“근거 중심 의학”은 이렇게 강탈 당했다 [스타틴 연구 대사기극] 마케팅 도구로 전락해버린 부패한 의학 연구들
Summary
TLDRThe video script discusses the ethical dilemmas in the pharmaceutical industry, particularly the manipulation of clinical trial data by drug companies to favor their products, such as statins. It highlights the conflict of interest between academic institutions, medical journals, and the industry, with a focus on the Clinical Trial Service Unit at Oxford University. The script criticizes the lack of transparency, the withholding of raw data, and the influence of financial gain on medical advice, suggesting that profit motives are compromising evidence-based medical practice.
Takeaways
- 💊 Pharmaceutical companies are accused of withholding negative data on drugs, leading to a distorted view of their effects and safety.
- 🔬 Professor Rory Collins, a key figure in the promotion of statins, has been criticized for attempting to suppress research that questions the benefits of these drugs.
- 🏥 There is a significant conflict of interest in the medical community, with academic institutions and journals sometimes colluding with the pharmaceutical industry for financial gain.
- 💰 The pharmaceutical industry's profit motive is at odds with the goal of providing the best treatment, leading to concerns about the integrity of medical research and practice.
- 📊 The Clinical Trial Service Unit (CTSU) at Oxford University, influential in cholesterol treatment guidelines, has received substantial funding from the drug industry, raising questions about bias.
- 📚 The secrecy surrounding clinical trials for statins, with raw data controlled by a select group of researchers, has led to a lack of transparency and concerns about the authenticity of the data.
- 🤔 The general public and even doctors may be unaware of the true extent of statin side effects, as clinical trials may not accurately represent real-world usage and side effect rates.
- 🧐 The design of clinical trials can manipulate outcomes, such as through 'washout periods' that exclude participants with side effects, skewing the perceived safety of drugs.
- 📉 Despite controversies and reduced statin prescriptions in some regions, like France, there has not been a corresponding increase in cardiovascular deaths, suggesting that the benefits of statins may be overstated.
- 💼 The pharmaceutical industry's influence extends to discrediting skeptics and critics, using tactics such as public accusations and comparisons to other controversial groups.
- 🚫 There is a call for the science of clinical trials to become independent of commercial interests to ensure that health decisions are based on unbiased, transparent research.
Q & A
What is the main ethical issue discussed in the script regarding the pharmaceutical industry?
-The script discusses the ethical issue of drug companies withholding unflattering results, leading to a distortion of data and misinformation about the effectiveness and safety of their products.
Who is Professor Rory Collins and what is his role in the script?
-Professor Rory Collins is the head of the Clinical Trial Service Unit at Oxford University. He is portrayed as being heavily critical of anyone questioning the benefits of statins and has allegedly used his influence to suppress scientific papers critical of his research.
What is the concern regarding the guidance from NICE on cholesterol treatment?
-The concern is that the guidance from NICE, which is influenced by the Clinical Trial Service Unit at Oxford University, may be biased due to the unit's significant funding from the pharmaceutical industry.
What is the role of the CTT collaboration in the context of statin research?
-The CTT collaboration, under the Clinical Trial Service Unit at Oxford University, holds all the raw data on statin side effects and is responsible for publishing meta-analyses advocating the wider use of statins. However, it is criticized for its lack of transparency and potential conflicts of interest.
Why is transparency in sharing clinical trial data considered important?
-Transparency in sharing clinical trial data is important because it allows independent scientists to scrutinize the results, which in turn fosters greater confidence in the true benefits and risks of a medication, enabling both doctors and patients to make informed decisions.
What is the alleged discrepancy between reported statin side effects in clinical trials and real-world observations?
-The script suggests that clinical trials, which often use data provided by drug companies, report very low levels of muscle side effects from statins. However, observations in the general population indicate a side effect rate that is 100 times higher.
How might clinical trials be designed to minimize the appearance of side effects?
-Clinical trials might be designed with a 'run-in period' where participants are given the drug for a short period, and those who experience side effects are excluded from the trial. This can grossly underestimate the actual side effect rates in the general population.
