John Abramson exposes how U.S. pharmaceutical practices—like Pfizer’s $1.195B Bextra fine, Merck’s Vioxx scandal (40K–60K deaths), and insulin price gouging (11x markup)—drive healthcare inequality, with brand-name drugs costing three times more than global peers. He links opioid crises, preventable diseases, and vaccine controversies to profit-driven distortions, including FDA’s approval of Agihelm despite expert opposition, while noting 800 child COVID deaths vs. 16K annual preventable deaths. Rogan and Abramson agree systemic change demands transparency, accountability, and Abramson’s Sickening (Feb 8) offers solutions to Big Pharma’s broken healthcare model. [Automatically generated summary]
So the United States and New Zealand allowed drug companies to advertise.
But New Zealand has very active oversight of its pharmaceutical program, active oversight of the evaluation of the efficacy of the drugs and whether the pricing of the drugs is reasonable.
So it turns out that even though we in New Zealand allow drug advertising, New Zealand spends the least per person amongst developed countries, and we spend the most by far.
So has there ever been a conversation, like whether it's publicly or privately that you know of where they've tried to stop this?
Is this one of those things that once it gets into play, once there is a law that allows pharmaceutical drug companies to sponsor or to advertise?
Are we doomed then?
Because then the amount of money that's involved in advertising and when you see those brought to you by Pfizer, those CNN commercials, and when you see the, whether it's for allergy medications or antidepressants, the sheer volume of money that's involved, it seems like extracting that from our system would be very difficult to manage because they're going to fight tooth and claw to keep that in.
So as best I understand it, from the lawyers who do understand it, in our Constitution, the advertising of prescription drugs falls under the free speech mandate of our Constitution.
And some things you can control the advertising of cigarettes and alcohol.
There's no beneficial use of those.
They're not a, I mean, they can be recreational, but there's no absolute benefit to them.
But with drugs, there is an absolute benefit.
And because of that, they qualify as protected under the First Amendment.
However, that said, the floodgates were opened, and it's clear that the drug company is going to spend as much advertising, however many billions of dollars they want, to make as much money as they can.
But there's nothing that says the drug ads need to be allowed, that we need to allow them to be misleading.
So you never see in a drug ad that you have to treat 323 people with trulicity for a year to prevent one cardiovascular event.
They don't tell you that.
They tell you trulicity for diabetes prevents cardiovascular events in diabetics.
But if they said you have to treat 323 people to get one better and the other 322 aren't going to have a cardiovascular benefit, then you'd be delivering information that people can use.
And if you said that you can't play violins or have family picnics while you're reciting all the side effects, then people would listen to the side effects.
So I think the key is that the drug companies know how to use the ads very skillful to manipulate people on an emotional level.
And we don't have to settle for that.
We can have, you want to advertise drugs?
Okay.
Let's decide what facts need to be told about this.
Is this better than other therapies?
Is this better than lifestyle intervention?
How much does it cost?
How many people do you need to treat in order for one to get better?
I think if that information were included in the ads, they'd be much less, the cost-benefit of the ads would be reduced or the benefit cost ratio would be reduced for the drug companies and then they wouldn't advertise so much.
But right now they can make these ads that make anything look great and make people want them and make people go to their doctor and ask for them and they make a ton of money.
Advertising in terms of the way they're advertising, not just showing something in a print form like there is a new medication that stops the damages of high blood pressure or whatever it is.
What they're doing is they have these theatrical representations of the most beautiful and wonderful life where people are dancing in wheat fields and delivering picnic food while everybody laughs and cheers.
That should be illegal.
I mean, it's manipulation.
It's clear.
They're clearly fucking with people's heads and they're using psychology.
They're not doing it in a way where they're trying to objectively, coldly rely facts and have people see these facts and recognize that this has benefit to them.
No, what they're doing is they're trying to get people excited about the possibility of living a life like they're seeing.
When they're relaying these facts of the they're doing it with music, they're doing it with joyous dancing and it's bullshit.
It's really wrong because you're not selling a car.
If you want to do that to sell a car, that doesn't bother me at all.
But you're doing something that people who have health problems are really thinking that they're going to wind up like these people in this video.
You're manipulating them to the point where you're getting them to bring things up to their doctor, things about antidepressants or anti-anxiety medication or all kinds of stuff that people could just ask for.
And it's just, it seems insane that of all the countries on earth, there's only two that allow it.
And as you're saying, one that allows it pretty much unchecked.
But I think we could make the drug ads, you could ensure that the drug ads leave people with an accurate understanding of what the benefit of the drug is going to be.
I just think that it's not going to happen that we get rid of them.
But if we made them tell the truth, and if we did studies that looked at the messages that people actually take away from these drug ads and made sure that the messages were accurate, that it would be an improvement.
The right to advertise is so baked into our Constitution that it's not going to happen.
But I do think that if you made the ads tell the truth about how the drug compares to other therapeutic approaches, how it compares to taking charge of your lifestyle, what the real cost is, not what your copay is.
If you made the ads communicate an accurate picture of the role of that drug in therapeutics and the price, the relative price, that it wouldn't be so bad.
I agree 100% with you.
It makes no sense.
Doctors know how to read medical journals and they should be deciding what's good for people.
We don't need the TV ad to tell us that.
All that said, it ain't going away.
So I think the energy ought to be to figure out how to deliver a constructive message.
It seems like, but if you did have a constructive message and it was comprehensive, it would take, you'd need like a half an hour infomercial.
It wouldn't necessarily fit inside a one-minute advertising.
If you're talking about the benefit of different lifestyle choices, if you're talking about diet and exercise and how it affects the way these things interact with the body and what's the actual cost, copay, all the, if you have all those factors in, how are you going to squeeze that into a one-minute ad?
So I think you and I share one common thought that we're not on one side or the other and that pharmaceutical drugs have some amazing benefits and they've been incredible for mankind in so many different ways.
The problem is unchecked capitalism, like unchecked profit, unchecked where you have so much money that you can influence the way things are regulated.
You can influence the way things are promoted by health officials where you just have full reign with your ability to distort information and to cover up the damaging and detrimental effects of these drugs.
And that's where I think we agree about pharmaceutical companies, what they've done in terms of whether it's lying about studies, lying about the addictive properties of these drugs.
It's been absolutely horrific.
But as well, some pharmaceutical drugs are amazing.
And I think there are two important points to be made.
One is this may sound impolite, but the primary function of the drug companies is to make money for their investors.
And we've got to get over the illusion that they're somehow, their purpose is to serve our health.
Their purpose is to make money.
And in our largely unregulated system, uniquely unregulated health care system, pharmaceutical system amongst developed countries, we allow the drug companies to control the information that flows to doctors and patients.
And the amount of accountability that drug companies have.
So like, you know, we've talked before about Pfizer and that, what was the one drug where they had the largest settlement ever with the largest penalty ever?
I spent about 10 years, a little more than 10 years in litigation as an expert in the national drug cases.
And when I served as an expert, I got to see all the documents.
So there would be like 20 million documents in a case.
And I could see the science, and if I needed a statistician to do a reanalysis of the primary data, I got that.
I got to see how the marketing people strategize to exploit the science to create the most profit.
I got to see how they marketed doctors, how they wrote the articles in the medical journals.
And I did that in the case of Pfizer.
Plaintiff's attorneys hired me to analyze the situation.
So I wrote a report and it got submitted to the court.
And Pfizer's behavior was, in my opinion, so outrageous that I picked up the phone and called the Department of Justice and said, I know a lot about this drug, but I can't tell you because I've signed a confidentiality agreement as an expert.
So the Department of Justice and the FBI sent me a subpoena and said, you must come with your computer and tell us what they did wrong.
And I did.
And that was the end of it.
They keep their cards close to their chest.
And six months later, I read in the newspaper that the Department of Justice had found the company had committed a felony, and they were dealt the largest fine in U.S. history, the largest criminal fine in U.S. history.
