Panaceia or Hygeia

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Archive for July 9th, 2008

CALIPSO

Posted by Colin Rose on July 9, 2008

Here is a good example of a “study” of statins written by a non-medically licenced employee of a statin-peddling drug company, Merck Frosst Schering, with the names of prominent “experts”, many known to be financially associated with drug companies, shown as secondary authors.

What a nice name! Reminds one of sunny Caribbean islands. Except they had to use an “I” instead of a “y”. Guess they couldn’t find an acronym that fit easily. What was done? Doctors were paid to collect data on patients to whom they prescribed statins. Results? Horrors of horrors, many of them did not reach “target” LDL (bad blood cholesterol). Conclusion? You guessed it. Not enough people are taking enough statins. Suggestion? “Strategies should be implemented to promote achievement of lipid treatment goals…”

Who sets these “targets” anyway? Again, you guessed it, the same sort of doctors as the authors listed in CALIPSO, most paid by drug dealers in one way or another. See the evidence in the US and Canada.

More than half of the subjects had no history of cardiovascular disease, so statins were being used for primary prevention and there is no overall benefit of statins this class of patient.

Note that the first author is employed by a Merck, a big seller of statins.

No attempt was made to alter high risk lifestyles (42% had abdominal obesity and 17% smoked). That’s hard work and takes a lot of time. But, why bother? Surely, after years of medical terrorism by drug dealers, everyone knows that atherosclerosis is caused by bad blood cholesterol and there is a very profitable strategy for attaining “lipid treatment goals”; pay doctors to give statins to reach those arbitrary targets as is now happening in parts of the USA.

The Canadian Journal of Cardiololgy, at least 80% of whose revenue comes from drug companies, does not require financial disclosure by authors but we have found them from another source. In the Acknowledgements those nice people at Merck and  BioMedCom, contracted to do the “study”, are thanked.

While BioMedCom claims to do “scientifically rigorous” work, CALIPSO is not science at all. It is a highly biased sample of what doctors will do if paid to report on the patients to whom they prescibe statins. There is no proof that if the patients had reached “target” they would have benefitted at all. There is no control group who did not receive statins and there is no indication of outcome at all. This is not science, but another attempt at medical terrorism to sell more drugs and any doctor who would put his name on such a study cannot claim to be an expert in “hypercholesterolemia” nor should he or she be part of any group advising other doctors like the “Working Group” in Canada.

Why would all those “experts” in the author list need to hire BioMedCom, to do this “study”? What did these doctors do to justify putting their names on the “study”? And why is an employee of Merck first author? We leave the answers to the reader’s imagination.

 

Financial Conflicts of Interest Not Reported in CALIPSO Paper

 

Posted in atherosclerosis, cardiology, cholesterol, drugs, obesity, professionalism, statins | Tagged: , , , , , , , , , , , , , , , | Leave a Comment »

Drug Dealers Bribe Doctors to Prescribe Statins

Posted by Colin Rose on July 9, 2008

Here is a very important post from Dr. Catey Shanahan documenting direct bribes from drug dealers to clinics who can attract more doctors by paying them more as long as they pledge to get every patient’s LDL below 100. Without major dietary change, counseling for which takes a lot of unpaid time of the doctor, this can only be done by prescibing statins, already the most prescribed drugs in the world. When will the physician licensing bodies stop this corruption of the medical profession and forbid any financial connection of practicing doctors with any industry associated with medical practice?

Unlike Dr. Shanahan, I do blame the doctors. This sort of behavior is highly unprofessional. If no doctor went along with this highly unethical practice, contrary to the Hippocratic oath, it wouldn’t exist.

It seems insurance companies are so occupied with getting $zillions from drug dealers that they can’t be bothered to look at the data. Here are some from the ALLHAT-LLT study. In spite of a large reduction in LDL, bad blood cholesterol, there was no effect on mortality or morbidity in this group of very high risk people including diabetics, all of which the insurance company says should be give statins. Where a bar crosses the vertical line there is no significant effect in that sub-group.

And look at the baseline characteristics of the participants in ALLHAT-LLT: all overweight, 43% obese, 23% smoking, 35% diabetic. Is it not highly unethical to perform a drug study for lifestyle diseases in such a group with obviously atherogenic lifestyles BEFORE optimizing the lifestyles of all participants?

Legal Addictions

An ALLHAT-LLT type subject

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Many of the comments on the NYT and other articles on the new recommendations for pediatricians and family doctors to put children on brain-damaging statins are expressing outrange that drug companies are taking over the minds of doctors. Don’t blame doctors. We’re being threatened by insurance companies. If we don’t do exactly what drug companies want, we’ll be paid less. In some cases, some of us might loose our jobs. (OKay, we do deserve some blame for not standing up for ourselves!)

I went for a job interview in Portland and in a conversation with the medical director of a large group there, I was told that if I failed to get my patients LDL levels down to 100 “someone will sit down and talk with you.” This particular group was able to offer a better starting salary than average. I had assumed that the reason they could offer more was through efficiencies. During the interview, I learned there was more to it than that. They had special arrangements with drug companies called ‘incentive programs.’ The medical director told me with absolute glee “we keep asking them [meaning drug companies] for money and they keep giving it to us.” He sounded like a kid at Christmas!

This group’s policy is to get everyone’s LDL under 100, regardless of risk factors. Stratifying risk is “too complicated.” So they make it simple for their docs. How convenient for the drug companies. I suspect that because this organization has such an aggressive general policy, the drug companies reward them handsomely for taking such a progressive position. They can offer about $50,000 more per year than doctors working in their own, independent offices.

HMSA is Hawaii’s largest medical insurance company. They are paying me to prescribe statins to people who have had heart attacks. Next year, they will pay me to prescribe statins to every single one of my diabetic patients. If I don’t I may loose about $20,000 and my entire group will be penalized financially as well.

If any of this disturbs you, please write to John Berthiaume MD, HMSA Vice President/Medical Director. 818 Keeaumoku Street, Honolulu, HI 96814. Or, you can write to the medical director of your own insurance company and let them know what you think about your payments going into programs that force doctors to write bad prescriptions or loose money!

Posted in atherosclerosis, cholesterol, diabetes, professionalism, statins | Tagged: , , , , , , , , , , , , | Leave a Comment »