Big Pharma, Bad Medicine

Forumpharma_35.3_stossel Marcia Angell in the Boston Review with responses from Adriane Fugh-Berman, David Korn, Howard Brody, Dan W. Brock, Emma D’Arcy, Suzanne Gordon, and David Bollier.

In May of 2000, shortly before I stepped down as editor-in-chief of the New England Journal of Medicine, I wrote an editorial entitled, “Is Academic Medicine for Sale?” It was prompted by a clinical trial of an antidepressant called Serzone that was published in the same issue of the Journal.

The authors of that paper had so many financial ties to drug companies, including the maker of Serzone, that a full-disclosure statement would have been about as long as the article itself, so it could appear only on our Web site. The lead author, who was chairman of the department of psychiatry at Brown University (presumably a full-time job), was paid more than half a million dollars in drug-company consulting fees in just one year. Although that particular paper was the immediate reason for the editorial, I wouldn’t have bothered to write it if it weren’t for the fact that the situation, while extreme, was hardly unique.

Among the many letters I received in response, two were especially pointed. One asked rhetorically, “Is academic medicine for sale? These days, everything is for sale.” The second went further: “Is academic medicine for sale? No. The current owner is very happy with it.” The author didn’t feel he had to say who the current owner was.

The boundaries between academic medicine—medical schools, teaching hospitals, and their faculty—and the pharmaceutical industry have been dissolving since the 1980s, and the important differences between their missions are becoming blurred. Medical research, education, and clinical practice have suffered as a result.

Academic medical centers are charged with educating the next generation of doctors, conducting scientifically important research, and taking care of the sickest and neediest patients. That’s what justifies their tax-exempt status. In contrast, drug companies—like other investor-owned businesses—are charged with increasing the value of their shareholders’ stock. That is their fiduciary responsibility, and they would be remiss if they didn’t uphold it. All their other activities are means to that end. The companies are supposed to develop profitable drugs, not necessarily important or innovative ones, and paradoxically enough, the most profitable drugs are the least innovative. Nor do drug companies aim to educate doctors, except as a means to the primary end of selling drugs. Drug companies don’t have education budgets; they have marketing budgets from which their ostensibly educational activities are funded.

This profound difference in missions is often deliberately obscured—by drug companies because it’s good public relations to portray themselves as research and educational institutions, and by academics because it means they don’t have to face up to what’s really going on.

Raymond Geuss on Realism and Utopianism in Political Philosophy

Over at Philosophy Bites:

Raymond Geuss discusses the place of utopian thinking in political philosophy and its relation to realism in this episode of the Philosophy Bites podcast. The conversation touches on wishful thinking, ideology and Foucault's notion of genealogy.

Listen to Raymond Geuss on Realism and Utopianism in Political Philosophy

Listen to an earlier Philosophy Bites interview of Raymond Geuss on Real Politics

The magic cure

From The Boston Globe:

Pills__1273257722_8825 You’re not likely to hear about this from your doctor, but fake medical treatment can work amazingly well. For a range of ailments, from pain and nausea to depression and Parkinson’s disease, placebos–whether sugar pills, saline injections, or sham surgery–have often produced results that rival those of standard therapies. In a health care industry fueled by ever newer and more dazzling cures, this phenomenon is usually seen as background noise, or even as something of an annoyance. For drug companies, the placebo effect can pose an obstacle to profits–if their medications fail to outperform placebos in clinical trials, they won’t get approved by the FDA. Patients who benefit from placebos might understandably wonder if the healing isn’t somehow false, too. But as evidence of the effect’s power mounts, members of the medical community are increasingly asking an intriguing question: if the placebo effect can help patients, shouldn’t we start putting it to work? In certain ways, placebos are ideal drugs: they typically have no side effects and are essentially free. And in recent years, research has confirmed that they can bring about genuine improvements in a number of conditions. An active conversation is now under way in leading medical journals, as bioethicists and researchers explore how to give people the real benefits of pretend treatment.

In February, an important paper was published in the British medical journal the Lancet, reviewing the discoveries about the placebo effect and cautiously probing its potential for use by doctors. In December, the Michael J. Fox Foundation announced plans for two projects to study the promise of placebo in treating Parkinson’s. Even the federal government has taken an interest, funding relevant research in recent years.

