BIG MEDICINE: WHOSE HEALTH ARE THEY PROTECTING? 333 is known to be "overly positive and prescribing habits are less appropriate as a result."1 7, 21, 22 • Research and academic medicine merely carry out the pharmaceutical industry'S bidding This can happen because: the drug companies, and not researchers, may design the research, which allows the company to "rig" the study 23, 24; the researchers may have a direct financial stake in the drug company whose product they are studying I5 ,25; the drug company may be responsible for collecting and collating the raw data, and then only selectively allowing researchers to view the data 2), 26; the drug company may retain veto power over whether the findings are published, and may retain editorial rights over any scientific publications resulting from the research 2),25, 27; the drug company may hire a communications firm to write the scientific article, and then find researchers willing to attach their names as authors of the paper after it has already been written.26 • The major scientific journals have turned into little more than marketing vehicles for drug companies The leading medical journals derive their primary income from drug advertising This advertising is not adequately reviewed by the journal, and companies often present misleading claims about drugs Perhaps more disconcerting, the majority of clinical trial research reported in the journals is funded by drug company money, and the financial interests of the researchers involved are not fully acknowledged.24 In the past couple of years there have been well-publicized scandals at major medical centers that confirm these charges In one instance , a scientist's integrity was maligned in a variety of ways by both a drug company and her university administration after she found that a drug under study had strong side effects and it lost its effectiveness 27 In another case, a scientist speaking out about the possible side effects of antidepressants lost a job opportunity at the University of Toronto 26 The examples go on and on Dr Marcia Angell, an ex-editor of the New England Journal oj Medicine, wrote a scathing editorial called "Is Academic Medicine for Sale?"15: The ties between clinical researchers and industry include not only grant support, but also a host of other financial arrangements Researchers serve as consultants to companies whose products they are studying, join adviSOry boards and speakers' bureaus, 334 THE (HINA STUDY enter into patent and royalty arrangements, agree to be the listed authors of articles ghostwritten by interested companies, promote drugs and devices at company-sponsored symposiums and allow themselves to be plied with expensive gifts and trips to luxurious settings Many also have equity interest in the companies Dr Angell goes on to say that these financial associations often significantly "bias research, both the kind of work that is done and the way it is reported." Even more dangerous than the threat of fraudulent findings is the fact that the only type of research that is funded and recognized is research on drugs Research on the causes of disease and non-drug interventions simply doesn't occur in medical education settings For example, academic researchers may be furiously trying to find a pill that will treat the symptoms of obesity, but not be devoting any time or money to teaching people how to live a healthier life Dr Angell writes 15 : In terms of education, medical students and house officers, under the constant tutelage of industry representatives, learn to rely on drugs and devices more than they probably should [my emphasis] As the critics of medicine so often charge, young physicians learn that for every problem, there is a pill [my emphasis] (and a drug company representative to explain it) They also become accustomed to receiving gifts and favors from an industry that uses these courtesies to influence their continuing education The academic medical centers, in allowing themselves to become research outposts for industry, contribute to the overemphasis on drugs and devices." In this environment, is it possible for nutrition to be given fair and honest consideration? Despite the fact that our leading killers can be prevented and even reversed using good nutrition, will you ever hear about it from your doctor? Not as long as this environment persists in our medical schools and hospitals Not unless your doctor has decided that standard medical practice as it is taught does not work, and decides to spend a Significant amount of time educating himself or herself about good nutrition This takes a rare individual The situation has gotten so bad that Dr John McDougall said, "I don't know what to believe anymore When I read a paper that says I BIG ME I (I NE: WHO SE HE ALT H ARE THE Y PRO TE CT IN G? 335 should be giving my heart patients beta blockers and ACE inhibitors, two classes of heart drugs, I don't know whether it's true I honestly don't know if its true because {drug research] is so tainted." Do you think the following headlines are related? "Schools report research interest conflicts" (between drug companies and researchers)28 "Prescription use by children multiplying, study says"29 "Survey: Many guidelines written by doctors with ties to companies"3o "Correctly Prescribed Drugs Take Heavy Toll; Millions Affected by Toxic Reactions"3l We pay a high price for allowing these medical biases A recent study found that one in five new drugs will either get a "black box warning," indicating a previously unknown serious adverse reaction that may result in death or serious injury, or will be withdrawn from the market within twenty-five years 32 Twenty percent of all new drugs have serious unknown side effects, and more than 100,000 Americans die every year from correctly taking their properly prescribed medication?3 This is one of the leading causes of death in America! DR MCDOUGALL'S FATE When Dr John McDougall finished his formal medical education, he set up a practice on the Hawaiian island of Oahu He began writing books about nutrition and health and established a national reputation In the mid-1980s