Whom to Believe


Last updated Jun 12, 2017 @ 11:03 am

When making vaccination decisions, parents will wonder whose information can be trusted. It should be remembered that:

  • Vaccine manufacturer GlaxoSmithKline was fined a record $3bn in July 2012 for criminal behaviour, including withholding safety data
  • Vaccine manufacturer Pfizer was fined $1.3bn ($2.3bn if costs are included) in 2009 for being a repeat offender in off-label marketing (selling drugs for conditions they aren’t approved for); there were 3 previous cases.
  • Vaccine manufacturer AstraZeneca was fined $355m in 2003 for a 3-year long Medicare fraud and settled claims without admitting liability, that it had bribed doctors. In 2010 it settled another $520m without admitting the charges, again for illegal marketing and illegal kick-backs to doctors. Further cases are too numerous to mention here.
  • Vaccine manufacturer Merck has had to pay several billion dollars over recent years in criminal fines and to settle civil law suits over its illegal marketing of Vioxx.
  • Vaccine manufacturer Wyeth (owned by Pfizer) was made to pay $490m in criminal and civil matters relating to illegal off-label marketing.
  • Vaccine manufacturer Novartis agreed to pay $422m in fines and civil liabilities related to off-label marketing and paying kick-backs to doctors.
  • Vaccine manufacturer Baxter has a multitude of smaller fines under its belt for various offences in the US, still amounting to many millions.

Doctors in the UK get paid for reaching certain levels of vaccination coverage.

These are 70% and 90% of their patients of the appropriate age and reaching these targets entitles them to the “lower” or “higher payments” respectively. The “bonus” payment is a fairly complicated calculation and varies with patient numbers but it certainly makes a difference of thousands of pounds to each practice.
This does not mean that GPs and/or their staff are dishonest or in it for the money. Most of them consider the issue of vaccination safety and effectiveness as settled and have few concerns over them. They have no time to do in-depth research and feel that they have to trust the NHS, government sources, the manufacturers or the regulators that are meant to oversee the manufacturers. But with this taken into account, parents do get pressured at times and the influence of bonus payments cannot be disregarded entirely, especially if medical staff believe that a parent is refusing for no good reason. Medical staff should not be considered as necessarily being better informed about vaccinations than parents.

Government/regulators/independent research

There is now no clear boundary between industry financial interests and government agencies or departments. Increasingly the latter rely on “advisors” who come from industry and who retain financial interests in the pharmaceutical industry. They also rely on industry data and research and due to the lack of central funding for research, there is now only very little research done which is wholly independent of industry funding. Considering the amount of information which comes straight from vaccine manufacturers and the limited funding available for officials to examine these, parents should not to use so called “official” sources as their only source of information.

Internet, “anti-vaccination” websites and fake news

On the internet it is easy to spread rumours and repeat information which was stated somewhere, without checking the source or veracity. Parents may wish to read such information as a means of balancing the information given by “official” sources, bearing in mind that it may be inaccurate. I personally have a lot of trust in parents who believe their child was vaccine damaged and who decide to spend years out of their lives campaigning and speaking the truth as they see it. If such campaigning is done without any financial interest, it is hard to see why anyone would do it unless they believed what they said. I would, however, also add a word of caution. Just like many newspapers use sensationalist headlines to attract viewers to articles which don’t actually back up the headlines, so do websites and blogs. As someone who writes from a vaccine-critical viewpoint I’m dismayed to find so many misleading headlines shared on social media proclaiming anything from “High Court agrees Wakefield paper wasn’t fraudulent” to “Bill Gates admits vaccinations are about population control”. While I would agree that the Wakefield MMR study wasn’t fraudulent, the headline was made up from the exoneration of Wakefield’s colleague Professor Walker-Smith, which made no judgment on the paper as a whole. The court looked at the General Medical Council’s decision to strike off Professor Walker-Smith and while it was highly critical of the former, calling it’s reasoning at times perverse, this doesn’t justify such a misleading headline. The second example is such a far-fetched headline that it probably doesn’t need any going into other than to say that it’s a genuine example of an article widely shared on Facebook by people who only saw the headline and then shared it.
Finally I want to point out that fake news is just as prevalent in the pro-vaccine camp, which doesn’t only consist of paid industry trolls, as some will have it, but also of many people for whom vaccinations are a shut case and who simply can’t understand why others still question them. Fake news disseminated by that part of the population ranges from overblown “deadly diseases are making a comeback thanks to anti-vaxxers” style headlines, which never stand up to scrutiny, to sharing of incorrect infographics, statistics and home-spun facts that are only designed to prove themselves right and others wrong.

Studies published in peer-reviewed medical journals

While for many of us this appears to be the ultimate source for reliable information, here too we need to be cautious. It never seems to get much publicity in the media but numerous current and former editors of medical journals have spoken out about the flawed peer-review process and have criticised their own industry as well as the pharmaceutical companies.

Dr Marcia Angell – former editor in chief of The New England Journal of Medicine has written about The Truth about the Drug Companies [1], Your Dangerous Drug Store [2] and Drug Companies & Doctors: A Story of Corruption [3] In the latter she states, “It is simply no longer possible to believe much of the clinical research that is published, or to rely on the judgment of trusted physicians or authoritative medical guidelines. I take no pleasure in this conclusion, which I reached slowly and reluctantly over my two decades as an editor of The New England Journal of Medicine.”

