Up to 1980, the pharmaceutical industry was small beer. Most of the companies had recently demerged from chemical companies, and were hiring management consultants to help them work out how to do the job.
A steady stream of life-saving drugs from the 1940s to 1960s that people and health services were willing to buy at prices greatly in excess of their costs of production gave industry time to consider the new marketplace. They faced a loss of revenue when their branded products lost patent protection and generic companies could muscle in and undercut their profits. They warned politicians things were not as rosy as they might look and not to think about interfering with the golden egg laying goose, or everyone would be worse off.
Adolf Jann, the Chairman of Hoffman la Roche in the 1970s, when Roche’s Valium was the best-selling drug in the world gave a great example of this when asked
The amount you have spent on research, especially considering the great profits you are making for example on Librium and Valium have made which you say you are spending most of it on research is giving you an immense amount of power over the direction in which pharmaceutical research around the world is going. It’s a large sum of money – don’t you think you should be accountable for that?
Jann responded: I would say no.
Interviewer: Why not?
Jann:
Because it is in my opinion absolutely logical that my task, my responsibility is to develop Hoffman La Roche. And why are we doing that? We are doing it because it is absolutely clear that the only chance for the social security or social health service is to make economies by finding new drugs.
It is worth seeing the full The Antidepressant Story from which this Adolf Jann snippet comes – starting circa 19.30 minutes in and running to 20.40.
Big Risk
In 1980 a door opened to Pharma becoming Big. Geoffrey Rose, an innocent British medical academic, floated the idea of preventive medicine – managing a person’s risks before a disease developed when putting things right would be more expensive and difficult. Lowering blood pressure is easy and cheap compared to repairing stroke damage.
Rose figured getting people to eliminate salt from their diet and stop smoking could save lives – and money. And there is no hazard to things like reducing salt or getting fit.
Neither Rose, nor many others, noticed the lemons lining up in Pharma eyes. They had just the products to manage risks – drugs to lower sugars, cholesterol and blood pressure, increase airway diameters, reduce allergic and inflammatory responses, thicken thinning bones, and nip any possible nervous problems in the bud before they developed.
Lowering blood pressure, they agreed with Rose, was more easily done than repairing stroke damage and much more efficiently done with a drug than by stopping salt.
Better again, where people only had one disease or medical emergency at a time, and that only lasted for a short time till they recovered or died, they had multiple risk factors and would have every one of them every day for the rest of their lives.
The logic was compelling. This is where the money is. The research costs for developing an antihypertensive drug were minimal compared to developing a cancer drug. Antihypertensives were pretty well certain to work, anti-cancer drugs aren’t. Doctors, patients, governments and insurers could all be persuaded to lay out money now in order to prevent paying more later.
One big risk to industry, which came into view in the 1990s, would vanish. AIDs led to intensive efforts to develop innovative new treatments that would save lives. Industry came up with antivirals that were marginally effective but for which they could charge a lot of money. Then patients discovered Triple Therapy – combining several antivirals together did save lives. All of a sudden, industry were under pressure to drastically reduce the cost of their drugs so that the poorest of the poor could afford them. When a treatment saves lives the moral pressure on industry to cut prices is huge.
Goldman Sachs commented – Saving Lives is not a good Business Model.
Industry’s turn to treating risks was cemented in place. There was no risk in treating risks. Industry could set its price and if people didn’t like it they didn’t have to pay. Those on the Left who still lobbied to get prices reduced for not so life-saving life-savers were effectively lobbying to get ever more people on ever more meds.
Better again, this opened the door to seducing parties of the left – the Democrats and European socialist parties. The lure of saving money on healthcare caught in the GSK advert above was potent.
The Labour party in Britain put in place a quality and improvement framework that aimed in the interests of equity at getting all of us treated for all our risks.
Previously we consulted doctors when we had a problem. Now doctors and clinics began to call us in for screening. They began giving us problems we never thought we had. Governments incentivized docs with bonuses to get us on meds. Industry could start thinking about disbanding its sales’ force and let governments do the selling for them.
Government endorsement was more effective than Free Lunches. The only reason to keep the Free Lunches in place was so that people had something to point to and claim – there that’s the problem. Get rid of that and everything will be just fine.
