone in our family. Let’s just get ride into our guest today. Dr. John Abramson served as a family physician for over two decades. He’s been on the faculty of the Harvard Medical School for fifteen years where he’s taught primary care and currently teaches health care policy.

He’s also served seven years as the chairperson of the Department of the Family Practice at Lahey Clinic at Burlington Massachusetts. He consults as an expert in litigation involving the pharmaceutical industry and served as an unpaid consultant to the FBI and the Department of Justice. Therein you can see why we have him on the show because of his insights into the pharmaceutical industry and specifically in authoring the wonderful book: Overdose America, the Broken Promise of American Medicine.

Dr. Abramson drove on his background and statistics epidemiology and health policy to reveal the ways in which drug companies have misrepresented statistical evidences, mislead doctors and compromised our health. However the good news which we will get into today is the best scientific evidence shows as we know that reclaiming responsibility for our own health is far more effective than the latest blockbuster drug. Dr. Abramson welcome to the show.

John: Jonathan it’s a pleasure to be with you today.

Jonathan: Dr. Abramson let’s start from the very very beginning. Obviously you wrote Overdosed America, it’s a wonderful book. You’ve got five stars on Amazon. It’s blowing the roof of things that a lot of us would never even fathom. What started you on this journey to dig on what’s going on the pharmaceutical industry?

Jonathan: That’s a great question Jonathan ’cause it’s really an unplanned journey. I was a family doctor and quite happy as a family doctor and was teaching a course at Harvard Medical School to medical students about mind body medicine, healing and spirituality. In that course, I was trying to help medical students understand that being a good doctor requires being in two metaphysical frameworks at the same time. The frameworks of science where you look at the external world objectively and measure it and test it and the metaphysical perspective of subjectivity or soulfulness or consciousness or spirit.

I was trying to help medical students who just get barraged with science and learn the implied view of reality that the science is really the truth with science and learned the implied view of reality that science is really the truth and subjectivity or soulfulness is a very secondary love of reality and secondary concern in health care. I was trying to explain to medical students that to be a good doctor, you have to work in both realms simultaneously. It’s almost never that good medicine is practiced entirely in the scientific realm or entirely in the inter-subjective realm.

As I was granted myself a year leave for my practiced to write a book that would help medical students to understand this I got into the data in the FDAs website about the arthritis drug Vioxx. There was an article on the journal of American Medical Association that wasn’t a particularly strong article but had a foot note that brought me into a website within the FDA that you couldn’t possibly find on your own that shows that the arthritis drug Vioxx which was a huge blockbuster drug was really a killer drug.

In fact that it was killing approximately forty thousand Americans. Almost as many Americans died in the Vietnam War under the guides of being a safer drug because of fewer gastrointestinal complications. It was really causing far more heart attacks and strokes and blood clots. When I understood that I tried to explain to my colleagues, to the press, to television, to magazines that the information that doctors had about Vioxx was not correct. The information that had been published in one of our most prestigious medical journals was not correct. People just couldn’t accept that that might be true.

They thought I was nuts and when I couldn’t get that story out and had been trained to understand research and statistics epidemiology and knew that this facts were true I decided to leave that first book about helping medical students to understand that treating their patients as people are important and switch books which lead to Overdosed America to explain to people that information upon which even the best doctors were lying to make a medical decisions is tainted and has no more integrity than the advertisements you see TV.

Jonathan: Dr. Abramson that is such a powerful message and when we step back and we think about this is not an evil empire type thing it’s just there are companies their job is to make money. Their job is not to help us run in fields and play on the beach as the commercials would advertise their job is to make money and it seems as though sometimes this pursuit of making money comes at the expense of our health rather than at the benefit of our health. Is that correct?

John: That’s absolutely true. There are really two wishes involved here. One is that as a society we very quietly make the decision in the 1970s and 80s to privatize the production of medical knowledge. Prior to mid-70s most researchers, medical researchers wanted to do research could apply for the grant of National Institutes of Health and more often than that funded and able to do research based on the health consequences of the issue and question. What happened is that the funding, the public funding for clinical trials got radically cut starting in the late 70s and then when President Raegan took off in 1980 with the mandate to downsize government and a bad economy, the funding for clinical trials of DNH got radically cut.

