#1756 – John Abramson | Joe Rogan Experience

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Key Takeaways

  • “The primary function of the drug companies is to make money for their investors. We have to get over the illusion that their first purpose is to serve our health. Their purpose is to make money.” – John Abramson
    • The American people are the ones that suffer. The balance in big pharma between incentives to innovate and predatory behavior is a complicated problem.
  • Pharmaceutical companies own the rights to their clinical trial data so they can manipulate the success rates and side effects
    • The data is private; only the analysis of the data is public
    • There is too much incentive to distort medical knowledge in the U.S.
    • “They are paid to win and they are calling their own fouls” – John Abramson
    • Continue reading for more info on billion-dollar fraud cases against Pfizer and Merck
  • The United States also does not have a system for Health Technology Assessments
    • This system compares therapeutic and economic value between old and new drugs
    • 75% of all new drugs do not show a meaningful clinical advance over existing drugs
    • We need a referee that promotes cost-effective alternative solutions
  • “We do such a poor job in the United States at preventing preventable diseases” – John Abramson
    • America is 68th in the world for healthy life expectancy
    • Consumers need to represent their own interests. 80% of your health is determined by how you live – this can be used as leverage to bargain against high-cost solutions from big pharma.

Intro

  • John Abramson, MD, is a lecturer at Harvard Medical School, an expert in national drug litigation, and author of Sickening: How Big Pharma Broke American Health Care and How We Can Repair It. John joins JRE to discuss the predatory and deceptive behavior of big pharma and how it has caused deep-rooted problems in American health care.
  • Host: Joe Rogan (@joerogan)

Pharmaceutical Advertisements

  • The United States and New Zealand are the only two countries to allow pharmaceutical advertising
    • But, New Zealand has a more active oversight in regards to communicating transparent drug efficacy and costs
  • In the United States, the right to advertise pharmaceuticals falls under the free speech mandate of the constitution
    • Unlike cigarettes, pharmaceuticals qualify for advertising due to absolute benefit
    • Unfortunately, the beneficial efficacy is never communicated sufficiently. The ads can make anything look great–especially through dramatizations.
  • We can’t get rid of drug ads but they must be held accountable for the accuracy
    • Standard accuracy checklist: how it compares to alternatives/lifestyle, how much it costs, rate of success, etc.

Capitalism and Big Pharma: The Good, the Bad, and the Ugly

  • “The primary function of the drug companies is to make money for their investors. We have to get over the illusion that their first purpose is to serve our health. Their purpose is to make money.” – John Abramson
    • The capitalistic nature of pharmaceutical companies has created some incredible innovations. While at the same time, it birthed a dangerously unregulated environment.
  • Pharmaceutical companies own the rights to their clinical trial data so they can manipulate the success rates and side effects
    • The data is private; only the analysis of the data is public
    • Doctors and peer reviewers are supposed to assume the data analysis is complete and accurate. This manipulation caused John to quit his family medical practice and enter litigation.
    • We must change how the drug companies can control and misconstrue data
    • “They are paid to win and they are calling their own fouls” – John Abramson
  • The United States has no cap on drug costs
    • Brand name prescription drugs cost 3x more in the U.S. than other countries in the OECD
  • The United States also does not have a system for Health Technology Assessments
    • This system compares therapeutic and economic value between old and new drugs
    • 75% of all new drugs do not show a meaningful clinical advance over existing drugs
    • We also don’t allow government-funded cost-effective studies–completely diluting the dialogue around alternate and cheaper treatments

Bextra & Neurontin by Pfizer

  • John Abramson spent 10 years in drug litigation – he’s not allowed to reveal the details involved in the Pfizer Bextra case
    • John tipped off the Department of Justice and FBI
    • Pfizer was convicted of felony fraud and the largest criminal fine in U.S. history (at the time) – all the data is still private
  • Pfizer was also convicted of fraud and racketeering with their drug, Neurontin
    • Pfizer misled doctors by altering the control group, this neutralized the ability to observe causation
    • Pfizer staff promoted the use of Neurontin for the off-label treatment of bipolar disorder, migraines, neuropathic pain, and nociceptive pain–but was no more effective than a sugar pill for these conditions. The drug is only approved for the treatment of epilepsy.
  • Yet, Pfizer has been glorified for their Covid vaccine development–which is going to make them over $65 billion in two years
    • Why do we allow Pfizer to charge the government $25+ per dose when it costs them roughly $3 per dose to manufacture?

Vioxx by Merck

  • Merck Vioxx was an anti-inflammatory that manipulated their test data to cover up the risk for a cardiovascular event
    • Merck removed three heart attacks from their clinical data that flipped the statistics
    • 40,000 – 60,000 Americans died from the cardiovascular consequences of Vioxx
    • Vioxx wasn’t even more effective at treating arthritis and pain than non-steroidal anti-inflammatories
    • No one went to jail and Merck still profited roughly $1 billion after paying their financial penalties
  • Proper punishment in the Vioxx case was an opportunity to re-establish proper consequences and change the deceptive framework of big pharma; but, we decided a slap on the wrist would do

Health Crisis in America

  • America ranks horribly in age-adjusted mortality rate compared to other wealthy countries
    • America is 68th in the world for healthy life expectancy
    • “We do such a poor job in the United States at preventing preventable diseases” – John Abramson
  • Social and economic pressures in American culture are driving a force in deteriorating health
    • Proportionally comparing wealth to 1980, a middle-class citizen should be $20,000 richer today to be equal. The wealth has transferred to the top 1%.
    • Deaths of Despair and the Future of Capitalism by Anne Case & Angus Deaton
    • Obesity-related diseases, drug overdoses, suicide, etc.

How Do We Fix This?

  • Greater oversight on communicating the economic and therapeutic value of prescription drugs – we need a referee, market failure doesn’t fix itself
  • Lower costs – there is too much incentive to distort medical knowledge in the U.S.
  • Consumers need to represent their interests – 80% of your health is determined by how you live. This can be used as leverage to bargain against high-cost solutions from big pharma.
  • Doctors must be well-informed – all data must be transparent
  • Check out John’s book: Sickening: How Big Pharma Broke American Health Care and How We Can Repair It
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Notes By Drew Waterstreet

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