The Conspiracy Theories Surrounding Big Pharma: Part 2

**Discussion begins at 7:30**

Have you ever taken a pill before?  Have you ever received a prescription?  Did you think to yourself, 'is this diluted with water'?  Did you think to yourself, 'what truly is behind the theory behind this medicine'?  Today we are talking about all of the conspiracy theories surrounding Big Pharma…  People have long alleged that that pharmaceutical companies suppress cures for diseases to maintain a steady revenue from ongoing treatments. In fact, there is a belief that big pharma is actively working to suppress alternative treatments that could compete with pharmaceutical products.  Further conspiracy theories include assertions that data from drug trials are manipulated to ensure FDA approval and market success, that the government colludes to enforce regulations that favor their interests, and that big pharma influences doctors through kickbacks and promotions, which could lead to biased prescribing practices.  Today we’re going to have our resident PharmD breakdown these and other conspiracy theories.

Transcript

Hey, guys.

Hey, guys.

What's up?

Welcome back.

Hello.

We're back with our favorite veteran, our favorite.

Andrew.

You've heard him before.

Now, hear him now.

Yeah, hear him again.

Thanks for having me back.

Thank you.

Well, we were so educated in the last episode.

I found that was a really interesting episode.

Yeah, it was awesome.

I just got back from a road trip, and I just wanted to comment.

You saw so many things for me, guys.

But the big one, I stumbled upon the new Plum Island.

As we discussed in the episode, Plum Island episode, it got relocated to Kansas, Manhattan, Kansas on the Kansas State University campus.

And you went there.

And I pulled up, and there was so much security, and they were like out of their booths, waving at us to turn around.

It was a little bit-

What are they protecting?

Well, I will say there's less cattle than I thought.

There's a lot of cattle in Kansas, but the area around Kansas State University, at least that I saw, was mostly agricultural farmland.

But yeah, it was definitely very secure.

Is there a biodome situation to contain the insects?

Isn't it insects that really screwed us?

It's right next to an insect farm that I think they do studies on.

It was making me uncomfortable.

They better not be investigating ladybugs.

Those are my favorite bugs.

They're also pretty benign, right?

Ladybugs.

Also, but don't they come inside and they'll ruin your curtains and stuff?

Isn't that a thing?

They do poop on stuff.

Yeah.

But they eat the mites on plants.

If you're having plant problems, if you get a bunch of ladybugs, they eat the bugs that are killing your plant.

Regardless, what else did you see, Megan?

You saw things for me.

I saw the world's largest ball of twine.

The largest ball of twine, guys.

I went to the center of America.

Actual center.

The actual center of America.

What does that mean?

Like, equidistant from the...

Yeah.

So actually, full disclosure, there's two.

So the one I went to is like the actual center, coast to coast in Kansas.

And then I think it's like a hundred miles south is like the, they call it something else, like the geodetic center.

And that's like when you account for the curvature of the earth and everything.

So there's really two of them.

But you went to one of them.

I went to one of them.

That's that's an account.

I went to the Christmas Story House.

Yeah.

I tried to see the world's largest pair of underwear, but it had been relocated from Bowling Green to St.

Louis.

So how many states are you have you now gone to, Megan?

Forty five away, guys.

And they're all together.

So we're going on a road trip, right?

Yeah.

I have a question for you guys.

Yeah.

What state is the only state that does not have any straight borders?

Hold on.

Let me think this through.

I'm so happy you asked.

Hold on.

No straight.

It's Missouri.

Yeah.

It has zero straight borders.

I would say Delaware.

I was thinking Delaware.

Missouri.

Michigan.

Hawaii.

Whoa.

Oh.

But it is kind of crazy.

It doesn't even have borders, really.

But if you look at a map, it is wild that 49 states have at least one straight edge, right?

Of course, an island doesn't have.

That shouldn't even count.

Yeah, that doesn't count.

Fake news.

So is it time for our drink check?

Drink check.

Today, we're all drinking something different.

Today, we've raided Andrew's kitchen.

Kitchen.

Yeah, he fed us with chicken.

We were really excited about.

We found.

Yeah, we were.

It was rotisserie.

It was Costco rotisserie, which is like five bucks.

Even better.

Yeah.

And he had this really good buffalo sauce that we put on that.

It was really yummy.

They always have a well-stocked kitchen.

Yeah.

Yeah.

And he had.

So listen, I went to Lone Pine a couple of years ago in Maine, the brewery, and it was really good.

And they have the best liquor store less than a mile away that sells Lone Pine.

And I always stock up here.

Andrew took care of me.

He's got me a pumpkin par-

I might have had pumpkin party last year on this episode, but pumpkin party, pumpkin ale.

So cheers.

Thank you.

Cheers.

Andrew, what are you drinking over there?

I have a Lazy River Pills from New Trail Brewing, which is out of Williamsport, Pennsylvania.

They're like really, really popular around here for some reason.