What is the controversy surrounding the increase in statin prescriptions in France?
-In France, there was a controversy when the price of statins increased by 50%, leading to concerns about people's health. However, the script suggests that despite the increase in prescriptions, there was no significant increase in mortality or cardiovascular deaths.
How does the pharmaceutical industry allegedly influence medical professionals and public opinion?
-The script alleges that the pharmaceutical industry influences medical professionals and public opinion by providing financial incentives, such as placing doctors on advisory boards or as consultants, and by investing in medical education to create a favorable bias towards their drugs.
What is the potential impact of the pharmaceutical industry's influence on the practice of evidence-based medicine?
-The influence of the pharmaceutical industry can corrupt the base upon which evidence-based medicine is built, leading to biased research and potentially subjecting many people to treatments that may not be in their best interest.
What is the script's final message regarding the relationship between the pharmaceutical industry and the practice of medicine?
-The script concludes that until the science of clinical trials can break free from commercial interests, decisions about health rest in the hands of big business, suggesting a need for greater transparency and independence in medical research.
Outlines
🤔 Ethical Concerns in Pharmaceutical Research
The first paragraph discusses the ethical dilemmas in the pharmaceutical industry, particularly the issue of drug companies withholding unfavorable results, leading to a distorted view of data. It highlights the influence of Professor Rory Collins and the Clinical Trial Service Unit (CTSU) at Oxford University, which has been accused of bias due to significant funding from the pharmaceutical industry. The paragraph emphasizes the conflict of interest, the lack of transparency in clinical trials, and the impact of this on healthcare decisions, suggesting that profit motives may override ethical evidence-based medical practice.
🔍 Manipulation and Secrecy in Statin Trials
The second paragraph delves into the specifics of how clinical trials for statins may be manipulated to minimize reported side effects, such as through 'washout periods' and 'run-in periods' that exclude participants who experience adverse reactions. It points out the discrepancy between reported side effects in trials and real-world observations, questioning the validity of the data presented by influential figures like Professor Rory Collins. The paragraph also touches on the tactics used to silence dissent and discredit critics, revealing a potential suppression of information that could affect public health.
📉 The Impact of Statin Controversy on Health Outcomes
The third paragraph presents a case study from France, where a decrease in statin usage did not lead to the predicted increase in mortality rates, challenging the narrative that statins are essential for preventing heart attacks and strokes. It discusses the polarization within the medical community regarding statins' necessity and efficacy, and the influence of pharmaceutical companies in shaping public and professional opinion. The paragraph also highlights the financial ties between researchers and the industry, suggesting that this may compromise the objectivity of medical advice and education.
💰 The Corruption of Scientific Integrity by Commercial Interests
The final paragraph reflects on the broader implications of commercial interests on scientific research, suggesting that privatized research may prioritize sponsor obligations and profit maximization over public health improvement. It criticizes the naivety of believing that commercial sponsorship does not taint scientific findings and calls for an acknowledgment of this bias. The paragraph concludes with a warning about the potential criminal activity within the industry and the need for transparency to ensure that healthcare decisions are based on unbiased evidence.
Mindmap
Keywords
💡Ethical Issue
💡Clinical Trial Service Unit (CTSU)
💡Statins
💡Conflict of Interest
💡Pharmaceutical Industry
💡Data Withholding
💡Bias
💡Transparency
💡Cholesterol
💡Efficacy
💡Side Effects
Highlights
Drug companies may withhold unflattering results, leading to a distortion of data.
Professor Rory Collins, a staunch defender of statins, has been accused of trying to suppress critical research.
The pharmaceutical industry's profit motive may conflict with providing the best treatment.
Collusion between doctors, academic institutions, and the pharmaceutical industry for financial gain is a scandal.
The Clinical Trial Service Unit at Oxford University, heavily funded by the drug industry, may have a conflict of interest.
Bias in medical information due to financial ties can affect clinical decisions and healthcare practices.
