Overdosed America (44 page)

Other friends have discussed these issues at length and contributed views from outside the world of medicine: Wolf Kahn and Emily Mason (who also suggested the second best title, “Pandora’s Pillbox”), Anne Spirn, Lynn and Joel Altschul, Thelma Dionne, Chester Wolfe, Bonnie and Peter Rollins, Nate Spiller, Rev. Edward Simms, Stephen Walker, Ron Fox, Elliot Lobel, Paula and Michael Nathanson, Carol Curry, Tom Jarvis, Ruth Kahn, Jean Abramson, Julie Nagazina, and Jay Altschul.

In the various stages of this project, Becky Shafir suggested that it was time for me to write a book; Jane Lawrence gave me the courage to put unrefined and disorganized ideas on paper as a first step; Jeannette Hopkins did her best to show me what I didn’t know about writing and how themes are organized into a book; and Virginia LaPlante skillfully coached me in the preparation of the book proposal.

Thanks to the dedicated people who worked with me in the office (especially Holly Bouchard, the office manager), contributing so much to the care of our patients. Great thanks to my former patients for their trust and for the lessons that they taught me. (Except for Sister Marguerite Kiley, I have changed the names and characteristics of patients in order to protect their privacy.)

I want to remember David Schmidt, M.D., who guided me through the early stages of my career—respecting me enough to let me accept his mature advice. I also want to remember Sister Marguerite, whose spirit still shines as a beacon in my family.

Special thanks to my children, Rebecca and Seth. They have put up with my career as a family doctor and with the demands of this project. And they have given me the greatest gift a parent can receive—they have become adults guided by their own sense of compassion and integrity.

About the author

On Swapping the Scalpel for the Pen

About the book

Post-Publication Notebook: Two Unanticipated Paths

Medical Developments: An Update

Read on

Author’s Picks: Healthy Literature

© Seth Abramson

During a live radio interview on a powerful Midwestern station, the host asked what seemed like a softball question: Why did I leave my practice to write
Overdosed America
? I told him that I had witnessed great medical progress during my more than twenty years as a family doctor. But at the same time I had also watched the influence of the drug industry and other medical industries grow, and neither the public nor doctors understood how detrimental this was to American health care.

He said he believed that, but that he knew other doctors who felt the same way. So what led me, as opposed to them, to write this book? I told him that I had studied statistics, research design, and epidemiology twenty-five years earlier as a Robert Wood Johnson Fellow. That the skills I had acquired during those two years allowed me to read the articles in medical journals with a more critical eye than most practicing doctors. And that once I really understood the startling impact of this growing commercial bias on the “scientific evidence” that informs medical decisions, I wanted to share my findings with health professionals and the public.

Once again, he said he believed all that, but still I hadn’t explained why I would have committed three years of my life and exposed myself to considerable personal risk to take on an industry as powerful as Big Pharma. I reached deeper, telling him I had come of intellectual age during the late 1960s, when the country was being torn apart by our ill-conceived military venture in Vietnam. I told him that during those years I learned that public information often cannot be taken at face value and that committed scholars and journalists could make the truth available for those who cared enough to seek it out. My awakening to the potential of critical scholarship as the antidote to public disinformation purveyed by vested interests was, ultimately, what led me to write this book.

To be sure, there was an element of throwing caution to the wind in leaving my practice to write an exposé of American medicine. But, I explained to my host, I had no option: not writing
Overdosed America
would have left me forever knowing that I had been in a position, a privileged and somewhat unique position, to explain the commercial hijacking of my profession, but that I had lacked the courage to go forward. Finally, my host was satisfied.

“I had come of intellectual age during the late 1960s, when the country was being torn apart by our ill-conceived military venture in Vietnam.. . . During those years I learned that public information often cannot be taken at face value.”

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The withdrawal of Vioxx nine days after
Overdosed America
was published catapulted me into the public arena. Less than twenty-four hours after Merck’s announcement, I was sitting on a couch talking with Katie Couric as if we were chatting in my living room, except for the wall of television cameras in front of us and the millions of viewers. Television and radio interviews took up a lot of my time in the following weeks. Three months later, a study showed that Celebrex might increase the risk of cardiovascular complications too, and there was another flurry of media activity and another appearance on the
Today
show.