Just a new thing that showed up and now it's everywhere.

Oh, neat.

You know what that reminds me of?

Summer camp.

Oh, we've got it.

Yeah.

Like summer camp in the early 2000s.

Yeah, Lazy River.

Their shtick is like craft versions of easy drinking American beers, like Bud Light in the mix and stuff like that.

Oh, I like that.

New Trail.

I'm drinking a soda that we all believe is from the Midwest.

It's very delightful.

It's called Verner's.

It's like a ginger vanilla soda.

It's really good.

He's got like a little viking on it.

Yeah.

Is that a viking?

Oh, it's a leprechaun.

I don't know.

The beard threw me.

It's good.

I'm drinking chicken wine.

Not to be confused with.

I also call it the chicken wine.

It's like La Vie Farme.

Yeah, I don't know.

I don't know what to say, but I always say that to him.

I'm always like the chicken, the one with the chicken on it.

It's a box with chicken on it.

A chicken box wine.

No, you can get it in a bottle for like six bucks.

It's good.

Smooth.

White wine.

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Have you ever taken a pill before?

Have you ever received a prescription?

Did you think to yourself, is this diluted with water?

Did you think to yourself, what truly is behind the theory behind this medicine?

We're talking about all of the conspiracy theories surrounding Big Pharma.

Big Pharma!

People have long alleged that the pharmaceutical company suppress cures for diseases to maintain a steady revenue from ongoing treatments.

In fact, there's a belief that Big Pharma is actively working to suppress alternative treatments that could compete with pharmaceutical products.

Further conspiracy theories include assertions that data from drug trials are manipulated to ensure FDA approval and market success, that the government colludes to enforce regulations that favor their interests, and that Big Pharma influences doctors through kickbacks and promotions, which could lead to biased prescribing practices.

Today, we're going to have our resident PharmD break down these and other conspiracy theories.

Oh, bum bum bum.

You guys want to...

I think the homeopathic thing is good.

It's fairly lengthy.

Okay, you want to come back for...

You want to do your other stuff and then we'll do a...

Do a third one on homeopathic.

Yeah.

That's truly a conspiracy.

Yeah.

The water.

It's like, it's a big mess and it's very silly and you guys are going to be appalled.

Yeah.

Oh, okay.

Yeah.

So we're going to break down some of the conspiracy type theories around who controls the medicine, where's the money in medicine.

Is somebody making me do this because they're getting a kickback and talk through some of that stuff, but hopefully make you feel, by the end of it, a little bit better about your care team and your medicines.

All right.

Take it away.

Yeah.

So on about the FDA and how I guess there's a concern that they're in on the scheme to separate you from your money and that they're not taking, that health is a secondary priority.

I just want to kind of break down some of the processes on how drugs get through, maybe tell you some interesting tales about how some recent things with drugs have gone wrong and gone right and let you kind of hear how the inner workings go so that you can kind of see there's not as much conspiracy, room for conspiracy as you might think.

For example, in order for a drug to get to market, okay, we kind of talked about the legal landscape, and they have to do all this to prove that it is what it is and that it's safe and that it's effective.

And so throughout this, what happens is the manufacturer of the drug sends the materials to the FDA, and the FDA employs committees of folks with specific specialties.

So they gather groups of supposed experts or interested parties and generally, they also have laypersons on these committees as sort of an interested party, right?

So to kind of represent the people who aren't-

Yeah, exactly.

And so they let them sit on these committees, and then the drug company sends a huge packet of information about their drug, what it is, what it does, how it worked, what the studies are, and this gets diffused out to the entire committee.

Then they all have a certain amount of time to review it and get back.

And so while these people are paid by the FDA to do this, it's certainly not enough to be their full salary.

It's basically volunteer work, community service, with basically lunch money attached to it.

But what this does is it gives perspective from real users, allows the drug company to have a dialogue, but gives some very precise oversight into the approval.

And so drugs don't just come to market because Bayer paid their fees and they can now market aspirin to anybody.

Yeah, so there's a committee of people and it's sort of spread out.

However, this isn't a flawless process.

So we talked a little bit about thalidomide, what happened there, but that was before there was regulation requiring that things were-

The baby one?

Yeah, where the flipper babies were the result of a drug not having been tested appropriately in the right populations to say it was safe.

Being used to treat pregnant women's nausea, but not tested on pregnant women.

But isn't that like a big, like aren't pregnant, aren't women of childbearing age left out a lot in these studies because of their risk of being pregnant?

Yes.

Yeah.

Yeah, that's the pro-

and then that's-

It makes sense why it would be a harder population to study, but it just is interesting that they would market this as a morning sickness medic-

like I feel like that makes sense in general, but like, yeah, market as a nausea medication.

I wouldn't mark it as like a morning sickness medication that hasn't been tested on pregnant women.

Yeah, it seems crazy now because we're kind of used to that.

But before there was no rules so that it did work for that and it was very effective, but it also very much harmed the fetus.