But any attempt to harness the placebo effect immediately runs into thorny ethical and practical dilemmas.

More here.

How English erased its roots to become the global tongue of the 21st century

From The Guardian:

Monsoon_wedding_cover_gross The India of Hobson-Jobson has also found a new global audience. A film such as Mira Nair's Monsoon Wedding is typical of the world's new English culture. The Indian bridegroom has a job in Houston. The wedding guests jet in from Melbourne and Dubai and speak in a mishmash of English and Hindi. Writing in the Sunday Times, Dominic Rushe noted that Bollywood English is “hard to reproduce in print, but feels something like this: “Yudhamanyus ca vikranta uttanaujas ca viryanavan: he lives life in the fast lane.” Every English-speaking visitor to India watches with fascination the facility with which contemporary Indians switch from Hindi or Gujarati into English, and then back into a mother tongue. In 2009, the film Slumdog Millionaire took this a stage further. Simon Beaufoy's script, a potpourri of languages, adapted from an Indian novel, was shot in Mumbai, with a British and Indian cast, by Scottish director Danny Boyle, but launched worldwide with an eye on Hollywood's Oscars, where it eventually cleaned up.

India illustrates the interplay of British colonialism and a booming multinational economy. Take, for instance, the 2006 Man Booker prize. First, the result was broadcast on the BBC World Service from Delhi to Vancouver. The winner was The Inheritance of Loss by Kiran Desai, an Indian-born writer who had attended writing classes in New York. So far removed from any English experience, though steeped in its literary tradition, was The Inheritance of Loss that, finally, the British critic John Sutherland was moved to describe Desai's work as “a globalised novel for a globalised world”. The writer herself is emblematic of the world's new culture: educated in Britain and America, she wrote her novel in her mother Anita Desai's house in the foothills of the Himalayas, and boasts on her website of feeling “no alienation or dislocation” in her transmigration between three continents.

More here.

The Arabs have their gulags too

Robert Fisk in The Independent:

56fiskro_369781t How many Independent readers can name a single man imprisoned in the Arab gulags? How many tourists to Egypt know that in the Tora prison complex, prison guards have forced inmates to rape each other? How many men have been “renditioned” to Egypt and Syria and Morocco by the Americans or by our Muslim “allies”? So this week, let’s be specific. Take the cases of Bahaa Mustafa Joughel, Syrian identity card number 01020288992, and Mohamed Aiman Abo Attot, Syrian ID no 01020265346. Haven’t heard of them, have you?

Here, according to their families, are their stories. Bahaa Joughel, born in Damascus in 1976, is married, has two children and used to live in Pakistan with his family, his sister and her daughters. A partial cripple, Joughel worked on computers and ran a small IT company from his home. Again, according to his family, he engaged in no political activities. On Jan 30, 2002, Pakistani security police raided their home in Islamabad, apparently under the orders of a US officer. Joughel disappeared for five months, his family told only that he was being “investigated” by the Americans. But the Joughel family was later shocked to learn that he had been “renditioned” to Syria scarcely three months after his arrest – on May 4, 2002, to be precise – and jailed at the “Palestine” branch of Syrian military intelligence. This institution makes the adjective “notorious” irrelevant. He spent 20 months in underground solitary confinement – tortured in his grave-like concrete cabin, his sight damaged by his confinement, just as Canadian Maher Arar was after the Americans sent him to Syria around the same time – before being transferred to Sednaya prison. He was released on 12 February 2005, but was forbidden to leave Syria and then re-arrested on Christmas Eve the same year. No charges have ever been made against him.

More here.

The Battle for Justice Heats Up

Charlotte Dennett in the Huffington Post:

Untitled The growing accountability movement got a major shot in the arm recently when it learned that on April 19, an Argentinian judge sentenced the last of Argentina's dictators, Reynaldo Bignone, age 83, to 25 years in prison. Bignone's crime: kidnapping and torturing 56 victims in a concentration camp during the reign of terror known as the “dirty war” that gripped Argentina from 1976-1983. This is huge, surpassing the arrest of Chilean dictator Augusto Pinochet in his hospital bed back in 1998. (Pinochet died before justice could be done). The conviction of a former head of state for crimes he committed while in office sends a powerful message to all those suspected war criminals still on the loose, including some of the top leaders of the Bush administration.