We can read what the Department of Justice, you can read the Department of Justice press release, and I would encourage anyone who thinks this story is too crazy to be true to just search Department of Justice and Bextra, and they'll see the story that I just told.
And it's even more serious because the drug companies own the data from their clinical trials.
It's so serious, Joe.
When a drug company sponsors a clinical trial and they do the analyses and they write up a manuscript and they say what happened and they send it to a medical journal and it gets peer-reviewed and doctors are trained that they should read and trust peer-reviewed articles that are well conducted and that's how the system works.
The peer reviewers and the editors of the medical journals don't get to see the data.
They have to take the word of the drug companies that they've presented the data accurately and reasonably completely.
And you only get to see it in litigation, you know, five years later, when it doesn't matter because everyone's formed their opinion.
They're taught there's this paradigm of evidence-based medicine where good doctors practice evidence-based medicine and that's based on the peer-reviewed articles published in medical journals and the clinical practice guidelines.
And the doctors don't know that the peer reviewers didn't have access to the data and couldn't perform their independent analyses.
And the experts who write the clinical trials, excuse me, the experts who write the clinical practice guidelines don't have access to the data.
They don't understand that they're getting manipulated, that the control of the knowledge has been turned over to the drug companies.
And the drug companies, they pay for, I think, 86% of the clinical trials.
They design them.
First, they decide what they're about, and they're about the things that are going to make money, obviously.
They're not about the things that are going to make people healthy.
They're not prioritized that way.
But they design the studies, they figure out the doses, they figure out the conditions and exclusions of the people who are in the trials, and they do what they can to exercise their fiduciary responsibility to their shareholders, which is to make this thing come out with data that's going to sell the drug.
And then after they've done all of that, they own the data.
How did that ever become the way that system is set up?
Like, what steps were not put into place to protect people from the kind of fraud that's possible when the pharmaceutical drug companies are the ones who are relaying the data in their interpretation of the data to the peer reviewers?
And what made it so important, so destructive to American health care is that we don't put a limit on what the drug companies can charge so that our prescription drugs, our brand name prescription drugs, cost three and a half times more than the same brand name prescription drugs in the other OECD countries, Organization of Economic Cooperation and Development.
So we have a price that is making this manipulation of data, some people would say BS, the price drives, it creates an enormous incentive.
And then we don't have what's called health technology assessments.
So we have no governmental or quasi-governmental oversight that compares the value of new drugs in terms of the therapeutic value and the economic value to old drugs, to older drugs, older other available therapies that inform coverage decisions and inform physicians about how best to apply the new therapeutics.
And we also don't allow, this one is just mind-boggling.
We don't allow government-funded cost-effectiveness studies and we don't allow cost-effectiveness studies to be used in government-funded healthcare.
So we've created this situation where the prices are sky high, where the knowledge is not being overseen, and where the cost-effectiveness is not, the government is not allowing cost-effectiveness to get into our dialogue in the way it should be.
And we're essentially like playing a professional basketball game where the players are calling their own fouls.
They're paid to win and they're calling their own fouls.
It's craziness.
And that's why I wrote this book.
I've been fortunate enough to be in this unique position as a family doctor for 20 years and then as an expert in litigation.
And I understand how this works.
And the docs, they're trying hard.
They're drowning in information and they're under more and more pressure.
Were you aware of how twisted the system was before you started doing this litigation, before you started going over the peer-reviewed papers and finding out where they did?
So after I finished my residency in family medicine, I did a Robert Wood Johnson Fellowship for two years.
And that was a wonderful training in epidemiology and research design and statistics.
So that's where I got these skills that I came back and drew on.
But family medicine is very hard in an academic environment.
The purpose of the fellowship was to train academics in family medicine to increase the prestige of family medicine, which seems like a good idea.
But family medicine is very difficult in an academic environment because the family docs are a low man on the totem pole in the hospital and all the specialists, specialists often don't treat them with the respect they deserve.
And I decided that my calling was to go be a doctor in a smallish town.
And I did that for 20 years.
But I had this Robert Wood Johnson fellowship training always in the back of my mind.
And as we got through the late 90s, it became clear that the drug companies were influencing what was in the journals.
So, yeah, I got a letter from a mother whose child died, 14, 17-year-old child died from taking Viox, eight samples of Viox.
But Viox came along, and there was an article in the New England Journal that Merck had sponsored, and it said it was safe and was advantageous, not because it was any more effective, but because it reduced the risk of serious GI problems.
And then there was another article in the New England Journal of Medicine that fessed up to cardiovascular problems.
But the review article said this may be due to the play of chance because there were only 70 events and such a small number of events is subject to statistical variation.
And I knew that that was crazy because there were only 53 serious GI events, which was the whole reason for selling this $2 billion a year drug, was that it was safer on the GI tract and there were only 53 events.
And is something like this, the issue is the size of the trial, because you could have 10 people and none of them could have a problem, but you could have 10,000 people and you could have quite a few problems.
So you have to make this study as large as possible so you get all this biological variation between human beings where different things affect different people in different ways.
And you can have a study of 8,000 people where you leave out three heart attacks and you flip the statistics and claim that there's not a cardiovascular risk.
And you couldn't tell the fraud from the article in the New England Journal.
Merck had submitted this data to the New England Journal and they did what peer reviewers do, which is not have the data, but make sure that the article makes internal sense.
They published the article.
And then this review article came along and they gave a little bit more insight into the cardiovascular problems, but they blew it off as the play of chance because there were only 70 events.
And that was crazy.
And at that point, I was sitting in my office at lunchtime reading, taking a break between sessions, reading this article.
And I said, that's it.
I've got to find out.
I've got to figure this out.
There's something so wrong going on here that it's beyond my comprehension.
So an article was published in JAMA two weeks later that had a footnote that led to FDA, an FDA website that had enough data to see that Merck had been fraudulent about the heart attacks.
And when I saw that, I said, I'm going to leave practice and I'm going to figure this out.
And I worked for two years on a book called Overdosed America.
It was published in 2004, and it had the Viox story in it.
And a week after that book was published, Viox was pulled from the market.
It wasn't my doing.
Another study had, Merck had done a second study that showed the same thing, that the risk of strokes and heart attacks and blood clots was doubled.
And at that point, they had to pull it because they were hiding the data on this first study.
Now the second study came along and it was clear that the jig was up for them.
So between 20 and 25 million Americans had taken Vioxx, and between 40 and 60,000 Americans had died, died from the cardiovascular consequences of Vioxx.
In the same ballpark as the number of Americans who died in Vietnam died from taking this drug that was no more effective at treating arthritis or aches and pains than non-steroidal anti-inflammatories and caused 40 to 60,000 deaths.
And Merck's chief scientist saw the data from that first study where the three heart attacks were omitted.
And there's an email that the Wall Street Journal published from March 9th, 2000, when they opened up the data on that.
And the email, I'm paraphrasing, but the email said something like, it's a shame, but the cardiovascular effect is there, but the drug will do well and we will do well.
There's slaps on the hand, but usually when the fines are announced by the Department of Justice, the stock goes up because the shareholders are happy to have this burden of.
And even when they plead guilty to a felony, it's often the, I don't know why this happens, but the Department of Justice allows a subsidiary of the parent company to take the hit so that if there's another flagrant foul, the subsidiary gets, it's called disbarred, but prohibited or excluded from the Medicare program.
The parent company doesn't even take the hit, the legal, doesn't get the legal foul counted against them.
No, but I mean, as far as these regulations, like how is it possible that they would allow them to have such egregious violations where people die and they also have all these safety nets in play to make sure that people don't go to jail and make sure that the parent company doesn't get hit with the foul.
I mean, that doesn't seem like it's not negotiated.
It's going too far to assume or to assert.
Like, what's going too far?
It didn't happen that way organically.
It didn't like, this seems like the best way to do it.
