Dr. Jason Fung: Financial Conflicts of Interests and the End of Evidence-Based Medicine

Dr. Jason Fung: Financial Conflicts of Interests and the End of Evidence-Based Medicine

so what I’m going to talk about today is
a little bit different I usually talk about nutrition or fasting or type 2
diabetes but today I’m going to talk about financial conflicts of interest
and really how it influences medicine and it really shouldn’t be so the
question is really how we got to this stage because you know as doctors we are
really supposed to be part of the solution not part of the problem but
increasingly doctors are seen as part of the problem and you can see it
everywhere so this is on CNN for example with the opioid crisis New York doctors
wrote more opioid prescriptions after Pharma payments it’s like okay well that
doesn’t sound very good for us this is in New York Magazine for example our
doctors to blame for the opioid crisis New York New Yorkers think so right and
it’s like okay this is not good this is all actually from the last couple of
months it’s all come from you know 2018 so we’re increasingly seen not as people
who are safeguarding the health of our population but sort of people who just
sort of perpetuate this problem and it all comes down to the fact that we were
seen as pawns of Big Pharma or other corporate interests when really we
should be looking after the health of our patients not trying to promote this
so for example Memorial sloan-kettering in New York is of one very very famous
cancer hospital and this is Craig Thompson who’s the chief executive
officer and he was sitting on the board of Merck one of the giant pharmaceutical
companies and everybody is wandering rightly hey if you are taking all this
money from Merck from Big Pharma how can you be looking after the interests of
patients and then the answer is you can’t really and he was paid $300,000 a
year by Merck you took six point seven million dollars home in 2006
and it’s like well if you’re taking money from them like where do your
loyalties really lie this is another Sloane caring doctor so this is Jose
bezel guy again in the New York Times you know basically exploding this all
over the front pages this doctor is one of the top breast cancer doctors in the
world really you know one of the top two or three in the last ten years and he in
87 percent of the papers he wrote he never actually disclosed that he’s
taking all this money so he’s basically hiding it because regulations say that
you really have to tell people if you have a financial conflict of interest
and he sat on the board of bristol-myers Squibb another big pharmaceutical he in
he you know he is the director of this Varian Medical Systems which sells to
Memorial sloan-kettering so and yet another financial conflict of interest
so he had to resign as well from the New York Times another study for example
this was supposed to be an unbiased study of drinking so there is the
National Institute of Health said well let’s let’s let’s study if alcohol
drinking is actually good for you because a lot of observational data says
if you drink one to two drinks a day it’s actually pretty healthy but we
don’t actually have any data so let’s get the data so the NIH goes to this
doctor doctor doctor mu Kamal and he immediately goes to all the alcoholic in
history and tries to get funding for this and of course you don’t want the
alcohol industry writing a paper to see if drinking alcohol is good for you like
you don’t have to be that smart to understand that you want an unbiased
trial of this and yet here he is trying to get millions of dollars and if they
have email after email of the of the alcohol industry people saying well you
should do it like this you should do it like this well if you do it like this
it’ll look bad for a solution to it and and this lead investigator saying yeah
yeah you’re right you’re right please give me money
it’s like okay but you know you’ve biased the trial so badly right from the
start that the NIH had to actually pull the funding and stop the study so this
is all of these these these stories are like within the last six months so this
is all the ways that we got into this mess which is the financial conflicts of
interest in medicine and unfortunately it’s basically corrupting all of
Medicine in what we do so there’s lots of ways the first way that most of us
are very familiar with is that they just pay you straight held so this is doctors
and this is the insider’s view so this is dr. Elman and he is a former
editor-in-chief of the New York you know the New England Journal of Medicine
which is one of the top medical journals in the world and what he said was that
they’re slowly being bought by the pharmaceutical industry not only in
terms of the practice the practice of medicine but also teaching and and
research and this is an insider’s view like this is a guy who knows what he’s
talking about he spent decades being one of the editors of the top journals and
what does he mean well if you take a look at how much contact physicians have
with the pharmaceutical industry well it’s everywhere and these are basically
gifts to doctors so it’s not as bad as it used to be but it’s still pretty bad
and 94% of patients had ties to the pharmaceutical industry and these are of
course a conflict of interest because we’re supposed to be on the side of the
patient we’re not supposed to be on the side of prescribing drugs just for the
hell of it right we’re supposed to be looking after our patients and if we
take money from these pharmaceuticals we’re gonna look favorably on it
everybody knows that so why do we allow it but 94 percent of physicians do it
and what they see again New York Times so this is all out there it says that
people don’t even understand that if they get gifts it is going to influence
their opinion it’s like why do you think they give gifts in the first place it’s
so you look favorably on that it’s like come on you got into medical
school you’re not that stupid but 61% of medical students felt the
gifts did not influence their own behavior right that is corruption it’s
only a problem for somebody else right it doesn’t influence them they don’t see
that they don’t have the self-awareness to see that of course if you take a big
gift if you take 300 million dollars from Merc you think Merc is great and
this is the thing if you if you look at this published study so this is in the
the public journal Matthew what you can see is that if you compare sorry this is
a little small so if you look at the blue bar here those are the people that
the physicians that got gifts from pharmaceutical and the red bar is the
ones that didn’t get any gifts so what you can see in almost every case and
these are by specialties so general surgery urology in almost every single
case doctors who got gifts from pharmaceuticals prescribed more
pharmaceuticals so the evidence is very clear as if we needed it that if
pharmaceutical companies give gifts at doctors they give more drugs because you
feel good and therefore you give more but it’s not in the interests of health
it was all just advertising so this was a very interesting study here talking
about pharmaceutical firms and what they did was they sent a number of doctors to
sort of a free conference in a sunny location all-expenses-paid symposium so
really stuff that happens like every single day and then they ask them they
