Wikipedia:Pharmanoia

Pharmanoia is a term coined by science writer Jon Cohen in a 2006 article written for Slate that describes an extreme distrust of pharmaceutical companies, the drugs they produce and the research used to produce them. For Wikipedia, pharmanoia is the belief that pharmaceutical companies represent an all-powerful, profit-oriented entity that either directly controls, or works with government regulatory agencies to the detriment of the general consumer. Pharmanoia is generally expressed in the idea that Big Pharma^TM is either actively suppressing a variety of cheap, effective cures for nearly all diseases, or is actively working to suppress research on such cures. The motivation ascribed is usually that Big Pharma^TM wishes to keep people sick with chronic conditions in order to keep selling drugs, or that expensive drugs are much more profitable than the alternative, presumably equally safe and effective natural cures that exist. Generally pharmanoia occurs when an editor attempts to use conflict of interest and other spurious objections to justify removing a reference, eliminate criticisms or otherwise promote the idea that alternative medicine has more to offer the world than medicine.

Most Americans love a good conspiracy theory that neatly explains all suffering as caused by a monolithic, faceless block rather than the fact that reality is complicated and not easily amendable to the understanding of Joe Plumber and John Q. Public. There is a strong trend of antiscience in the modern world, which features beliefs like:

1. science is just another way of knowing that is no better than (say) the revealed truth of religion or the inherited wisdom of ancestors.
2. science creates more problems than it solves
3. science can be wrong at times, or produces findings which are contradictory, which invalidates the entire process
4. scientists disagree, therefore there is no "truth" in the process
5. the products and processes of science are too complicated to have any impact on the lives of average citizens

Some of the claims, versus some of the reality

Claim

Big Pharma^TM just wants to maximize its profits at the expense of the general consumer.

Reality

True. Like all companies, pharmaceutical companies wish to make a profit. Often the competitors of Big Pharma^TM, individuals and companies selling "natural" "cures", vitamins and unproven medical treatments, are the ones making this claim. This is usually to discredit the products Big Pharma^TM, who are their primary competitors, and they are usually trying to sell you something (making this a bit hypocritical). The difference is, the pharmaceutical companies' products are regulated by various agencies who mandate their products meet specific risk-to-benefit ratios, have clearly demonstrated effectiveness and adhere to strict manufacturing standards with exacting purity and dose requirements. The claims made by "vitamin sellers" are often unsubstantiated, wildly exaggerated or flatly contradicted by existing research. This claim and criticism also contains the unspoken assumption that if Big Pharma^TM wants to make a profit, that makes them evil and further - that means the "natural" "cures" work. This is a fallacy, specifically a false dilemma (and maybe a bit of ad hominem). Vitamins, herbs and the like either work, or do not - whether Big Pharma^TM makes a profit or not is irrelevant. In fact, vitamin and herb sellers often have to make claims like this because they lack any evidence their products actually work and have to resort to cheap rhetorical tricks instead of the proof required for real medicine.

Claim

The FDA and other government agencies are in the pockets of drug companies, who use their powers to suppress the effective treatments of kind, gentle naturopaths, chiropractors and acupunctuists.

Reality

There is a transfer of personnel between upper registers of the FDA and pharmaceutical companies. Of course, given these people are highly trained in both managing people and knowledgable about the products being sold it's hardly surprising to see both drawing from similar pools of expertise; where is industry and government supposed to draw experts from except those who have worked in industry, government and academia? Still somewhat worrisome, and let's not pretend the researchers and process is perfect - there are certainly reasons for concern. Of course, the fact that this transfer exists doesn't mean the treatments of naturopaths, chiropractors and acupuncturists are kind, gentle, safe, or most importantly, effective. Again, the claim is made to distract from the fact that these other groups can't actually demonstrate what they are doing actually works.

