“A thousand things advance, nine hundred ninety nine retreat; that is progress.”

Henri Frederic Amiel.





Science is the curiosity to unravel the mystery surrounding many unknown aspects of this world. Many a time this is interpreted as finding out the truth. Every scientific truth is true only until it is proved to be untrue by another new finding. The illiterate and the poor in this world are happy in one way. They are not worried about their future illnesses and what the medical science has to offer them about their future. They live only in the present as their greatest worry is not knowing where their next meal comes from. The educated human being is robbed of this happiness as he is being bombarded with all kinds of advertisements about the wonder drugs and the divine interventions to keep him healthy for all times to come. The truth is that most, if not all, of these tall claims are not backed by hard scientific data. That said, I must hasten to add that there has been significant progress in many areas of medical science that has added to man’s comfort. Medical science has also been able to eradicate only one human malady-smallpox- in all these years. Every advance, hailed in the beginning as the greatest discovery of all times, has brought in its wake suffering in the long run. The antibiotics story is an ideal example. Claimed to have ended the era of germ diseases they have only brought out deadly super bugs that threaten most of us in the present hospital atmosphere. Over enthusiasm and the greed of the Pharma companies eventually landed us there.



Although I have been writing about these happenings in the medical field regularly for the last four decades, recent two books from the US have brought out the same truth in more elaborate style. The author of the first book, The Truth about Drug Companies-How they deceive us and what to do about them, Marcia Angell, has been an award winning editor-in- chief of the most prestigious American medical journal, The New England Journal of Medicine for two decades. She, along with her present soul mate, Arnold Relman, had been at the helm of affairs of the Journal since 1977, he first and, later she, as chief editors. Their opinions count a lot more than all other opinions put together. Hence this effort to reiterate what I had been saying all these years. Many of my articles have been brought out recently in a book form by the College of Physicians and Surgeons of Delhi with the title Ancient Wisdom in Medicine and Science-Search and Research. Marcia brings out many of the facts that I have written about time and again in the past, in her above mentioned book which was published by Random House in New York.



“The pharmaceutical industry claims to be a high risk business, but year after year, drug companies have higher profits than those in any other industry-by a long shot. The industry claims to be innovative, but only a small fraction of its drugs are truly new; most are simple variations of the older drugs. Contrary to popular belief, big drug companies spend far less on research and development than on marketing. The pharmaceutical industry has an iron grip on the Congress and the White House. It has the largest lobby in Washington-with more lobbyists than there are elected representatives in Congress-and contributes heavily to political campaigns. Drug companies promote diseases to match their drugs. Millions of normal Americans have come to believe that they have dubious or exaggerated ailments. Drug companies have enormous influence over what the doctors are taught about drugs and what they prescribe. Drug companies have substantial control over clinical trials of their drugs. There is good reason to believe that much of the company supported research on prescription drugs is biased as a result.”



The above quote is the long and short of Marcia’s book. Similar, but more glaring, revelations are made by another American author, John Abramson, in his recent book, Overdo$ed America. The two together could certainly replace the pharmacology textbooks in the medical schools for the good of humanity at large. What worries me most now is the new avatar of drug trials done by advertisement companies on behalf of the drug giants of America on the hapless Indian patients. This is a new big time business and there is big money in it. Many brokers in India have started this business. These are called Contract Research Organizations (CROs). In 2001 alone there were about a thousand of them operating around the world, with revenues from their drug company clients of around $7 billion. They establish networks of physicians who, working under their supervision, are paid handsomely by Indian standards to administer the study drugs and collect information. The information is passed on to the parent company that might or might not publish the results depending on their need. If ever published they are doctored and sexed up before being published. Marcia reveals in her book that many of the articles in prestigious journals are in fact ghost written by the drug companies. The company then buys up authors for respectability only! Most of these drugs are not new but old ones being tried for new indications for which they had not been licensed in the first place. These are called phase IV or post-marketing trials to find out unknown side effects.



In the year 2001 alone nearly 2.3 million Americans served as human volunteers and there were about 80,000 such studies going on in the US. Having now realized that unknown adverse drug reactions are the fourth important cause of death in the US, as per the Institute of Medicine report there, the drug companies are keen to have these trials conducted in developing countries. India is the preferred destination because of our reputation in the medical field. This is a worrying new development. The doctors roped in by these CROs have little realization of what they are in for. They get paid much more than what they would have got by treating patients in their jobs. They are being lured into this. Hospitals are also being used with the same carrot dangling in front of their eyes. Many hospitals have taken this up very enthusiastically as there is good money in it and they are told that they are doing high class research. In fact, there is no science or research in this game at all. “All clinical trials cut into the limited supply of human volunteers. In fact, the scarcity of human subjects-not FDA roadblocks, as is often claimed by pharmaceutical industry-is the biggest cause of delay in getting their new drugs to market,” writes Marcia in her book. The interventional technology sellers need not go through all these as there are no mandatory clinical trials needed prior to release of their tools. They sell their wares by obfuscating the public and brainwashing the doctors. They also get their research papers written up in prestigious journals to give the aura of science.



In the US a patient on these trials gets anywhere between a few hundred to a few thousand dollars, but they could get free patients in India-human life is cheap here, they think. In addition, the requisite informed consent is only a farce in poor Indian patients anyway! Doctors involved in the US also get a large bounty averaging $7000 per patient in 2001. Imagine how much does doctors in India get compared to this! So the business of CRO clinical trials in India is a very good business for American drug giants. In the US to get patients for trials is difficult these days what with all the recent revelations about the medical world. The Pharma companies there use several tricks to solicit patients, the latter being disguised as public service. Drug companies set up patient advocacy groups as magnets for attracting other patients. Postings on health related internet services, radio, television ads, newspaper ads, individual mailings, posters and flyers distributed among communities are the other methods. All these are not attracting enough bakraas now in that country and so their foray into Indian market. We have enthusiastic brokers here who have their eyes on the big money. This worries me a lot and we do not seem to learn our lessons from others’ mistakes. We try and do the mistakes ourselves to know the truth. God save mankind from this kind of monetary economy! Long live scientific medicine for the good of humanity at large. Hippocrates must indeed be turning in his grave recapitulating his motto for medicine-“cure rarely, comfort mostly, but console always.” Doctors seem to have forgotten the golden rule in medicine-primum non nocere-first do no harm.



“I don’t give them hell. I just tell the truth and they think it is hell.”

Harry S. Truman.