During the years between 1977 and 1990, the funding for clinical trials by private industry, by the pharmaceutical industry went up six fold. We did in changing the way medical science is funded is we changed the fundamental purpose of medical science without acknowledging that that happened. Instead of medical science being a public good whose fundamental mission is to figure out how best and most effectively and efficiently improve the public’s health we made that transition that you referred to where medical science became a tool for corporations to achieve their fiduciary goals which is to make money not health.

That’s one issue is the purpose of our medical knowledge changed though the structures that over see the integrity of medical knowledge didn’t changed commensurately so that the oversight of this research was solely lacking. Much like the oversight of mortgage back security that cause the economic crisis a few years ago. Step one is that the fundamental fiduciary purpose of medical knowledge changed when the funding was privatized. Now step two is that there’s is law breaking going on.

It’s fairly common place now for scientific research to be misrepresented in an unlawful way and the problem is that our legal system is not structured in a way that has penalties that create a disincentive to break the law. Even in the worst drug debacles the drug companies haven’t yet lost money and nobody’s gone to jail. The example of the kind of law breaking that’s going on, I testified, there was a six week trial Kaiser Health Systems sued Pfizer, the biggest the drug company in the world for fraudulent, for fraudulently misrepresenting scientific evidence about its drug Neurontin.

Kaiser alleged in this lawsuit that it purchased forty seven million dollars’ worth of Neurontin based upon fraudulent misrepresentation by Pfizer and wanted its money back. This trial lasted six weeks in Federal court, I testified for a day and a half in this trial. And the jury in Federal court, this is 2010, found that Pfizer, the world’s largest drug company was not only guilty of fraud but was guilty of racketeering violations, rico violations. The biggest drug company in the world was found guilty in Federal court of racketeering violations, the law that was made to constrain, organized crimes activities.

Unfortunately very few people know this happened. So that the tower of the finding of the jury that the biggest drug company in the world was guilty of fraud and racketeering has not had an impact on the public consciousness either in health care consumers or in doctors as a huge red flag warning that the integrity of what we believe to be our medical knowledge can no longer be trusted.

Jonathan: Dr. Abramson I appreciate you bringing this message and dedicating your life to educating us on this because I can imagine there’s been some blow back and I want to get into that but before we do I want to give a quick disclaimer. Maybe not a disclaimer but sometimes people hear things like this, oh conspiracy and they tune out. Folks would just really back up, remember our guest today is Dr. Abramson, he is a clinical faculty member of the Harvard Medical School. He is an unpaid consultant to the FBI and to the Department of Justice.

His recent academic article titled Clinical Trial Data is a public good, was published in the journal of the American Medical Association last year 2012. And of course the author of the book Overdosed America. I mention that only because it’s not a conspiracy theory. If you look at our society, our culture, how sick we are, how we believe sickness is just the new normal. We believe that it’s just standard care to get older and have to take all this medications and to feel terrible. Something horribly wrong has to be going on for us to think that’s normal.

What Dr. Abramson I believe is doing such a good job explaining this one element of how broken the system is that has yielded the population that has a 100,000% increase in the rates of diabetes. That sees over two thirds of us being overweight. Over 40 million of our children are at the age of five are being overweight. It is a very broken system, it’s not a conspiracy. Dr. Abramson, great guy. Thank you for your work. Keep going, keep going, tell us more.

John: Well thanks. Alright let’s keep going exactly what you are talking about. There’s an article in the journal American Medical Association within the last couple of years that explained why so many Americans are taking blood pleasure medicine. Provided the history of this position. It used to be up until the early 1980s that high blood pressure was considered to above a 160/100 and there were three meetings that were sponsored by the world health organization in the early 1980s that lead to the definition of high blood pressure coming down from 160/100 to 140/90.

Then there were guidelines that were issued to the United States that’s said optimum blood pressure is 120/80. Many people, virtually all doctors will treat blood pressures that are above 140/90 and many doctors will treat those blood pressures down towards the goal of 120/80. That’s the way medicine is practiced in the United States. The truth is, that the three, and this is published in JAMA. The truth is that the three meetings that were held by the World Health Organization in the early 1980s were all sponsored by the pharmaceutical industry and there was not evidenced at that time that treating a blood pressure under a 160/100 provided a clinical benefit.

