Pharmageddon Read Online Free PDF Page B

surprise of everyone many of the hostages, as if hypnotized, spoke well of their captors. “Stockholm syndrome” was born. Now recognized as common, the conditions that trigger this change in behavior seem to be isolation, a fear that your life is at risk, and kindness on the part of the hostage-takers.
    Disease isolates us as profoundly as incarceration or anything else might. Our lives are at risk, and our doctors who control the exit to freedom are almost certain to be kind. But not a single doctor is trained to manage Stockholm syndrome, to suspect that our apparent insouciance or congenial conversation might conceal deep unhappiness with a proposed course of treatment or, even worse, alarm at new problems that have emerged on treatment.
    From about the time of the 1973 Kreditbanken siege, doctors have become increasingly likely to suffer their own variant of Stockholm syndrome. If something goes wrong with a treatment a doctor gives, even though the label may concede that the drug can cause the problem, the makers of the drug and the doctor's colleagues will deny that it is likely to have done so in any particular case. Speaking up about a problem, once the material of medical advance, is now a recipe for professional suicide. A doctor attempting to rescue a patient is likely to be accused of being a persecutor who victimizes the patient by withholding effective treatment.
    Offers to describe problems at professional meetings are turned down. Journals are ever less likely to accept publications outlining a new problem. Invitations to apply for better jobs, to attend conferences, or simply to go with colleagues to local eateries funded by drug companies are ever less likely to happen for doctors linked to adverse events. Those holding doctors hostage have been very kind indeed—there are ever fewer medical departments or medical conferences not awash with company support, when it comes to paying for meals with colleagues most doctors have forgotten what a credit card looks like, and of course in supplying drugs they supply the objects that make doctors desirable.
    As a result bit by bit over the last forty years any of us seeking treatment have been disappearing in front of the eyes of our doctors, who in turn are increasingly inaudible and invisible to companies, academics, and regulators. A key component of the fog that envelopes both us and our doctors lies in the published trials that have hypnotized everyone. Individual observations, the logic goes, are unreliable, while trials supposedly offer reliable estimates about the consequences of treatment. When a doctor does report an adverse event to regulators, the report is invariably marked and filed as uncertain and unreliable information.
    But we know that over 80 percent of the reports on the adverse consequences of treatment, dismissed as anecdotes, have turned out to be correct. 11 We also now know that close to 30 percent of the clinical trials that have been undertaken remain unreported, and that of the 50 percent that are reported almost all will be ghostwritten 12 and roughly 25 percent of the published trials altered to the extent that a negative result for a drug will have been transformed into evidence the drug works well and is safe. 13 In 100 percent of cases, the data from trials remain inaccessible to scrutiny. Given these facts it is not reasonable to suggest that the observations of doctors or patients are any less reliable than clinical trial evidence.
    Reporting the adverse effects of treatments has always been a delicate thing for doctors, because it involves recognition that they may have harmed a patient they intended to help and also because drugs once seen as poisons are now seen as fertilizers necessary to our growth and wellbeing rather than risky. There is also no feedback to doctors after they make report that would incentivize them to report further—nothing that recognizes that what they have done could be beneficial.
    As a