I got to thinking about big pharma’s similarities with big oil reading Fred Pearce’s article in New Scientist this week. It was about plans for a massive pipeline – Keystone XL – to deliver Canadian tar sands to refineries in the Gulf of Mexico.
There were the obvious and familiar dangers – the large carbon footprint, the sands’ corrosive effect on the pipes making spills more likely, threats to the water table – but what caught my eye was his gloomy conclusion that it was virtually impossible to stop.
Not because the dangers weren’t all too real but simply because big oil is so firmly embedded in America’s economic and political infrastructure. A huge delivery system backed up by lobbying muscle in Washington. What he calls “fossil fuel lock-in”. It’s easy to see the parallels with a drug system that dominates medicine and also has an army of lobbyists.
The result for fuel, says Pearce, is that we have an outdated energy system: “that stifles alternatives”. Sound familiar? “Being locked into 20th century technologies,” he goes on, makes it impossible to “solve 21st century problems.”
Not solving the diabetes crisis
He could be talking about the absurdity of trying to cut the rate of chronic lifestyle disorders by relying on ever more expensive palliative drugs instead of developing effective life-style approaches that benefit the body as a whole.
Take the way we deal with obesity and diabetes. Relying on a pharmaceutical approach developed in the 1950’s , the vast bulk of research and development money goes into developing drugs that come with a range of sometimes deadly side effects that have done nothing to slow down let alone reverse the 21stt century problem of a growing number of people with weight and blood glucose problems.
Lip service is of course paid to the importance of diet and life style but the reality is most people try it briefly but with little or no formal support it doesn’t work so they are put on drugs. “Obesity and nutrition are inadequately represented in medical undergraduate degrees,” concluded the report “Action on Obesity” published earlier this month by the Royal College of Physicians.
Yet the drugs do little to cut the risk of heart disease. “Diabetes patients, according to evidence based guidelines, are prescribed six to eight drugs every day for life,” writes Professor Mike Lean of the Population and Health Sciences unit at Glasgow University “Their combined effect has been estimated to reduce cardiovascular risk by only about 5% to 10%.”
A lousy return on investment
The total UK spend on diabetes drugs is around £600 million a year and growing fast. Is that a lousy return on investment or what?
And not only are they very ineffective but they could become largely unnecessary because we’ve known how to reverse diabetes for years – even though the diabetes establishment claims it is irreversible and progressive. A significant weight loss of about 15 kilos will do it.
Clinical evidence for this comes from bariatric surgery which reduces the size of the stomach, dramatically cutting calorie consumption. The first study published over 20 years ago. In the past getting that sort of weight loss with Weight Watchers and the like was rarely possible. What new is evidence that it can be done with a low calorie liquid formula diet that gives you 800 nutritionally balanced calories a day for three months.
This was a small pilot study published 18 months ago by researchers at Newcastle University and Professor Lean has been trying to raise funds to run a big trial ever since. Imagine how fast funds would have been found if that a mixture of minerals vitamins and nutrients had been a drug. The most important element in ensuring the weight stays off is a multi-disciplinary team – dieticians, psychologists, sports trainers, cooks.
No incentive to help with weight loss
What is striking here is the mismatch between the problem – a growing epidemic of chronic diseases rooted in lifestyle – and the solution we have adopted – treat it with multiple drugs patients will have to take for life.
It’s a truism that a change in diet, increase in exercise, support and possibly counselling can make a huge difference to weight and diabetes but the myth persists that people won’t do that so give them the drugs. This attitude is reinforced by the fact that doctors receive little training in nutrition. What’s more the system of incentive payments (known as QOF) that GPs get for other health promotion schemes such as giving drugs to cut the rate of heart disease or hitting a vaccination target, offers nothing for treating obesity.
The use of diabetes drugs is firmly evidence based but it seems more a case of “pharma lock in” than a remotely rational solution.