Jay D. Amsterdam and Leemon B. McHenry : The Paroxetine 352 Bipolar Study Revisited : Desconstruction of Corporate and Academic Misconduct
Daniel Kanofsky’s reply to Samuel Gershon’s comment on Karen Starko’s comment on Daniel Kanofsky’s comment
Should We “Thank God for Big Pharma”?
The Paroxetine 352 controversy initiated by Amsterdam and McHenry continues to generate much thoughtful commentary. I offer a response to Samuel Gershon's July 1, 2021, comment. He insinuates the influence of Big Pharma can make us question “how much material overall can be accepted as factual.” This “is not well for teachers, students, practitioners and patients. This would seem to damage scientific communications as well, if we read and do not know what is factual.” Public health communications can also be damaged.
Commentary magazine has a distinguished history of being a trusted key opinion maker. The reader may not agree with the opinions expressed but I thought the information provided was scrupulously fact checked. Apparently, not always.
The May 2021 Commentary cover story “Thank God for Big Pharma” left me flabbergasted (Meigs 2021). Big Pharma is given credit for vanquishing the pandemic by creating incredibly effective vaccines as well as many other medical miracles. Specifically talking about the benefits of “new drugs” the article states “The numbers are staggering. Deaths due to heart disease have been cut roughly in half since the 1950's [sic], in large part thanks to cholesterol-lowering and other drugs.” This is highly unlikely.
The large decline in heart disease deaths started precipitously in 1968, 20 years before statins were made available to lower serum cholesterol. Many if not most epidemiologists believe the large decline was not primarily due to the introduction of new medications, but rather largely attributable to smoking rates in the USA plummeting from an all-time high of 42% in 1964 to less than 14% by 2019 (Weir, Anderson, Coleman King et al. 2016). This is a great American public health success story and should not be casually tossed aside.
During the pandemic many other common sense public health directives have been oddly downgraded. Public health authorities have been hesitant to advocate for better life style habits. Despite there being an abundance of evidence that obesity, smoking and possibly vitamin D insufficiency are strong risk factors for severe Covid-19, little effort has been made to treat or correct them. Medical authorities on media outlets rarely recommend weight loss, exercise or smoking cessation programs. Since the onset of the pandemic, Americans have become less fit. They weigh more, smoke more and drink more. It should come as no surprise that a recent CDC report shows some “alarming” health trends. In 2020 the death rates due to heart disease, diabetes, high blood pressure and stroke increased by 3%, 14%, 12% and 4%, respectively (Associated Press 2021). Are these pandemic associated consequences at least partially due to Big Pharma stealing stage time from longstanding public health advice?
Robert M. Kaplan is a faculty member at Stanford University's Clinical Excellence Center, a former associate director of the National Institutes of Health and former chief science officer for the U.S. Agency for Healthcare Research and Quality. In his article “Preventing heart disease requires more than medicine” he analyzes the health benefits of the statin he is being prescribed (Kaplan 2019).
A meta-analysis showed that statins can reduce the absolute risk of dying from heart disease over the following decade by 0.5%. He got this by subtracting the statin treated risk of dying from heart disease (1.2%) from the placebo treated risk (1.7%). He then asks, “How does this square with what you have likely heard, that statins reduced the risk of death from heart disease by about 29%? The exaggeration in benefit comes from reporting what epidemiologists call relative risk. In this case: 1.7% minus 1.2% divided by 1.7% equals 29%. I prefer to know the absolute risk... Relative risk can be used to make a small benefit seem bigger than it is. Pharmaceutical companies often use both relative and absolute risk: relative risk to make a benefit seem larger and absolute risk to make reported side effects seem smaller.”
Professor Kaplan contrasts this self-serving manipulation of statistics with the point he wants to make: “The problem is that both doctors and patients have focused on medication while paying too little attention to the remedies that might do much more for cardiovascular (and whole-body) health. We know what they are: regular exercise, prudent diet, and not smoking or quitting cigarettes.”
If the great effectiveness and glitter of the Big Pharma vaccines are dominating current medical thinking at the cost of not continuing to send a strong message to keep good life style habits, then neither God nor Big Pharma should be thanked for this.
Associated Press. Heart disease and diabetes deaths climbed amid Covid, CDC says: Data released this week by federal health authorities shows biggest increases in the death rates for heart disease and diabetes in at least 20 years. NBC News June 11, 2020.
Kaplan RM. Preventing heart disease requires more than medicine. Stat April 3, 2019.
Meigs JB. Thank God for Big Pharma. Commentary June 2021.
Weir HK, Anderson RN, Coleman King SM, Soman A, Thompson TD, Hong Y, Moller B, Leadbetter S. Heart disease and cancer deaths–Trends and projections in the United States, 1969-2020. Prev Chronic Dis 2016;13:160211.
September 16, 2021