George W. Bush, who lied our country into war resulting in the deaths of over 4,000 American troops, heads the list. He, former Vice President Dick Cheney and former Secretary of Defense Donald Rumsfeld also authorized waterboarding of prisoners seized in Afghanistan, violating U.S. and international law against torture in the process. Worse yet, they authorized torture, at least initially, not to get actionable intelligence, but to get forced confessions from detainees about nonexistent links to Al Qaeda, Saddam Hussein, and 9/11 in a horrific attempt to strengthen their nonexistent case for sending troops to Iraq. Evidence abounds that all three are guilty of murder and war crimes.

More here. Click on the ad for Charlotte Dennett's book in the right-hand column to buy it.

The Shadow Biosphere

Caleb Scharf guest posting at Cosmic Variance:

Microbes In recent weeks one might be forgiven for thinking that a shadowy biosphere surrounds us, aliens are poised to dismantle civilization, and that time traveling species are flitting in and out of view like barflies on a Saturday night. It’s a little disconcerting, does the Kool Aid have something special in it this Spring?

Unfortunately I think that all of these headline grabbing items miss the real story of what life is, here on Earth and potentially further afield. The idea of ‘shadow biospheres’ or multiple origins of terrestrial life sounds intriguing, and certainly helps bring focus to the fact that we can be very blinkered in our outlook. It also steers attention away from a more interesting and demonstrably real point.

In the past couple of decades we have found a shadow biosphere, except that far from lurking in the cracks it turns out to be the biggest, most critical, biosphere on the planet. An astonishing 99.9% of life on Earth cannot be coerced to grow in a lab, and so we have overlooked it. Microbial life – single-celled bacteria and our ancient cousins the Archaea – is not just the stuff under your fingernails, it is what makes multi-cellular life like us function, and it helps govern the grand chemical cycles of our planet, from the continents to the oceans to the atmosphere. Such organisms have, over three to four billion years, evolved into an eye popping array of microscopic machines, the ultimate nano-bots. They can extract energy and raw materials from, it seems, almost any environment. A particularly good example is Desulforudis audaxviator – discovered 2.8 km down in a South African gold mine in a pocket of isolated water. Little audaxviator lives all alone when the vast majority of microbial life is utterly reliant on colonial symbiosis. It earns a living by mopping up the molecular detritus left after radioactive decay in the uranium rich rocks dissociates water and bicarbonates. That’s a very, very neat trick.

More here.

It was a dazzling piece of wartime espionage. But does it argue for or against spying?

Malcolm Gladwell in The New Yorker:

100510_r19603_p233 On April 30, 1943, a fisherman came across a badly decomposed corpse floating in the water off the coast of Huelva, in southwestern Spain. The body was of an adult male dressed in a trenchcoat, a uniform, and boots, with a black attaché case chained to his waist. His wallet identified him as Major William Martin, of the Royal Marines. The Spanish authorities called in the local British vice-consul, Francis Haselden, and in his presence opened the attaché case, revealing an official-looking military envelope. The Spaniards offered the case and its contents to Haselden. But Haselden declined, requesting that the handover go through formal channels—an odd decision, in retrospect, since, in the days that followed, British authorities in London sent a series of increasingly frantic messages to Spain asking the whereabouts of Major Martin’s briefcase.

It did not take long for word of the downed officer to make its way to German intelligence agents in the region. Spain was a neutral country, but much of its military was pro-German, and the Nazis found an officer in the Spanish general staff who was willing to help. A thin metal rod was inserted into the envelope; the documents were then wound around it and slid out through a gap, without disturbing the envelope’s seals. What the officer discovered was astounding. Major Martin was a courier, carrying a personal letter from Lieutenant General Archibald Nye, the vice-chief of the Imperial General Staff, in London, to General Harold Alexander, the senior British officer under Eisenhower in Tunisia. Nye’s letter spelled out what Allied intentions were in southern Europe. American and British forces planned to cross the Mediterranean from their positions in North Africa, and launch an attack on German-held Greece and Sardinia. Hitler transferred a Panzer division from France to the Peloponnese, in Greece, and the German military command sent an urgent message to the head of its forces in the region: “The measures to be taken in Sardinia and the Peloponnese have priority over any others.”