Secrecy surrounds clinical trials on statins, with raw data controlled by a select group of researchers.
The CTT collaboration, under the CTSU, advocates for wider statin use but is not transparent with raw data.
A legally binding agreement with drug companies prevents independent verification of statin trial results.
Lack of transparency in science undermines confidence in medication benefits and risks.
Data manipulation in clinical trials can underestimate the prevalence of side effects.
The Heart Protection Study's design may have minimized reported statin side effects.
Discrepancy between reported side effects in trials and real-world populations raises concerns.
Professor Rory Collins' public statements on statin safety contrast with his commercial interests.
The divide in the medical profession regarding statins reflects differing views on their necessity and safety.
Financial ties between pharmaceutical companies and medical professionals can influence public and professional opinion.
The influence of pharmaceutical companies extends to education, potentially shaping medical beliefs and practices.
The privatization of research may prioritize sponsor profits over public health improvements.
Commercial sponsorship of science can introduce bias, affecting the integrity of research findings.
The need to break free from commercial interests in clinical trials to ensure health decisions are evidence-based.
Transcripts
[Music]
arguably the biggest ethical issue in
science is that drug companies withhold
unflattering results so in the end what
we're presented with is a distortion of
the data the clinical trial Service Unit
is run by Professor sory Collins
Professor Collins has been heavily
critical of anyone who questions the
benefits of statins he's also tried to
use his influence to have scientific
papers that are critical of his research
removed from the British medical journal
is we need to accept that the
pharmaceutical industry are there to
make profit their profit making
businesses they don't have a legal or
fiduciary obligation to give you the
best treatment but the real Scandal is
that doctors academic institutions and
medical journals collude with industry
for financial gain and when you look
specifically at the guidance coming from
nice over the years on cholesterol take
their advice from a unit in Oxford
University called the clinical trial
Service Unit now this is not to say that
individual academics in those
institutions are deliberately misleading
people but there's a huge conflict of
interest because this particular unit
which is one of the most influential
units in the world when it comes to
cholesterol treatment um is also one of
the ones that receives the most money
from the drug industry hundreds of
millions from pharmaceutical industry so
so this needs to be made upfront so
there's a big bias there and when what
happens Downstream is that doctors and
then making clinical decisions on biased
and commercially influenced information
so we've got our Healthcare System now
which is finance and eminence-based not
ethical evidence-based medical practice
so this is the point we're making with
this now but there's been a cloud of
secrecy around the clinical trials on
statens most people are are not aware
that the raw data on stattin side
effects have never been released to the
public is controlled by one group of
researchers led by Professor Rory
Collins um the uh under the CTT
collaboration which is under the ctsu at
Oxford University so they hold all the
raw data on the Staten side effects now
this is an incredibly influential group
of scientists they periodically publish
metaanalyses that Advocate The Wider use
of statens this is the group that um
were promoting that everybody over the
age of 50 even if they had normal
cholesterol should be on Statin
medications now they claimed to be an
independent organization but we know
from internal documents that revealed to
the British medical journal that ctsu
has received over
25060 million pounds from the makers of
cholesterol lowering
medications now the reason they obtain
this data and um is because they've
signed a legally binding agreement with
the principal investigators of the
clinical trials which are the drug
companies and they've agreed to withhold
the raw data from any third party and
they will not permit independent
researchers to verify these results so
this is an egregious lack of
transparency in science sharing data
with other researchers is vital for
scientific transparency because it
allows for independent scientists to
scrutinize the clinical trial results
and then it Fosters a greater confidence
about the true benefits and risks of a
medication now this is not just for the
public who are taking these medications
this is for the doctors who want to
relay balanced information to their
patients when they prescribe these
medications they want to tell patients
about the harms and the benefits of
these medications so that patients are
able to make informed choices about
which pills they want to take
take so it's not surprising that all of
this secrecy around the side effects of
stattin uh has raised concerns about the
authenticity of the Staten data the