On an epidemiological basis it’s better to have a lower blood pressure but there was no evidence to getting down there with drugs was beneficial. 140/90 became the law of the land, any doctors who didn’t treat the patient with a blood pressure of a 140/90 became a bad doctor. Then the JNC guidelines, JNC7 guidelines for the treatment of hypertension brought us optimal level down the 120/80 again with no evidence, that drug therapy to get down there was beneficial.

Millions and millions of Americans are taking multiple blood pressure drugs based on the standards that doctors really have to follow because it they don’t and there’s a heart attack or stroke, these guidelines will appear on court on the other side and yet what we’ve down is we’ve taken Americans and we’ve convinced them to focus on the blood pressure and take drugs. Instead to live a healthy lifestyle were exercise is going to add three and a half years to their life and these blood pressure medicines may not add me any years in their life and they actually shorten their life.

What we have done is misdirected the effort of medical care away from helping people to take personal responsibility and actually improve their health to actually drugs that are both expensive and have side effects.

Jonathan: Keep going, keep going. I’m so sorry.

John: Yeah what happens is an expropriation of self-responsibility and self-authority to determine what a good life is. That’s taken over by the medical authority, the medical industry authority, but it’s then over for their purposes not for our purposes and what we need to do to cut the chase is to fold, two things. One is we need to learn that 70% of our health is determined by how we live our lives. We make those decisions and when you are working with your doctor that’s not a matter of numbers.

It’s not a matter of tracings, it’s not a matter of objective science, and it’s a matter of working with somebody you trust to help you take control of your life. That’s number one. Number two is that our medical knowledge is corrupted by corporate influence both legal and illegal. We need a society to confront the fact that when we turn the generation of knowledge over to the market that market has to be properly overseen where it’s going to disturb society.

Jonathan: Dr. Abramson how do we as a society, I mean you really have a nail in the head with the personal responsibility taking back responsibility for health but so often I hear personally that, for example I’m going to continue to eat a certain way because it doesn’t seem having an impact on me now. Even if it does and I become diabetic, there’s a pill for that. It’s almost like the iPad mentality but for our health. There’s an app for that, there’s a pill for that. So we continue to do this behaviors on the pretense that there will be a pill for that in the future maybe not realizing that that is maybe an allergist to putting a splint on a broken leg. How do we fix that?

John: Yeah, it’s not an allergist to put in a splint in a broken leg because a splint in a broken leg works but pills for diabetes do very little to prevent the complications of diabetes, heart attacks, strokes, amputations. The pills do a little bit to prevent eye complications, maybe a little bit to prevent kidney complications but the major complications of diabetes are the cardiovascular complications are not prevented by pills. The myth, we had an interesting ethical question and a societal question. If the pills actually worked and were just a question of taking for the pills, eat all the fat and, saturated fat and whatever trans-fats that you want and just take a pill and fix it.

That would be an interesting social question about who should pay for the pill and so forth. The problem is that the ideal that the pill work is an illusion that is created by the purveyors of medical knowledge who are largely private industry. It doesn’t work. We need to get people to understand that these magic solutions aren’t magical solutions. For example there’s no medical evidence that cholesterol lowering statin drugs benefit high risk women who don’t have heart disease. There’s no evidence to the ideas that oh, I can eat what I want, I don’t have to exercise, it doesn’t matter how much stress I’m under, I can even smoke and I can take a statin pill.

Being a woman, I can take a statin pill and it will mitigate all those risk and I’ll be very happy and I can just go ahead and I don’t have to exercise and to self-discipline or put the energy and to change my habits. It’s just plain false. If it were true it would be an interesting question but it’s false. The scientific data does not show that the statins benefit women who don’t have heart disease.

Jonathan: Dr. Abramson I’m so glad that you brought up smoking in that segment because it seems like we do have a model that maybe more effective and that’s the model we have around smoking. For example there is no I don’t know of anyone yet who continues to smoke based on their anticipation of a medication which will reverse the impact that smoking has on their health and because it maybe because I don’t know, we also don’t recommend smoking in moderation.

We just say that if you smoke these negative thing happen. The way to avoid this negative thing is not to smoke. It doesn’t need to be any more complicated than that. Smoking equals lung cancer maybe to over simplify. If you don’t want to have lung cancer don’t smoke. Don’t rely on medication, don’t do anything else just don’t smoke. Why is it that some of these trans fat, sugar, starch edible products which have shown to be deleterious as smoking is not more, don’t get that same kind of treatment?