The Germans did not realize—until it was too late—that “William Martin” was a fiction. The man they took to be a high-level courier was a mentally ill vagrant who had eaten rat poison; his body had been liberated from a London morgue and dressed up in officer’s clothing. The letter was a fake, and the frantic messages between London and Madrid a carefully choreographed act. When a hundred and sixty thousand Allied troops invaded Sicily on July 10, 1943, it became clear that the Germans had fallen victim to one of the most remarkable deceptions in modern military history.

More here.

Faisal Shahzad’s anti-Americanism

Pervez Hoodbhoy in Dawn:

Capt_a6ad023d4907449d8147e488f754452a-a6ad023d4907449d8147e488f754452a-0 As anti-US lava spews from the fiery volcanoes of Pakistan’s private television channels and newspapers, a collective psychosis grips the country’s youth. Murderous intent follows with the conviction that the US is responsible for all ills, both in Pakistan and the world of Islam.

Faisal Shahzad, with designer sunglasses and an MBA degree from the University of Bridgeport, acquired that murderous intent. Living his formative years in Pakistan, he typifies the young Pakistani who grew up in the shadow of Ziaul Haq’s hate-based education curriculum. The son of a retired air vice-marshal, life was easy as was getting US citizenship subsequently. But at some point the toxic schooling and media tutoring must have kicked in.

There was guilt as he saw pictures of Gaza’s dead children and related them to US support for Israel. Internet browsing or, perhaps, the local mosque steered him towards the idea of an Islamic caliphate. This solution to the world’s problems would require, of course, the US to be destroyed. Hence Shahzad’s self-confessed trip to Waziristan.

Ideas considered extreme a decade ago are now mainstream. A private survey carried out by a European embassy based in Islamabad found that only four per cent of Pakistanis polled speak well of America; 96 per cent against.

More here.

rebecca west reviews The Barbarians (from 1915)

West

Yesterday I went into a bookshop in one of those streets which, though only a mile or so from the heart of London, have kept themselves inviolate from London. It has such dignified enjoyment of its own spaciousness that it might be the high street of a county town, or at least a part of London in the eighties. The shops are small and restrained, the pavements give hospitality to violet-sellers and their dispersed wares, the ladies walk, slow and unruffled and lovely like the ladies in Whistler’s pictures, the white stucco houses shine clean and their linden trees are dustless. Yet the first thing I saw in the bookshop of this delicate-spirited suburb was a pile of thick red books which I knew to be, at the first sight of their binding, Mrs. Constance Garnett’s translations of Dostoevsky’s novels. And as I turned over the pages of “The Brothers Karamazov” and looked on that wonderful story that works like a yeast, that struggles like a live thing to be born, it struck me that it is really art which governs the world. It was plainly due to the book in my hand that the Germans are floundering in the mud of Flanders instead of stealing our spoons in the interests of the Pan-Germanic ideal. That England, with her habit of judging other nations by their political institutions, should be the ally of Russia is almost a miracle. It is only to be explained by the fact that wherever people who write and think gather together, Russian literature is loved and praised.

more from TNR here.

laura bush, a decent lady

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One of Laura Bush’s best qualities as a memoirist — and she is a particularly fine, lyrical one — is her ability to speak the language of feelings without recourse to cant or contemporary psychobabble. Partly, that may reflect her deep — and deeply appreciated — roots in the hardscrabble West Texas oil country where she grew up. Partly, it probably reflects her deep reading and obvious appreciation of great literature, something that surfaces here again and again, though always unselfconsciously. She was, after all, the bookish only child of a doting father and bookish mother, and would go on to become a teacher of inner-city children and, later, a librarian trained at the University of Texas’ great school of that so painfully underappreciated vocation. The former first lady has written two actual memoirs in this book. The first, more compelling of the two concerns her girlhood in Midland, Texas, and her life up until her husband decided to run for president, a decision she signed onto with some reluctance. (She clearly would have preferred an earlier retreat to the ranch she so loves in Crawford.) The first section is rich in elegantly recounted detail; the second has a somewhat flat and, often, detached tone — except in a few crucial instances. Even so, the account of her eight tumultuous years in the White House is singularly free of the mean-spiritedness and payback that has become a routine feature of contemporary political memoirs.

more from Tim Rutten at the LAT here.