Richard Smith – former editor (for 25 years) of the British Medical Journal and for 13 years of the BMJ Publishing Group has written about Medical journals and pharmaceutical companies: uneasy bedfellows [4], Medical Journals Are an Extension of the Marketing Arm of Pharmaceutical Companies [5],  Peer review: a flawed process at the heart of science and journals [6], Should scientific fraud be a criminal offence? [7] and Revealed: how drug firms ‘hoodwink’ medical journals [8].
In [7] he states, “…research misconduct is common, terrifyingly common. What is also highly unsatisfactory is how hundreds of studies (and probably many more) that are fraudulent remain in the scientific literature without any signal that they are inventions. I’ve been involved closely with two fraudulent researchers who between them have generated more than a hundred studies that are not retracted. Science is failing in its duty to the public.
“Fraudsters escape because of the incompetence of the institutions, whereas investigation and collection of admissible evidence is the daily job of the police.
It’s time, sadly, to criminalise research fraud.”

And in [8] it is stated that, “Dr Richard Smith, editor of the British Journal of Medicine, admitted ghostwriting was a ‘very big problem’. ‘We are being hoodwinked by the drug companies. The articles come in with doctors’ names on them and we often find some of them have little or no idea about what they have written,’ he said.”

Richard Horton – Editor of The Lancet has warned about The Dawn of McScience [9], in which he states, “Journals have devolved into information-laundering operations for the pharmaceutical industry.”
Further, in the Lancet he has stated:
“The case against science is straightforward: much of the scientific literature, perhaps half, may simply be untrue. Afflicted by studies with small sample sizes, tiny effects, invalid exploratory analyses, and flagrant conflicts of interest, together with an obsession for pursuing fashionable trends of dubious importance, science has taken a turn towards darkness. The apparent endemicity of bad research behaviour is alarming. In their quest for telling a compelling story, scientists too often sculpt data to fit their preferred theory of the world. Journal editors deserve their fair share of criticism too. We aid and abet the worst behaviours. Our love of “significance” pollutes the literature with many a statistical fairy-tale. Journals are not the only miscreants. Universities are in a perpetual struggle for money and talent, endpoints that foster reductive metrics, such as high-impact publication. National assessment procedures, such as the Research Excellence Framework, incentivise bad practices. And individual scientists, including their most senior leaders, do little to alter a research culture that occasionally veers close to misconduct.” [10]

Drummond Rennie – former Deputy Editor of the New England Journal of Medicine and Journal of the American Medical Association (JAMA) wrote in Health Services Research [11]:
“It has been clear for at least two decades that, when clinical researchers have a financial stake in the results, it opens the door to a pervasive distortion of science. When a drug company sponsors a trial, the company employees usually select the drug tested, its dose, and the comparison drug. Company employees design the trial, often to produce the result they desire rather than to answer a scientific question. They have a powerful and fateful role in managing the trial, sometimes stopping it for reasons unrelated to science and despite any commitment to the trial participants. They may even suppress the results completely. … In addition, they collect and analyze the data, and write up the report. In other settings, companies may “ghost-write” favorable meta-analyses of clinical studies. Only after the design, methods, and results are completed may the academic “authors” be selected and paid to have their names on the byline, thus joining in all but name the marketing arm of the sponsor. And authors frequently ignore the requests of editors to disclose their financial ties.

“For journals publishing reports directly applicable to the care of patients,..the distorting effect of money represents by far the single biggest challenge to the system’s integrity. … the Federal Drug Administration (FDA) has been emasculated. As a major new stream of funding for the FDA’s critical roles of oversight and protection of the public’s safety and health, the FDA has, since 1992, charged a pernicious user fee, which requires that companies seeking FDA approval pay the FDA to evaluate their drug applications. Congress has continued to reauthorize the relevant act. Predictably, this has had the effect of guaranteeing that the FDA, set up to protect the public, ends up beholden for its operating budget to the very industry the agency is supposed to regulate.”

In Annals of Internal Medicine he wrote:
“The main point of the seeding trial is not to get high-quality scientific information: It is to change the prescribing habits of large numbers of physicians. A secondary purpose is to transform physicians into advocates for the sponsor’s drug. The company flatters a physician by selecting him because he is “an opinion leader” and incorporates him in the research team with the title of “investigator.” Then, it pays him good money: a consulting fee to advise the company on the drug’s use and another fee for each patient he enrols. The physician becomes invested in the drug’s future and praises its good features to patients and colleagues. Unwittingly, the physician joins the sponsor’s marketing team. Why do companies pursue this expensive tactic? Because it works.” [12]

These quotes come straight from the editors of the most prestigious journals in the world and can therefore hardly be ignored.

References

  1. The New York Review of Books, July 2004
  2. The New York Review of Books, June 2006
  3. The New York Review of Books, January 2009
  4. BMJ 2003;326:1202
  5. PLoS Med 2(5): e138
  6. J R Soc Med. 2006 Apr; 99(4): 178–182
  7. BMJ blog
  8. The Guardian website, December 2003
  9. The New York Review of Books, March 2004
  10.  The Lancet Vol 385 April 11, 2015
  11.  Health Serv Res. 2010 Jun; 45(3): 885–896
  12.  Ann Intern Med. 2008;149(4):279-280