Well-known nephrologist and author Dr. Jason Fung is an orthodox medic who has become wary of scientific research that purports to be “evidence based.” Fung has spoken extensively about Type-2 diabetes reversal and the metabolic effects of intermittent fasting, but in this presentation (Dec. 2018), he focuses on the many ways that medical research and the system that flows from it has become corrupted.
This is worth watching all the way through! (49 minutes long), but here is a timeline of the talk if you are impatient!
- 00:00 Financial conflict of interest
- 03:20 Influence of alcohol industry
- 05:00 Doctors receiving payments from industry
- 06:00 How gifts affect doctors but they don’t realise it
- 07:54 How free conferences affect prescribing
- 09:20 The more prestigious a doctor the more money they are given by pharmaceutical companies
- 10:50 Doctors advising the FDA receive $100,000’s of industry payouts
- 11:50 Drs (like Malcolm Kendrick) who try and point out the corruption are being shut down
- 12:30 Statin advice underpinned by corrupt science
- 13:15 No effect when France stopped statins
- 14:50 Fructose research corruption
- 15:50 Sugar industry funding biases research
- 18:25 7 ways the industry corrupts research
- 19:45 Corruption of the medical journals
- 20:20 Industry payments to journal editors – $100,000+
- 20:38 Drug companies publishing drug reviews
- 25:18 Reprint income
- 26:35 Rosiglitazone — doctor bias
- 27:20 Evidence based medicine is so corrupt as to be useless or harmful
- 28:15 Publication bias — the bias in favour of antidepressants (28:15)
- 30:20 Publication bias — Neurodegenerative disease
- 31:00 Multiple publication of positive studies
- 32:45 Selective publication of positive studies
- 33:50 Changes in study bias pre and post 2000
- 35:30 Bias in guidelines — PSA screening recommendations
- 37:30 Bias in guidelines — antidepressants
- 38:40 Bias affects the standard of practise
- 39:05 Failure of clinical practice guidelines
- 39:55 The current state of evidence based medicine
- 42:00 The opioid crisis — “If you are in pain you can’t get addicted”
- 42:50 Riding the Gravy Train leads to people dying
- 43:45 We wouldn’t accept this if it were the police or judiciary that were accepting bribes. Why do we allow it from doctors?
- 46:05 The solution — make the receipt of bribes illegal for doctors, like it is for teachers, judges and policemen
Excerpts from the video
- 94% of doctors receive gifts from the pharmaceutical industry.
- 95% of doctors think their judgement is unaffected by financial receipts from the industry.
The current state of evidence based medicine
- Selective Publication
- Rigged Outcomes
- Advertorials as ‘Best Practice’
- Reprint Revenues
- Bribery of Journal Editors
- Financial Conflicts of Interest
“You thought doctors taught at prestigious institutions for the good of mankind. That might have been why they went there in the first place, but they stayed for the money.”
Dr Jason Fung
“There’s a clear correlation: The more prestigious a doctor, the more money they’re getting from the pharmaceuticals.”
Dr Jason Fung
“We wouldn’t accept this if it were the police or judiciary that were taking bribes. Why do we accept it from doctors?.”
Dr Jason Fung
I watched the Fung presentation and I get the picture, though I could have already guessed it for the US. But what is the situation with pharma influence on doctors in the UK? I thought payments from pharma to doctors was already disallowed.
Good point – clearly there are differences in the UK and US. Here, the Association of the British Pharmaceutical Industry code regulates what Pharma can give as incentives to GPs, and the 2008 guidelines [1] make it clear that direct payments are a no-no. However, inexpensive promotional aids, ‘education’, hospitality, sponsored meetings and events, plus unbranded medical goods and services for patients are all acceptable.
In 2016 The Financial Times [2] reported a new open access database that drug companies have set up ‘to be more transparent’ showing payments they made to GPs and health workers. It totalled £340 million in 2015. two thirds of that was for research — just as Fung mentioned, paying doctors to do research — but the rest included consultancy, education, attending and arranging meetings, again along the lines Fung indicated. Due to data protection GPs had to opt in for their financial receipts to appear in the database. Whilst 70% of recipients gave consent, the remaining 30% received the lions share of the funding (52%).
A 2018 article in Pulse Magazine (a “leading publication for GPs in the UK) [3] has an article ‘Should GPs work with the pharma industry?’ in which two doctors with opposing viewpoints share their insights. The first believes that the new regimen means there is no longer any significant influence on GPs prescribing patterns — which is exactly what Fung claims many doctors think: ‘it doesn’t affect me’. The second doctor is far more sceptical pointing out that rather than target GPs directly, Pharma now heavily leans on key opinion leaders (KOLs) — many of whom chose not to appear on that database yet are accredited by the Royal College to provide GPs with CPD. Their influence extends to inventing new conditions such as ‘mild cognitive impairment’ to create new markets.
One comment on the pulse article says: “The carrots have been banned by the party poopers so now we are left with stick. The real worry is the influence that big pharma has over medical regulation. Doctors regularly field complaints from patients who are angry when they are denied a treatment that NICE or it’s ilk say they can have. The courts, tribunals and complaints industry holds us to account through these guidelines. It’s insidious but far more powerful than a ‘free’ Biro.”
My own experience from a few years back bears this out. I used to attend the local GP luncheon club at the local hospital where doctors would listen to a lecture — usually by one of the consultants — while eating a very nice dinner provided by the Pharma sponsors who were there with stands, smartly dressed young representatives and ‘educational material’. It was sometimes obvious that the lectures were promoting a particular drug as its brand name would come up repeatedly. Speakers that I chatted with before the talk would express a broad interest in diet or other approaches for their specialist conditions but the moment they were up on the stage that all went out of the window and they were clearly peddling their fave Pharma product or avoiding anything to do with diet. The duplicity was quite shocking. During their talk I would put my hand up and ask questions to bring out the points they had been discussing with me minutes before, but they never appreciated it and I was eventually asked to stop attending!
1. https://www.guidelinesinpractice.co.uk/the-abpi-code-clarifies-what-gps-can-receive-from-drug-companies/300010.article
2. https://www.ft.com/content/b3e42806-3ec7-11e6-8716-a4a71e8140b0
3. http://www.pulsetoday.co.uk/clinical/clinical-specialties/prescribing/should-gps-work-with-the-pharma-industry/20037595.article