track their use of the drug so you see in drug a the use of that drug went up
by three hundred and thirty five percent and the drug BIA went up by two hundred
and twenty five percent and then they asked them hey do you think that
symposium had anything to do with your medical practice which it clearly did 95
percent of doctors said no not a problem not a problem at all
like it doesn’t influence me at all this is what doctors think this is what you
see you see your mentors doing it you see your colleagues doing it
they sent dr. XYZ to Phoenix and the winter they went to like st. Lucia and
all that but hey it’s okay they’re doctors they’re above this thing right
corruption only a problem for somebody else when the data is right in front of
us that it clearly influences their practice and not in a good way in a way
that increases expenses for everybody else the drug minor magnet might not be
good and if you thought that the universities are free of it it’s like
the worst place in the world the universities are the most corrupted
places in the world you thought that people taught at prestigious
institutions for the good of mankind that might have been why they they they
went there in the first place but they stayed for the money if you look at the
number of articles and citations that researchers do these guys out at the top
where they’re writing 600 articles a thousand articles these are the guys at
Harvard Yale everywhere well that’s the amount of money on the lot on the the y
axis there that’s the amount of mind yet so there’s a clear correlation the more
prestigious a doctor the more money they’re getting from the pharmaceutical
right so it’s like okay you think that this guy who teaches at Harvard
University is giving you an impartial opinion you shouldn’t be talking to him
you should be talking to your family physician who is getting the you know 10
buck pen right not the $500,000 right it just is a terrible system but yet
these people are the people that are in the newspaper they’re the ones that are
teaching medical students are the ones who are teaching the the dietitians the
pharmacist everybody these highly highly corrupted people who don’t even know it
95% of them think they’re really good people but this is this is from the Mayo
clinical proceedings and again you can see exactly the same thing this is the
the number of speakers who went before the FDA to help you know promote a drug
and you see that this is the amount of yes so there’s like 180 mm there’s an
outlier if you can’t see this one person who met outlier criteria with payments
receipt totaling 2.8 million dollars it’s like
these are the people who are arguing to the FDA that drugs should or should not
be approved for certain indications and almost every single one of them is
taking hundreds of thousands of dollars and this isn’t a system that we allow
this is in front of everybody this is public knowledge this is stuff that’s
out there but nobody ever talks about why because you’re not getting Harvard
University to talk about it because all their doctors are on the take that’s why
we talk about it here because this is the truth so you have you have the
situation now where all these doctors who are trying to you know point out the
problem basically just try and get shut down like like Malcolm Kendrick like
he’s disappearing from the internet they shot him down in the careers of
Wikipedia this guy’s Steve Nissen for example he says well you know if you’re
against statins you’re like an anti-vaxxer that’s that’s what he says
right now it’s like well he’s also the guy who’s taking all the money from
Amgen and Pfizer and everything right so it’s not an unbiased opinion and then
you get like crazy crazy stuff you know like talking about the statins that oh
everybody should be getting it they should be putting it in the drinking
water everybody over the age of 50 should be getting it it’s like where are
these opinions coming from because if you look at the actual science which
Malcolm does it’s not there there’s nothing to support that sort of use to
put these drugs into you know the mouths of millions of patients yet as a family
physician as a medical student you get taught by these people then they write
guidelines that you’re almost forced to follow because otherwise you’re not
following standard of practice so you’re almost forced to give these because they
wrote that guideline so what happens when you stop statins well in France
there was actually a sort of natural experiment where this happened
so there is a a controversy in 2012-2013 there’s some big controversy the
discontinuation increased by 50% and so everybody’s like oh people are gonna die
people are gonna die it’s like what happened what didn’t happen was they
didn’t die so if you look at mortality 558 in 2012 and 556 in 2013
cardiovascular death 32.2 and 2012 31.6 in 2013 so it’s like here’s all these
big you know people who are raising all this ruckus off you talk about statins
people are gonna die people get a heart attack they don’t die they don’t get
heart attacks you’re just trying to give it to the right people and this is the
problem is that there are a population of people who take these drugs who
should but that’s a relatively small amount then it’s like oh but you don’t
make money by selling a small amount of drug you make money by selling a large
amount of drugs so you want to push it out into the general population so that
everybody over 50 is taking this stuff but it’s not that useful this is what it
showed and then you got crazy crazy stupid stuff right so this guy John
Steven Pifer at the University of Toronto so he says that well frock dose
like sugar like first of all like everybody knows that sugars not really a
health food and this is what he says that we’re fructose was once indoors and
later announced it is now in a position to be endorsed again so fructose it’s a
health food it’s like okay that’s crazy and he says there’s a need to clarify
the benefits okay forget cutting down on sugar he’s saying we should be doing
Studies on how it’s really good to eat more sugar it’s like okay how does that
even work it’s like how can you be a professor at a university and think
these crazy stupid thoughts well like here’s this conflicts of
interest coca-cola coca-cola coca-cola coca-cola coca-cola the Coca Cola
Advisory Board and coca-cola okay well now I see why you think coca-cola is a
health and right put it next to the kombucha
the whole problem is that they have no insight into the fact that their
opinions have been corrupted they think that these are hey this nice lady from
coca-cola is giving me all this money and therefore this must be my opinion
this must be what’s right and then so this was this is what happens it winds
up in one of our national newspapers oh hey they get hundreds of thousands of
dollars from soft drink makers and this is at the University he’s a professor at
the University of Toronto that’s where I’m from
so if you look at the financial conflicts of interest specifically for
sugar what’s really interesting is that in the annals of internal medicine so
another very highly regarded journal they looked at the reporting bias
between sugar sweetened beverages and weight gain so here’s all the studies
these are the number of trials so if you have no association on the Left there’s
about 26 trials that showed that there’s no association between drinking sugary
