Silver Bullet Award for dangerous drug promotion

When I saw recently that Simon Singh,  energetic “quack buster “ and scourge of  homoeopaths, chiropractors and their ilk, had established an award called the Golden Duck to be presented to the person who had “supported or practised pseudoscience in the most dangerous or irresponsible manner” , my first thought was: How unfair! 
 
 What about all those major league pseudoscience practitioners promoting dangerous and/or ineffective drugs, supported by dodgy or invisible data? Shouldn’t we also have the chance to point the finger at them too? 
Having read Ben Goldacre’s excellent new book Bad Pharma – not to mention written two of my own – that set out exactly how pharmaceutical companies can, and do, accentuate the positive and eliminate the negative results in drug trials, I was well aware of just how many candidates there were in need of recognition.
The obvious thing to do was to set up a rival award, a sort of Oscars to Singh’s BAFTAs, but first I had to make sure the playing field was level. Since the duck denotes quackery, I checked that the definition of quackery – restricted by Singh and his allies to CAM (complementary and alternative medicine) – also applied to drugs and other medical products. Here’s a definition from the mainstream medical site – Medicinenet.com : “Deliberate misrepresentation of the ability of a substance device ….to prevent or treat disease.”
Aggressive promotion and quackery
That’s a pretty clear description of such common practices as hiding unfavourable drug results or continuing to prescribe them even though trials have shown them to be dangerous or ineffective. And here is Wikipedia’s explanation, which also seems right on the button: “… quackery’s salient characteristic is aggressive promotion (“quacks quack!”).” Promotion doesn’t get much more aggressive than the multimillion dollar marketing budgets available to drug companies.
The Silver Bullet seemed a good name – sense of fantasy from its use on werewolves and from the implied promise that this will hit the target and sort out the problem.  To be awarded to the company, product or medical device demonstrating the most blatant “aggressive promotion” or “deliberate misrepresentation”.
The Golden Duck is officially awarded by a self-congratulatory sounding group set up by Singh called “The Good Thinking Society”, which has proved remarkably unimaginative in its choices. Winner was Andrew Wakefield who was found guilty of serious professional misconduct by the GMC (General Medical Council) two years ago, while runner-up Prince Charles has been out of the CAM picture even longer.
Busy confiscating water pistols
If CAM quackery is so widespread and harmful, it’s curious that another of Singh’s groups – The Nightingale Collaboration, whose members have been enthusiastically reporting CAM practitioners to the Advertising Standards Authority for making unjustified claims – have been unable to come up with anyone more active or up to date.  The great thing about the Silver Bullet is that there is no shortage of candidates who are both.
The Golden Duck is a distraction from real and deadly quackery that is all too common. If Singh were put in charge of cutting the high school death toll from America’s gun laws, he would be busy confiscating water pistols while ignoring the loners wandering the corridors with high velocity assault rifles.
So please let me know which of these you’d like to see given the bullet and do send in your own suggestions with supporting details because I plan to have another awards round soon – I’ve got at least another half dozen already.
1) Aggressively promoting drugs
Companies can greatly increase sales by illegally promoting drugs to treat conditions for which they don’t have a licence i.e.  without proper evidence that they are effective for that disorder. Last year alone in America Abbott Laboratories agreed to pay $1.6 billion for illegal marketing of its anti-seizure drug  Depokote, GlaxoSmithKline paid a, so far, record $3 billion for illegal marketing of the diabetes drug Avandia along with several others, while Johnson & Johnson was ordered to pay $1.2 billion for violating consumer protection laws in the way it promoted its anti-psychotic drug Risperdal.  This would have to be a joint award.
2) Misrepresentation of patented memory pill.
Aricept is the only drug licensed to treat Alzheimer’s but the patent on this two billion-a year seller ran out in 2010. Pfizer and the Japanese company Eisai persuaded the FDA to grant them a valuable 3-year patent extension with a so –called “new” version – Aricept 23. The only thing new was the dose – 23 mgs per pill rather than the 5 or 10 mgs in the old version. A BMJ investigation found the benefits were minimal but the side-effects were significantly increased.
3) Sleeping pill scandal surfaces – again
For at least twenty years the doctors have known you can easily become addicted to benzodiazepines – tranquilizers and sleeping pill with names like temazepam, valium and Sonata. Guidelines say they should only be taken for a week and only in cases of serious trauma. Yet 18 million and rising prescription are written for them every year and an estimated 1.5 million people are addicted. It is almost impossible to get any help withdrawing. Recently angry campaigners met with the British Medical Association to try yet again to put an end to this dangerous and evidence-free prescribing.
4) Claims backed by invisible evidence
This is probably the best known scandal but is such a blatant case of hiding data it is worth including. Back in 2009 the NHS spent £500m on Tamiflu (oseltamivir) a drug that was supposed to reduce your risk of getting swine flu and if you did catch, to reduce its severity. But when scientists from the Cochrane Collaboration (a charity that assesses whether a drug is worth taking) asked the manufacturer to see all the trial data, Roche refused and is still refusing three years later. There have been at least 123 trials of Tamiflu yet over half the data about how patients actually responded still hasn’t been published. The Cochrane scientist suspect effectiveness has been exaggerated and serious side-effects downplayed.
5) Licensed antidepressant no better than placebo
Reboxetine is an antidepressant, whose manufacturer Pfizer has also been playing hide-and-seek with the evidence. In England alone the NHS spent a million pounds on this drug in 2004 and a bit less – £740 thousand in 2011. The drop may have had something to do with the fact that in 2010 a German equivalent of the Cochrane Collaboration (the IQWIG) eventually managed to get to see all the trial data and found that out of seven trials comparing it with a placebo only one had found it was more effective.  The positive one that got the licence was the only one published, the rest had remained hidden. ( Bad Pharma – Ben Goldacre. 4th Estate.) This was also the one reporting the fewest side effects, the hidden ones showed the drug to be more harmful. Remarkably in 2011 the UK drugs watchdog – the MHRA – declared it was OK to continue prescribing Reboxetine because the “benefits outweighed the risk”.
The cumulative effect of distortions like these are huge and make it impossible to make sensible decisions about treatment as well as damaging hundreds of thousands of patients. Do vote, putting your votes in the comment box below. The choices are as follows:
1) Aggressive promotion: GSK and Abbots and Johnson & Johnson.
2) Misrepresentation Aricept 23 (Pfizer and Eisai)
3) Sleeping pill scandal – BMA
4) Invisible evidence – Tamiflu (Roche)
5) Selling a Placebo – Reboxetine (Pfizer and MHRA)
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Comments