So that was definitely a good example of getting it wrong, but that helped us establish what is now the regulatory environment that protects us.

But even still, some drugs have gotten through that have caused problems.

And these are the ones that you hear about, like the lawyers are putting on the daytime TVs, ads saying, if you were harmed by this drug, we'll help you sue.

So one good example is a medication called Vioxx, which is a very potent anti-inflammatory drug in the same family as ibuprofen.

Cox-2 inhibitors.

There you go.

Yeah.

Cox-2, no pain, as they used to say.

Two cox, no pain.

Oh, dear.

So anyway, Vioxx is a very potent anti-inflammatory, works great for aches and pains, arthritis marketed for that.

But after it was approved, widely sold and used because of its great efficacy on arthritis pain, it was found that the patients were having heart attacks and strokes at an extremely high rate compared to non-users.

And so Vioxx and one other drug in the class were both pulled from the market by FDA rule because the fact that they were eventually found to be more harmful than good in the general population.

So the only one that's left, I think, is Celebrex.

Celebrex, right.

And when you compare, so if we want to nerd out for a second, when you compare Celebrex to Vioxx, Vioxx has a specificity for Cox too, somewhere in the order of like 20,000 to 1, and Celebrex is like 2,000.

Oh, okay.

Interesting.

And so it's a scale that's not really comparable, even though we consider Celebrex to be in that class.

Yeah.

Somewhere between 2,000 and 20,000 is the line at which it causes more problems cardiovascularly than it does helpful, than it is helpful.

So, but Celebrex has been studied extensively because of this, in that regard, and looked at over and over and over again, and we truly believe that it's okay.

So I don't want to leave that lingering in anybody's mind that that's unsafe.

And so, with that, obviously we see that the process of proving things in the scientific way, sending them through the FDA committees, getting all the scrutiny is good and important and helpful, but it's not without risk of getting it wrong.

Well, also, like, yeah, exactly.

You can try and replicate, right, what a drug is going to do in the greater population, but there's only so much you can regulate, and there's only so much that you can actually do with controlled studies, you know, rather than when it actually does get into the greater population.

And then you do have a bigger pool to study, like, what are the side, what are the bigger side effects and things like that, that you won't be able to do in a study.

Yeah, exactly.

And so the FDA has this built in, actually.

There are considered to be four phases of drug approval studies.

So phase one is like, does it do anything in a test tube?

Does it do anything to people?

And then there's phase two, phase three, they get broader and broader.

And then phase four is actually called post-marketing analysis.

So you approved phase four is now a requirement in that drug companies have to continue to monitor, at least passively monitor what's going on with their drug.

And so, for example, if you have a bad outcome with a drug and you call the drug company, the drug company is obligated by law to report this all the way to the FDA.

And the FDA collates all of these reports.

And that's how they build a database that says, well, we got 7,000 calls last year about Vioxx causing a heart, you know, with heart attacks.

And maybe we should look into this, right?

So maybe we should do something.

And so, you know, there's mechanisms, but you're right.

It's not until you get, sometimes the side effects are so rare that until you give it to 100,000 patients in a real world market, at post-marketing event, you're not going to see the three cases of something really terrible happening.

Right.

Because it's like releasing it to the public is kind of a study in and of itself.

Yeah.

Well, at least it should be, right?

You should be held accountable to make sure that it does what you said it was going to do.

Yeah.

And that's part of it now.

So, I mean, I guess all these people who are arguing, all these people who are arguing that, yeah, Big Pharma is trying to keep everyone sick, why they wouldn't release the information, they wouldn't pull the drug, right?

Because wouldn't it make them, they'd be like, oh, we've got heart attacks, it's the money maker, you know, right?

It could be.

So that in and of itself.

So you're disproving these people's theories.

Yeah.

Yeah.

And there's a couple of...

There's more, like the FDA, it's also like this whole regulation, like, no, it's like, it's not just pharmacy that they're like, the FDA regulates, right?

It's like the food and drug administration.

So like all the things that are in our food right now, what is linked to the chronic diseases and why are we still...

Why is glycosate...

It's not...

It is illegal in Europe to have glycosate in their food, but it's still being processed in our food.

Or if you take like Heinz ketchup and you like look from America or you look at the ingredients in America and you look at the ingredients in the UK, it's completely different.

Because all of that stuff is in the food, it creates a chronic illness which then creates more people down the line using, so more consumerism from the cholesterol, like I'm just saying hyperlipidemia, hypertension, that sort of thing, diabetes.

So that's, that is, I think that's more like, why is there, from a food standpoint, people are getting sicker.

Yeah, people are getting sicker.

And why is that happening?

And is it happening because big pharma still needs their money?

It's not just so much like, oh, they have the cure to cancer because that would be profitable or, you know, the HIV drugs are profitable and they've done a great job helping with the, you know, mortality.

On detectable levels of the virus.

Yeah, yeah, exactly.