beverages and getting fat and on the right hand side positive association
there’s about 30 to 33 that says there is an association if you drink if you
drink more sugary beverages you gain more weight so it’s about even you’d say
so if you just look at the data and you say okay well it’s about like say 34 to
26 it’s not it’s not a slam dunk it’s not like every single study shows that
drinking sugar makes you fire well let’s break it down this is what the study did
let’s break it down to who sponsored the study and this is what you show like
eighty three point three percent of the studies that showed no association
surprised where sugar funded like that guy Stephen Piper and when you actually
have this in the red which is not sugar funded almost every study shows that yes
drinking sugary beverages actually makes you gain weight which is sort of like
it’s not that difficult to understand because we all knew this your
grandmother to it your great-grandmother knew it if
you eat a lot of sweets if you eat a lot of candy leo sugar you’re going to gain
weight but this is the problem they can simply pay researchers to do studies
that show that hey it’s not that bad and then say look it’s not that it’s not
that obvious like there’s studies that show it doesn’t make you gain weight
there’s lots of studies there’s like 26 studies that show that it does not make
you gain weight of course almost all of them are funded by the sugar industry so
this is the problem is that if you have evidence-based medicine but the evidence
base upon which you base your facts is so corrupted then you have to throw the
whole thing out so there’s lots of different ways that the the
pharmaceuticals actually corrupt medicine so there’s the gifts of course
there’s the advisory board membership which is you know most of us know this
they invite you out and they say we’re gonna get your advice but they have to
have no interest in what you’re talking about they just want to sit you down and
show you an ad for an hour and then give you like a thousand dollars that’s all
that happens right so there’s honoraria for attending meeting so we’ll send you
to the American Board of Cardiology meeting at so-and-so right and it’s
several thousand dollars of airfare and hotel and so on you have speaking fees
for these talks you know all those dinner talks that everybody gets invited
to so those are interesting because when you actually talk to pharmaceutical
representatives they actually have nothing about education they just want
to pay that doctor a thousand two thousand dollars so that they’ll look
favorably upon their their things there’s consulting fees travel expenses
and then participating in clinical trials so that’s at the level of the
doctor there’s a lot of problems but it actually goes much much much beyond just
paying the doctors not just the regular doctors who are caught in this but also
all the academic doctors but the journals themselves are very biased as
well so this is again the insider’s views of Richard Horton and 2015 made a
comment in The Lancet so again one of the most prestigious medical journals in
the world that’s that again science is straightforward much of
the scientific literature and he’s talking about health perhaps half may
simply be untrue it’s like wow this is a guy who spent
his career looking at the science and he thinks it’s crap that’s very interesting
because that tells you a lot about what we should do so this is more ways that
they influence the practice of medicine and that’s industry payments to editors
so remember the editor of journals have a lot of power okay so they decide what
gets published what doesn’t get published if you write something like
you know statins are bad they can decide not to publish it so they actually you
know form the conversation they wreck the conversation so they should be
impartial because that’s what we all as physicians rely upon well here’s so this
in the BMJ 2017 look at very very influential journals and how much money
editors are being paid by this so look at the Journal of the American College
of Cardiology on average each editor is getting four hundred and seventy five
thousand dollars in that year that’s crazy
with thirty five editors that’s about fifteen million dollars every year
almost half a million dollars going straight into that doctors pocket and
it’s like I wonder why they’re all pushing drugs and devices it’s like if
I’m getting half a million dollars I’d be like sort of slightly partial to and
then there’s all this research right so on average JAMA for example eighty four
thousand dollars per editor per year eighty four thousand dollars and we all
know that if you get research money it goes a lot of different ways but a lot
of it goes to you know paying for that conference in Hawaii because it’s like
yeah there’s this conference on this and this and this and it’s happens to be
held in Hawaii like you can learn the same thing in your underwear in front of
your computer you know it’s like you don’t
have to go to Hawaii for that but of course research dollars can do that so
then you go to Hawaii and it’s like no wonder the jack loves devices like it
pays this private school bills right momoney momoney baby that’s what I say
so for the practicing physician it’s like no pen for you right but for the
journal editor here’s a couple hundred thousand dollars right so here’s the
crazy part right so you go to a conference these days you can’t even get
a pen that’s that’s the rules okay so I go to the American Society of Nephrology
and about five or eight years ago they say you can’t give out any free stuff
not even a pet okay and that’s like a I think that’s pretty reasonable so you
you used to go around used to collect a bunch of like drug stuff right that’s
the way it used to be and now it’s all gone so that’s good but it’s because we
know that that’s corrupting so that’s gone but we don’t talk about what about
the journal editors who’s far more influential than one physician you can’t
even get a pen without us thinking that you’re gonna be biased but we allow
journal editors to get half a million bucks per year that’s that’s crazy
in the New England Journal of Medicine so another way that they corrupt the
evidence is to publish very influential articles so this is talking about
bisphosphonates and fracture risks so if you take this phosphonates for a very
long time they cause fractures because they’re not back great drugs but anyway
they published this in 2010 in the New England Journal of Medicine which says
that fracture rates from lucrative bisphosphonates are very rare that’s
what they said it’s like well who wrote this well if you look up here it’s like
climb nutrition paid for doctor Gucci right quit being a full time employee
you have a full-time employee of the truck of the company that makes this
drug writing an article telling doctors that this drug is not that bad really
you don’t see any conflict of interest in it and it’s like the journal is
obviously making a lot of money for this but practicing physicians are going
to rely on review articles in the New England Journal of Medicine not
realizing that they’re actually written by the company it’s like that’s insane
like it’s a total conflict of interest this other one dr. Centura end up acting
full-time employees and having equity interests in Merck it’s like you think