This is going to protect American people the best.
We're going to make it so that you don't get in trouble.
Joe, I'm not an expert at what happens at the level of the Department of Justice, but I have a lot of experience about what happens in civil litigation.
Same drugs, same situation, but civil litigation.
And a lot of times the plaintiff's lawyers will settle.
They'll make a settlement and oftentimes bury the data, agree to bury the data in civil litigation.
And I've been on the inside of some of those decisions.
And the plaintiffs are representing the plaintiff's lawyers are representing the interests of the people who were injured, and they're trying to get the best deal for them.
And it's hard to get a jury to understand this.
Now, I did participate.
I testified in a federal in federal court in a federal trial where Pfizer, I apologize to Pfizer for their names coming up a lot, and they're all the same.
One was as a second-line seizure drug, and one was for post-herpesoster pain.
Those were the two indications for which neurontin was approved.
And let me preface this by saying neurontin is still the sixth most free, or gapapentin is still the sixth most frequently prescribed drug in the United States.
So a lot of insurance companies sued Pfizer for misrepresenting and marketing neurontin off-label use for general pain, mostly some migraines, some bipolar disorder.
But Kaiser was the only plaintiff that the judge who was overseeing this litigation allowed because Kaiser creates like a bottleneck through which information comes to doctors.
So in the other insurers where doctors are getting information from all over the place, the attorneys couldn't prove that Pfizer's marketing had misled the doctors.
But they had the opportunity to prove that it had misled the doctors in the Kaiser health system to prescribe this drug.
The short of it is that there was a six-week trial.
I testified in it and would love to talk about that.
But that Pfizer, the jury found that Pfizer had committed fraud and racketeering.
It was the first RICO charge against a drug company.
It's in civil litigation, so they're not going to RICO jail.
The damages were tripled.
But when the jury heard the story, and I got to explain it to him, I got to explain it to him sitting, standing at an easel next to the jury box as close as I am to you, and explain one of the tricks that Pfizer used to mislead doctors.
So occasionally it comes out, but again, nobody went to jail.
So what they did, this actually is something that I wanted to talk to you about because it has to do with how you feel about hydroxychloroquine not being approved or not being embraced as a therapy for COVID.
What Pfizer did to mislead doctors was there was a randomized controlled trial, and it was neurontin against placebo for the treatment of diabetic painful neuropathy.
And the guy who did the trial faxed them the results and said, it doesn't look like neurontin works.
And Pfizer rejiggered the results so they instead of looking at the comparison between the change in pain level between neurontin and the placebo group, which wasn't significant, they just looked at the pain level of the people who took the neurontin.
And the pain level went down from the beginning of the study to the end.
But it went down to the placebo group almost as much.
But when they just showed the neurontin arm of the randomized controlled trial, which is no longer a randomized controlled trial, they misled doctors and claimed that it was effective.
So in hydroxychloroquine, for COVID, to change the subject a little bit, people get better.
And that's good when people get better.
But it's like one arm of a randomized controlled trial.
And I firmly believe that people who want to take hydroxychloroquine, if they get COVID, should be allowed to take it.
And they should talk to their doctor.
And there should not be this propaganda against it.
Here, the Florida Surgeon General says that Biden administration is actively preventing monoclonal antibody treatments.
But they're saying that they're not effective with Omicron.
But they're very effective with Delta.
And a lot of people still have Delta.
It's not like Delta went away.
But they're blocking the use of monoclonal antibodies.
The suspicion is that the Florida Surgeon General sends terse letter to Health and Human Services concerning monoclonal antibodies.
Dr. Joseph Ladapo says that state-facing life-threatening shortage of treatment options.
The idea is the primary concern is the reason why they're doing this is to encourage vaccination only.
The only way to treat COVID is to get vaccinated.
If you don't get vaccinated, you have no other options.
If you do get COVID and you take monoclonal antibodies, they're extremely effective.
What was bizarre to me was that I listed off Z-Pak, prednisone, monoclonal antibodies.
I talked about vitamin IV drips that I took.
All these different things that I took and I got better really quickly.
But they focused only on ivermectin.
And it became this thing that seemed to be a concentrated effort to demonize and mock this one type of treatment by connecting it to veterinary medicine.
Medical devices, artificial hips and pacemakers and the like.
But the point that I'm making is that it's like the drunk looking for his keys under the streetlight, and he keeps looking, looking, looking, and someone comes along and says, why do you keep looking there?
And he says, that's because that's where the light is.
The keys aren't there, but that's where the light is.
That's where the money is.
The money is in new therapeutics, so-called innovation, new therapeutics.
It's not in looking about which drugs make you healthier.
I mean, the problem they have with that, with monoclonal antibodies, in that it doesn't, you don't have to necessarily be vaccinated for them to be effective.
The whole idea, the binary approach has been everyone needs to get vaccinated.
They keep saying it over and over again, even in light of Omicron, where it shows that it's a vaccine escape variant, or the vaccines aren't effective with it, even though it's mild.
Strain of the health care system, and because we don't know yet how many people are going to get seriously ill and whether the unvaccinated people are going to get more seriously ill than the vaccinated people.
The data that I'm seeing suggests that that's true.
But so when you look at data, do you always have to take it and put it through a filter of I wonder what's really going on here and I wonder how much influence is being exerted on these results?
Now, when you were practicing family medicine and you had to make these calls in terms of like medications that you prescribe for patients, how did you do it where you were at least reasonably assured that you were making the right call?
I was a hotshot residency completed certified family physician who had done a two-year essentially MPH program.
It was master science where I took the courses.
And I thought I knew a whole lot about medicine.
And as time went on, that was 1982 when I went into private practice.
As time went on, it was clear that things were going off the rails.
I remember I went to a continuing medical education lecture at our local hospital, so-called Grand Rounds at the local hospital.
And that's the thing with good doctors do, is they go and you sort of get a sandwich and you talk to your friends and you get a lecture from an academic doc.
And I went to a lecture and the guy gave the lecture about a pain drug, and the pain drug had been withdrawn two days before.
He gave this lecture about why we should prescribe this pain drug, which had been withdrawn because it was causing severe adverse effects.
And I realized that he had signed his contract to get paid to give that lecture.
So he was going to give his lecture, come hell or high water, even though the drug had been withdrawn.
And at that point, the light went on that this is a commercial proposition that we've got going, that the academics who are coming out to Beverly, Massachusetts to give us a lecture at the Beverly Hospital are getting paid to do that, and that we can't trust everything we see.
And then from there, that was maybe mid-1980s.
From there until 2001, when I saw that article in the New England Journal of Medicine, the awareness of the financial manipulation, the commercial manipulation of what we were basing our decisions on had become just overwhelming, and I couldn't practice.
So you have gone through a process of understanding the influence that money and the pharmaceutical drug companies have on the data and the way doctors perceive medications.
Now, I was listening to this interview with Robert Kennedy Jr.
And one of the things he said that really confused me, and I wanted to ask you about this because I couldn't believe this is the whole story.
He was talking about when you describe something as being 100% effective.
And what he was talking about was the trials for COVID vaccines.
And that in one of the trials for COVID vaccines where they had 22,000 people who took the vaccine and 22,000 people who took a placebo, the people who took the vaccine, one person in that 22,000 had died of COVID.
The people that took the placebo, two people had died of COVID.
So because two people is double one people, they decided to say that it's 100% effective.
It's the problem with both these pharmaceutical companies to distort information, but also the people that distort what the pharmaceutical drug companies are saying to make it seem more outrageous.
And that's what I'm concerned with.
When I keep hearing people repeating what he said, he was on the Jimmy Doer show, and that's where I listened to that particular assertion.
See if you can find that.
Maybe there's a clip where Robert Kennedy Jr. is describing how they labeled the COVID vaccine as 100% effective.
I know I listened to it on Jimmy Door show, but I listened to it.
