by Dr.Harald Wiesendanger– Klartext
What the mainstream media is hiding
Today’s medical student is tomorrow’s prescription maker. That is why the pharmaceutical industry ensnares prospective doctors from the very first semester. If they practice, the brainwashing will continue relentlessly – in compulsory education.
“Students are lulled to sleep early on at university,” writes political scientist Ina Brzoska, “by companies providing them with small, harmless conveniences in everyday hospital life, they pay for further training and good food,” whereby they are “always polite and courteous.” “This is how Big Pharma conveys a positive image of their work to the prospective physicians.” (1) In their third year of medical studies, 93 percent of medical students receive industry-sponsored gifts or promotions at least once a week; without exception, all of them have already been invited to at least one pharmaceutical-financed meal. (2) Most of them are well aware that industrial influences influence their education and increase from semester to semester. (3)
“This constant exposure,” notes a British-American research group, “insidiously provides a brainwashing that changes medical students’ attitudes towards the marketed products”. (4)
The temptation to please big pharma and thereby become susceptible to industrial interests having a say in setting the agenda, mocking the much-vaunted freedom of research and teaching, is increasing at cash-strapped universities that are inevitably hungry for pharmaceutical drugs – and get plenty of them: for example the University of Cologne from Bayer, the Free University of Berlin from Sanofi-Aventis, the University of Mainz from Merck. (5)
The pharmacologist Bruno Müller-Oerlinghausen, once chairman of the German Medicines Commission and now a red rag for the pill industry as a refined crosshead, would prefer to see seminars critical of pharma firmly anchored in the examination regulations of all prospective doctors. “They need to become more resilient to the pharmaceutical industry’s manipulation of opinion,” he says. (6) He often holds seminars on “Advert Retard” – “long-lasting, sustainable advertising” – in which medical students should learn how tricky the pharmaceutical industry tries to trap them – and how to deal with it. Why does the lecturer only describe the positive properties of a drug but withhold possible side effects? Why doesn’t he use his own slides but prefabricated ones from the manufacturer? How do you discover what part-time jobs he does – and who pays him for them? How do trade journals that do not print advertisements differ from those that keep printed pages free for pharmaceutical advertising? At least at the Berlin Charité, “Advert Retard” has recently become a compulsory elective.
CME becomes CMM: Continuing Medical Manipulation
Doctors have to undergo further training, which is prescribed by law and the professional code. Pharmaceutical companies are involved to the best of their ability. In the USA alone, they spend 1.2 billion dollars annually on Continuing Medical Education (CME), bearing 50 to 60 percent of the total costs. (7) As sponsors, they have the greatest possible influence on training programs and content: they finance relevant events’ preparation, organization, and implementation. They let professorial hirelings praise their latest products, conveniently with ready-made PowerPoint presentations that the manufacturer provides. (8) You assume travel and accommodation costs related to further training, conference, and participation fees, including the supporting program. You pay for the meals.
All of this has been proven to pay off: Sponsored CME has been shown to entice participating physicians to ensure higher prescription rates. (9)
Who’s going to drain this swamp?
The scandal surrounding the CME provider Omniamed in 2018, which was commendably uncovered by the medical initiative MEZIS, showed the swamp that needs to be drained. Most of the speakers at the Omniamed events had received money from the very pharmaceutical companies that sponsored these events, on average, 100,000 to 200,000 euros. (10) The lecture topics corresponded to the sponsors’ products. It was only as a result of the media echo (11) that the state medical associations of Baden-Württemberg (12) and Münster (13) refused Omniamed the CME certification of events for the first time – due to “lack of product neutrality”. As a result, Omniamed ended its business activities, at least in Germany. (14)
Why haven’t medical associations and, if necessary, the legislature put a stop to the outrageous goings-on – in general? Is the quality of a conference measured by the hotel’s star rating? Who would seriously expect that a pill manufacturer would emphasize the risks and side effects of their product on such occasions, warn them to be cautious when prescribing, do not shy away from comparison with products from the competition, the advantages of naturopathic treatments and proven home remedies, of psychotherapy and social support praises? For the drug industry, nothing is more business-damaging than comprehensive, balanced information about all available treatment options. Pharmaceutical companies, therefore definitely have no place in medical training.
Why all the effort to avoid influencing incorruptible doctors?
