Overdosed America (43 page)

clinical guidelines and, 127, 130, 227

diabetes web sites, 230

public relations campaigns and, 163

non-steroidal anti-inflammatory drugs (NSAIDs), 6–7, 24, 25, 29–36

Norpace, 114

Norvasc, 245

Novartis, 109, 212

Nurses’ Health Study, 63, 66–67, 202, 229–30

nutrition.
See
diet

obesity, 204, 222, 229–30, 235–37

observational studies, 64–68

omission of data, 29–31

Omnicom, 109

organ transplantation, 43, 44

Osler, Dr. William, 197, 208

osteoarthritis, 190–94.
See also
Celebrex and Vioxx

osteopenia, 210, 215

osteoporosis, 210–20

drugs, 246–47

marketing of hormone replacement therapy for, 62–64

Our Bodies, Ourselves
, 219

overuse of medical services, xix–xx, 52–53, 84, 178–81.
See also
supply-side medical care

OxyContin (oxycodone), 102–3, 121

pain control, 121–22, 191

paradigms, medical, 202–3

Pasteur, Louis, 189, 194–95

patents, 153, 241

patients

medical consumerism of (
see
marketing; medical consumerism)

persons vs., 56–57, 206–8

relationship of, with doctors (
see
doctor-patient relationship)

responsibility of, 256–60

rights of, and health insurance, 80, 162–63

uninsured, xxi, 20, 46, 253–54

unrepresentative study, 16–17, 33, 103–4, 206–8, 251

Paxil, 116–17, 163, 243

peer review.
See also
medical journals

hidden data and, 106

reforming, 252

Percocet, 102–3

performance, health care system, 46–47, 180–81, 184, 210, 248–49

persons, patients vs., 56–57, 206–8.
See also
patients

Pfizer, 21–22, 107–9, 119, 232–33

pharmaceutical industry.
See
drug companies

Pharmaceutical Research and Manufacturers of America (PhRMA), 122, 154, 160, 245

Pharmacia Corporation, 23–24, 30, 104–5

physical fitness.
See
exercise

placebos, 14, 102–3

polio, 42, 241

politics.
See
government, U.S.

postapproval studies, 29

poverty, disease and, 204

pravastatin (Pravachol), 13–18, 133, 136–37, 142–46, 165, 227–28

preapproval clinical trials, 29

prednisone, 33

preemptive pain medication, 102–3

Premarin.
See
hormone replacement therapy (HRT)

premature research termination, 70, 104–5, 243–44

prescribing habits

commercial influence on, 120–24

drug company access to, 126

medical consumerism and, 155–57

prescription drug coverage.
See also
health insurance

commercial incentive of, 21–22

HMOs and managed care plans, 79–80

Medicare, 244–49

preventive care, 49, 166.
See also
lifestyle health factors

Prilosec, 43, 101–2, 246

primary care, 11, 78, 82–85, 208.
See also
doctor-patient relationship

primary care doctors

breast cancer and, 39

diminishing role of, 82–85

drug ads and, 156

HMOs and, 75–76, 78

persons vs. patients and, 208

ranking of innovations by, 44, 114–15, 181–83

specialists and, 255–56

Procter and Gamble, 135

professional societies, 127

profits.
See also
costs, medical

marketing and, 158–59, 163, 242

media, 166–67

medical industry, xxi, 110, 253

medical journal, 112–13

statin drugs, 135, 147–48

supply-side medical services, 179–80, 184–85, 254–55

surgical procedures, 174–78

universal health insurance and, 253–54

progestin, 62, 70

promotional campaigns.
See
marketing

Pronestyl, 114

PROSPER study, 145, 246

PROVE IT study, 146, 246

psychotherapy, 11, 232–33

publication bias, 113–17.
See also
commercial research bias

Public Citizen, 86, 121, 167

public relations campaigns, 63, 159–63.
See also
marketing

Pub-Med web site, 28

pulmonary edema/congestive heart failure, 7–8

Purdue Pharma, 121–22

quality, health care, 46–47, 180–81, 184, 210, 248–49, 254–56

Quinaglute, 114

rabies, 194–95

raloxifene, 217

randomized controlled trials (RCTs), 64–68, 250

ranitidine, 246

rationing, health care, 162–63

red meat consumption, 45, 238

relationships.
See
conflicts of interest; doctor-patient relationship

relative risk, 14–16, 165–66, 229

Republican Party, 90–91, 247

research companies, 95, 109–10.
See also
medical research; commercial research bias