There's so much to sort through, especially when you're someone like me who doesn't have an education in this and you're just trying to read these studies and listen to people talk and trying to figure out what's what.
And a lot of the noise is distracting us from the real issues.
We got real trouble in the United States.
For the past two years, about 1,300 people a day have died of COVID.
That's bad.
We can talk about things we could do or should do, whatever.
That's bad.
For the four years before the COVID pandemic, that many people were dying in the United States because our health and health care are so inferior to the other wealthy countries.
1,300 people a day dying because our age-adjusted mortality rate, which allows you to compare different countries of different ages, is so much worse than the average of 10 wealthy countries.
And in order to and our healthy life expectancy has gone down from 38th in the world in 2000 to 68th in the world in 2019.
We ranked 68th in the world in healthy life expectancy.
Our health, the health of Americans is just abominable compared to the other wealthy countries.
And for this, for this devastating health situation, we're spending an extra $1.5 trillion a year.
We're spending 7% more of our GDP on health care than the other wealthy countries are.
And 7% times a GDP of $22 trillion is $1.5 trillion a year.
So whatever you think of President Biden's Build Back Better plan, and not getting into politics here, but it's $1.5 trillion, $1.7 trillion over 10 years that he's arguing for.
And this is 10 times that much money that we're pissing away each year while Americans' health ranks 68th in the world.
But what they do differently is what I'm writing about in Sickening.
What they do is they oversee the integrity of the medical knowledge that reaches doctors.
They can't control the journals.
They can't control that problem with peer reviewers not having the data.
But they can do governmental or quasi-governmental, it's called health technology assessment, where they determine the medical value of new drugs and the economic value of new drugs and make recommendations about covering new drugs.
And they also control the price of drugs because with our allowing drugs to be three and a half, brand name drugs to be three and a half times more expensive than in the other developed countries, we're creating such an incentive to distort the medical knowledge.
So we've got a Wild West situation where the drug companies pay PR people and the lobbyists to create this illusion that their innovation is our only hope for a long and healthy life when that's rarely true.
One out of in terms of new drugs, new molecular entities that are approved, about one out of four is actually an improvement over a previous drug.
But in the United States, we don't know that because there's no oversight.
In the other countries, they're evaluating it.
So when, for example, insulin analogs come along and replace human recombinant insulin and they start to jack up the price and there's no evidence that it's better for type 2 diabetics who use 80% of the insulin in the United States.
There's no evidence that it's better.
Doctors are bombarded with marketing materials that say you've got to give your type 2 diabetics insulin analogs because it's more physiologic and it reproduces natural insulin function.
And in the other countries that have health technology assessment, they're saying there's no evidence that it's superior to recombinant human insulin.
So use that first.
If your patient fails on recombinant human insulin, if they have idiosyncratic problems with low blood sugar or anything else, you can use it as a second-line drug, but not a first-line drug.
But we're essentially playing this game without, it's like professional athletes not having umpires.
Yeah, healthy life expectancy is probably the best single measure of the overall health.
It's how many years you live in good health.
So if you live to be 86 and you had kidney disease for the last six years that compromised the quality of your life for 50%, then your healthy life expectancy would be 83.
So it integrates longevity with the time you spend in good health.
So one of the issues that I'm sure you've heard of is the diseases of despair that Professors Deaton and Case, Professor Angus Deaton is a Nobel Prize winner and his wife is a professor at Princeton as well.
They wrote a book about diseases of despair and how non-college educated, non-college educated white Americans are having an epidemic of drug overdoses and suicides and liver disease.
And that it has to do with the economic context, that the wages and quality of life are not as high, that people's expectations about how their lives are going to unfold and having families and living independently and owning a house have gone down.
And that all that adds up to these diseases of despair causing 100 deaths out of 100,000 white Americans and they chose ages between 50 and 54, but you could take any age group.
But the important fact here, that's true, and that's awful.
But the increased death rate in that group is not 100 per 100,000, but 400 per 100,000.
And the other 300 deaths have to do with cardiovascular disease and diabetes and all the things that die of.
But those folks are exposed to the social pressures that are compromising their health.
This is a long answer to you, short question.
But so my opinion, what I tell you as a medical fact, I stand by.
My opinion on this is that since 1980, the United States has had a radical growth in economic inequality.
That essentially the share of the income pie has been so distorted to the wealthy that it's like the average family living at the median income level of $55,000 with 2.6 people in their household.
If they were getting the same share of the income pie that they got in 1980 as they are now, they would have $20,000 more a year.
But as it stands now, that $20,000 is transferred from people who are working hard and trying to keep their kids in clothes and pay their bills to the top 1%.
So it's like the working people in America are donating $20,000 per family to the top 1%.
If the economy is such that companies on their own are suppressing the wages of working people and transferring that money to the wealthy people, you simply do it with tax policy.
If you can't do it pre-tax, you can do it with tax policy.
The problem people have with taxes, whether this is accurate or not, is that no one trusts the government to do well with that money.
No one trusts the bureaucracy and the nonsense and red tape that's involved in our overbloated government to the point where they're like, yeah, I'd be more than happy to give them extra money because I know they're going to do with it very good things.
And some of the laws that have passed about right to work and so forth have made it harder for unions to hold their grip.
But in 1952, we had the professors Deaton and Case that I referred to a minute ago from Princeton, they coined the term blue-collar aristocracy.
That in the post-war years, in the 35 years after World War II, the blue-collar Americans were living well.
They were making a fair wage.
They were getting, as our economy grew after World War II, blue-collar workers were getting their fair share.
And the economist John Kenneth Galbraith attributed this to the countervailing power of government.
So you've got business on one hand trying to make money.
And in those years, business had a broader definition of their primary responsibility.
It wasn't just to make money.
It was to be responsible in the community and take care of their workers and their consumers.
Now it's to make money.
But Galbraith identified this countervailing power of the government when there was a balance.
And we don't have that balance.
That's what's gone.
When in 1980, when 1981, when President Reagan was inaugurated and he said government's not the solution, it's the problem.
And the libertarian economists were given great sway, we moved towards this anti-regulation free market ethos that led to this massive distribution of maldistribution of wealth.
So the French economist Thomas Piketty says the United States now has what is probably the greatest inequality of wages, of income from labor that's ever existed in the history of the earth.
And what we've got is social media that is making money from inflaming the extremes and drowning out the center that's trying to get to reasonable solutions.
Yeah, whether it's by design or not, whether it's just human nature that's sort of filtered through this medium of social media, which is a strange medium, right?
And it's one we're not accustomed to.
We don't have any history in it.
And it's being used by the vast majority of people, and it's being used through algorithms which favor what is more inflammatory, what people gravitate towards, what's going to get your eyeballs and get your clicks.
And we're really not designed.
We don't have the discipline to handle it.
We're not designed emotionally or intellectually to be able to mitigate the influence of this stuff.
So is there maybe there could be a way where companies could make it a very public part of their policy that they pay great wages and that they take care of their workers and that they do this because they recognize that they also have a responsibility to do well for the community and not just make money,
but do this and proclaim it publicly in a way that people would gravitate towards their business as opposed to a business that's purely gross capitalism where they don't give a shit about the workers.
They're just trying to make the most amount of money every year for their shareholders.
And in order to make that transition, you've got to make the private equity investors and the stock investors and the institutional investors happy along the way because they want to see every last dime that you can squeeze out of the proposition.
Well, if they don't get it from those managers, they'll get new managers.
So in sickening, we get to the same place in healthcare.
How the hell do we fix this?
I can tell you what's wrong, but how the hell do we fix it?
And we fix it with exactly the solution that you've proposed, that the constituencies that are affected need to move into positions of power in society.
So we've got the constituencies are the doctors who are not getting good information.
They think they are, but they're not.
And the doctors got to understand that this is a very serious problem and that they're trusted to be learned intermediaries to apply medical science in the service of the patients, and they can't do it under these circumstances.