they might have an interest in Merck being able to sell more drugs even if
it’s harmful like what we’re talking about is these are drugs that can be
harmful and they’re downplaying the risk but they’re employees of that like how
is it that the New England Journal of Medicine our top journal actually allows
that it’s so biased there’s other ways they do that so there’s reprint income
so if you ever go to yo your drug rep they buy stacks of these reprints and
they hand them out to family physicians and other physicians and it’s not a
small part of the money they make because if you look at reprint income
The Lancet gets 41 percent of its income from selling reprints to drug companies
so drug companies will buy reprints of articles that are favorable and start
handing them out like candy so The Lancet gets 41% the American Medical
Association gets 53% of their income from reprints so it’s like if they print
a good article they can turn it into a blockbuster which is great for the
journal and their impact factor goes up and they get a lot of money as that
Merck or whatever buys tons and tons of these reprints right so who needs
journalistic ethics when there’s a Mercedes in the driveway right that’s
the whole point this is not good medicine this is the stuff that gets out
there and actually traps the honest doctors who are looking at this and
saying well I trust the New England Journal of Medicine that’s my journal
it’s like it’s corrupt that’s what the insiders have said the whole thing is a
pile of crap so you can look again at the association between the industry
affiliation with Rogan si glitters so here’s yet another example if you
look at rosy glitter zone so that this is a band yes it was a drug that was
causing heart attacks eventually got pulled right when they looked at the
authors who had conflicts of interests they were three to four times more
likely to have a favorable risk of the the risk of heart attacks so if you have
so-called experts who have taken money from the drug company they look much
more favorably and downplay the risk of heart attack even though it wound up
being shown that this was actually a real risk right but these these these
doctors these researchers actually don’t don’t know anything about that so that’s
that’s biased journals then you have selective publication so journals
publish articles and you assume that that’s the evidence base upon which we
evaluate whether medicines are good or not so here’s the insider’s views of
marshall angle said it’s 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 and again this is the former
editor of the New England Journal of Medicine so this is an insider spent
decades working at evidence-based medicine saying that evidence-based
medicine is actually so corrupt as to be useless or harmful this is basically
what she’s saying and she reached this conclusion only after several decades of
being in it so this was a study done in the New England Journal of Medicine
looking at selective publication so when you do studies you send them out to the
journal to get published and the problem is that you hope that all the studies
get published as opposed to only the good ones right because if you only
publish certain ones you can get a very biased view so say you have a you know
coin and you flip heads or tails every times its heads you you count it every
time the tail you just kind of hide it right that’s that’s gonna give you a
biased view of what’s happening well this is what they did in this study is
that they took seventy four FDA registered studies of which 31% were
never and the FDA sort of reevaluated all
these studies and decided was it did it support the use of antidepressants or
did it not support the use of antidepressants and this is what they
found was that if you look at the journals the way they were published so
there’s almost 50 articles published on various antidepressants so you can see
that almost all the studies that were published we’re positive so if you are a
doctor you’d say wow it is overwhelmingly positive like there is
clear evidence from this evidence-based medicine that antidepressants are good
medications when the FDA went back and said let’s look at all the publication’s
so it’s thought that the way they were published and if they’re and we’re gonna
make our own determination if they’re good or bad this is actually what the
FDA found of the exact same trials it’s like 50/50 they don’t really work
there’s an equal number of studies that show that this the antidepressants don’t
work as to show it works but if you’re looking at the journal version of it
you’d say as an evidence-based medicine practitioner I think this stuff really
works but in fact it’s actually a toss-up and it’s because of selective
publication so yet another way that the they they buy is it in favor of it so
you can look at neurodegenerative diseases for example so discontinuation
and non publication while 12% of trials were discontinued and if you look at if
they’re sponsored by industry versus University sponsored what you see is
that there’s five times more likely to be unpublished of us from the industry
that’s like of course if the industry if Big Pharma does a study that shows that
it’s drug is no good it has the option of not publishing it why because it paid
for it so it simply gets rid of it and that’s how you wind up in this mess
where you think that there’s something very very beneficial when it’s actually
not beneficial in the least and it was because people are playing game
so this is another way that people do it so if you look at and this was published
in the British Medical Journal if you look at selective reporting from studies
the the yellow the yellow boxes here are the pooled publications and what you see
is that sorry I can’t really do this but the the yellow box what you can see is
that you can have one study of which they published multiple studies so one
positive study and they’ll publish multiple publications from it and then
when they’re not good so if you look at the red bars it says this this this
orange circle is submitted study primary result in law is significant so a good
study and the blue circle is not significant and then the the green
diamond is whether it was published or not so if you look on the bottom what
you can see is for that drug four of the the orange circles got published but
only one of the blue ones are the three other blue ones which were negative
study simply disappeared from the evidence so if you’re to look at that
drug for example you’d say wow four out of five draw a four out of five
published trials say it’s good but there are actually eight trials for positive
and for negative and if you look at drug five for example there’s five studies
done out of which only two got published the two positive ones just like this is
how we get into this the mess because you don’t have to publish everything so
there’s multiple publications they’re selectively publications and then
selective reporting because you can report trials that are positive that
really aren’t so this is in 2008 if you track the trials for example you can see
that for example in 2008 you had 92 studies that was that were completed by
Sanofi this is just one example of which they only published 14 it’s like what do
you think those ones they didn’t publish were well clearly you only publish the
stuff that’s good for you right it’s just like your kids you say oh my kid