John was contacted by St Helena Hospital in Napa Valley, California, and asked if he would accept a position running its health center The hospital was a Seventh-day Adventist hospital; if you recall from chapter seven, the Seventh-day Adventists encourage followers to eat a vegetarian diet (even though they consume higher-than-average amounts of dairy products) It was an opportunity too good to pass up, and John left Hawaii and headed for California John had a good home at St Helena for a number of years He taught nutrition and used nutrition to treat sick patients, which he did with fantastic success He treated over 2,000 very sick patients, and over the course of sixteen years, he has never been sued or even had a letter of complaint Perhaps more importantly, John saw these patients get well Throughout this time, he continued his publishing activity, maintaining a national reputation But as time passed, he realized that things weren't quite the same as when he first arrived His discontent was growing 336 THE CHINA STUDY Of those later years he says, "I just didn't think I was going anyplace The program had 150 or 170 people a year and that was it Never grew Wasn't getting any support from the hospital and we had gone through a lot of administrators." He had small clashes with the other doctors at the hospital At one point, the heart department objected to whatJohn was doing with heart patients John told them, ''I'll tell you what, I'll send everyone of my heart patients to you for a second opinion if you'll send yours to me." It was quite an offer, but they didn't accept it On another occasion John had referred a patient to a cardiologist and the cardiologist incorrectly told the patient that he needed to have bypass surgery After a couple of these incidents, John had reached the limit of his patience Finally, after the cardiologist recommended surgery for another one of John's patients, John called him and said, "I want to talk with you and the patient about this I would like to discuss the scientific literature that causes you to make this recommendation." The cardiologist said that he wouldn't that, to which John responded, "Why not? You just recommended that this guy have his heart opened! And you're going to charge him 50,000 or 100,000 bucks for it Why don't we discuss it? Don't you think that's fair to the patient?" The cardiologist declined, saying that it would just confuse the patient That was the last time he recommended heart surgery for one of John's patients Meanwhile, none of the other physicians in the hospital had ever referred a patient to John Not once Other physicians would send their own wives and children to see him but they would never refer a patient The reason, according to John: They were worried [about what would happen when] their patients would come to see me, and it happened all the time when patients would come on their own They'd come to me with heart disease or high blood pressure or diabetes I'd put them on the diet and they'd go back off all their pills and soon their numbers would be normal They'd go to their doctor and say, "Why the hell didn't you tell me about this before? Why did you let me suffer, spend all this money, almost die, when all I had to was eat oatmeal?" The doctors didn't want to hear this There were other moments of friction between John and the hospital, but the last straw involved the Dr Roy Swank multiple sclerosis program mentioned in chapter nine BIG MEDICINE: WHOSE HEALTH ARE THEY PROTECTING? 337 John had contacted Dr Swank when he learned that Swank was about to retire John had known and respected Dr Roy Swank for a long time, and he offered to take over the Swank multiple sclerosis program and merge it with his health clinic at St Helena Hospital, preserving it in honor of Dr Swank Dr Swank agreed, much to John's excitement As John said, there were four reasons that this would be a perfect fit for St Helena's: • it fit in with the philosophy of the Adventists: dietary treatment of disease • they would be helping people who desperately needed their help • it would double their patient census, helping to grow the program • it would cost almost nothing In thinking back on it, John said, "Could you think of any reason not to this? It [was] obvious!" So he took the proposal to the head of his department After listening, she said that she didn't think the hospital wanted to this She said, "Well, I don't think we really want to introduce any new programs right now." John, dumbfounded, asked her, "Please tell me why What does it mean to be a hospital? Why are we here? I thought we were here to take care of sick people." Her response was a doozy: "Well, you know we are, but you know, MS patients are not really desirable patients You told me yourself that most neurologists don't like to take care ofMS patients." John could not believe what he had just heard In a very tense moment, he said: Wait a minute I'm a doctor This is a hospital As far as know our job is to relieve the suffering of the sick These are sick people Just because other doctors can't help them in their suffering doesn't mean that we can't Here's the evidence that says we can I have an effective treatment for people who need my care and this is a hospital Will you explain to me why we don't want to take care of those kinds of patients? He continued: I want to talk to the head of the hospital I want to explain to her why need this program and why the hospital needs this program and why the patients need this program I want you to get me an appointment ... pressure or diabetes I'd put them on the diet and they'd go back off all their pills and soon their numbers would be normal They'd go to their doctor and say, "Why the hell didn't you tell me... money, almost die, when all I had to was eat oatmeal?" The doctors didn't want to hear this There were other moments of friction between John and the hospital, but the last straw involved the Dr... know our job is to relieve the suffering of the sick These are sick people Just because other doctors can't help them in their suffering doesn't mean that we can't Here's the evidence that says we