But like that's, I think that's more of the like, nice shift and focus towards FD, at least on my social media.

So the level of villainous, the villainy that you are describing in collusion that is possible within the people who are making our food, making us sick, and pharma being in on it, it is, I think giving people too much credit.

I think it's much more simply a matter of doing things cheap and fast, causes corners to be cut, causes things to be added to food to make it cheaper and faster.

And that capitalism, the pure, the unfettered, unethically bound pursuit of making as much money as possible, is driving all of it in the sense that they don't care about the downstream.

The person who put the glyphosate in the food doesn't care about the downstream effects of it, because their shareholders, their profit margins are based on how much of that profit gets eaten by a wasp or whatever before it gets to market.

And beyond that, they've sold it.

Their hands are, they're done.

And I think it's just a matter of those compartmentalized business decisions being the priority as opposed to caring about people's health and wellness and food supply as a holistic experience.

I guess the question is, why is it regulated?

I think you just go back to like, why is it regulated in Europe?

And it's not just food, it's the beauty products, it's our makeup, it's our perfumes, it's everything.

Yeah, well.

Why is it regulated in Europe?

And then why is it not regulated in the United States?

And how much is that related to follow the money?

Yeah, I totally agree that regulations, they always add expense.

Yeah.

And so if you're a company who is selling wheat that's covered in glyphosate, right?

To keep the weeds down or whatever it is.

Yeah.

Whatever it does.

It's a weed killer.

Weed killer.

What's it called?

People used to use it all the time.

They spray it.

Roundup?

Roundup.

Roundup.

Roundup.

Yeah, yeah.

So roundup.

It causes cancer.

It's like legit proven to cause cancer.

Yeah.

So let's say a company is faced with a regulation that would cause them, you know, a billion dollars to fix.

Right.

If the regulation was enacted that they couldn't do what they're doing anymore.

And in order to return to their production levels that they currently are, it's going to be a billion dollar difference.

Yeah.

It is to their advantage to spend 500 million dollars on lobbying.

Yeah.

To prevent the regulation from being changed.

It's cheaper for them to go that way.

It's cheaper for them to lobby.

Yeah.

And so when you follow the money, that's what you find out, is that these companies are making the decision that they can spend their money and prevent regulation so that they can prevent improving things.

Right.

But really, it's not even that.

It's not that sinister.

It's just that it's a billion dollars to not lobby or 500 million to lobby.

Right?

And it's that black and white.

And unfortunately, while if we were running our household, we would make the decision that makes us healthier and happier.

But when you're running a business that's solely based on getting the most money, then the answer is obvious on the scale that it is.

We're not going to take the net deficit.

We're going to go.

Yeah.

Unfortunately, it's just a business.

And health care is a secondary outcome.

Right.

Healthiness as a general goal is a secondary thought, which is sad to think about.

It's frustrating.

But there are a couple of cases, though, where drug companies have kind of realized that their drug doesn't work and have pulled it from the market somewhat compulsory from the FDA, but ultimately it's considered a voluntary move by both companies.

But a drug called Zygres.

Yeah, Zygres.

This one.

It was used to treat sepsis, and it had a very narrow criteria that it might help these certain people who were dying.

People who are going to die anyway.

Who were dying from sepsis.

What was Zygres?

Vitamin C?

That was before that.

Activating protein C.

This was before the Richmond study.

Yeah, yeah.

Not the vitamin C.

But something called activated protein C, one of the complement whatever.

Warfarin.

Doesn't warfarin?

Yes, it does.

Seegate that.

Yeah.

Look at you with your pharmaceutical knowledge.

Just like fortified or something.

Yeah.

So anyway, the company continued, it was continued to be studied in the post-marketing phase 4.

Turns out that there was no efficacy.

And so patients didn't get better, didn't survive longer from sepsis.

And the company just decided to stop making it and stop selling it.

And then more recently, a drug called Ryluzole, I believe it's called for ALS, a Lou Gehrig's disease.

But that was on TikTok.

It was a drink, right?

Like it was a powder.

Maybe.

Yeah.

Well, there's a girl who's very outspoken about it.

Because she has ALS in it.

She thought it was decreasing the speed of her symptoms.

It's a desperate situation.

ALS is just one of the most awful things that you can ever imagine happening.

You put yourself taking it.

Yeah, it was like a lot of pills and powder or whatever.

And it turns out that it didn't seem to make a difference.

In the broad population.

So again, the company made the conscious decision to say that in the absence of benefit, there's only risk.

And so we're not going to sell this thing anymore.

There are, there is evidence that ethics and healthiness does come into factor at times, right?

And there are checks and balances in the system that can kind of protect you somewhat.

But it's definitely easy to believe that people are actively choosing to make people sick, to make more money.

So I think, well, yeah, I think it and it's easy.

I think it's like more spotlight has been put on this when, I mean, I guess in the recent years, right, like the post COVID era that we're living in, the spotlight is heavier on this, I think, because COVID was so for whatever reason, it became this like really controversial area.

