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

Channel: CrossFit®

Views: 106,381

Rating: 4.9530168 out of 5

Keywords: crossfit, dr, doctor, jason, fung, ddc, lecture, talk, science, scientific, research, pharma, conflict, of, interest, physicians, gifts, editors, journals, publications, medical, drugs, prescriptions, fasting

Id: z6IO2DZjOkY

Length: 49min 42sec (2982 seconds)

Published: Tue Sep 24 2019