And we've got businesses, non-healthcare-related businesses that are paying a fortune for their health care and losing their competitiveness, and they should be in on this.
And most of all, we've got consumers who want the best health.
But in order for each of those constituencies to become competent political activists, they've got to understand what's going on.
Have you ever seen the documentary, The OxyContin Express?
No.
It was on Vanguard.
And it was essentially they showed that Florida had created this situation where they would have these pain management centers that were essentially just pill mills.
The pain management center was connected to a pharmacy that only had pills.
They only served opiates.
So you would go to this pain management center, you go to the doctor, and you say, doctor, my back is killing me.
Doctors say, well, you needed some OxyContin, son.
And they would write you a prescription.
You would literally go right next door and they would have the pills for you.
And they also did not have a digital database.
So you could go to Jamie and get a prescription from Jamie and then leave him and then go to another doctor, Mike, right down the street and get a prescription from him.
And you could do it all day long.
And people were doing this.
And then they were selling these pills on the OxyContin Express.
It drove it straight up into Kentucky and Ohio and wherever the highway took it.
And they were seeing how there was a direct chain of events where these people were going to these pill mills, stockpiling all these pills, and then they were selling them into these other states and making a lot of money.
So you see the synergy between the folks whose lives aren't working out the way they want it to and they're miserable and maybe they're miserable because of back pain or maybe they're miserable because life doesn't have the meaning they hoped it did.
And you have the drug company which is telling doctors that they've got a new product that's less addictive.
It's so much less addictive that you can treat non-cancer pain and not get into trouble with it.
That it lasts 12 hours, but they know it doesn't last 12 hours.
And when it wears off before 12 hours, they tell the doctors to increase the dose because that means they're not taking enough, not that their drug doesn't last 12 hours.
And that it can't be abused, and people are crushing it and putting it in the straw and shooting it up and so forth.
So you've got the drug company that's an actor, and you've got the social circumstances where people are hurting, whether it's medical hurting or spiritual hurting or whatever you want to call it.
And it's just a recipe for disaster.
And without the appropriate oversight of the drugs, the faucet, the spigots turned on.
And that's in this country has been one of the most egregious offenses by the pharmaceutical drug companies is distorting the data on the addictive properties of opiates.
These other countries, I mean, I'm not totally familiar with France and what their food choices are like, but do they rely as heavily on fast food as we do?
I don't think so, but it's easy to ⁇ I think we can get a quick and dirty answer by the rate of obesity.
40% of Americans are obese, and that's way above any other developed country.
And we're going to be at 50% within the next 10 years or so.
So it's a whole way of life.
And I know about health care.
I know what is wrong with healthcare.
I know what the drug companies do.
But it's the food industry, and it's every industry.
And I totally understand when you say, you know, but government screws up and they get bossy and they overstep their authority.
It's true, but you need a referee.
We need the center doesn't hold here.
We need to get a center that holds so that we get common values, so that we could talk about our shared and common values instead of what splits us apart.
But we need to recreate the center with authority so that you can't make a whole bunch of money selling fat food to poor people and you can't make a whole bunch of money lying about your drugs and getting them covered by Medicare or private insurance.
It doesn't work.
The center is not holding.
And we're paying a price.
Our country, I mean, the divisions in this country are predictable.
Yeah, that's It's pretty it's it's pretty it's confusing and it's also disheartening because you look at this and you go, there's no clear way out of this.
There's no like real clear path where we just pass this law or elect this person and all of our problems are going to go away.
These are compounding problems that seem to be getting worse every year.
And when the constituencies that are coming out on the short end learn, they need to learn about what's going on and then become, they can't be politically active until they understand what's going on.
And I am hoping that the six years I dedicated to writing this book will help people to understand that the health care that they're getting, which we believe is the best in the world, is the worst among the wealthy nations.
We're getting ripped off.
It's a way to transfer wealth to the wealthy, and Americans are paying the price.
How we can repair it is by the constituencies that are affected becoming knowledgeable and politically active.
If the consumers who want to be healthy, and instead of putting their hope in Adihelm to reverse Alzheimer's disease when there's no evidence that it does that, if the consumers would understand that 80% of their health comes from how they live their lives and 80%.
80%.
80%.
And now some of that has to do with social context that people who live in disadvantaged circumstances can't just turn around.
They can't just decide to go jogging five times a week.
So it also has to do with inequality.
We've got to address that.
But consumers say, look, we're not getting a fair deal.
We're paying a fortune for our health care.
Our wages aren't going up because so much money is going to health care and our out-of-pocket costs are out of sight.
We're not going to take it anymore.
And that doesn't mean settling for a government program that says the copay for insulin will be $35 because that's just shifting.
That's just having the government pick up the money.
That doesn't help to contain the costs.
It makes it better for somebody who needs insulin, but it doesn't help to contain the costs or rationalize the use of insulin, insulin analogs and human recombinant insulin.
So the consumers need to represent their interests, and their interests are to live the longest, healthiest lives they can.
It's not to get the most expensive medicines.
It's not to invest so much money in medical innovation that we can't invest in social services.
It's to live the longest, healthiest lives that we can.
Business, fair business people who want to run an honest business, pay their employees a decent wage and make an honorable product, they're getting ripped off.
And they need to get into this in some kind of buyer's trust to control the price of the new drugs.
Say, we're big enough now, so we're just not going to buy your new drug at that price.
No, that's too kind because it's not a real market like that because most of the drug is paid for by insurance.
So people, it's not Adam Smith's economy where you go and buy the bread or the beer from the one who's selling quality products for a fair price.
The consumer is only worried about the copay, or most consumers are only worried about the copay.
So what you do is you get a pharmaceutical benefits manager, a middleman, and you say to them, we'll give you a rebate, which really means kickback.
We'll give you a sizable rebate if you place this drug that doesn't have therapeutic advantage over less effective drugs higher in the formulary so it has a lower copay.
We'll give you, the PBM manager, a rebate.
So it's this whole other level of chicanery that's going on.
So the drug company is thinking about how are they going to get their drug.
It's not how do we price this so consumers can afford it so we sell a high volume.
It's how do we get this drug marketed to PBMs, pharmaceutical benefits managers, so that they'll let us give them a rebate and have an advantageous tiering.
The thing that's missing in this equation is nobody's saying, wait a minute, there's a ceiling on this.
This drug is not worth this.
So that the end result is that between two-thirds and three-quarters of global pharmaceutical profits come from the United States.
It's crazy, and it gets crazier because when the Democrats passed, it was H.R. 3, the Democrats in the House passed the drug Medicare negotiation bill in 2019 that they would negotiate the price of 25 to 50 of the most revenue consuming drugs.
And the CBO said that that would cost $456 billion in pharmaceutical profits over the next 10 years.
And the pharmaceutical company went into this spasm of saying this is going to be a nuclear winter for drug innovation, and you're not going to get the drugs that you need to be healthy.
Meanwhile, the drug companies, instead of $456 billion in 10 years, had just spent $577 billion in cash buying back their own stock to jack up their stock prices between 2016 and 2020.
So they're out there saying, if you control our drug prices, you won't have any more innovative drugs, and they're buying back their stock.
And since 2020, they have another $500 billion in cash that they're going to use to buy startup companies and inflate the price of the new drugs that are coming online.
I know how much fuckery there is, and it's in that book.
And you don't need to know all these facts, $577 billion and $456 billion.
You don't need to know those.
But what you do need to know is that the drug company is in the business of making money, and they do it very well, and they will continue to do it ever better until they're stopped.
And we might as well stop them sooner rather than later.
And we need the drug companies.
We need them to commercialize medical science.
I'm not for socializing this.
I think we need a market.
But for all those folks out there who are afraid of what I'm saying because I'm going to destroy the market, the market's going to get destroyed if this keeps going.
And if you believe in the market, you better get it to work.