But still I didn’t have a plan for what I would do after the post-publication hoopla died down. Just when I was feeling the need to seek an academic position or apply for a fellowship to fund ongoing research, two unanticipated paths, kind of the yin and the yang of my work, opened up.

“I was sitting on a couch talking with Katie Couric as if we were chatting in my living room.”

During my first trip cross-country to give a lecture and do publicity for the book, the woman sitting next to me pulled a medical-looking article out of her briefcase. I couldn’t help but notice that the title had something to do with using predictive modeling to contain health care costs. I told her I had some experience with health issues and asked her what the article was about. She said that predictive modeling involved using artificial intelligence to analyze medical and prescription drug claim data to identify people at greatest risk of becoming seriously ill in the following year. Once identified, she explained, specially trained nurses could contact these people and their doctors to head off impending medical disaster at the pass. Consistent with her metaphor, the woman told me that she worked for a subsidiary of Wells Fargo, and that predictive modeling was part of a package of health management services they offered to self-insured companies with the goal of controlling medical costs and improving employees’ health.

As we flew across the western half of the United States, we talked about the opportunity to combine predictive modeling, wellness interventions, and health information free of commercial bias to provide optimal health care. More than two years of work later, we made a site visit to our first client, a hospital and health center serving a Native American community in Arizona. This community has major health challenges, and provides an opportunity for us to facilitate workplace, family, and community-based interventions informed by predictive modeling and non-commercially biased health information.

“As we flew across the western half of the United States, we talked about the opportunity to combine predictive modeling, wellness interventions, and health information free of commercial bias.”

At about the same time, a lawyer in Houston who read
Overdosed America
invited me to present a seminar about Vioxx and Celebrex to his firm. This was the cat’s meow for me—the lawyers were interested not just in an overview, but in the smallest statistical details of my research showing that these drugs are not nearly as safe as doctors reading their trusted journals like the
New England Journal of Medicine
and the
Journal of the American Medical Association
had been led to believe. When I was doing the original research on Vioxx and Celebrex for the book, I often felt as if I were writing a legal brief. But I never imagined that lawyers would actually pay me to show how the drug companies were using distorted science to convince doctors to prescribe their drugs.

In the fall of 2006 I was asked to make a similar presentation about Celebrex and Bextra, this time at a special “science tutorial” for a federal judge and two state judges who would soon be hearing cases involving these drugs. The judges, sitting in the federal courtroom in San Francisco, listened intently and interrupted my presentation frequently with very thoughtful questions. They clearly wanted to understand the science and the marketing of these two drugs. What a thrill: having found the truth about Vioxx and Celebrex on the FDA Web site while I was still a practicing family doctor, having spent three years piecing together how the drug companies produce science that is favorable to their products (sometimes going further than just bending the rules of science), and now sharing my findings with judges playing a pivotal role in litigation that will determine just how far the drug companies can go in exaggerating the benefits and minimizing the risks of their drugs before they risk having to pay a prohibitive price.

In addition to these projects, I continue speaking around the country to medical students, doctors, and general audiences, and continue with academic writing and research. Though I had no preconceived plan, I could not have asked for a more engaging or productive combination of projects. What began as a passion and an intellectual challenge has now become an ongoing mission.

“The judges, sitting in the federal courtroom in San Francisco, listened intently and interrupted my presentation frequently with very thoughtful questions”

VIOXX

Merck pulled Vioxx from the market after its own APPROVe study was stopped prematurely because the people taking Vioxx were developing almost twice as many heart attacks, strokes, and blood clots as people taking placebos. Merck was praised for withdrawing Vioxx as soon as it learned about the interim results of the APPROVe trial in September 2004. But reports now available to the public on the FDA Web site show that exactly the same situation had existed in November and December 1999 in Merck’s VIGOR study. In this study (discussed in
chapter 3
), Vioxx was being tested against naproxen (sold over the counter as Aleve) in patients with rheumatoid arthritis. Just like in the APPROVe study, the committee monitoring the safety of the people participating in the study was informed that there were “excess deaths and cardiovascular adverse experiences,” nearly twice as many, in the group that was obviously taking Vioxx. But unlike the APPROVe trial, not only was the VIGOR study not stopped, but the
New England Journal of Medicine
article that reported its results didn’t even report that there were more serious cardiovascular complications caused by Vioxx than there were serious GI complications prevented. Instead, the article presented just the results for heart attacks.