got 96 that’s what you tell your friends you don’t tell your friends oh yeah
my kid failed like you know math three times right the same thing select the
publication they they come out 92 times they’re like oh hey yeah my drug is so
great my kid is so great yeah it’s like yeah why is he like he’ll back two years
you know like come on but this is what we accept we accept this of drug
companies it’s like but the problem is that people die because there’s side
effects to this right and we allow it the the fact is that we allowed us to
happen so this is a very interesting trial where they looked at positive
trials versus negative trials by year so before year 2000 what you see is that
all a lot of trials were positive 57% of trials were positive after year 2000
only 8% were and what was the difference that was the year that everybody had to
register what their endpoints were so that means there is no more cheating
because what used to happen before 2000 is that you’d finish a trial and say
your your your outcome was heart attacks but you look at the data and says oh the
heart attack data is negative so let’s make it heart attacks and strokes and
hospitalization does that work it’s like no okay well let’s add you know stubbing
your toe it’s like does that work that’s like yes it works okay let’s publish it
but you never meant to analyze all that stuff together you just changed the
goalposts so before 2000 is pretty easy to change
the goalposts and so every but every trial was positive positive positive
after 2000 all of a sudden nothing works anymore
it’s like 92 percent of trials were negative because the only thing you made
them do was declare ahead of time what it is you’re going to measure right so
this is all about changing the goalposts that’s what used to happen so every
trial before year 2000 was more or less garbage and that’s what we base it on
that’s is what we based evidence-based medicine on and this is a problem then
you have crooked guidelines so we know about all about crooked
physicians and they don’t think they’re crooked right they think they’re good
people but they take a lot of money from
pharmaceuticals but then they write guidelines which are obviously bias so
if you look at this you can compare two guidelines one with conflicts of
interest in one with no conflicts of interest so they’re guidelines on how to
write guidelines for example so they’re a red flag so these are listed on the
side if your sponsor is a conflicted professional organization that’s a red
flag industry’s response ership can mean you know multiple panelists are
conflicted they’re all red flags right so certain ones will have a lot so this
if you look at this single test for PSA you can look so the on the left hand
side you have the u.s. present Preventive Services Task Force looking
at PSA saying is PSA a good test or a bad test and you see that they actually
pass all those red flags are there guidelines committee is set up properly
there’s nobody who’s conflicted the sponsor the US Preventive Hausa they
don’t take industry money and all this sort of stuff and basically what they
say is that PSA is useless recommends against PSA screening okay it’s useless
at the very same time you have the American neurological Association on the
right which does have multiple red flags that is they take a lot of money from
industry all the people who write the guide things are taking money from
industry and sometimes a lot of money and what they say is that they promote
screening in fact we should lower the age of baseline screening to 40 it’s
like oh my god you’re saying PSA saves lives and the difference between the two
because they’re looking at the same exact studies is that one has conflicts
of interest and the other does not and this is not just for PSA so here’s
antidepressants so again on the left-hand side no conflicts of interest
you have the depression from Kaiser Permanente and the nice guideline so you
can see that there’s really no red flags in the way they set up their committee
to write the guide and they say antidepressants are largely
useless so kaiser permanente says recommends against it for mild to
moderate and the nice actually explicit statement against prescribing as in do
not prescribe they’re useless or harmful and the American Psychiatric Association
at the very same time and you can see that they have a number of red flags
that’s the only flag they have right it’s all of it if they’re taking a lot
of money there’s a lot of sponsorship everybody is taking money it’s like yes
we recommend antidepressants for the initial treatment of mild to moderate
depression or these drugs should be distributed like Halloween candy these
are the exact same trials they’re looking at it’s the exact same data the
difference is how you make up the guidelines and yet when you have
guidelines that start to come out it’s very difficult because then as a
practicing physician if you don’t prescribe these things you could get
nicked on not following the standard of practice but the standard of practice is
set by a number of physicians who have a large amount of conflicts of interests
right and the stuff is like just so just so obvious right the archives of
internal medicine said failure of clinical practice guidelines because
these clinical practice guidelines how to set up a committee to write
guidelines they’ve been around a long time
two more decades of little if any progress and what they’re saying is that
if you look at the guidelines since they initially published 20 years ago and
this is now 26 years ago how to set up guidelines they say well 71% of
committee chairs had conflicts of interest and 91% of co-chairs have
conflicts of interest in fact that means the people who lead these guideline
committee they’re on the take right and that’s the big problem so we haven’t
made any progress even though this issue was raised 26 years ago so this is all
the ways this is a current state of evidence basement
right and this is why the insiders say evidence-based medicine the way we have
it with the financial conflicts of interest is largely useless or harmful
because you have all of these problems selective publications you have rigged
outcomes remember you’re just moving the goalposts right so if you you don’t
declare ahead of time you have advertorials that is the the people who
work for the company who write an editorial for the New England Journal
Medicine you have reprint revenue which is making a substantial contribution to
the viability that journal journal editors are on the take the publication
bias and then financial conflicts of interest like everywhere there’s like
this is what we accept as our gold standard of how we should be treating
patients and you wonder why the public thinks that doctors are all crooked
it’s like unfortunately they’re probably right that’s the big problem you have a
bunch of corrupted journals you have a bunch of corrupted physicians and
researchers and then the the guy at the end of the line the medical student is
coming in and being taught that how they should take all this evidence-based
medicine make sure everything is evidence-based
evidence base of its base but the base upon which you base it is corrupted so
this is the way it works right and unfortunately this is true so you have
pharmaceutical companies who gives through glyphs flattery and stuff they
