Check out this video on this topic. It is definitely worth your time. It is an interview with Dr John Abramson who is a family doctor, Harvard lecturer, and expert witness in drug company litigation. Let me start by making this important point. Big pharma has done tremendous good. The medications that work so well in chronic illness were all developed by drug companies. The problem with them is to be expected. Their operations are designed to make money for their executives and stockholders. They are designed to sell their product. That means other scientists and regulators don’t have access to all data from drug trials. They spin the data to maximize perceived benefits and minimize potential harms. They don’t fit their medication into a best practice treatment protocol for cardiovascular disease, they just promote their new drug. And it is all about new drugs.
The whole system of drug promotion and regulation is riddled with conflicts of interest. Sixty-one percent of the FDA budget comes from drug companies. The people regulating drug companies are paid by them. These companies sponsor academic medical societies with results that are sometimes catastrophic. The journals that we depend on for evidence-based practice run advertisements from pharma companies. They only see a synthesis of the data from the drug companies. Neither the editors or reviewers see the raw data. The trials and the data reported are designed to maximize perceived benefit and promote sales. It is distorted. Spun.
Let’s take the example of diabetes drugs. You have seen the commercial with the happy guy dancing to the music while he pushes the lawnmower. Empagliflozin is a great drug and it is in our protocol. It lowers the blood glucose risk factor, but it does not reduce the number of heart attacks and strokes. Metformin is a generic drug that we have been using for 50 years. It reduces the risk of heart attack by 30-40% in an analysis of 204 studies. Metformin costs $4 a month at Walmart with no insurance. The retail price of empagliflozin is $678. The happy guy with the lawnmower is leading you down the wrong path. Empagliflozin and metformin both produce their benefits by activating AMPK. Empagliflozin (Jardiance) is promoted to patients and doctors constantly as a treatment to lower blood sugar. Metformin is generic. It is cheap. No one is going to make any money promoting it.
Drug company promotion focuses on new medications for single risk factors but that is not even the real problem. That fact is critically important. Metformin lowers the risk of a heart attack by 30-40%. Patients who don’t consistently receive metformin for diabetes, statins for cholesterol, and lisinopril or losartan for hypertension have 4 times as many heart attacks and 5 times as many strokes as patients on a protocol combining these medications. That is the approach that keeps patients out of the hospital, cemetery, and the cath lab. That is best practice!
Improving health and reducing cost requires a different way of providing the evidence on best practices for patients with chronic illness. It requires a different approach. Our entire optimal medical therapy protocol combines lisinopril or losartan and spironolactone or eplerenone for hypertension, statins for cholesterol, and metformin for diabetes. You can buy the entire protocol for $30-40 a month. The question is not which individual drugs are best. It is what combination of medications produce the best health at the lowest cost. We have a long way to go.
We are working with provider groups to help them provide optimal medical therapy. We are generating a large amount of data that will only build with time. There is a built-in control group. The intervention group receives care from primary care teams trained in optimal medical therapy using our protocols. The control group is made up of patients receiving usual care in the community. New drugs for cardiovascular and related conditions should be tested in patients who are on maximized optimal medical therapy. Only then can we learn if they provide incremental benefit to best practice
This site has no conflicts of interest. Our training for providers has no conflicts of interest. We are working with other stakeholders to produce optimal medical therapy for cardiometabolic diseases consistently. We maintain our protocols constantly based on the latest information. We get no support from drug companies, device companies, or other commercial interests so that we can be unbiased and transparent. We depend on a small subscription price and CME payments to support this content.
I forgot to mention. Taxpayers support research in universities that lead to new pharmaceutical products. Then private interests are able to take that research and create commercial products for their private gain. It is a system that benefits the few at the expense of the many
I learned that in the 1990’s. They cherry pick the “data” to fit their preordained narratives to deceive us. If we question the validity, they will attack us violently. This is how the American Medical Industrial Complex Kabuki Dance Theatre plunders us!