The insane effort that companies go to to bring doctors up to date with the latest “knowledge” was brought to light, for example, in a criminal case that the Attorney General of the Southern District of New York instituted against the Swiss giant Novartis at the end of March 2016 – because of massive bribery. A whistleblower who was formerly in the service of Novartis had started the investigation: He revealed that his former employer in the USA alone had invited a whopping 25,000 “scientific courses” between 2002 and 2011. All of them were, in fact, marketing events in disguise with zero educational value. Their sole purpose: is to get tens of thousands of participating physicians to prescribe Novartis preparations.
The pattern was always the same: for a lavish fee, willing doctors gave lectures on the pharmaceutical company’s medicines while the audience enjoyed luxurious meals – at the company’s expense, of course. Analysts at the US banking group Citigroup estimate that this corruption practice may have cost Novartis “with a high probability of more than two billion US dollars a year.” It has certainly paid off well so far. (15) Why else would they exist?
“Why,” wonders senior physician Markus Pawelzik from the EOS Clinic in Münster, “does the industry spend so much money so as not to influence incorruptible doctors?” He immediately followed up with his answer: “Because it pays off.” (16)
Blind to organized crime
A “frightening level of delusion” within the medical profession, so that “one can almost speak of a collective psychosis,” complains the Danish physician and pharmaceutical critic Peter Gøtzsche. To shake people up, he likes to provoke peers with a hearty comparison during lectures. What would you think of a judge declaring before starting a mafia trial: “I received travel grants from Silvio Berlusconi. I sit on the Relentless Loan Sharks Advisory Board. I took money from drug dealers. I received discretionary training grants from Camorra. I am advising the spokesman for the murder company.” Gøtzsche then asks his audience why we should “accept money from industry but reject it from criminal organizations” – when “organized crime kills far fewer people than the pharmaceutical industry “? (17)
Professional codes would be necessary as long as there is a lack of insight into practices and clinics. Doctors should be obliged not to receive a single pharmaceutical representative (18), to refuse pharmaceutical invitations, to refuse pharmaceutical fees – without exception. And how about a compulsory membership in MEZIS? The charitable initiative “I’ll pay for my food myself,” launched in 2007 by incorruptible doctors, has only had a thousand members so far. For the remaining 380,000 doctors in Germany, I propose compulsory membership.
Useful idiots – secretly mocked
In the management of pharmaceutical companies, people secretly laugh up their sleeves at how easily the majority of doctors allow themselves to be seduced into acting as useful idiots. This became clear to the Austrian medical journalist Hans Weiss when he researched undercover. To be able to take part in an industry-internal conference, he pretended to be a “pharmaceutical consultant” in the service of a fictitious company called “Solutions”; for the entrance ticket, he shelled out almost 4000 euros. “There were around 500 top people from the pharmaceutical industry among themselves, no public, no journalists, around 30 top pharmaceutical managers from Germany. And then you hear blunt truths, such as: ‘We puke a marketing mix in the doctors’ faces, and the amazing thing is: they swallow it. And as long as they swallow it, there is no reason to change our business policy.’ (19)
In this jungle, Klaus Lieb must feel like a nostalgic representative of a dying species. In the clinic for psychiatry and psychotherapy at the University of Mainz, of which he has been a director since 2007, he set clear boundaries: “We don’t have any pharmaceutical representatives on the ward.” Gifts and medication samples are refused, and further training is paid for entirely from our funds. (20) “We doctors have a blind spot when it comes to conflicts of interest,” he complains. (21) ”If we become puppets of the healthcare industry, we will lose patients’ trust.” (22)
Their preference is clear. 96 percent want to know about their doctor’s financial ties to the pharmaceutical industry. And 79 percent demand that doctors, instead of receiving pharmaceutical representatives, should obtain information from independent sources. (23) Your wish in the ear of the white demigod.
Meanwhile, supreme deities are enthroned above demigods: the opinion leaders of the guild. And ultimately, they are the ones who dictate what has to take place in the lower spheres. I dedicate the rest of this series of articles to you.
(Harald Wiesendanger)
Remarks
1 Ina Brzoska: “The Quiet Lobbyists”, Uni-Spiegel 5/2012, p. 24.
2 F. S. Sierles et al.: “Medical students’ exposure to and attitudes about drug company interactions”, Journal of the American Medical Association 294/2005, pp. 1034-1042.