Milton Friedman, the conservative economist, wrote in 1962, he wrote a book called Capitalism and Freedom.
And he said there's only three legitimate functions of government.
To preserve law and order, to enforce private contracts.
And number three is to ensure that private markets work.
Law and order, enforce contracts, ensure that markets work.
That was very radical at the time.
We're failing on all three.
We're not enforcing law and order.
When the drug companies commit fraud and felonies and whatnot, they pay their price, take their slap on the hand, and move along.
So is the fear that if you punish Pfizer more robustly or more fairly, as a lot of people would think, that they're going to go under and they're not going to make medicine anymore and then people are going to die or their quality of life is going to deteriorate because there's not going to be the innovation, the medical innovation that leads to these pharmaceutical drugs they need.
But if Pfizer really wanted to be a responsible corporation, they would say, let's have health technology assessment so our drugs are tested fairly and are used appropriately.
And if the medical journals wanted to be responsible players in this nexus, they would say, let's insist that the data from the clinical trials is available to the peer reviewers.
And if the people who masterminded the OxyContin scandal were at risk not just of losing their last $8 billion or whatever it is, but going to jail, that too would change it.
But we've got this sort of system where it's somehow, you used a term that was like an agreement, but somehow this isn't working properly.
Now, when you see the way the system is established currently with pharmaceutical drug companies, with just the whole medical industry, and you see the future, where do you think it's going?
Like, is it going to continue to deteriorate?
Do you think there's some hope that we will have some common sense regulations that are put into place to try to move this into a more beneficial direction?
Or do you think people are just going to continue to make as much money as they possibly can extract it from the system at their own personal gain to the detriment of all of us?
That's another story we could talk about another time.
I'll come back.
But they're going to make $36 billion.
They're going to make $65 billion in two years.
Now, they're going to make that money with most of their doses being sold in the first world.
They and Moderna both declined to actively participate in creating the development of the capacity to manufacture drugs in underdeveloped countries.
So in May of 2021, the IMF, the World Bank, the World Trade Organization, and the World Health Organization got together and said, we need $50 billion right now to get vaccines to the third world,
and we need to get 40% vaccination rate in the third world before the end of 2021, which we're now at, or we're going to have $9 trillion in economic losses from COVID spreading and from variants that emerge out of undervaccinated countries.
Now, there were 17 individuals at that point who had made $50 billion from the vaccines.
17 people made the 50 billion bucks.
But nobody came forward with the $50 billion.
It didn't happen.
And now we see Omicron coming back to bite us.
Could Omicron have been prevented if the $50 billion appeared and this program of global vaccination were underway?
I can't promise that.
But maybe the next one, I don't know what the, you know what the next Greek letter after Omicron is?
And they said, no way, it's dangerous to give that out, to give that information out.
Moderna didn't quite tell the truth.
They said, yeah, we'll give the patent out.
We're good global citizens.
And they offered to release their patent, but they didn't make any effort to help any country with the know-how that's necessary to put the patent into action and build a plant to manufacture the drugs.
I don't know what's going on, but I don't think it's stable.
A lot of people have antibodies in Africa, and it's unclear because those cases were never reported.
It's an unknown.
It's a very interesting mystery.
But I would not count my chickens on that one because I think you're going to have a huge population of vulnerable people.
And without them being vaccinated, and with all those doses going to the first world for first dollar, it's like we're building this huge swimming pool and we've created for ourselves a no-peeing zone in the swimming pool.
And we think we're going to be just dandy because we are allowed to swim in the no-peeing zone and we're going to get dirty.
Now, the ivermectin proponents and hydroxychloroquine proponents, they point to that, is the wide distribution of ivermectin in Africa because of river blindness and dengue and yellow fever and that it's a very cheap generic drug that's commonly distributed.
They also say that in India as far as Uttar Pradesh, like how they have essentially eliminated COVID.
Well, first let me say that I've said a lot of bad things about drug companies.
Merck was the most respected drug company for seven years in a row starting in 1987.
And during that run, the CEO, ivermectin, was developed by Merck during that run.
And the CEO, Dr. Vagilos, made a program with the World Trade Organization to give ivermectin away to the areas of Africa that were at risk of river blindness.
And you've got to tip your hat.
Times have changed.
The next CEO was an MB, a master of business, not a scientist, and we got Viox is how radically things changed.
But for river blindness, I believe you just give two pills a year.
So it's pretty unlikely that a population taking two ivermectin tablets a year would be protected.
I don't think so, but this is a very easy problem to solve.
I mean, you've got a natural experiment.
Usually you say for better or worse, but for worse, Africa has a very low vaccination rate.
I think it's 8%, up from 6% to 8%, but a very low vaccination rate.
You could go in there and do a randomized controlled trial where you gave 100,000 people ivermectin at whatever interval the proponents think would be effective and give another 100,000 people a placebo, and you'd have your answer pretty quickly.
The NIH is on the record to their credit of saying that there's not enough evidence to say it does not work and there's not enough evidence to say it does work.
So that's certainly an invitation for somebody to fund a study.
The problem is, even if they did fund it, like you were saying before, that these studies, the vast majority of them are funded by these pharmaceutical companies.
Why would they do that for a study for a drug that's generic?
I think if there were a government-funded study, if the NIH said we're going to fund a study, a massive study, and it's an ethical study because we don't know whether ivermectin works or not, sometimes you can't do it.
I mean, you can't give monoclonal antibody or a placebo because monoclonal antibodies work.
But this would be an ethical study because we genuinely don't know the answer to the question.
It's a very simple study to do.
And if that study were done by the government, funded by the government, I think you'd get an honest answer.
Let me give you an example.
There was a government-funded study called the Diabetes Prevention Program done in the 1990s.
They took people at very high risk of diabetes, so-called pre-diabetics, and they randomized them to a control group, to a group that got treated with the diabetes drug metformin, or to an exercise group.
And you couldn't mask the exercise group, but everybody got a placebo pill.
So the question was not, does this drug, which was on patent at the time, does this drug help to prevent diabetes, high-risk people from developing diabetes?
It wasn't that.
It was what's the best way to prevent diabetes?
Nothing.
Metformin or lifestyle.
And it turned out that lifestyle was the winner by far.
Lifestyle prevented 58%, 58, had a 58% efficacy rate of preventing diabetes.
Metformin had, I think, 39%.
Lifestyle was significantly better than metformin.
Now, the results of that study were fairly reported.
They weren't implemented so well.
We went on to develop these fantastically expensive diabetes drugs instead of programs to get people to make the lifestyle changes that that study showed you can get people to make and they're effective at preventing diabetes.
Their feeling of not being told what to do by their father, being beaten up by their brother, whatever it is.
But yeah, one-on-one, it was pretty successful.
But the point is not that I claim to be a good behavior modification guy, but that in this randomized controlled trial where people were randomly assigned to go to these counselors and have these sessions, I forget one every fourth week or something, and then they tapered down and then they turned into group sessions, that it worked.
They lost weight, they started exercising, and they prevented diabetes.
It works.
I think the idea that it doesn't work and doctors can't motivate people to change, I think that's drug company your word that ends in ERY.
Well, I don't know about if I agree with you on that because I think it's just a problem with human nature.
And, you know, I've been around fitness and involved in martial arts most of my life.
And there's always been an issue getting people motivated.
There's always been an issue with people self-sabotaging.
There's always been an issue with discipline.
It's a very difficult thing for people to acquire discipline.
And that's one of the reasons why people like David Goggins or Cameron Haynes or these incredibly disciplined people that talk about it are so appreciated because the motivation of listening to a guy like Goggins talk about discipline, it actually, you can impart some of it or rubs off on some people and get you to throw your sneakers on and go for a run.
It really will get someone to sign up at a gym and maybe get some of those first baby steps going and develop some sort of a habit.
But it's very difficult.
It's one of the most difficult things to do to motivate people that are sedentary into changing the way they live their life.