target the doctors the universities the professor’s because they’re giving them
sort of like ten times or 15 times more than the individual doctors which
develop a favor of bias towards this drug of choice which means more drugs
are prescribed which means more money for the pharmaceuticals from which they
can then pay the doctors again you see this is the problem is that people are
catching on they clearly see and if you take the opioid crisis this is exactly
what happened so the opioid company Purdue gave a lot of money to the
doctors to say that hey if you are in pain you can’t get addicted it’s like
that actually wasn’t true at all but that’s what I was
taught in medical school if you’re in pain you can’t be addicted and it’s like
okay we all learned that a whole generation of doctors learn that and it
was not true at all it was all just money going to the medical school that’s
what was funding this message that was coming down to the medical student which
means we gave a lot of opioids and then people died a lot of people died and now
in the newspaper it’s like yeah it’s all the doctors fault it’s like yeah because
the doctors were the ones prescribing it but we allowed that to happen right and
then and unfortunately everybody’s sort of riding the gravy train right
everybody’s on the take from all this and-and-and when you have the complicit
doctors to this sort of corruption of medicine then people die so look the
opioid crisis is a perfect example where doctors were not part of the solution
we’re part of the problem we are the ones prescribing it and and people are
dying tobacco smoke smoking doesn’t cause
cancer that was pretty common in the 60s and 70s lots of doctors came out in
defense of smoking nutrition obesity type 2 diabetes sugar is a health food
like despite all the evidence you have physicians who are coming out like you
know in the newspaper writing articles about how fructose should really be
considered healthy for you it’s like why because of the corruption in the system
and this is what I showed before so this is how it works for doctors right so
doctors are on the take everywhere throughout medicine and it’s okay but
would we accept it if it was a police officer like what if people were giving
your police officer you know here’s a couple hundred thousand dollars just
look the other way while I do my drug deals right they’d be like okay there’s
no way you’re allowed to give money to a police officer it’s like you do that
then he’s fired and you’re in jail right no question about it
what if it’s like a judge do we allow this for judicial ‘he’s like a Supreme
Court judge oh yeah he took a couple hundred million dollars from this
company and no not at all it’s not acceptable anywhere and if you look at
pharmaceutical companies they actually have explicit bans on their employees
getting gifts it’s like okay so you know as a pharmaceutical that if somebody
gives your employee a gift that’s gonna corrupt them but your whole modus
operandi is to give gifts to doctors because you know it will corrupt them
it’s like wow that is crazy and then everybody thinks I’m super anti
Pharma is like I’m not the pharmaceutical company a big
pharmaceutical company should be doing that it’s whole purpose is to sell drug
and if you say you’re allowed to bribe doctors then they should bribe doctors
because that’s why they’re there to make money the problem is that the doctors
are doing a really lousy job policing themselves and saying we can’t be taking
money because our job is not to make ourselves rich our job is to protect the
health of our population so there must be rules on this but yet the people who
are to be in charge of making the rules are getting the most money so that’s why
there’s no rules that’s why you have a CEO of the Memorial Sloan Kettering like
you know how huge that is like that is like one of the top cancer doctors
cancer hospitals in the world this is one of the top cancer researchers of the
last decade they’re all just corrupt it’s like that
is not the problem that is not the way to do it so the thing is that there’s
actually a fairly easy solution right unfortunately this is very no fun so the
solution is really about any doctor or researcher who teaches at a medical
school or university you really just shouldn’t be getting all of this money
you shouldn’t be getting any of it and it might sound really bad but you’re
actually just following the same rules that you would apply to a kindergarten
teacher or a policeman or a judge or somebody who worked at the DMV right if
you work at the DMV and somebody gave them 50 bucks or something
they get fired if you gave you know your New York City policeman a cup of
lemonade on a hot day he could get fired you’re not allowed to do that they’re
not allowed to take stuff they’re not allowed to take gifts like teachers are
not allowed to take a couple hundred bucks from a parent like everybody would
be up in arms but yet when you give a couple hundred thousand bucks to these
these doctors hey it’s okay it’s okay so way it works right and as a
medical student you actually think it’s okay because everybody around you is
doing it and all of your mentors are doing it the people you look up to the
people you try to emulate they’re the ones going on that trip to Hawaii and
you go okay I want to grow up and be just like that I’m gonna take drug money
and go to Hawaii because that’s what doctors do and it shouldn’t be there
should be clear rules on that and universities can do that organizations
that published guidelines should not have any financial conflicts of interest
and every committee member who writes a guideline should not have financial
conflicts of interest and editors of journals should not have conflicts of
interest like these are not like you know then really not that much to ask
they’re really just trying to follow the rules of everybody else and this is how
we get into the mess because what happens of course is that if everything
that we believe is been you know so tainted then you can make arguments that
sugar as a health food that opioids are good for you and all this stuff but it
harms patients and we always have to remember that at the end of the day this
is not why we became doctors the reason we paint doctors was to help people but
we’re not until we kind of set those same rules as everybody else and it’s
not something that you can just do by yourself which is why I think you know
I’m so grateful to Craig for having me here because this is the whole point of
having something like CrossFit health that can point out to the people who do
make the rules that hey we need to save doctors from themselves because if we
don’t we’re gonna lose all credibility we have for the most part and if you
look at all these articles in the New York Times like we
have to be saved from ourselves we have to apply the same rules that everybody
else applies them to because we have good evidence now that it is harmful
that we are harming people and if we don’t do something about it we’re gonna
we’re gonna have more problems in the future we’re gonna have obesity problems
you know it took forever to get the smoking you know bands and all that
stuff because there are so many doctors that said it was there was no linked to
lung cancer we had so many doctors I said opioids were good for you right and
that’s the real problem that’s it for me thank you