  1. Paul Burnett says:

    Excellent idea of ‘The Silver Bullet Award’, but the question has to be what long-term punch the award may give. Identifying the best targets for official complaint to the Advertising Standards Authority (ASA) is my recommendation, followed by large-scale letter writing to MPs and the Dept. of Health if the ASA fails to act.

    With that in mind, wouldTamiflu and Reboxetene be amongst the places to start? The ASA may well attempt to throw it all on the MHRA: so linking in that MHRA have, you say, already failed to act would appear beneficial.

    I hope that others will wish to develop this plan further.

  2. Difficult to choose really – its all pretty disgusting. I suppose the aggressive marketing (1) for sheer scale might be my top pick overall.

  3. carol whittle says:

    No 1 gets my vote. However, it is a pity we can’t make all five joint winners. Keep up the good work.

  4. veronica says:

    Yep No 1 has my vote, although No 4 is close

  5. Gill Clark says:

    I vote for tamiflu.

  6. Difficult to choose between such a dispiriting display, but I’ll go for number 4 – Tamiflu. When thousands of perfectly reasonable health claims on foods and food ingredients are being rejected despite the existence of good evidence in their favour, it’s amazing that a drug like Tamiflu is promoted as a wonderful flu treatment on the basis of wafer-thin and hidden evidence. The world is upside down!

  7. A brilliant initiative. I vote for 1) – aggressive promotion.

  8. Has to be No1 on sheer scale alone!

  9. How about Vioxx for silver bullet? 88-139,000 heart attacks with an estimated 30-40% dying.

  10. I vote for 4) Invisible evidence – Tamiflu (Roche)

    • I made an observation ydsaerety. You know how your parents always tell you to take a shower every day and wash your face to stay clean and healthy. Well it is true, but I noticed that whenever most people wash there face that have acne break out or for that matter have pimples. Like if you worked out really hard and sweated and didn’t wash your face for a couple of days or more your face actually starts to clear up! So I did a little research on Sebum. I found out that Sebum forms part of oil that coats the skin. Sweat, lipids and environmental dirt are other ingredients of the oil on the skin. This oil protects skin from BACTERIAL INFECTION(ACNE!). It also reduces the natural water loss from the skin(WRINKLES). I thought to myself WOW!! Could it be that were actually causing our own problems!! I realized then that washing your face actually washes away the good oil(sebum) and causes more sebum to come back even more.. but after that wash of the face you remove that skin protection!I asked my wife who has beautiful clear skin without ever getting acne if she ever washed her face or put anything on it. She told me that she never puts anything on her face and never washes her face with water. The only time it gets wet is maby from washing her hair or from going swimming in the lake. I am pretty convinved that peoples own sebum might actually be the cure for our acne. If we keep washing our face we are removing that protective oil on our skin, then it comes back even more oily and aggravates the bacteria that has formed because of the last washing of the face wich removed that sebum protection.Ok then why does the pores get blocked?