The difference in there, though, is that these random, this trial, these people are a part of a trial and they're also recognizing that they're getting a wake-up call because they're pre-diabetic.
So they're realizing like, hey, do I love my children?
Do I want to see them grow up?
Do I love my parents?
Do I want to be around them?
Yeah, you have to do something.
Like the time is now, and you're also now a part of a trial.
So there's a thing where you're in a group and you sign up for it.
Now you're part of this thing with a lot of other people and they're giving you these steps and you start taking them and then you see positive results.
I think everyone should belong to some sort of an organization, like a local community gym that has exercise programs and classes and things like that.
That would help a lot.
And I think if there's something that we could do, you know, there's this, people are, they hate the concept of socialism, and I understand why.
But if there was anything that I think that we could benefit from, like our taxes go to things that we all agree are important that aid the community.
That is kind of a sort of a socialist thing, like the fire department.
Like it has nothing to do with how much money you make, right?
The fire department is there to put out fires.
Your taxes go to the fire department.
Everybody agrees that's a good thing.
I think there would be extreme benefit if that same sort of thing was in place for nutrition and the same sort of thing was in place for exercise.
That was a part of being a part of this community.
You have access to healthy food.
Part of being a part of this community is you have access to the gym.
As far as all the other luxuries and all the things that people want, televisions and cars, you got to work for that.
But just the basic necessities of life, nutrition and to enhance your experience as a person, exercise and education, and especially exercise in terms of like a group dynamic, because then it gets everybody motivated because you're doing it with a bunch of other people in class.
And that's we're talking about recreating the center here.
The fourth chapter in that book is called Insulin Inc., Inc.
Like Incorporated.
And what I show is that you could do that program that you're talking about.
The CDC has funded a small program.
It has 15,000 people in it, and it's working through YMCAs and through community organizations.
It's working.
So you say, well, we don't have the money for it.
It costs $20 billion a year to do that for everybody who needs it.
Well, it happens to be that we're wasting about that much money by giving insulin analogs instead of human recombinant insulin to type 2 diabetics.
And if we just spent that money rationally in helping people to straighten out their lives and exercise and prevent the disease and feel better, we'd be a much better society.
But as it unfolds, Big Pharma controls so much of how doctors think the best way to treat diabetics is that they're taking that $20 billion and they're spending it on insulin that is more expensive, like 11 times more expensive than is necessary.
So you've got to go back to 1982, in the 70s, genetic engineering was coming along, the scientific infrastructure for genetic engineering of drugs was coming along.
And once they figured out how to insert human DNA code into E. coli bacteria or yeast or whatever the organism they wanted to use was, once they figured that out, they wanted a drug.
And the obvious drug was insulin, because people who have diabetes were using insulin that came from cattle and pigs.
And it was a pretty easy sell to say, look, this bioengineered insulin is pure and creates less immunologic reaction.
And it had a sort of prima fascia logic to it.
So it was a pretty easy sell to get doctors to believe that replacing the animal insulin with recombinant human insulin, which is exactly like human insulin, amino acid for amino acid, that was a pretty easy sell.
And more than 90% of the insulin prescriptions flipped over very quickly when that drug came out in 1982 when bioengineered insulin came out in 1982.
Unfortunately, there was no evidence that it was superior to animal insulin.
And the Cochrane reviews that came out afterwards said no difference.
So they did the human recombinant insulin, and that cost like $21 a vial or something.
You know, this is not very expensive.
It was a lot more expensive than the animal insulin, but not very expensive.
So the innovators said, well, now what do we do?
We got this insulin, and it's cheap, and now how are we going to make another buck to make our investors happy?
And in 1996, they came out with these insulin analogs that are just slightly changed, an amino acid or two are changed, and supposedly they more closely mimic the actual natural secretion of insulin in the body.
That was a challenge.
And that's one of the most fun stories that I discovered while I was writing this book.
I didn't know about this before I was writing this book, and kind of backed into this story about how the manufacturers, to get back to the question you asked, the manufacturers manipulated the standards that the doctors were held to, and they created an artificially tight control of insulin to lower the blood sugars beyond what medical science showed was beneficial,
but they could claim that the insulin analogs could get you down there more safely with less hypoglycemia.
Am I making sense?
Yes, yes.
Okay?
So they sold this.
They hired an advertising firm and they sold this standard of getting hemoglobin A1C down to seven, that that was good control, even though there wasn't evidence of medical benefit.
And that's how it happened.
That standard, that became standard insulin care.
And the manufacturers created bonus programs if doctors had a certain percentage of their patients controlled like that.
And then nonprofit organizations like the National Committee for Quality Assurance adopted that standard and they certify outpatient Healthcare providers as being high quality, and they defined that as a high-quality issue to have a standard of a hemoglobin A1C of seven or less.
There was no evidence.
There was no evidence.
And then a study came out in the New England Journal that showed that diabetics who were more tightly controlled had a higher risk of dying, published in the New England Journal.
That didn't change anything.
And it hasn't changed until 2018, 19, 20.
It's been that image in doctors that high-quality medicine means treating your type 2 diabetics with insulin analogs instead of $21 a vial, we're talking about $330 a vial at the peak, that that's standard medical care.
Meanwhile, we're not doing the exercise program that you know would not only prevent diabetes, but heart disease and stroke and everything else, and people would be happier and their families would be better and the community would be better.
And when you extrapolate, when you look at where we're at, and then you go to 10 years from now, 20 years from now, it seems like the direction we're on, this is only going to be worse.
It's going to be accelerated because these drugs, the vaccines and the drugs for COVID are going to be effective, I hope.
But why should a company be allowed to charge a government $25 for a vaccine when it costs them about $3 to make, and much of the technology was done by the NIH anyway?
Why should we allow that to go on?
Why should Pfizer be selling $65 billion worth of vaccine when their profit margin, one of the stock analysts said their profit margin after the first year or two is going to be 60 or 80 percent.
Because they spend so much in lobbying and so much in political contributions and they're nonpartisan in their political, bipartisan in their political contributions.
The Democrats get paid and the Republicans get paid.
And we're in this charade.
We almost had an opportunity to have some effect controlling drug prices.
And we came up with this plan to limit the price of insulin, the copay for insulin for $35 when you're using the wrong insulin.
Just get some experts together and decide which insulin you should use.
But what you're saying makes a lot of sense, that there's no evidence that this is beneficial, it's superior, but yet they've sold this to people based on no science and for extreme amounts of profit.
When you wrote this book while you're writing this, did you is there any moment where you're, because I'm looking at this book and I'm hearing you talk, and there's an incredible amount of data that you have to go over when you're doing something like this.
But I got to a breakthrough in this book when I figured out what's really happening is that there's a nexus of influence.
I don't want to use the word conspiracy, but the drug companies are working with the journals and selling them back reprints or buying back reprints of the articles.
And the journals part of the deal is not to ask for the data.
And the academic medical centers are working with the drug companies and giving them more control than you would think academics would give to private industry because they're making money.
The institutions are making money and the researchers are making money.
And the physician societies, the professional organizations, are getting paid by drug companies.
They're taking drug company money.
They, in large part, oversee the guidelines that are made.
So that we've got this nexus of confluent interest that's feeding at the trough of drug company money.
And that's called market failure.
And market failure doesn't correct itself.
You need government.
You need to break this.
It's like a trust buster.
It's like breaking up Microsoft.
The market failure is so comprehensive that it's got all the parties' impression of how medicine should be run in the United States going in their direction.
When a drug company does a clinical trial, they do what's called, they get all the patient forms and truckloads of data, and they put them on electric, they digitize it, and then they produce what's called a clinical study report that it doesn't have the raw data in it, but it has all the data tabulated.
It's like 3,000 pages.
And they do that.
And as I got along in litigation, I got pretty good at reading these clinical study reports.
I could, you know, in maybe 10 hours or 20 hours, I could figure out what happened, what didn't happen.