hitle ….. i mean ….. heidegger

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It may seem surprising that so many books continue to be written debating Martin Heidegger’s Nazi affiliations, since the fact that Heidegger was a Nazi has never been in dispute. How could it be, when the great philosopher took office as rector of Freiburg University in April 1933 specifically in order to carry out the Gleichschaltung, or “bringing into line,” of the school with Hitler’s new party-state? Didn’t he tell the student body, in a speech that November, that “the Führer and he alone is the present and future German reality and its law”? After the war, didn’t he go out of his way to minimize Nazi crimes, even describing the Holocaust, in one notorious essay, as just another manifestation of modern technology, like mechanized agriculture? Yet by the time of his 80th birthday, in 1969, Heidegger had largely succeeded in detaching his work and reputation from his Nazism. The seal was set on his absolution by Hannah Arendt, in a birthday address broadcast on West German radio. Heideg­ger’s Nazism, she explained, was an “escapade,” a mistake, which happened only because the thinker naïvely “succumbed to the temptation . . . to ‘intervene’ in the world of human affairs.” The moral to be drawn from the Heidegger case was that “the thinking ‘I’ is entirely different from the self of consciousness,” so that Heideg­ger’s thought cannot be contaminated by the actions of the mere man.

more from Adam Kirsch at the NYT here.

Saturday Poem

Waiting

There are no calls from the outside.
Miracles are the perversity of literature.
We should know that by now.
Only that these never revealed connections of things
lead us oddly on. Caesar's legions
enetering Greenland ice, the scout far in front
wanting to do battle where there are
no enemies,
never were any enemies.

by Jim Harrison

from Selected & New Poems;
Dell Publishing, 1982

A life in writing: Tariq Ali

From The Guardian:

Tariq-Ali In photographs and news footage of political demonstrations of the 1960s, Tariq Ali is unmistakeable: the thick black hair and thatchy moustache; the clenched fist and characteristic surge to the foreground amid a sea of fair faces. Almost immediately on coming down from Oxford in 1966, Ali began to agitate for a workers' uprising – not just in Britain but across the world. His book 1968 and After: Inside the Revolution (1978) stressed “the key importance of the working class as the only agency of social change”. His hero was Che Guevara. Meeting Malcolm X at an Oxford Union debate in 1964, he was pleased to discover that Malcolm was “a great admirer of Cuba and Vietnam”. Ali was Britain's own “other”, a role he took up with zeal and played with dash and style. He didn't get his revolution, but he did get a Rolling Stones anthem in his honour. Mick Jagger is said to have written “Street Fighting Man” for him. Ali returned the compliment by calling his autobiography Street Fighting Years.

Ali had a strong personal presence then, and he has it still. Now 66, he lives in a roomy neogothic house in Highgate, north London – friends have been heard to call it “Chateau Tariq” – with his partner of 35 years, Susan Watkins. She edits New Left Review, to which Ali has been a longstanding contributor. They have two children (Ali has another, with a former partner). In 1974, he ran for parliament as the International Marxist candidate, but the sloganeering public persona is tempered by an erudite domestic man.

More here.

Nietzsche: A Philosophy in Context

Francis Fukuyama in The New York Times:

Fukuyama-t_CA0-popup Context is particularly important in Nie­tzsche’s case because his life story was so dramatic. The young Friedrich (or Fritz, as he was known) was, by all accounts, simply the most brilliant student any of his formidable professors had ever encountered, going all the way back to his boarding school days at Pforta. His teacher of classical philology at Leipzig, Friedrich Ritschl, said that in his 39 years of teaching he had “never known a young man who has matured so early.” Nie­tzsche was awarded a doctorate at age 24 and a professorship at the University of Basel the same year; he was promoted to full professor at 25 — a feat not even Larry Summers could duplicate.

From a very early age, however, ­Nie­tzsche was afflicted with a host of maladies, including blinding headaches that would last for days, problems with his digestion that would leave him vomiting and bedridden, and a progressive blindness that allowed him to read, painfully, for only a couple of hours a day. So debilitating did these symptoms become that he was forced to give up his professorship at age 34, after which he withdrew into a solitary and nomadic life, traveling between Switzerland and the South of France in search of a climate that would marginally ease his suffering. His great works were written in the few days of lucidity that were permitted him between long bouts of physical disability, “On the Genealogy of Morals” having been composed for the most part in a mere three weeks in 1887.

More here.