Like either you believed COVID was real or like it was a government conspiracy.

And then like in the post COVID era, people are less likely to believe medicine and believe the media or believe the FDA or that people are doing it.

They're trying to do what's best for the greater public because there's this all this, this, you know, dissension between, I don't know, the population and, you know, what happened during COVID.

There was a lot.

Yeah, there was a lack of trust.

Yeah, exactly.

And I'm not saying that lobbyists are just giving Congress money to make a decision that favors them.

There's certainly, it's a savvy business where people go in and they have these very artful discussions.

They can't possibly be all bad.

Yeah.

And so, you know, you can spin it that if you pass this regulation, then the food supply is going to drop by 25% for the next five years while we, we spend the billion dollars that we need to spend to fix it.

Right.

And you're like, well, I can't let the food supply drop.

I got to vote against this.

And then, you know, but ultimately the outcome is, is that regulation doesn't happen and glyphosate continues.

Right.

But it's a troubling pattern for sure.

If I tell you that you can try cinnamon for your diabetes and your foot falls off, then now I'm in trouble because cinnamon wasn't the only answer.

But even now, you go to the doctor, you're not on any medications, your A1C is borderline.

They don't prescribe diabetes medication when your A1C is borderline.

They give you counseling to be like, go home, maybe cut down on your carbs, maybe exercise a little bit more.

Doctors are also not being told, push these drugs, push these drugs.

It's also, again, it falls on the patient to have some sort of responsibility for their health.

But then the patient then goes back, says, oh, maybe they've changed their habits for a week, and then they go back to what it is.

They go back, their A1C is still borderline, and their doctor's like, okay, let's start you on the stride.

Yeah, and the doctor's assessment is, we tried that.

Yeah, exactly.

I learned how the patient actually did anything different, behavioral.

Exactly.

A lot of doctors in primary care specifically that are prescribed first.

Like, I've turned down meds, and be like, I don't think I need that right now.

Oh no, I don't need that right now.

Like, I feel like they're too quick to prescribe things.

Yeah, for sure.

It might be also coming back to the legal side of things.

Are they afraid they're gonna be sued?

Yeah, exactly.

I would say from your health care providers here, from your friendly neighborhood pharmacists, don't come for us, right?

The system, the system is the issue.

And yeah, it is a system issue, but I like the take that Andrew says about like, well, I think it's part of like, you know, you got to speak up, you got to ask questions, you got to be your own advocate.

You got to take some accountability.

You got to take some accountability, but also like know that your health care team is actually like working, trying to...

We're on your side.

We're not trying to...

Yeah, we're not trying to like, you know, say, do this or else.

It's like, we're trying to work with you.

And if you approach this as like a team and we're coming together to work as a team towards a unified goal, the goal is everyone wants everyone to be healthy, right?

Yeah.

Like that is a good approach to take.

And that to me is the spirit and the energy that insulates patients from the effects of kickbacks.

So tell us about that, because I was interpreting it as there's like a financial benefit.

I thought it was illegal to take kickbacks.

Yeah.

So there definitely was a system in place for a long time.

The drug companies would do things like if you had X number of prescriptions of our product or the top prescriber of our product in this region would get invited to the conference in Grand Cayman, right?

Is this like when you would go to the doctor and they'd be like, I have a free sample of that?

Yeah.

Yeah.

And so there was definitely some ethical issues with providing somebody a free trip to Grand Cayman.

Oh yeah.

Being the top prescriber of your branded product.

Right.

So like that is-

MLM.

That's troubling.

That's what MLM does too.

Yeah, exactly.

Main or-

And a lot of that-

They learn some of those tricks from the pharmaceutical reps, right?

But there's a lot of things that kind of insulate the patients from that nowadays.

One of them is the fact that ethical training, ethics training is a big part of medical training.

So the Department of Veterans Affairs is the largest.

So this is, in the US., is a large health care system that treats military veterans.

And they are the single largest.

Oh, they're experimented on.

Well, yeah, that's a different, that's a scary rabbit hole we're not going to go into.

But ultimately, they're the biggest provider of graduate medical education, meaning residencies, med school rotations, nurse practitioner program rotations, PA training.

They're the biggest in the world, in the US., and probably in the world, by the fact that the US is just so big.

But a component of onboarding for every one of these people is to do this training that's very clear about accepting financial kickbacks, accepting money for basically any act.

And the other side of that is that anybody that works in the VA, if they were to invent something, actually it becomes a property of the government.

So, it's kind of interesting that, you know, but what it does is it kind of insulates us from some of that.

And make sure that most providers, prescribers have gotten at least trained in ethics.

Not all of them choose to follow it, but at least there's a broad base of very clear training.

And anything over $10 becomes like a reportable event in the government.

No more, you know, free lunches from the drug companies, right?

Yeah, those have dried up a lot.

We still get.

We still get.

It's for education purposes.