67 thoughts on “Dr. Jason Fung: Financial Conflicts of Interests and the End of Evidence-Based Medicine

  1. HURRAY !! DR. FUNG – long may you reign !!! Thank you!!!
    We need to get industry OUT of universities, science, nutrition and their influence in government. The simple fact is MONEY = CORRUPTION.

  2. Is there any way to find out which doctors accept gifts or money from Big Pharma? Can't just outright ASK your doctor … won't be your doctor much longer. 🙁

  3. I just heard, the other day, about a doctor lecturing somebody who's on a Keto diet, "Sugar gets a bad rep. Everybody needs some sugar." This was said to someone who's turned his health around, who's now successfully managing a normally-debilitating disease via diet and exercise, and who, well past 40, now looks like a fitness model. But that doc lecturing him on the "goodness of sugar" only knows what he's been taught by the lie machine described in this video. Dr. Fung is a hero. Thanks, CrossFit,! I just subscribed.

  4. Is there a video link of the Canadian female doctor, who was introduced at a medical conference (on cancer I believe) and proceeded to out the doctors in attendance who hadn't divulged their ties to the pharmaceutical industry?

  5. Hi, my family were pharmacists when people owned their own "drug store".. I am sad that there is nothing I can do to make the world improve. I was born on withdrawal from tranquilizers prescribed to my mother and feel strongly about preventing biased prescription writing. I am thankful that my Mom kicked the habit once I became about 4 years old, but am still saddened by the time we lost bonding while writing prescriptions for tranquilizers was the trend… Sugar killed my husband of 26 years, and is trying now to kill every one I know.

  6. On top there are religious beliefs like the anti-meat 7th-day Adventists in nutrition science. They are 40% of all professionals in the sector in the USA.

  7. “You don’t want the alcohol industry writing a paper to see if drinking alcohol is good for you.” Well of course… but now substitute va((ines for alcohol and gross conflicts of interest become totally kosher. And yet, nobody is proposing mandating consumption of “healthy” amounts of alcohol in order to access the services you pay taxes to fund.

  8. Eustace Mullins exposed the corruption of the medical community in his book, Death by Injection. The J. D. Rockefeller set the whole corrupt system up on the medical (A.M.A.) and pharmaceutical side.

  9. Dr's have Always been part of the Problem. The UK has Industrialised and systematised the whole process to effectively Farm the UK population in their National Health System, more euphemistically know as the National Harvest System. It's grotesque.

  10. We need to clone this man……more importantly we need to give his colossal support and share the shit out of this talk….as a consumers of medicine we need to know

  11. Many have been promoting truths for a long and being pushed down by mainstream medicine.
    The more obvious and common sense it is, the more 'medics' hate it.
    This is not just about making money from pharma, sick people are exploitable people and potential pharma customers.
    Pharma companies hate healthy people as much as broadcasting companies hate people that don't watch TV.

  12. Another good vid you guys might find interesting.

    The million-dollar drug that patients can't access | In-Depth CBC

  13. Dr Jason Fung is a man of HUGE integrity. There's no doubt Big Pharma would've tried to buy him out but no … he cares more about humanity than dollars! God bless his parents for bringing him up to know what's right and wrong and to have the courage to speak out. Truth is truth! Share this on social media. People need to have their blinkers removed!