Hand in hand with screening went Evidence Based Medicine (EBM). No Free Lunch was a relatively ineffective stick – refuse the carrot-cake – to beat industry with. EBM would effectively rein industry in by offering eyesight improving carrots to help doctors distinguish between reliable evidence and anecdotes. Governments and other medical bodies built these carrots into Guidelines (Sticks).
Industry trials switched to endpoints like blood sugar, lipids, or pressure, producing convincing significant changes on these – although without saving lives. The Guidelines for risk factor treatments were based on industry trials – there was nothing else they could be based on – trials that could be written up as positive even when they were negative.
And the guidelines never mentioned adverse effects. Risk controlling drugs effectively became vitamins. There might occasionally be problems but nothing significant that might warrant getting in the way of encouraging people to put their biology right. There were incentives for doctors to prescribe the drugs and no rational (evidence based) basis not to.
Willie Sutton was not a man to echo Mark Twain’s ‘There’s Gold in Them Thar Hills. There’s Gold in Them Thar Banks seemed a better bet to Willie. But given that the new blockbusters were literally worth more than their weight in gold – There’s Gold in Them Thar Pills might have given Willie pause for thought.
A Good Long-Term Model?
From a common-sense point of view, controlling a risk factor by stopping something like salt is very different to controlling it by taking a drug. Risk controlling drugs can all be expected to produce more side effects in 6-8 week trials than either nicotine or alcohol would. How sensible does it sound to get someone to take modest amounts of nicotine or alcohol every day for the rest of a life?
Twenty years into the preventive medicine era, the word polypharmacy came on our radar. But not to worry – this was just a problem among older people.
The idea that managing risks might end up disabling the young and crash social security systems lay a further 20 years in the future. Long before that, industry had moved on. Those of us fighting fires on one front rarely realize that industry have often lost interest in the fire we are fighting.
The New Prevention Racket
Even though in 1991 I had fingered Lilly’s Prozac as causing suicide, in 1993 Lilly approached me to help run a duloxetine trial. I was astonished. Prozac was just a teenager, still ascending to adult blockbuster status. Could Lilly be already planning for life after Prozac? When duloxetine crashed in early trials, it became clear it was only one of several options Lilly were working on to replace Prozac. See The Prozac Era.
Similarly I’m sure that many of ‘us’ tracking the bigger picture around 2010, watching what was now Big Pharma in action, wheeling out blockbusters like Lipitor making over $10 Billion per year, would have been brought up short by company talk about their pipelines containing 200 to 300 vaccines.
Are there that many viruses or bugs around? Even adding RSV of which there is more than one type, to hMPV or any number of coronaviruses, is this going to add up to 200? Part of the answer turned out to be that the pipelines contained vaccines for different forms of cancer. Another part was companies aimed at getting monoclonal antibodies like Beyfortus redefined as vaccines.
Yet another part was vaccines for drug abuse as well as gene therapies for genetic disorders revealed by screening. While some might find controlling drug abuse with a vaccine disturbing, it was not difficult to see the political appeal to eliminating drug abuse by vaccinating infants before the problem begins.
Still, this seemed like pharmaphantasy until recently. Bioethicists campaigning to have pregnant women included in clinical trials – in order to empower them – were among the first swallows hinting at a new Spring. Women’s need, not just rights, to be involved in trials in order to have the best possible evidence for things to take in pregnancy was spun as part of a diversity agenda – we would be recruiting pregnant people rather than women. The US government swung in behind this, pushing it as just as worthy a cause as ensuring Afghan women were not oppressed by the Taliban.
The Covid pandemic with its redefinition of vaccines to include gene therapies and later monoclonal antibodies made it obvious that vaccines are the way forward for pharma.
You can get governments to mandate your treatments for you, without asking for any evidence of possible long-term consequences.
You can now get governments to license vaccines on the basis of antibody levels, which almost anything injected into the body can raise, rather than evidence that the vaccine has eliminated an infection or other problem.
You can produce vaccines that only give seasonal protection and need to be given every year for the rest of your life with experts claiming there is no problem with being given 1000 at a time.
You can produce experts to claim the equivalent of the earth is flat – vaccines offer better immunity than natural immunity.
Better again you can engineer a lot of this to be administered in pregnancy or in the hours or days after a birth, where it is impossible to decide between problems that might have happened anyway and problems linked to the vaccine.