resident doctors.
See
medical education

Response Oncology, 51

responsiveness, health system, 48

review articles, Celebrex and Vioxx, 25–27, 33, 37

Rezulin, 86–88

rheumatoid arthritis drugs.
See
Celebrex and Vioxx

risedronate, 214–15

risk, absolute vs. relative, 14–16, 165–66, 229

risk factors, 205–6

Rockefeller Foundation, 196–97

Rorer Foundation, 212

safety, 86, 160–61.
See also
side effects

sales reps, drug company, 124–26

Salk vaccine, 42, 241

salt, 238

samples, free drug, 124–26

Sandoz (Novartis), 109, 212

scans, MRI and CT, 44, 181–83

Schering AG, 89

Schering-Plough, 148, 152–53, 157

science, medical.
See
medical education; medical research

scientific evidence, spinning.
See
commercial research bias

screening, 49, 235

Scully, Thomas A., 247–48

sedentary lifestyle.
See
exercise

self-censorship, journal, 113

septic shock, 161–63

side effects

advertising and, 150–51

antidepressant drugs, 116–17

Celebrex, 32

Claritin, 153

coronary artery bypass surgery, 173

hormone replacement therapy, 69

Vioxx, 36

significance, statistical, 14, 26

sleep, depression and, 10–11

SmithKline Beecham, 163, 212

smoking

cancer and, 234–35

coronary heart disease and, 129, 201, 221, 222

diseases and, 49, 204, 237

heart attacks and, 100–101

strokes and, 20, 225

social anxiety disorder (SAD), 163, 232–34

specialty care, 82–85, 255–56

speech, commercial, 37–38, 157–59

spinal fusion surgery, 177–78

spinning of scientific evidence.
See
commercial research bias

standards of care.
See
clinical practice guidelines

statin drugs

biomedical model and, 201

cancer and, 145–46

commercial research bias and, 13–22

continuing education and, 119

coronary heart disease and, 221 (
see also
cholesterol guidelines of 2001)

C-reactive protein (CRP) test and, 164–66

diabetes and, 231

Medicare prescription drug bill and, 246

statistics

absolute risk vs. relative risk, 14–16, 165–66, 229

statistical significance, 14, 26

strokes, 225–28.
See also
coronary heart disease (CHD)

hormone replacement therapy and, 58, 70

statin drugs and, 13–22

Vioxx and, 26

studies.
See
commercial research bias; medical research

subjective experience, 206–8

sugar consumption, 236, 238

suicide, antidepressant therapy and, 116–17

supply-side medical care, 169–85

costs, 184–85

failure of, 254–56

heart attack care, 169–73

market pressures and, 174–78

medical services vulnerable to overuse, 178–80

more care vs. better care, 180–81

MRI and CT scans, 181–83

neonatal care, 173–74

terminal care, 183

surgical procedures, 43, 174–78

Tagamet, 43

tendonitis, 6–7

terminal care, 183

termination, premature study, 70, 104–5, 243–44

tests.
See
diagnostic tests

thought leaders, 119

tobacco.
See
smoking

total cholesterol, 18–20.
See also
cholesterol

training.
See
medical education

transparency, data, 27–28, 94, 105–6, 251–52.
See also
data

transplantation

bone marrow, 41, 51–52

organ, 43, 44

trazodone, 11

tricyclic antidepressants, 116

trust.
See also
doctor-patient relationship

medical journal articles and, 17, 93–94, 106, 112–13

myth of excellence and, 39–42, 50–53

tuberculosis, 49, 195

type 2 diabetes, 222, 228–31

ulcers, 9, 28, 29, 43

unbiased information, 167, 219

uninsured patients, xxi–xxii, 20, 46, 253–54.
See also
health insurance

United Kingdom, 174, 250

universal health insurance, xx–xxi, 20, 46, 253–54.
See also
health insurance

University of British Columbia Therapeutics Initiative, 167

university-based research, 94–95, 109, 196–97

United States.
See
government, U.S.; health care system, U.S.