And occasionally needed to go back and have a statistician get the primary data.
But what I'm saying is that there's no reason in the world why medical journals wouldn't require the clinical study report to be submitted with a manuscript for publication.
No reason in the world.
And if the ordinary peer reviewers who aren't adept yet at going over those things, they could hire statisticians that were.
They've already been done.
There's very little redaction that's necessary, but let them redact if there's some commercial process or something.
It's a no-brainer.
They exist.
I mean, that's what makes it even crazier.
So you can fix that with clinical study reports, and then you can dip into the, you can request the individual patient data if you need to.
You could fix the professional societies and say, okay, docs, you want to have a society.
If someone already has this incentive and they're making this profit, how do you get them to abandon that profit for the greater good of mankind when they figure it, you know, you have that diffusion of responsibility aspect of it because there's so many doctors and so much money and there's like, I'm not helping anything.
That's scary, because that means that they think that they're acting in good faith and that they're doing a good job and they're using evidence-based medicine, and in fact, they're getting manipulated.
How much of an impact do you think that would have?
I mean, it seems like this manipulation of data in order to ensure profits is a part of their business model.
It's a part of the way they act and operate.
And a lot of this is because of this constant growth paradigm where every year, and this is what scares me about these current years, because of the amount of money that's being generated by the vaccines.
How do you tell them, like, what if COVID goes away and there's no need for these vaccines anymore?
How do they recreate these golden years of profit?
They don't.
So what do they say to their shareholders?
When the shareholders are like, hey, why are the profits down so low?
What's going on with the stock?
Like, this is a real problem with money being integrated into health care, right?
I don't think it's ⁇ I'm not sure it's that much of a problem.
I mean, this is a windfill, windfall profits for COVID.
But they're sitting on $500 billion right now.
That money is probably going to be used, at least in large part, to buy drugs in development by smaller pharmaceutical companies, startups, and companies that are funded by the NIH to do research.
But they'll be finding other targets to aim drugs at.
And I think that's where you get Adjihelm, the story.
Agihelm is a drug for Alzheimer's disease that got approved a few months ago, despite the fact that the FDA Advisory Committee voted 10 not to approve it, one to abstain, and the FDA approved it anyway.
And the reason why the 10 voted not to approve it is because the studies show that it did not have a clinically meaningful benefit.
It decreases amyloid plaque in the brain, which is associated, not necessarily causal, but associated with the onset of Alzheimer's disease and progression of Alzheimer's disease.
So this drug decreases the accumulation of the amyloid plaque, but it doesn't make a significant improvement in clinical status, and it has about a 33% incidence of brain side effects, brain swelling, brain bleeding.
They did a backdoor move where the FDA said they weren't going to approve it because it hadn't shown efficacy.
And there was some back-channel communication between FDA and one of the people in Biogen, executives in Biogen, who's the manufacturer.
And they came up with this scheme to have it approved on a I don't know if it was emergency use or accelerated approval, accelerated approval, because there was no other therapy for the disease.
But it was just they made it up.
So three of the advisory committee members quit.
They said, we're not going to work.
We're not going to do this for you anymore.
And there are two parts of that story that are just three parts that are just mind-boggling.
One is the price of this drug, which is shown to have significant harm and no benefit, is $58,000 a year.
$58,000 a year.
It was projected.
It hasn't taken off.
It was a bridge too far.
But it was projected to increase the total cost of Medicare Part D by 150%, single-handedly.
It was approved.
Number two is that a survey was done of Americans who heard about the Agile Helm issue, and 60% of Americans believed that it worked.
Well, they reported a true fact, which is that it reduces amyloid.
But they didn't pick up that there are 27 studies that have been done that the FDA wrote a memo about of drugs that reduced amyloid, and none of them improved Alzheimer's.
They've gone from being, in many people's eyes, a pariah because of things like Vioxx and because of the opioid epidemic to being a savior of a public health crisis.
Six months before COVID was heard of, the drug industry stood at the bottom of 25 industries in terms of public approval, the lowest it had ever scored since 2001, since they've been doing the statistics.
And suddenly, after the vaccines came out, Moderna and Pfizer in the top 10 most respected corporations.
Especially when it's such a large part of our life.
You know, medicine and health care and being able to go to the doctor and find some sort of a viable solution to whatever your health issue is for you or your family.
I've thought about ways other than having healthy people come on the podcast and influence people and sort of motivate people.
I've thought of ways that I could contribute to that, and I'm not exactly sure, other than like opening up a chain of gyms and making it free for people.
I don't know what else I could do to sort of inspire people to do things.
Maybe put together some sort of an online program that's free where it allows people to check in with other people that are in the same sort of situation and motivate them to participate and have readily available classes and things you could follow along online in a free form, like a YouTube type deal.
So the CDC has this project going on with local YMCAs and other such institutions.
And they had 15,000 people in it, and I don't know how many are in it now.
And they're getting good results.
I think if you and other people like you who are social influencers, who understand that individual responsibility is just so important here, worked with that program, that maybe together you could make you could get something done.
Something has to be done other than just some people are motivated and some people are, you know, they're self-starters and they get going.
And I think we have to, I think most people are at least partially aware of how much of a benefit it would make to their life if they exercised and took care of themselves.
I don't think people are aware of that number, the 80%, that 80% of your health is how you live your life.
Do you get concerned at all about the reports of myocarditis and pericarditis and the adverse side effects of the vaccines as reported by VAERS and anecdotal reports from people who either know people that have had bad side effects or what have you?
We don't know about people that have shortness of breath and chronic fatigue and issues that are associated with myocarditis where people don't get treated or don't get medical treatment or don't get tiresome.
But on that slide, the point that I wanted to make is that myocarditis is a significant issue.
And if the CGC data is correct, not about myocarditis, but about the benefits, that the benefits don't outweigh the harms of myocarditis, but they're not that far away.
There are maybe half as much.
They maybe nullify.
Can we look at that slide again, go over the...
So if we looked at hospitalizations prevented, you're preventing more hospitalizations than you're causing myocarditis.
And the myocarditis in the kids tends to be not disastrous.
Like, I was reading this thing about myocarditis about when people develop the type of myocarditis that they've had from vaccine injuries, a significant swelling of the heart tissue, like that over time, like this is this could be a significant issue in their life.
But here's the thing about these children, when you're saying deaths and hospitalizations, but deaths in particular, they're all with comorbidities.
And many of these comorbidities are lifestyle related, right?
Many of these comorbidities are kids that are grossly obese or that have all sorts of health problems that are associated with that 80% that you talked about, the way they live their lives and the food they take in.
That seems like an easier prevention, and then you avoid the possible, even though it's a small number, if you're dealing with healthy children, that's what's so scary.
Because if you're dealing with healthy children that seem to be getting myocarditis, a lot of them, I was watching this video on TikTok that was removed for whatever reason because it had millions and millions of views, but it was a 14-year-old boy that was in the hospital who was talking about his case of myocarditis, and they deleted the video.
It was a personal account of kids who got vaccinated.
The thing is, if it's affecting healthy people that aren't at risk from COVID, like the number of kids that are at risk from dying of COVID is fairly small, right?
I believe that's the data that I saw, was that they can't account for, I don't know what the number is, but very, very few kids have died that didn't have something significantly wrong with them.
So that's what scares people.
The idea of vaccinating a child that's not at risk, that's a healthy child, because you've mandated this for all children.
And I think we've raised so many issues in this that I think people are going to have to dissect this and take notes and go through your book, of course, which is not out yet.
And thank you for all your hard work and putting this together.
It's much, much appreciated.
And, you know, I think slowly over time with conversations like this with you and with people reading your book and getting the kind of information that you work so hard to put out, we're going to get a better sense of what's going on.
Because I think it's very hard for people, as it was, you know, for you being a young doctor and learning this kind of the hard way and piecing it together.
And I really, really appreciate that you did that.