      • Not a skincare expert myself although I never use soap except for hands and hair, but it sounds plausible. There are also those who claim that the same idea works for your hair. Don’t shampoo and after about two weeks it will adjust itself and natural oils will mean no conditioning or washing needed. Never tried it myself but suspect you need some tolerant friends while you shift to the new natural look

  11. Colin Hunter says:

    I vote for the joint award of Abbott/Glaxo/Johnson.
    Thanks for your work on this unmasking!

  12. Sonja Muller says:

    Great initiative! For me the vote goes to no. 1 for aggressive promotion of drugs that no one needs. I am thinking especially of the HPV vaccines which are aggressively pushed on young girls. The benefits are highly disputable but the side-effects devastating.

  13. I’d go for no 1 – especially in relation to GSK’s illegal promotion of Avandia. GSK paid out 3 billion to avoid a full-blown fraud charge. Imagine what the public might have felt when their docs prescribe meds made and supplied by a convicted fraudster…..as it stands this is incredible yet not widely acknowledged quackery.

  14. Jennifer Symonds says:

    Selling a Placebo- Reboxetine

  15. Gill Pyrah says:

    Well aimed bullet. Fire!

    • I know this is a silly question for a guy who is 15but I don’t want to have wknirles as I grow olderI don’t want to grow up lolWhat are some things that can make skin wrinkle less or can cure wknirles?I hate botox I don’t want my face to sag after 5 yearsI want healthy wrinkle less natural glowing skin I know nothing can stop it around 50 =(I have lines under my eyesand I have lines on my cheeks after I smileand tiny thin line above my forehead when I open my eye wide.O-0I’m very expressive for example I met an Asian who looked 13 but after finding out she was 25 I wanted to ask her what her secret was to such healthy glowing wrinkle less SKIN! But I didn’t want to meddle around into her personal business.Unless it was makeup and botox lolwhat do I have to do?heres what I concluded1.Exercise2.Eat fish3.Drink Green Tea4.Eat a lot of veggies such as tomatoes and bell peppers5.Eat fruits such as strawberries, blueberries, raspberries6.And 8 oz of water very day more if I wanted8.Drink milk9.Limit my exposure to sunlight10.Don’t experiment to much on products such as proactive use natural and organic things from the ground on face.11.Use moisturizer after cleaning face.12.Don’t eat carbs [bread pasta muffins]13.Open pores by setting face over streaming water and wash face.14 After washing face get an ice cube let it set until clear as water and rub on face.15.Use lemon and apply on face.What else can I do??Have any suggestions??

      • Best thing to do when you are 15 is to revel in the fact your skin is great right now have lots of frightening/exciting/funny/sexy experiences and put any thoughts about it in a box marked “To think about a lot later.” But if you must, your top 13 tips are all very sensible (although done too conscientiously could seriously interfere with your fun regime) except for the sun one – you need about 20 minutes a day to get enough vitamin D and is well worth the trade-off of a few more lines.

        However if you want to get serious about it here are the first couple of paragraphs of the Skin Secret in my book “10 Secrets of Healthy ageing”. Get copy on Amazon or even better if you want to register your protest at their tax evasion support a bookshop.

        “Your skin is a remarkable thing. Weighing in at around 5kg (11lb) and with a surface area of area of 2m2 (22ft2) it is the largest organ of the body – and it is constantly renewing itself. The outermost layer of dead cells is sloughed off and replaced every month. Like all frontiers, it has to keep out invaders – such as micro-organisms and pollutants – and keep vital resources in. But at the same time it must allow warmth to flow in and water for cooling to be sweated out, while simultaneously working as a vast sensory organ for touch.
        [PI]As we get older, another of the skin’s special features becomes all too obvious. The skin is the external representation of the processes of ageing going on within. It reflects our gradual decline, starting at about the age of 25 when the replacement of old cells begins to slow down. By 45 the skin is thinning, partly due to hormonal changes, and so it becomes more fragile and vulnerable to damage.

        “Not so long ago, the general belief was that the sagging, wrinkling and loss of plumpness was an inevitable part of ageing and that there was little you could do about it. But now we know that, just as you can help interior processes to age more healthily, so you can slow down the visible signs of decline your skin reveals, by understanding its specific nutritional needs. As well as explaining how you can slow down natural ageing, we’ll show you how to reduce the harmful external effects and how you can undo some of the damage that has already occurred.”

  16. 1) Invisible evidence – Tamiflu (Roche)
    2) Selling a Placebo – Reboxetine (Pfizer and MHRA)
    3) Aggressive promotion: GSK and Abbots and Johnson & Johnson.
    4) Misrepresentation Aricept 23 (Pfizer and Eisai)
    5) Sleeping pill scandal – BMA

  17. I vote no .5 – Reboxetine

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