As a result, a lot of private practices nowadays, because I've interacted with a lot of drug reps in years of going to conferences and things like that.

And a lot of them really pigeonhole those lunches to like doctor's day.

They come in and they allow the drug rep to come in and give us a free lunch for everyone.

And like, it's not, and really you're just leveraging their budgets, but you're not allowing them to come in every week and give you a refresher on how their drug is the best, etc.

And so they're using some of this and they're doing it less.

And then the other thing is the Sunshine Act.

The Sunshine Act was passed, I think, in 2010s.

But you can go out and on a website, every time that a drug rep interacts with a licensed prescriber, they have to record that person's identifiers, and they report however much whatever it was is worth.

Oh, wow.

And so you can look up your own names and see how much money drug companies have given you.

Is that why there's always a sign-in sheet?

Yeah, that's why there's a sign-in sheet with your license on it.

I like that.

I've seen a lot of sign-in sheets.

Me too.

So you can go out there and you can look up your prescribing, your prescriber teams and see where they sit on the Sunshine website.

Wow, that's cool.

And that's public.

That's public.

You can do it right now for anybody.

And you know how much-

I usually dodge the services.

I worked with a professor at the University of Kentucky who was a pharmacist, but he was in oncology and he would do a lot of speaking for new branded oncology drugs.

And so he would go around and he would be the presenter at these drug dinners and things that still do exist.

Yeah.

But his line was always that he's so conflicted, like conflict of interest standards, because he speaks for everyone, he's so conflicted that he's not conflicted anymore.

Basically by speaking for everyone, he has washed his bias in the sea of money that he receives.

Yeah.

From everyone.

Yeah.

But obviously that's, you know.

He's in everyone's pocket.

You got to take his word for that, right?

But, you know, you can look up this information, you can know about it.

He's in everyone's pocket.

And honestly.

Or he's in no one's pockets, basically.

I only got $15.

I'm only worth $15, but your wife is raking it in here.

Oh, yeah.

Yeah.

So while there are, in theory, something of a kickback, right?

You can get invited to dinners.

It's generally not allowed to be.

Kind of illegal.

It's illegal for it to be tied to prescribing trends or practices anymore.

There's no checks getting sent to them.

Exactly.

So you're going to a dinner that is telling you why Zarelto is.

It's all happening at the table anyway.

And they have a little bit of a marketing spin to it, but that's also heavily regulated.

And then you leave and go about your business, right?

Is that really changing your prescribing?

And is that $15 dinner that they gave you going to make an impact?

But I feel like, I'm going to be honest, if I'm like, do I want to prescribe Eloquis or Zarelto?

I'm not thinking back on the Chick-fil-A I got last week, right?

Exactly.

You're at a research pace.

You're not easily swindled.

Yeah, Megan, it's a purchase window.

Full of the literature.

Is this part of the literature?

When they squashed the thing about getting trips based on how many prescriptions you write, like that, that was a problem.

But the pattern is now of getting a Jimmy John's sandwich kit from once a week, once a month, once a year, is not influencing anyone's prescribing.

Right.

But I think the general vibe is that people are really pushing back on all of this optics-wise.

The prevalence of academic medicines, the Sunshine Act, those people who are having to put on their CV and all these things and say where they're getting their money from, and conflicts of interests.

Documentation is much more prevalent, right?

You're always asked now whenever you publish something or present something to disclose a conflict of interests.

So it's a part of the conversation.

I think there's enough, we'll say, sunshine on it now, that there's really not an environment of a kickback anymore in the sense that it used to be.

And you'll hear people say that, and they were right, they are right that it did happen, but it's really not happening anymore.

And in some ways, all these medical graduates who are coming out have all had this ethical training that we talked about, have all been exposed to this stuff.

Yeah, and it's just a system that's like too big now.

One whistleblower would surely come out if it was a thing, right?

And it's just not, it's been squashed, and we don't live in a world where that's relevant anymore.

I mean, I don't even have any branded materials in the pharmacy anymore.

We used to like, all our pens, all our sticky notes, all our everything was like-

Meds.

Lavaquin branded and all that.

But like, I can't even find, I think we have to pay for all of our pens and paper now.

It's pretty terrible.

In wrapping up some of this discussion, I think what I wanted to do is talk about how, just a few quick tips on how patients can sort of advocate for themselves and their interactions with their clinicians.

And we touched on this before, but maybe some ways you can protect yourself against some of these, what we think might be conspiracies.

And everyone should be asking, why are you giving me this medicine?

Yeah, you're right.

And asking it in a way that is genuine enough to say, are you giving this to me because you believe it's the right medication for my condition?

Or is there some other factor that makes you lean that direction?

And if you're not satisfied with the answer, then keep asking.

Thinking about it enough.

And that's totally fair.

Nobody would fault you for asking those questions.

So that hopefully would uncover a bias or somebody who's saying, well, I heard from a drug rep last week that this is brand new and yada, yada, yada.

