This is the Sixteenth in the Persecution Series, after The Persecution of Heretics, The Persecution of Vulnerable Adults, Harassment from the BBC to GMC, Harassment from Rolf Harris to James Coyne to Doctor Who, Persecution: Black Riders in the Shire, Persecution: Rumbles from Mordor, of which there were eight in the SUI Cide Series SUI Cide in Betsi, SUI Cide Trick or Treat, The SUI Cide Note, SUI Cide or Homicide, SUI Cide in the OK Corral, SUI Cide & Peace in our Time, The SUI Cide Apparatus, Professional SUI Cide. This is the second in the Pharma series after He Who Would Do a Great Evil.
Faced with questions about the $3 Billion fine imposed on GSK – Is it just the cost of doing business? Andrew Witty, GSK’s CEO, snapped back:
“Although corporate malfeasance cases end up looking very big, they often have their origin in just… one or two people who didn’t quite do the right thing. It’s not about the big piece. The 100,000 people who work for GSK are just like you, right? I’m sure everybody who reads the BMJ has friends who work for drug companies. They’re normal people… Many of them are doctors”.
This comes from an article in the BMJ in a issue that featured AW on their front cover in Barack Obama political poster Shepard Fairey mode with the word HOPE underneath and a strapline – GSK’s Andrew Witty… The acceptable face of big pharma?
But AW wasn’t asked to take off a GSK hat, and answer as someone with a treatment related adverse event whether he would take the blue pill or the red pill.
“This is your last chance. After this, there is no turning back. You take the blue pill – the story ends, you wake up in your bed and you believe whatever you want to believe”. Morpheus to Neo in The Matrix.
Having taken the Red pill, Neo wakes up to find the following:
1. A Gulag Archipelago
Trials in branded pharmaceuticals from 1960 to 2000 were done in Western clinical centers where the patients did not always exist. Publications based on these non-existent patients litter the academic literature without retraction or even a cautionary note in the case of trials where it is known the patients didn’t exist or the investigators have been jailed, or the company charged with fraud.
Since the mid-1990s trials have moved to South Africa, Russia, India and other countries were patients have little idea what is going on and where if the patients exist and are injured they are routinely lost to follow-up.
2. The disappeared
The New Disappeared aren’t Argentines killed by the Junta. They are ordinary unsuspecting people who have death and disability visited upon them by their treatment. The apparatus of disappearance begins with elaborate methods to avoid collecting the data, to concealment of evidence, to concealment of company agreement that our drug causes this problem, to statistical and controlled trial techniques to make deaths and injuries vanish.
Treatment induced death is now just about the normative mode of death. There is silence all around.
The lengths to which companies go to get an efficacy message out – ghostwriting trials, hiding data, and legal threats – pale in comparison to what they are prepared to do to hide or deny responsibility for the bodies of the Disappeared (See American Woman, American Woman 2).
This now extends to a growing number of children with birth defects, miscarried or born developmentally delayed. Something for Jorge Mario Bergoglio to speak up about.
3. Upper Volta with biologicals
Effective treatments should lead to a reduction in healthcare costs and in levels of disability but healthcare costs and levels of disability are rising. We have some very sophisticated drugs but behind the high tech façade healthcare is crumbling with patients in some cases more scared to go into hospital or even see a doctor than they have been for close on a century or as scared as they might be in Liberia or Sierra Leone.
(Helmut Schmidt in the 1980s described Russia as Upper Volta with Missiles).
4. TTIP pact bloc
Most Western countries have signed up to TRIPs and TTIP which are aimed at maximising pharmaceutical company profits to an extraordinary extent. These put in place a range of punitive sanctions should a country deem the needs of their citizens outweigh the right to profit of a pharmaceutical company.
Aside from the punitive sanctions, if a country does not support their marketing, companies threaten to relocate their operations elsewhere. Countries (viz. the UK) will do almost anything to keep a company operating within their borders – even offering up their citizens as all but involuntary participants in company trials run by doctors whom the taxpayer has educated and salaried. And these clinicians have been told they must partner industry.
Consent forms were put in place in 1962 as a means of safeguarding patients. These have been transformed into an instrument of legal jeopardy, with patients unwittingly consenting that their data will be hidden from everyone for ever. This means that even when people have been injured in trials companies will say in public and in court we have no evidence for any injury on our drug.
Studies are undertaken on drugs that almost certainly have been undertaken in the knowledge that the drug causes death or injury and detailed knowledge of this hazard has been used to construct RCTs that will help hide the hazard. Neither the patients nor other doctors involved in such trials have any idea what is going on.
6. Ministry of truth
Close to all of the published literature about on-patent drugs is ghostwritten. Prestigious medical journals have encouraged this for the last 30 years. In terms of ensuring the integrity of the primary sources of a story and ensuring the authors are who they appear to be we would all be safer if clinical trials were published in the New York Times than in the New England Journal of Medicine.
Even the most prestigious medical journals are scared to publish articles raising hazards about drugs, or even articles by anyone identified as someone who raises issues about treatment, for fear of legal action from companies. The situation is every bit as bad as the level of censorship in the former Soviet Union. Tackling Abu Bakr al-Baghdadi is kids play compared to tackling Pharma.
Academic journals and societies show an auto-immune response to information that should be the life-blood of medicine.
8. Propaganda 101
Not only has most of the academic literature become one big advert for branded pharmaceuticals but when hazards are raised, companies have learnt how to use any concerns about a drug as a means to increase sales of the drug, and as a means to bind even more doctors ever more closely to the company bosom.
Put a pregnancy category D (causes birth defects) on Paxil and the company will organize a lecture tour as now is a good time to sell Paxil.