unnecessary medical services, xix–xx, 52–53, 84, 178–81.
See also
supply-side medical care

unrepresentative study patients, 16–17, 33, 103–4, 206–8, 251

user fees, FDA, 85–86, 249

uterine cancer, 62, 70

VANQWISH study, 175

ventricular fibrillation, 98

verapamil, 104

VIGOR study, 26–27, 33–36.
See also
Celebrex and Vioxx

Vioxx.
See
Celebrex and Vioxx

Warner-Lambert, 87–88

Warning Letters, FDA

to Bristol-Myers Squibb, 227–28

decline in, 157–58

drug company responses, 244

to Eli Lilly, 217

to Merck, 36

to Pharmacia Corporation, 23–24, 32–33

web sites

commercially biased, 79, 218–19, 230–31

FDA reports and data, 28, 37

osteoporosis, 218–19

Public Citizen, 167

weight reduction.
See
diet

western diet, 234–35

Wilson, Dr. Robert, 60–62

women

coronary heart disease and, 139–43, 223

exercise and, 238–39

healthy life expectancy of, 47

hormone replacement therapy for (
see
hormone replacement therapy)

osteoporosis and, 210–20

strokes and, 16

World Health Organization (WHO), 45–48, 133, 211–12

worstpills.org web site, 167

WOSCOPS study, 136–37, 139, 201

Wyeth-Ayerst, 59, 63, 68

Xigris, 161–63

Zantac, 43, 246

Zocor, 133, 142

Zoloft, 116, 232–33

Zomax, 118

First and last
I thank Charlotte Kahn, who has been my inspiration, facilitator, and most fearless critic. She gave me the courage to explore the big issues and helped me focus my investigation, but most of all provided me with unfailing encouragement about the importance of this project.

Gail Winston, at HarperCollins, disproved almost everything I had been led to expect from a publisher. She coached me patiently throughout the process: from organizing themes to structuring chapters to crafting the language to preparing the final manuscript. Even more important, she was always enthusiastic and always believed in the value of telling this story fairly and completely. I quickly learned to trust Gail’s wise advice. Christine Walsh, also at HarperCollins, provided support and adroitly focused my attention on necessary details.

Kris Dahl, my agent, understood the importance of these issues immediately—even though this must have sounded like a wild story when we first met in March 2002—and has provided guidance since.

Delia Marshall skillfully, tirelessly, and compassionately labored with me to help organize the argument and improve the language. Her attention to detail and commitment to bringing forth the important points are greatly appreciated.

Besides showing me that well-researched, unflinching investigative writing can make a difference, Eric Schlosser provided friendly writer’s advice. He reassured me that the personal havoc that builds toward the end of a project is “normal.” And he suggested that I work with Ellis Levine, who would provide excellent legal advice and help me produce a better book. Ellis certainly did both. His attention to detail helped to ensure that I was telling this at times far-fetched-sounding tale fairly and accurately, and his literary sense helped me to tell the story better.

Bruce Spitz first introduced me to the pleasures and challenges of health policy research in 1981. We have been colleagues (intermittently) and friends (consistently) since, and I greatly appreciate the advice and guidance that he has provided over more than 20 years.

Many people have offered expert suggestions, and I am grateful for their efforts: Barbara Starfield, M.D., MPH; Elliott Fisher, M.D., MPH; Susan Love, M.D.; James Wright, M.D., Ph.D.; Marcia Angell, M.D.; Joe Vitale, M.D.; Arminee Kazanjian, Dr. Soc.; Richard Yospin; William Taylor, M.D.; Marty Farnsworth Richie; Paul Spirn, M.D.; Eve Leeman, M.D.; Stanley Sagov, M.D.; George Mann, Sc.D., M.D.; Larry Sasich, Pharm.D.; Richard Einhorn, M.D.; Professor Richard Lewontin; and Michael Klein, M.D. Herbert Benson, M.D., has provided sage advice and made many suggestions as these ideas have developed over the past five years. The inaccuracies that remain are my own.

Mike Curtis at the
Atlantic Monthly
read an early version of the chapter on Celebrex and Vioxx and confirmed its importance while at the same time gently suggesting that I be kinder to my readers. Melissa Ludke, from
Nieman Reports,
encouraged me to write about the press coverage of C-reactive protein.