And then you can tease out those motivations.

I think I said it before, but ask the question, what do you recommend I do to deal with this condition that I have?

And that should be posed in a way that's broader than medicine.

Yeah.

How can I be healthier?

How can I feel the best?

Right.

With this condition that I have?

How can I slow the progression of this disease as much as I can so that my limited days on earth are as healthy as possible?

How can we optimize our health literacy?

So those are the questions that are totally fair to ask, that don't get asked enough.

A lot of the times the answer is not going to be medicine.

It's going to be putting in some work, changing your behaviors, making time for self-care and therapy appointments or exercise regimen.

What I always do.

Move your body.

Move your body.

Right.

And so all those things are part of it.

And those need to be conversations that everyone's having at every juncture when they're offered a new prescription.

Yeah.

And so in doing that, you're insulating yourself from some of that.

And then, you know, feel free to shop around for doctors that give you the approach that is not medication focused, if that's how you feel you're best treated.

But ultimately, we all know, even those of us who sell medicine for a living, know that medicine is not always the answer for every ailment.

And so if you get a prescriber, somebody in your care team who you feel like is only pushing medicines and not pushing whole health, then they're doing it wrong.

It's flatly wrong.

There is no room for medication without behavior change, without healthy activities, health behaviors, and all of that should be part of it.

And even if medication is the answer, right?

So if I'm telling you to just take your diabetes medicine, but never telling you to check your blood sugar and write it down and do all the things and get the patterns and get the data and work on the next phase of getting better, then I'm not doing it right.

Yeah.

And it's not just about taking your medicine every day.

And that really should be the health focus.

All of us in medicine, I think, are willing to have those conversations, but we don't have them enough.

And part of it is because we're just not asked.

In the time.

In the time.

Yeah.

Sure.

On Instagram, people are always like, I like to go to the doctor because they always tell me to lose weight.

And I think that it's like, you have to also, if you're looking at a big picture, a big plan, the whole person, you have to be open to these lifestyle changes.

Yeah.

Whatever.

Yeah.

Well, I mean, again, it's not so much that nobody wants to lose weight.

It's the trauma of going into the hospital, going into the doctor, and all of your labs and everything is healthy, but they're just saying, well, your BMI doesn't meet.

I mean, I would agree with that for sure.

I think about people who go to ortho over and over and over again, right, with the same issue.

And it's like a knee problem.

And it's like, well, you know what?

In addition, we need to do a lot of things to help the knee problem.

But one of the things could be weight loss.

People on Instagram who are secretly recording the doctor, then they're like, they're just luxury.

I wait.

And I'm like, no, I think they're trying to do like a here are five things, five things that can help you.

And here's one.

Right.

And well, it's proven that if you promote health behaviors at every opportunity, then people, they will eventually stick.

And so the best example of this is with smoking cessation.

Nobody's like, how dare you tell me to stop smoking?

Right.

Like everybody kind of accepts that you're going to be told that.

But it's proven that by at every single encounter, so they started doing this in an emergency department.

They studied whether or not if every patient that came in as smoking to an emergency department got counseled for one minute on smoking cessation, regardless of their complaint, did it make a difference?

And it made a huge difference in people's behavior change by just bringing it up.

And so it's not wrong for someone to mention obesity or overweight as a risk factor for future poor health.

And it's definitely a fair conversation.

Well, I mean, I just feel like, you know, I'm pro-body positivity, but also I think there comes to a point where you have to like, there's body positivity.

I can't with this groundhog outside.

It's so cute.

There's body positivity.

And then again, it goes back to like taking responsibility for your health, right?

And bodies weren't created to be like, bodies were created to be in motion.

And I guess that's why I'm always like, go outside, move your body, da, da, da.

We aren't, we aren't meant to see it.

When people stop moving, that's the, like, I just think about that too with my older family members.

And I'm like, you got to just keep moving because if you stop moving, that's when it's.

Right.

So I guess like the focus should be on like continuing to to move your body, use it the way it was designed to be to be used.

And like that doesn't mean sitting on the couch, you know, watching TV or on your phone or whatever.

It's it's and it goes back to like we are we're in a mental health crisis.

You know, we can go to the doctor and the doctor can prescribe us SSRIs and prescribe us all these, like, you know, things that seem to help mental health.

But also one of the biggest thing that that helps mental health is like socialization.

And whereas where is our society right now in socialization, we are so isolated because we can't move outside of our phone and our social media platforms.

It's it's actually isolating us worse.

So again, it's like the the point is like, yeah, you there's there's all these different aspects of like, it's not just weight, right?

It's it's moving your body.

Now, if you're moving your body in a healthy way and your BMI is higher than what you think it is, and your labs all look really good.

How much of that is going to be tied to a chronic disease?

We don't know.

All we know is that obesity, you know, is coincides with hypercholesterolemia or high cholesterol.