There is one big snag to all this. Giving vaccines in the second half of pregnancy or early neonatal life is uncharted territory.
Back in the days of vaccine innocence, Christine Stabell-Benn and Peter Aaby showed that in children some vaccines could have non-specific beneficial effects. That is along with reducing the risks of infection with the target bug, they seemed to reduce risks from other infections. Later it became clear that other vaccines could have non-specific negative effects – they could interfere with other vaccines and lead to more infections. The good effects came from older, antediluvian, live vaccines. The not so good effects came from dead vaccines, which with DNA and mRNA compounds were becoming the norm.
This came to a head with recent RSV vaccine trials. Besides the greater number of adverse events the vaccines caused for mothers and infants, it looked like giving the RSV vaccine before other more important vaccines such as pertussis or influenza, interfered with the important vaccines so that they worked less well. Delaying the RSV vaccine until week 32 didn’t cause these problems. See It is Hard for Thee to Kick against the Pricks.
RSV is just one vaccine. What might happen when the vaccine business gets serious?
This RSV problem was one among several that revealed to regulators they were in virgin territory and had no rule book for trials of ‘vaccines’ in the second half of pregnancy or the neonatal period. Urgent harmonization meetings were convened.
The problem felt like building on Manhattan. How to concentrate so much real estate on such a small acreage – both above and below ground. Where would all the sewage and detritus go?
As all of this was happening, left to their own devices women were breast-feeding and increasingly taking care not drink alcohol, or hot drinks, not to eat soft cheeses or processed meats, not even to have hot showers for fear of harming their babies. But in the clutches of a medical Jabberwock, with not an obstetrician or neonatologist in sight, they were being signed up for an increasing number of trials, sometimes financially incentivized as never before – See It is Hard for Thee to Kick against the Pricks.
Willie S calling Wes S
Would Willie Sutton figure vaccines are a banker?
The logic of Risk Factor management might indicate what the end of this latest effort to seduce governments into continuing to pay through the nose could look like.
By 2024, there was increasing concern that not only were older folk polypharmaceuticalized, with life expectancy falling and healthcare costs going through the roof, but youngsters in the 18 to 35 age bracket were now collecting more disability payments than any other age group. To give them risk factor meds they have to be given diseases, and were now suffering from ADHD, ASD, Depression, Bipolar Disorder and PTSD, along with raised cholesterol disorder, Type 2 Diabetes, raised blood pressure and other problems. The diagnoses provide the paper basis for disability claims. The meds disable. The national debt of some Western countries was projected to triple from 100% of GDP to 300%.
Reproductive rates were plummeting primarily among the native populations in Western countries. Social systems would collapse without mass immigration.
The latest Peter Selley Research on RSV vaccines – new since last week’s post – shows pre-term births in the USA, births <37 weeks, increasing by 12% between 2014 and 2022 to 8.7%. This was before we got any RSV vaccines which cause pre-term births. Being born a few weeks earlier might sound harmless, after all we can do amazing things to keep babies alive from 28 weeks or younger. While this is true, pre-term births are still linked to neonatal deaths, poorer health in later life, and a shorter life expectancy,
There is no market, economy or business that can survive a ghostwriting of the evidence or lack of access to data from studies on which it bases important decisions. No society on earth can survive fraud on the scale that is now happening and such a loss of its bearings.
When a new Labour government came to power in Britain in 2024, the imminent collapse of what most Brits viewed as a jewel in Britain’s crown, its National Health Service (NHS), was high among the crises it faced.
In an effort to explain the problem to the wider public, the new health secretary, Wes Streeting, stated that Britain used to be a country, an economy, striding confidently into the future with a NHS that was no burden to it. Quite the contrary the NHS got people with serious diseases back to work.
But Britain, he said, had become a country with a heavier and heavier health service burden. It was rapidly becoming a less economically efficient country capable of supporting the burden its health service had become.
This analogy conjured up an image of the Descent of Man – slide made by Peter.
Streeting claimed more technology and more preventive medicine was the way to save Britain’s NHS. This is fine but what happens when it meets a ghostwritten and fraudulent vaccine and other medical literature? What happens if the NICE Algorithms are based on fraud?
Sounds like – Your Money and Your Life.
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