problem is that the clinical trials are
not designed to pick up all the side
effects the CTT collaboration for
example use mostly Drug Company data and
Report very low levels of Muscle side
effects from Statin but when you look at
the side effect effects in the general
population it's 100 times
higher there are a lot of ways that one
can manipulate data in a trial trials do
what they call a wash out period and
what that means is before they choose
the people that are going to be in the
trial they give everybody the drug and
the people that have side effects get
excluded from the trial and they say
that so people aren't uncomfortable when
they're in the trial but of course it
takes out all the people that have side
effects and that's very commonly done in
drug trials so the side effects would be
grossly underestimated yes it would
definitely grossly underestimate the
number of people that have side effects
they're not as safe as they've made out
to be no another way that uh you can
influence public opinion and doctor's
opinions about the efficacy of
um uh Statin medications is to design a
trial to minimize the harms and this is
essentially what happened in the heart
protection study they design a trial
with what they call a run-in period so
they gather say um you know thousands of
participants and they put all the
participants on the drug for a period of
uh 4 to 6 weeks then at the end of this
uh running period there's a high dropout
rate people stop taking the medication
they don't tolerate it mostly due to
side effect effects in the heart
protection study 36% of the participants
dropped out in this first phase of the
trial so with this freshly cold
population of
participants that's when they begin the
clinical trial and they separate them
between Placebo and Statin so at the end
the side effect rates between the Statin
group and the placebo group are fairly
similar so we know that cutting out all
of those people that had side effects
from the medication before the trial
began grossly underestimates the
percentage of people that will
experience side effects at the end of
the trial and this is probably why we
see that the side effect rate in the
Staten trials is wildly different to the
rates that we see in real world
populations so when you ask doctors what
the uh complication and side effect
rates are of statins they usually say
around 20 to 30% of their patients feel
muscle pain and um brain fog okay the
experts say stattin cause minimal side
effects so Rory Collins who heads the
ctsu he said that stattin are very well
tolerated and that side effects are only
uh or muscle weakness only occurs one in
10,000 people so that's pretty rare one
in 10,000 people and that's what he's
said publicly and has maintained this
for years in the media but then an
investigation by the times UK revealed
that Professor Collins actually
co-invented a diagnostic test for
stattin intolerance and the marketing
says muscle pains from stattin are up to
29% that's a far cry from one in 10,000
people this exponential rise in the
prescribing of stattin has caused a very
large Chasm between two parts of the
medical profession the proponent say
that statens are incredibly life-saving
that they're one of the most important
advances in medical history and have
prevented Untold heart attacks and
strokes but the other side of the
spectrum has become more skeptic um
skeptical and they say that Statin are
largely unnecessary and serve no purpose
in lowering cholesterol to prevent
cardiac problems so who's right and and
why is it that we've got this bitter
divide amongst uh a group group of uh
educated doctors who are all looking at
the same literature well my proposition
today is that we need to follow the
money uh and that's usually a
proposition when you're dealing with
industries of this size one of the ways
in which drug companies can effectively
influence public opinion in it's a
powerful way is to silence
denters uh one of the ways to do this is
scientific
Publications uh in 2016 there was a
30-page review um authored by Professor
Rory Collins again um in a very
high-profile Journal called the Lancet
um it claimed to end Statin debate once
and for all um statins were safe and not
to listen to any media hype uh because
these uh medications are wonderful even
for people at low risk of heart disease
so this received widespread media
attention and uh most of the um uh news
coverage in the UK the US and uh
Australia even uh widely publicized this
view another way to silence the centers
is to discredit them now Professor Rory
Collins in a UK uh uh Outlet said that
those who question Staten side effects
are far worse and have probably killed
more people than the paper on the MMR
vaccine so again accusing you of
murdering people is an effective way at
trying to discredit you so what happens
when you stop statens well in France
there was actually a sort of natural
experiment where this happened so there
is a a controversy in 2012 2013 there's
some big controversy the this
continuations increased by 50% and so
everybody's like oh people are going to
die people are going to die it's like
what happened what didn't happen was
they didn't die so if you look at
mortality 558 in 2012 12 and
556 in