But how much of that is related to the sedentary lifestyle and the people that are actually out there moving their body and don't fit into what we see as like societal norms, societal, you know, skinny thinness.

I guess like that, that, and I think that's sort of the, the nuance that now we're like trying to figure out as like the elder millennials, women specifically who were just targeted in diet culture and actually like anorexia.

And these, these skinny skinny girls were also actually very unhealthy as well because it's, yeah, it's a different illness and it's, and it created more problems in the future.

So I think it's the same thing.

How, how are we learning?

How can we still learn that like body positivity is a thing, but also there needs to be a line that we talk about in how to prevent chronic illness.

And I think that's a line we're still trying to find.

And I think that's fine.

As long as we're aware of it.

Yeah, certainly weight shouldn't be mentioned as an isolated thing.

And it's good to have conversations about that as a goal.

It's not that every time somebody mentions weight, they're being a body shammer.

Right, exactly.

Right.

And there's probably a pendulum that's maybe swung a little bit too far in the sensitivity department.

And the formalization of functional medicine as a school of thought is helping that as well.

People are getting exposed to those concepts in training, even if they're not fully practicing functional medicine doctors, but it's a holistic approach.

Yeah, I think that there is like a way, I don't know, I'm not anti-functional medicine, but I am anti, again, the like people that are like, there's no place for modern medicine.

I'm like, come on, you have a throat?

How are you going to treat that?

Right, right.

I think you're going to have problems.

Yeah, I like that.

And I also think that like there has to be a way to marry your two beliefs.

Like if you have a belief of like, you know, there's only one way, well, the other way has been proven to be.

They're both.

Yeah, they both work and they can work synergistically, I think.

In many cases, yeah.

Yeah, you just have to be able to, you know, figure out and navigate that with your provider.

Like what you were saying earlier, ask the questions, navigate it with your provider to see what can you do to optimize both therapies.

Yeah, and don't be a hypocrite, right?

Don't show up to the hospital and want all the medicine and then go home and not do any of it.

Right.

Exactly.

You know, balance is appropriate.

An open mind is appropriate.

Being informed is appropriate, but in any context, being judgmental of something because of its name, its origin, its natural or unnatural is not appropriate.

Right.

I'm like, do I think Big Pharma is finding the cures for things?

I think it's just a business and they're trying to make money and they're using, they're looking for weaknesses that are there.

And it's like our job to advocate for ourselves, to pick and choose what will be the right thing for us.

I don't think they're hiding the cure for anything.

No, I don't either.

No, I think you did an excellent job describing.

Yeah.

This is a capitalist society.

I am pro-capitalism.

Okay.

Or capital.

Get the money.

I don't think health care should be.

No, I agree.

I do think people are like, health care is a human right also?

It's like, yes, but also people had to go to school for 20 years, take out $500,000 in student loans.

They worked hard and then for everyone to just be like, I feel like it's a bit of a service.

It's like everyone talks about, all doctors make so much money.

You know who makes so much money?

The freaking CEOs.

Yes.

So I would argue that hospitals are a business.

There should be the people.

Yes.

People should not be making, should not be billionaires off of whatever.

But I feel like when I just get triggered by social media, who's coming for providers and stuff.

Yeah.

And we're like, yo.

Everybody just doing the best they can do.

Yeah.

Problem.

Yeah.

You didn't give it a thought.

I just got really negative.

No.

Yeah.

I think you guys are right.

I think that probably there are some higher up politicians, hospital CEOs.

Follow the money.

Who are probably making some profits.

Don't take that out on your health care providers.

I would say, at the front of the mill, they're really all just trying to help you and do the best we can.

Do the best we can.

And I think that Andrew gave some really good tips.

Yeah.

I don't think that Big Pharma is like hiding the cure for cancer.

I do think.

It would be a race to make the most money off of it as possible, even if they found it.

Right.

You know?

Capitalism would love to be cured of cancer.

Yeah.

So not much of a conspiracy, just kind of a broken health care system.

And I don't know how to fix it.

But yeah, it was very enlightening.

Yeah.

Thank you for having me.

Oh, well, that was fun.

Do another one of these some point.

Kait, what can the people do?

What can they do?

Yeah.

You know what, Megan?

You know what I want you to do instead of scrolling on down?

What I'd like you to do is pick up your phone right now.

Pick it up.

Yeah.

Pick it up right now.

Look it up.

I'm doing it right now.

And if this if this episode resonated with you and you were like, you know what?

This person would really like to listen to this episode.

Will you just text that person right now?

Send them the link to the episode.

We'd love for them to hear it.

And then after you do that, just, you know, scrolling down, leave us a five star review.

Then leave us a five star review.

All right.

Somebody you think will really either get angry listening to this episode, get really excited to listen to this episode.

Or it's just all the yeah, all the emotions.

We like all the emotions.

We're a passionate bunch.

Yeah, some more than others.

Yeah, me.

All right.

Thanks for joining.

We'll see you next week.

See you next Tuesday.