“근거 중심 의학”은 이렇게 강탈 당했다 [스타틴 연구 대사기극] 마케팅 도구로 전락해버린 부패한 의학 연구들

Summary

The 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

00:00

🤔 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.

05:01

🔍 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.

10:02

📉 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.

15:06

💰 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.

Keywords

💡Ethical Issue

An ethical issue refers to a dilemma or concern that presents a question of moral principle. In the video, the ethical issue discussed is the alleged withholding of unfavorable drug trial results by pharmaceutical companies, which distorts the data presented to the public and medical professionals. This relates to the theme as it sets the stage for the discussion on transparency and integrity in scientific research and its impact on public health.

💡Clinical Trial Service Unit (CTSU)

The CTSU is a specific unit within a university that conducts clinical trials and is mentioned in the script as being led by Professor Rory Collins. It is central to the video's theme as it is accused of having conflicts of interest due to financial ties with the pharmaceutical industry, which calls into question the objectivity of the research and advice provided on treatments like statins.

💡Statins

Statins are a class of drugs used to lower cholesterol levels and are a focal point in the video. The script discusses the controversy surrounding their efficacy and safety, as well as the influence of pharmaceutical companies on their promotion and prescription. The video's theme revolves around the transparency and trustworthiness of the data supporting statin use.

💡Conflict of Interest

A conflict of interest arises when a party's objectivity is potentially compromised due to a clash between personal interests and professional obligations. In the video, the conflict of interest is highlighted in the context of the CTSU's funding from the pharmaceutical industry, suggesting that this may bias their research findings and medical advice related to statins.

💡Pharmaceutical Industry

The pharmaceutical industry is the sector of the economy focused on the research, development, and marketing of drugs. The video discusses the industry's role in shaping medical advice and research outcomes, suggesting that profit motives may override the goal of improving public health, which is a key theme in the video.

💡Data Withholding

Data withholding refers to the practice of not sharing or disclosing all the data from a study, which can lead to a lack of transparency. The script mentions that raw data on statin side effects has been withheld by researchers, which raises questions about the completeness and honesty of the information provided to the public and healthcare providers.

💡Bias

Bias in research refers to a systematic distortion that results from non-random errors and influences the results or interpretations. The video emphasizes the bias that may be present in medical research due to financial incentives from the pharmaceutical industry, affecting the advice given to doctors and the treatments prescribed to patients.

💡Transparency

Transparency in science and medicine refers to the openness and clarity with which research is conducted and reported. The video argues for greater transparency in clinical trials, suggesting that the lack thereof undermines the scientific process and public trust, particularly in the context of statin research.

💡Cholesterol

Cholesterol is a substance found in the body and is a key topic in the video as it relates to the use of statins. The script discusses how guidance from organizations like NICE has been influenced by units with financial ties to the pharmaceutical industry, which may affect the advice given on managing cholesterol levels.

💡Efficacy

Efficacy refers to the effectiveness of a medical intervention, such as a drug, in achieving a desired outcome. The video questions the efficacy of statins, suggesting that the data supporting their use may be manipulated or misrepresented by pharmaceutical companies to promote their use more widely.

💡Side Effects

Side effects are unintended consequences or adverse reactions caused by a medication. The video discusses the underreporting and manipulation of data regarding statin side effects, which is a significant concern as it may mislead both doctors and patients about the true risks of these drugs.

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]