John: Yeah that’s a great point. I want to add to what you said when we say there’s nothing good about smoking. If you want to optimize your health, just stop. Another part of being successful is, I work very hard with my smokers as my family doc to get them quick, that was their number one problem, almost always. But it’s very important for people to understand that if you are a smoker, you are addicted to nicotine and you will always be addicted to nicotine.

You can choose to whether smoke or not but you’re always going to be a nicotine addict. Very much analogous to that model of understanding, my name is John and I am a nicotine addict. That when we were addicted to fat and sugars and addicted to TV and addicted to no exercise, it’s very hard to make that transition. We need to understand that we have a physical addiction that we need to overcome. It’s not going to just happen someday when the skies aren’t going to suddenly light up and say okay John, now you going to eat a healthy diet and exercise with no effort.

No, you’ve going to put the same effort in the making of those changes as people who smoke to stop smoking. It’s not easy. We have an enormous amount of inertia and I don’t have any scientific data to show this but I believe that people’s body is addicted to the diet they eat and making a transition is not easy. You going against the tide when you make the transition but with a deep personal commitment and working with a professional who understands you’re not just the challenge of the science but your personal challenge is in what the stresses are in your life and what the psychological baggage that you’re carrying in your life are. People can make these changes now unfortunately the drug industry which is offering a solution for every problem and they’re offering solutions for things that aren’t even problems.

Make this very hard to get the message, the exact opposite message which is now one of personal passivity and being an intelligent consumer of scientific products. It’s taking responsibility for what you do with your body in the world. That’s the way we get the good health. Now let me just say, in the United States we’re spending literally, this is not an exaggeration, a trillion dollars a year of the 2.8 trillion dollars total that we spend on health care. A trillion dollars a year goes to health care that’s either unnecessary or harmful. That’s 50% more than the entire federal budget deficit every year on unnecessary health care.

What we need to do is to understand that this industry is going to consume our society unless we figure out how to take personal responsibility for ourselves and our family members and how unless we figure out how to stop these false messaging that are simply design to extract as much money they can from society rather than improve their health.

Jonathan: Well Dr. Abramson I so appreciate all the years and effort and time that you’ve dedicated to getting that message out and in terms of getting that message out what’s next for you? Obviously your book I believe is in its third edition. Again that book is Overdosed America found it anywhere books are sold. You can also learn about it at overdoseamerica.com but what’s next?

John: What’s next is another book. The book that I’m going to write is about various of what we are talking about here that we’re at a crisis in our society with our health and with the entire direction of how we consume our precious resources in society. We’ve got to understand that the market system, I don’t know a better system than a market system, but if we’re going to work in a market based society there needs to be oversight of the integrity of the information that the experts rely on.

That’s a major problem. I’m continuing to teach and lecture, I continue to work as an expert in pharmaceutical litigation because that’s the only place where the real truth comes out. If you want to know the real truth about the science you need to have access to the corporate hard drives of the companies that sponsored that science. In my work in litigation, I get to be kind of a scientific detective and figure out what happened. Now some of that work I can’t talk about because it remains sealed but some like the Neurontin trial which when a trial actually goes forward in public. Then documents become unsealed then I can talk about it like I talked about it on radio.

So the mission that I have is to try to help people to understand that if they want to improve their own health they’ve got to take personal responsibility. As a society we are now ailing and we’re going to get sicker and sicker unless we can recapture our healthcare system and refocused it on improving our health most effectively and efficiently. If we don’t do that much like the global warming problem as a society we are not going to thrive and we may not, our days maybe numbered. As a society with a middle class the way we used to living in a free America.

Jonathan: Dr. Abramson brilliant, brilliant and thank you folks. His name is Dr. John Abramson. He is a member of the clinical faculty of the Harvard Medical School. He is the author of the book Overdosed America, the Broken Promise of American Medicine. Dr. Abramson, thank you so much for your time today.

John: It’s been a pleasure talking with you Jonathan.

Jonathan: Listeners I hope you enjoy today’s show as much as I did and please remember this week and every week after, especially after hearing what Dr. Abramson has told us today. Eat smarter, exercise smarter and live better. Chat with you soon.