In this article, we look at the “Ghost in the Machine” – the murderous forces in our health care system that harm patients instead of help them. This article will expose the deceptions that occur in almost all facets of health care today for no reason other than money. It will also expose the identities of the ghost’s “puppet masters” who perpetrate health misinformation and unethical drug marketing for profit, whether it’s Big Pharma or its helpers in academia, government and nongovernment agencies.
It should surprise no one that, in most cases, promotion of dangerous drugs and misleading health information is a direct result of conflicts of interest. For example, with the exception of CBS, every major U.S. media outlet keeps at least one person from the drug industry on its board, which clearly explains the dearth of reporting on Pharma dangers and corruption.1
The drug industry also spends billions a year on TV ads — revenue from just nine prescription drugs was worth $100 million in one year — which also stifles negative news stories about Pharma.2
Even so-called “public” media like PBS and NPR have accepted money from GlaxoSmithKline (GSK) and UnitedHealthcare.3 Similar conflicts of interest exist at medical journals, universities, medical associations, advocacy groups and government agencies, including those that are supposed to regulate the drug industry. The result is the Ghost in the Machine that we live with today — deceived patients taking expensive, often dangerous drugs and soaring health costs.
Revolving Doors Between Pharma and Government
One of the most damaging conflicts of interest is the revolving door between industry and government. It allows the worst forms of cronyism, quid pro quo arrangements and approval of dangerous drugs. Both Robert Califf, former Food and Drug Administration (FDA) Commissioner, and Scott Gottlieb, the current FDA Commissioner, are shining examples of conflicts of interest.
Before his appointment by President Obama in 2015, Califf received money from 23 drug companies including giants like Johnson & Johnson, Lilly, Merck, Schering-Plough and GSK, according to a disclosure statement on the website of Duke Clinical Research Institute.4 He even praised the involvement of Pharma in government affairs.
Gottlieb was named FDA commissioner this year by President Trump, despite his high-profile work as a Pharma consultant and stock trader. While serving as FDA deputy commissioner for medical and scientific affairs before becoming commissioner, Gottlieb had to recuse himself from work related to nine drug companies, including Roche, Sanofi-Aventis, Eli Lilly and Proctor & Gamble, because of his financial links.5,6
Another example of the “revolving door” between government and industry is former director of the Centers for Disease Control and Prevention (CDC) Julie Gerberding, who left the agency in 2009 where she had overseen vaccine decisions to head Merck’s vaccines division.7,8 In 2015, she sold 38,368 shares of her Merck stock valued at $2 million.9,10 Thomas Insel, former director of the National Institute of Mental Health (NIMH) also used the revolving door, leaving government for industry in 2015.11
And who can forget former Texas governor Rick Perry, who mandated that all girls in Texas be vaccinated with Gardasil, an HPV vaccine made by Merck, after his former chief of staff became a Merck lobbyist?12 Stipends from industry to government also skew drug messages. Gilead Sciences, an aggressive marketer of hepatitis C drugs, likely earned the right to add the CDC’s name to its ads because of its gifts to the CDC Foundation.13
Pharma/Academia Partnerships Are Lucrative Thanks to Taxpayers
Academia was once a source of unbiased drug and health information, untainted by Big Pharma and Big Pharma’s money. Not anymore. Universities now have a “renewed interest in partnering with pharmaceutical companies and are investing resources to ensure successful collaborations,” writes Pharma Voice.14 This is how Dr. Terrence Norchi, president and CEO of Arch Therapeutics, explains the profitable new partnerships.15
“For the past 15 years, the pipelines of the big [drug] companies have been drying up … At the same time, there is a tremendous amount of pressure on academic institutions in this country and abroad. To survive, many universities will have to find creative ways to make themselves more relevant. There are opportunities to mutually solve these challenges between academia and industry.”
Such Pharma/academia partnerships date back to the Bayh-Dole Act of 1980, which allowed universities to “patent discoveries that stem from government-funded research and then license them exclusively to companies in return for royalties,” wrote Marcia Angell, former editor-in-chief of the New England Journal of Medicine and Harvard lecturer, in the Boston Review.16,17
Similar laws also allow industry to co-opt and profit from NIH-funded research, which is also taxpayer supported, says Angell. Before the Bayh-Dole Act, government-funded discoveries were in the public domain — as they should be. Between 2000 and 2011 more than half of all new drugs approved in the United States were developed by collaborations with other entities such as universities.18
Increasingly, academia does not even attempt to hide its dual allegiances. Susan Desmond-Hellmann was invited to apply to be Chancellor of the University of California, San Francisco (UCSF), which includes a medical school, while serving as president of product development at Genentech.19 She remained at UCSF until 2014 after which she joined the Gates Foundation, which has its own serious conflicts of interest that you will read about in the Ghost in the Machine series.
Drug Trials Now Riddled With Conflicts of Interest
The faster Pharma can get a drug to market, the more money it makes — even if safety problems emerge later. Legal settlements from injury suits are simply built into the cost of the product launch and marketing. Gag orders with injured parties keep the dangerous side effects from reaching the public and dampening sales.
There are many examples of drugs rushed to market before they were proven safe, such as the painkiller Vioxx, estimated to have killed over 60,000 people, and the new, expensive hepatitis C drugs that were marketed before their ability to reactivate pre-existing hepatitis B was known.20,21
One way in which dangerous drugs are now rushed to market is the fast work of contract research organizations (CROs) to which Pharma increasingly outsources drug trials. CROs conduct drug trial design, recruitment, enrollment and consent of subjects, as well as preparation of the final drug submission package to the FDA in turnkey operations. If and when the new drug is approved, they will also take care of marketing and branding.
Another compromise in drug safety comes from the changing face of institutional review boards (IRBs), groups of medical professionals, laypeople and ethicists who monitor human safety during drug trials. Once linked to academic settings or hospital, IRBs have become for-profit ventures paid by the companies who do the research. When the financial livelihoods of members of IRBs depend on the company that hires them, that is a huge conflict of interest.
One example of the changing face of IRBs was revealed in a sting operation devised by Congress and the General Accountability Office. When they asked a Colorado review board to oversee a study of Adhesiabloc, a product designed to reduce scar tissue after surgery, it agreed to the work though neither the drug, developer nor lead researcher even existed.22
How can human subjects be protected in such eagerness to acquire new work? To cut costs, Pharma also increasingly runs trials in poor countries where informed consent is not easily explained and subjects sometimes think they are receiving real medical care.23
Conflicts of Interest Abound in Research
In the Ghost in the Machine series, we will review conflicts of interest in publishing that skews the perception of a drug’s safety in the public’s eyes as well as among medical professionals. Research and scientific papers boosting the benefits of new drugs and downplaying their risks often appears in medical journals, ghostwritten by the drug industry with a medical professional’s name attached for credibility.24