9. Holocaust denialism
Regulators never take it upon themselves to establish if a drug has a hazard. Their role is to manage risks. This does not mean that they warn about a hazard a drug might pose. It means they manage public perceptions or beliefs about a risk. Doubt is their product.
In the case of thalidomide the possibility that it caused birth defects met a regulatory response as to whether we have ruled out the possibility that it prevents the miscarriages of babies with birth defects. In the case of Matt Miller, a 13 year old boy who hung himself a week after going on Zoloft, it met a response that we cannot rule out that this was auto-erotic asphyxiation gone wrong and until we can it would be a mistake to blame the problem on Zoloft.
10. Una duce, una voce
Guidelines depend completely on the published ghostwritten literature on which all data has been withheld. Once guideline makers treat company articles as though they are science they are captured by Pharma. By skilful publication strategies Pharma can always ensure that their latest on-patent drug features on top of the most independent guidelines. Economic pressures have forced a standardisation of healthcare in an effort to contain costs and this has transformed what was guidance into tramlines. These tramlines increasingly dictate what doctors have to prescribe.
Anyone raising the profile of a drug’s hazards is likely to get harassed, marginalized or terminated. The harassment will include having people in the audience to challenge everything said, reviewing everything written to see does it provide the basis of a legal suit, actively targeting and spreading malicious gossip and disinformation through PR networks, calling colleagues or friends to “get the dirt”, “reading everything you have ever written Dr”, triggering tax inspections etc.
12. Medical McCarthyism
Anyone talking about the hazards of a treatment is marginalized by their clinical colleagues and any group seeking a balanced approach to treatment is likely to be stigmatised as Scientologists or as Ideological. This creates a Spiral of Silence where others observing what happens learn to remain silent.
Someone needs to speak up.
The norm in science is that there is free access to the data underpinning experiments. If free access is denied, it’s not science. In the case of branded pharmaceuticals, we do not even know what trials have been done. There is a denial of access to any raw data from any clinical trials. We have even less knowledge of what drug trials (healthy volunteer trials) are done and again no access to data even though there are no issues of clinical confidentiality. What is put in the public domain is not data. What will be put in the public domain under GSK’s proposal is managed access which is likely to be worse for everyone than no access.
The selected highlights of a football game and the comments of the pundits afterwards don’t change the score. The selected highlights of Pharma studies and the comments of pundits routinely change the score.
Clinicians and the public are routinely sold a biobabble about drugs and diseases that is as ideological as anything found in Soviet Lysenkoism. The problem in this case doesn’t lie in the biological sciences it lies in the social sciences and anthropology as well as the humanities which have been used to produce an informational reductionism and standardization on the one side and to develop marketing on the other. (For a first use of Biobabble – see 1999).
15. The five-year plan
Instead of the old-Soviet style Five Year plan we have the rolling marketing campaign linked to patent expiration. In sequence people have to be persuaded they are anxious, then converted to depression, and after that converted to bipolar disorder, or moved from pain to fibromyalgia, or from ulcers to GERD.
To get it to work, doctors are bribed to adhere to guidelines for illness that may have only been invented a few years before – or penalized for not meeting targets.
16. Homeland security
Few are aware that almost all drugs are made available under police state provisions and supervision. The availability of medicines on a prescription-only basis was introduced as a means to control heroin and cocaine addicts in 1914. The War on Drugs initiated then has become a permanent War in which all citizens are treated as addicts and all doctors as police.
Extending prescription-only privileges to all drugs was sold to the wider population as a means through which medical scepticism would temper patient zeal for treatment. But doctors now funnel drugs to people in the Matrix in amounts that leave many of us begging them to stop or else surreptitiously dumping our medicines.
Rachel Liebert outlines how recent school shootings have chillingly led to the creation of a Homeland Security apparatus in our schools and colleges aimed at detecting any signs of abnormality in any students and getting them on medication.
“The 100,000 people who work for GSK are just like you, right? I’m sure everybody who reads the BMJ has friends who work for drug companies. They’re normal people… Many of them are doctors.”
Any German in the 1930s or 40s could have said the same of his fellow-countrymen. And the subjects in the famous Milgram experiments were no doubt just like you and me also.
There are lots of Good Germans in the system. All tyrannies have passed – up till this anyway. You have to survive till then, and life is more comfortable in the Matrix than outside. Unless they come to take you away, its better keep your head down. Keep taking the blue pills.
In the 1960s, there was concern at the development of psychiatric techniques that looked likely to lead to brainwashed behavior. These concerns reached the level of a Congressional Hearing in 1967. Seymour Kety, the head of NIH, put the developments in context for Congress:
“The manipulation of the brain by any of the biological techniques which can be developed in the foreseeable future would involve such drastic invasions of privacy, integrity and the unalienable rights of the individual that in their application behavioral control would already have been achieved even if the electrodes carried no current and the pill were placebo”.
Our pharmacological and biological techniques have not moved on much since then. Most of our treatments are weaker now. Their weakness reveals that what has changed is that control has been achieved even when the electrodes carry no current and the pills are placebo or worse.
Jacques Ellul predicted exactly this outcome in the 1960s in The Technological Society. He said the techniques to worry about were our public relations and marketing techniques rather than our engineering or biological techniques. The social scientists and students of rhetoric (media studies) of the 1960s migrated from universities to populate the marketing departments of pharmaceutical companies (see Factories of Post-modernism). They brought with them a means of control through a set of techniques first pioneered by Edward Bernays.
Back in the 1960s the totalitarianism of the Soviet Union was a horror but Soviet citizens could very clearly see the enemy. The control is now far more complete. The mechanisms and levers invisible. We volunteer into rather than are coerced into running the apparatus of repression. We live in a Brand Fascist state.
Illustration: HOPE: Pills You Can Believe In, 2013 created by Billiam James