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184 thoughts on ““Toxins”: the new evil humours

  1. rosemary says:

    Ikw, I hope you aren’t including me in either the woo’er or non-woo’er category. I am not a Skeptic and I don’t call nonsense or irrationality “woo”. I call it crazy or silly. Neither do I consider all nonsense to be equal or equally dangerous. To me the silly kind is funny.

    Ikw, “the non-woo’ers often appear to paint with a very broad brush and seem to be disparaging epidemiology and statistics in general.”
    If that refers to me, I either didn’t express myself well or you have read into it something that wasn’t there. I do not disparage epidemiology or statistics. Neither do I worship RCT. I do my best to “weigh” the evidence in its entirety knowing full well that in the real world nothing is ever certain and that solid new evidence can appear at any time which leads to different conclusions than those previously indicated by the available evidence.

    IMO, journalists writing articles like those linked to in the NYT cleverly get the general public to jump to conclusions that are not based on evidence but rather loose associations. I suspect the reason is that some of the journalists themselves jump to those conclusions but that others know that the fear they invoke will sell copy.

    Ikw, “Finding a less broad (and bombastic) means for communicating the weaknesses of these studies might help the public better understand the scientific process and the manner in which both accurate and precise conclusions can be drawn from data.”
    I think that there are a lot of people like the bloggers here and academics who have been trying to do just that for ever and a day yet they are failing horribly to reaching a very large segment of the general public. As I’ve said repeatedly, people learn in different ways. My style is not that of the academic or the Skeptic and I think that there are people, many of whom do not understand or even want to listen to academics or Skeptics, who understand me very well. [Admittedly, that is just my opinion. The evidence is very weak and of the poorest quality. :-)]

    If any journalists are reading, I apologize. I think, but haven’t checked, that I may have used compliment instead of complement in a previous comment.

  2. rosemary:

    ” it is a very important point since a great many people jump to the erroneous conclusion that whenever an author lists scientific sites or citations from scientific journals that his work is scientific and that the science supports his conclusions.”

    That is an excellent point.

    The technique is sometimes referred to as “bibliography salad” and it takes advantage of a common misconception that lay people have about science. Many lay people believe that publication of a scientific paper means that the paper has been evaluated as “true.” But publication means nothing of the kind; it merely means that the paper has been deemed worthy of being included in the discussion. Other scientists, doctors etc. will take it in to consideration when evaluating the overall body of evidence on the topic.

    Moreover, as you point out, since the purveyors of “bibliography salad” depend on the fact that lay people will not read the actual papers, many citations do not support the claim or even undermine the claim.

    That’s why when someone presents a “bibliography salad” to me, I always ask whether they have read the actual papers (not just the abstract) and whether they can produce a quote that supports whatever claim they are trying to make.

  3. David Gorski says:

    However, in doing so, the non-woo’ers often appear to paint with a very broad brush and seem to be disparaging epidemiology and statistics in general.

    Not true. In fact, many of the studies upon which I rely and about which I’ve blogged about in order to show that there is no correlation between vaccines and autism are epidemiological studies, some of them quite huge.

  4. Harriet Hall says:

    re: Effectiveness in the blogosphere.

    Quality and effective communication are the goals of SBM. While traffic and comments may be the popular measure of success in the blogosphere, they are only an indication that a lot of people are reading and want to express their own opinions. In fact, the number of comments seems to correlate best to the amount of emotion generated by the subject itself. The numbers themselves are a poor indicator for what we are trying to achieve.

    I would rather write a high quality post understood by a few people and providing an enduring reference for information not readily available elsewhere than a lower quality popular post read by many. I hope I speak for all the SBM authors.

  5. Zoe237 says:

    I would rather write a high quality post understood by a few people and providing an enduring reference for information not readily available elsewhere than a lower quality popular post read by many. I hope I speak for all the SBM authors.

    Speaking of which, this article answered pretty much every single question I’ve had since starting to read at SBM (EBM v SBM, Bayesian stats, RCTs, etc), all in one place. I wish you could pin it at the top of the site and hand it out to all high school students.

    http://skepticstoolbox.org/hall/

  6. Karmakaze says:

    Oh my, I am so happy to know that Aflatoxins, Ochratoxin, Citrinin, Ergot Alkaloids, Patulin, and Fusarium toxins don’t exist! And that is just the mycotoxins!

    Let’s have a look at Ergot Alkaloids for a moment. How great is it that Science-Based Medicine has proved that Ergotism doesn’t exist, and as such the FDA can remove its limits for Ergot contamination of the foods we eat?

    Or is this a case of a skeptic being as bad or worse than the “believers”?

    For example, the author seems to not know the definition of “toxin” and “poison”. Here is a little help:

    “Main Entry: tox·in
    Pronunciation: ˈtäk-sən
    Function: noun
    Etymology: International Scientific Vocabulary
    Date: 1886

    : a poisonous substance that is a specific product of the metabolic activities of a living organism and is usually very unstable, notably toxic when introduced into the tissues, and typically capable of inducing antibody formation”

    A toxin is a poison created by the metabolic activity of living organisms. Pretty simple, and I am sure they teach it in medical school…

    But of course, in general use the words are interchangeable.