2013 cardiovascular death 32.2 in 2012
31.6 in 2013 so it's like here's all
these big you know people who are
raising all this Ruckus oh if you talk
about statins people are going to die
people going to have heart attack they
don't die they don't get heart attacks
you're just trying to give it to the
right people and this is the problem is
that there are a population of people
who take these drugs who should
but that's a relatively small amount
then it's like oh but you don't make
money by selling a small amount of drug
you make money by selling a large amount
of drug so you want to push it out into
the general population so that everybody
over 50 is taking this stuff but it's
not that useful and this is what it
showed Professor Steve Nissen from the
Cleveland Clinic also said that we need
to push back on people challenging
statens um and he uh he said that there
was a rise in the internet cult so
calling you a cult leader or a cult
follower it's an effective way to
discredit you this guy Steve Nissen for
example he says well you know if you're
against statins you're like an antivaxer
that's that's what he says right and
it's like well he's also the guy who's
taking all the money from Amgen and
fizer and everything right so it's not
an unbiased opinion and then you get
like crazy crazy stuff um you know like
talking about the Statin that oh
everybody should be getting it they
should be putting it in the drinking
water everybody over the age of 50
should be getting it it's like where are
these opinions coming from cuz if you
look at the actual science which Malcolm
does it's not there there's nothing to
support that sort of use to put these
drugs into you know the mouths of
millions of patients the influence of
the pharmaceutical companies is
everywhere they have their tentacles
everywhere and they try to I'm sorry for
this expression but that's true they try
to bribe every type of person they can
and they are examples that they have
bried every type of person there is
including Ministers of
health so the money is everywhere the
drug industry systematically buys
doctors they buy their loyalty by
putting thousands of them on their
advisory boards or as consultants or
they lecture for drug companies which is
also bad because um education of doctors
should have nothing to do with do
companies and in this way they buy
loyalty among doctors pharmaceutical
companies can increase the market size
for a medication by investing in the
education of doctors and the general
public so by the time a physician is in
practice he's been taught very
dogmatically by the way that cholesterol
is a villain that cholesterol ET FS
cause atherosclerosis and when they get
done with their training and they're out
there in practice they don't change
those belief systems very easily you
have a bunch of corrupted journals you
have a bunch of corrupted Physicians and
researchers and then the the guy at the
end of the line the medical student is
coming in and being taught that how they
should take all this evidence-based
medicine make sure everything is
evidence-based evidence-based evidence
based but the base upon which you base
it is is is corrupted so this is the way
it works right and unfortunately this is
true so you have pharmaceutical
companies who gives through glyphs
flattery and stuff they target the
doctors the universities the professors
because they're giving them sort of like
10 times or 15 times more than the
individual doctors which develop a
favorable bias towards this drug of
choice which means more drugs are
prescribed
which means more money for the
Pharmaceuticals from which they can then
pay the doctors again and you see this
is the problem is that people are
catching on in its effect it's certainly
scientific fraud and in its effect it's
organized crime um it's always difficult
to allege intent but it is clear that
manipulation of evidence subjects many
people to treatments that those people
should never have been subjected to
too I think there is criminal activity
that goes on there's a sense that
science is science so it doesn't matter
who pays for it and yet because the
research is privatized the fundamental
purpose for which it's conducted has
changed it's not to improve the Public's
Health it's to fulfill the fiduciary
obligations of the sponsors and create
an opportunity to maximize profits
instead of improve the Public's Health
some might say that that a rather
cynical view of how science Works to say
it's cynical that commercial sponsorship
of science taints the science is just
totally naive it's it's silly business
is in business their job is to make
money we ought to be clear in our public
discourse that to say we've got a bias
in commercially sponsored research is
neither cynical nor paranoid nor
impolite it's a fact so let's just
accept it as a fact and stop being naive
at our own
expense until the science of clinical
trials can break free from commercial
interest then decisions about our health
rest in the hands of big
[Music]
business the views expressed in this
episode of catalyst are not intended as
medical advice please consult with your
doctor regarding your medications
[Music]
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