  14. "if you thought that the universities are free of it, it's like the worst place in the world. The Universities are the most corrupted places in the world. You thought that people taught at prestigeous institutions for the good of mankind. That might have been why they went their in the first place, but they stayed for the money."

  15. Excellent talk, no surprise corruption in the medical system is so endemic. Pharma has complete control of the medical establishment including all regulatory bodies and medical charities. A process that started over 100 years ago with the Rockefeller (oil/pharma) takeover of the medical system. In the new medical monopoly, only doctors who prescribed petrochemical drugs would retain the title M.D. Doctors who continued to prescribe natural remedies were branded quacks and ostracised. Now 99.99% of the public and health professionals have no idea this ever happened.

  16. Dr. Fang is absolutely correct, in Sacramento
    CA, I was diagnosed with a work related injury my pulmonary physicians was meeting with AT&T/Broadspire and later Sedgwick, these same physicians are listed on Dollars for Doc's! They aren't just for sale to dole out drugs they're for sale to withhold diagnosis to prevent collection of benefits. I even had a Certificate of Disability that stated I had a work related injury they paid for a little while sent me to their Workmen's Compensation Doctor Roger G Nacouzzi whom stated he did'nt even believe I had Asthma (In CA, work related Asthma is an automatic win). The corruption goes all the way to the top including the judges whom choose to ignore evidence in their face. The attorney was caught committing perjury judge ignored it granted me LTD and told me I should be glad with that. I look forward to the day when we no longer will need physicians. Isaiah 35:5,6 & Revelation 21:4 NWT (New World Translation) But feel free to look up in the Bible your comfortable with the promises are the same. My story began 2004 Nov, still dealing with issues with Sedgwick LTD,AON and AT&T. Companies shouldn't be allowed to dispute Certificate of Disabilities the only reason I see this being allowed is they know they are sending us to court knowing it's going to end in their favor.

  17. Speaking the truth is a dangerous move in the pharmaceutical world, so hopefully he will be able to continue for a long time. Very inspirational. Thank you Dr. Fung for your courage. God bless and protect you and your family.

  18. You are so right Dr. Fung. I went through 2 rheumatologists who laughed at my trying to treat RA with diet. I knew that my pain lessened with low carb and even moreso without eating. I looked it up and both of them took money for talks which I suspect was just the tip of the iceberg. Thank you for what all that you do.

  19. I Can almost hear you arguing with yourself “should I do this video? Why look for trouble” thank you thank you thank you, integrity, congruence and guts !

  20. Senator/traitor Richard pan (dick pan) in California took almost 100,000 in pharma donations before mandating vaccines and removing personal and religious exemptions and placing government oversight to bully Any doctors who provide medical exemptions. Many doctors were investigated simply for lack of follow up visits.

  21. Dr. I am Bob Martin a Vaccine injured survivor. I had the H1N1 Flu Vaccine in 2010 see my site: ramgbs.wordpress.com. https://petitions.ourcommons.ca/en/Petition/Details?Petition=e-2072 We, all Canadians need your support. Please share and VOTE after nov12th 2019.

  22. I cringe to think how Dr. Fung faces his fellow doctors after exposing them for conflict of interest. He must have nerves of steel.

  23. In the height period of statines I by coincidence saw famous local heartchirurging in the shop with his chariot really piled up with BUTTER. A pile of butter I never seen in a chariot. I was only young then but they was for me the EUREKA moment!!!! Prescribed tons of statines to his patients but apparantly feeding himself and his family with the good stuff!!!

  24. Cheating with date and real battle between researchers and even a fight about publishing ( ego and money profitable…

  25. A big fault in Keto! If insulin stops fat burning & enhance storage… Switching to Keto will not burn fat because of Insulin!

    My proof is me. my poo is great. no eat any milk products have Betacar-15 to help Eyes & stop eating oil to poo. Yet I have not loss any weight!

    Thank you

    Sgt. E. Dickey

  26. He had to resign….. that’s it, that’s all that happens to these people. Eye for an eye needs to be brought back. Of course these spineless twits take the cash. It’s like a cop being put on administrative leave with pay.

  27. You should have dedicated a segment of your lecture to the doctors that are getting paid to promote crossfit contrary to common sense.

  28. I was told I would die if I didn't take Metformin and Insulin… then I read The Diabetes Code by Dr. Fung. I no longer take any medications and my diabetes is history. My success is all due to a low carb diet and intermittent fasting. Thank you Dr. Fung for saving my life! God Bless you.

  29. OMG!!!CNN,MSNBC, BBC and the rest of the dishonest liars in the mainstream media colluding with greedy pharma, doctors who have money interests in drugging us. Dr. Fung, I'll pray for you. But I believe you should buy a gun and be very careful.

  30. I have watched this video several times and each time it reinforces my decision to stop taking statins, and to look questioningly at everything Big Pharma says. I never used to be that way. I totally embraced medical science (and thus Big Pharma) because in 1900 the life expectancy was 49 years, but in 2000 it was about 75 years. Then I think about probably the two biggest drugs to save lives – insulin for Type 1 diabetes, and penecillin for bacterial infections – and realize the discoverers of these two drugs received no royalties or big payouts for their discoveries, and made no patents. Probably the only two drugs that had no conflicts of interest. I wish I could meet Dr. Fung and shake his hand 🙂

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