    Thus, an environmental toxin would be a toxin that you were exposed to in your environment – in the air, the food, or water you consume – say “second hand smoke”, or contaminated flour.

    Seriously is this what you think passes for skepticism? What does the MD stand for anyway? Surely not “medical doctor” when you don’t even know what a toxin is or any of the common environmental toxins we are exposed to?

    Sure, if you want to have a go at the “detoxifying treatments” have at it…

    But calling the entire gamut of toxins we are exposed to in our environments (not to mention chemical poisons) “imaginary” is the biggest “woo woo” (what a retard phrase that is!) I’ve read in a long time.

    Science-Based my ass.

  7. David Gorski says:

    You’re rather late to the party. In fact, these issues were discussed days ago, much earlier on in this comment thread. Did you even bother to read the discussion? The reason I ask is that I pointed out that the official definition of the word “toxin” is a biologically produced substance that is poisonous to living organisms (the abbreviated definition, but more or less the same as what you cite).

    This was back around Christmas Eve, actually–nearly a week ago.

    Really, if you’re going to jump into a thread, do at least take the time to read what others have said, lest you contribute nothing new, which is what you just did, contributed nothing new.

    I suspect, however, that you know full well that what Amy was talking about is how woo-meisters invoke all sorts of unnamed and mysterious “toxins” as the One True Cause of All Disease. They are not talking about Aflatoxins, Ochratoxin, Citrinin, Ergot Alkaloids, Patulin, and Fusarium toxins. Those toxins can be measured and produce characteristic toxic effects when introduced to the body. Not so alt-med “toxins,” which in general often can’t even be defined, much less measured. I also suspect that you buy into the whole “toxin” thing as the One True Cause of All Disease. I could be wrong, but we’ll see soon enough; that is, if your comment isn’t just a drive-by trolling.

  8. Martin A. Lessem, J.D. says:

    So based on the comments here, is this a good time to advocate the banning of dihydrogen monoxide in foods and medicine? ;)

    Seriously though, as a person who works in genuine pharma, I know that some “toxins” can have a non-detrimental effect if used in small amounts. There are currently studies ongoing (some may have been completed) about the uses of botulinum in diabetic patients.

    The claims that “all toxins are bad” are not only vague but are usually born from fear and lack of understanding.

    As a disclaimer, I did used to work for a company that produced a Botulinum Toxin – B, but have not worked for them since 2005.

  9. Karmakaze says:

    “You’re rather late to the party. In fact, these issues were discussed days ago, much earlier on in this comment thread.”

    Not my fault the same retarded bullshit is still there uncorrected. Where is the errata explaining why the ‘MD’ hasn’t got a clue about what a toxin is? But no, I didn’t read the entire COMMENT thread, I COMMENTED on the article. Sue me.

    As for “duscussed” let’s see what you said, (and yes I did read it before, and was one of the reasons I posted):

    “I can see some merit in your criticism that Amy contradicted herself (or at least was not as clear as perhaps would have been advisable) in discussing the differences between alt-med “toxins” and real toxins; I noticed it myself and her attempt to distinguish “toxins” from “poisons” struck me as a distinction without a real difference, at least as explained.”

    What a mealy mouthed load of bullshit that is!

    “a distinction without a real difference”?

    Sorry, but there is a clear definition in both the general world, and the scientific world, and neither of them are remotely close to “humours and miasmas”. Are you always this reserved when criticising bad science, or do you only save the “charltan! Woo Woo! Fraud! Quack!” bullshit for the ‘doctors’ you don’t agree with?

    “The reason I ask is that I pointed out that the official definition of the word “toxin” is a biologically produced substance that is poisonous to living organisms”

    Let’s see shall we:

    “But since in this post you seem to be harping on the difference between “toxins” and “poisons,” if you really want me to get pedantic (and why the heck not at this point?), technically by definition toxins are biologically produced poisons.”

    “However, I must admit that the criticism that you yourself weren’t all too clear on the concept of toxins is not entirely baseless. I realize that most people use the terms “toxin” and “poison” interchangeably, but that’s rather the point, isn’t it? They’re wrong to do that.”

    “there is no excuse to be invoking vague concepts like “toxins,” which , as Amy correctly points out, resemble ancient concepts of contamination and miasma”

    Yes, you pointed it out, then mealy-mouthed your way into saying the criticism is “not entirely baseless” (it’s NOT AT ALL baseless) Where are the insults? Is that reserved only for “them” and not “us”?

    “Really, if you’re going to jump into a thread, do at least take the time to read what others have said, lest you contribute nothing new, which is what you just did, contributed nothing new.”

    I came in late and decided to have a rant. The article is still there and many if not most people WON’T see YOUR correction (where is the author’s?). So I added mine to help make that less likely. Does that make you feel better about it? The fact is, this isn’t a discussion thread, it is a COMMENT thread. I commented on the article. What is your problem with that?