Claim

Natural cures are safer and equally, if not more effective, than the medications sold by pharmaceutical companies

Reality

Most natural cures have no proof that they are effective, nor is there much awareness of their safety profiles. Further, many are based on concepts that wildly contradict the current scientific consensus in biology, chemistry, and physics. When tested, many of these claims end up being either no better than placebo, or actively, wildly harmful. Drugs do often present risks, great and small. Still, despite flaws and in some cases considerable risks, most pharmacological treatments offer known, demonstrated benefits that can be measured and have an evidence basis to support their use with specific symptoms and conditions; the risks exist because they have an active effect on the metabolism. Chiropractic, naturopathic, homeopathic, traditional and herbal interventions may be kind and gentle, but may offer unknown or unacknowledged risks, uncertain benefits, unwarranted costs and nonspecific effects with no accompanying disease- or symptom-modifying effects. Further, many complementary and alternative medicine (CAM) practitioners actively resist research into the efficacy of their interventions, preferring to rely on their personal interpretations and impressions rather than the cold, harsh reality of a controlled trial. Before modern medicine and its drugs, humanity had access to these "natural" cures for centuries, and in that time, human lifespans were about half of what they had to day. In the 1960s, for example, cancer was a virtual death sentence, yet today, with modern phameceutia, survival rates are increasing. [1]

Claim

Employees at Big Pharma will do anything to see the stockholders profits' increased, even if it means letting themselves and their family members suffer and die from horrible diseases for which "secret" cures have been discovered and suppressed.

Reality

The millions of people working for Big Pharma companies are normal humans that would like everyone to be healthy. Furthermore, producing a wonder cure for a disease usually increases profits dramatically, and makes the individuals involved famous. Given a choice between being healthy, wealthy, and famous, or being dead, pharmaceutical employees are likely to choose health, wealth and fame over death. They would probably prefer their spouses, children, parents and friends don't die an agonizing death as cancer chews its way through their bodies.

Claim

Alternative medicine can't afford to do proper clinical trials.

Reality

The herbal supplements industry sold almost US $5 billion in products in 2008. Placebo-controlled randomized clinical trials can be performed for relatively small sums of money. Additionally, several government agencies, including the U.S. National Center for Complementary and Alternative Medicine (NCCAM), have undertaken such trials entirely at taxpayer expense. Alternative medicine doesn't want to do clinical trials because a) they don't have to - they can already sell their nostrums and b) when they've done clinical trials in the past, their treatments are generally found ineffective. Yet the FDA continues to let them be sold. Please write to your congressperson.

Claim

Scientists and doctors are biased against CAM and resent its intrusion into the medical arena

Reality

Scientists embrace all interventions that are effective, even incrementally (as many non-surgical and non-pharmacological treatments are). The most important part of research is the ability to deliver predictable, reproduceable results that can be used to reduce morbidity, mortality and suffering. What scientists do resent is the intrusion of politics into their research, such as the actions of Senator Tom Harkin (who was primarily responsible for the creation of the NCCAM), who complained that the NCCAM had failed to validate enough alternative therapies and treatments. This misses the point that the purpose of science is to test interventions, not prove certain favoured interventions to be true. By mandating and forcing funding of interventions that are not expected to be fruitful (because they are based purely on anecdote, they violate the laws of physics, they are wildly improbable or they have already been discredited), both the time and funding of scientists is wasted, and the free development of ideas is also interrupted. Forcing certain interventions to be researched also gives a veneer of respectability on these same improbable treatments, which unethical or even merely uncaring practitioners can leverage to promote their treatments - at the expense of their patients' health, wealth, hope and time.

Further reading

• Goldacre, B (2009). Bad Science. HarperCollins Publishers Limited. ISBN 000728487X.
• Ernst, E (2008). Trick Or Treatment: The Undeniable Facts about Alternative Medicine. W. W. Norton & Company. ISBN 0393066614. {{cite book}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)

External links

• Sciencebasedmedicine.org, a group blog written by doctors and researchers
• badscience.net, website of Ben Goldacre
• Respectful Insolence, skeptical and critical website written by a surgeon, published on ScienceBlogs