3 KE Austad et al.: “Medical students’ exposure to and attitudes about the pharmaceutical industry: a systematic review”, PLoS Medicine 8/2011:e1001037.
4 Ina Brzoska: “The Quiet Lobbyists”, Uni-Spiegel 5/2012, p. 23.
5 Emmanuel Stamatakis, loc.cit., p. 472; see also D. Grande/D. L. Frosch et al.: “Effect of exposure to small pharmaceutical promotional items on treatment preferences”, Archives of Internal Medicine 169/2009, pp. 887-893.
6 quoted from Brzoska, loc.cit.
7 As of 2007. M.A. Steinman/C. S. Landefeld/ R. B. Baron: “Industry support of CME — are we at the tipping point?”, New England Journal of Medicine 366/2012, pp. 1069-1071.
8 J.Avorn/N. K. Choudhry: “Funding for medical education: maintaining a healthy separation from industry”, Circulation 121/2010, pp. 2228-2234.
9 A. Wazana: “Physicians and the pharmaceutical industry: is a gift ever just a gift?”, Journal of the American Medical Association 283/2000, pp. 373-380.
10 MEZIS, CME Working Group: Omniawatch Analysis. (No longer available online.)
11 Medicine: The controversial business with medical training. Retrieved February 10, 2019; Deutsches Ärzteblatt: Conflicts of interest: Anger about CME certification. August 8, 2018, accessed February 10, 2019; Sebastian Carlens: Points for Bayer. 10 August 2018, accessed 10 February 2019.
12 Hanno Charisius: Authority refuses certificate for controversial medical training. In: sueddeutsche.de. 13 August 2018, accessed 10 February 2019.
13 Sebastian Carlens: Cover for pharmaceutical lobby. February 9, 2019, accessed February 10, 2019.
14 end of business activity Germany. (No longer available online.) In: OmniaMed, accessed 27 July 2019
15 Handelszeitung, March 29, 2016: “Novartis: US judiciary expands investigation”; Neue Zürcher Zeitung, March 30, 2016: “Novartis under threefold suspicion”.
16 Quoted from Harro Albrecht: “Ärzte, Pillen und Moneten”, loc.cit.
17 Peter C. Gøtzsche: Deadly medicine and organized crime, Munich 2nd edition 2015, p. 410.
18 This is what the Viennese doctor Dr. Fahmy Aboulenein in his book The Pharma Trap. How the pill companies manipulate us, Vienna 2016.
19 “There is no industry that makes such high profits”, interview with Hans Weiss in Deutschlandradio Kultur – Thema, February 12, 2010, www.deutschlandradiokultur.de.
20 According to Harro Albrecht: “Doctors, pills and money”, Die Zeit No. 51, December 11, 2008.
21 Quote from Markus Grill, among others: “Be embraced, millions!”, Correct!v, 14.7.2016, https:// correctiv.org/recherchen/euros-fuer-aerzte/artikel/ 2016/07/14/seid- entwined-millions, retrieved on 10/24/2016.
22 Quoted from Christoph Link: “Corruption in medicine – ‘What am I actually doing here?'”, Stuttgarter Zeitung, March 18, 2013.
23 According to an online survey by the British Medical Journal with 1479 participants, quoted from Arznei-Telegramm 34/2003, pp. 89-90.
This text is part of a series of articles with the following additional contributions:
1) Trained demigods – How doctors become drug dealers
2) Visit from the Rep – Mendacious Friendship based on the script
4) Off-label – crossing borders as routine
5) Purchased Observer – When the doctor becomes the “researcher.”
6) How easy – When doctors play “Kick-back.”
7) “As you do to me, so I do you” – reciprocity as the secret of success
8) Softened – education and training as brainwashing
9) Insatiable Renters – The uncanny power of paid opinion leaders
10) Among Gorillas – Silverbacks call the shots
11) As KOL to the Golden Nose – Why “Key Opinion Leaders” have taken care of it
Editors Note watch: BREAKING: US To Sign Over Sovereignty To W.H.O.
Medical Education, Medical College, Physician Education, Pharma Marketing, MEZIS, Advert Retard, CME, Continuing Medical Education, Opinion Leaders, Harald Wiesendanger