    “I suspect, however, that you know full well that what Amy was talking about is how woo-meisters invoke all sorts of unnamed and mysterious “toxins” as the One True Cause of All Disease.”

    No, I didn’t, I am not a mind reader (that’s impossible remember) and I don’t assume I know what someone is talking about when their words are so clear. It is not my fault your ‘MD’ friend there has no idea how to explain a concept in her mind clearly on ‘paper’.

    Of course you also failed to mention ANY of the myriad REAL toxins we are exposed to on a regular basis, including ones that the FDA has decided we can be exposed to in our food. And that can cause very severe illness or even death. One of them is most commonly associated with long term exposure at low levels… exactly the kind of thing ‘detoxification’ is supposed to help clear up.

    No, I am not defending THEM, I am just saying you lot are no better.

    “They are not talking about Aflatoxins, Ochratoxin, Citrinin, Ergot Alkaloids, Patulin, and Fusarium toxins. ”

    Oh, aren’t they? (nice cut and paste by the way) And you know this how? Are YOU a mind reader?

    “I also suspect that you buy into the whole “toxin” thing as the One True Cause of All Disease.”

    No, I am sitting here smoking a fag, drinking a beer and laughing my ASS off at your patently obvious attempt to change the subject. This isn’t about me, it’s about how your ‘MD” can’t seem to figure out that toxins are real and we are exposed to them regularly, and they DO cause disease and even death.

    They are NOT imaginary, unlike your retard MD seems to think.

    “I could be wrong, but we’ll see soon enough; that is, if your comment isn’t just a drive-by trolling.”

    Oh, it’s a trolling… just not a drive-by… I am going to have too much fun talking to you True Believers…

    Woo Woo!!!

  10. Karmakaze says:

    “Seriously though, as a person who works in genuine pharma, I know that some “toxins” can have a non-detrimental effect if used in small amounts. There are currently studies ongoing (some may have been completed) about the uses of botulinum in diabetic patients.”

    What the hell? Is that the only toxin you can think of that has been helpful to humanity?

    Ever herd of of the mold called Penicillium chrysogenum (aka Penicillium notatum)? It produces a toxin that is probably responsible for saving more lives than all the rest of the pharmaceuticals combined (my own guess – probably wrong).

    Man I wish Penicillin hadn’t turned out to be a figment of my imagination!

  11. David Gorski says:

    I came in late and decided to have a rant. The article is still there and many if not most people WON’T see YOUR correction (where is the author’s?). So I added mine to help make that less likely. Does that make you feel better about it? The fact is, this isn’t a discussion thread, it is a COMMENT thread. I commented on the article. What is your problem with that?

    My problem with it was that you ranted about old stuff that was hashed out a week ago, and I merely pointed that out because you were being tedious.

    My problem with it now is that you’re using profanity and referring to Amy as a “retard,” both of which are unacceptable behavior in the comments here. The discussions here can get quite heated at times. That’s fine, as long as some minimal decorum is maintained. If you have something substantive to say, say it. If all you’re going to do is keep throwing insults and profanity around, particularly offensive ones like “retard” (several of our regular readers have children with autism and neurodevelopmental disorders), you will be gone. This is your only warning. You won’t get another.

  12. margokatt says:

    What about epigenetics? I studied the effects of alcohol on the brain for four years at UCSF. Clearly, it is a toxin and toxicity levels vary for each person. Over time, various cells respond by altering gene expression at the protein level.
    I think it is dangerous to disreguard the effects.
    I submit that environmental medicine is a western preventative medical approach to dealing with toxins such as mold, heavy metals, and gluten. While not all traditionally “toxic,” they can have adverse effects on individuals. Removal of the toxins requires more than a stupid colon cleanse because your liver and kidneys eventually will remove the toxins, but if you continue to consume the toxic food you will maintain concentrations in your blood and tissues and you will stay in a toxic state. Special chelating agents are required to remove toxins from the body and usually requires the help of a knowledgeable medical professional.

  13. Karmakaze says:

    David Gorski

    “My problem with it was that you ranted about old stuff that was hashed out a week ago, and I merely pointed that out because you were being tedious.”

    Oh yeah… I am sure it is very tedious for you to listen to people correcting your and your friends mistakes… must happen a lot, based on how dumb this article is.

    “My problem with it now is that you’re using profanity and referring to Amy as a “retard,” both of which are unacceptable behavior in the comments here.”

    Ok, I apologise for the swearing (I thought skeptics wouldn’t be adhereing to the religious view on profanity), and I will refrain from using the word “retard”.

    But now can you see how you lot treat other people?

    ““Alternative” health practitioners are nothing more than quacks and charlatans and their “remedies” are nothing more than snake oil.”

    Quacks and Charlatans? Your MD’s whole career has come about because of the commercialisation (and artificial manufacture of) “alternative remedies”.

    Ask her if she is one of the 60% of American doctors that have prescribed placebos. Ask her to explain what the difference is between that and “faith healing”.

    What if the “woo woo” that makes people believe that “remedies” work actually makes them work? Do you REALLY want to remove what could be one of the most powerful “remedies” we have, that have no bad side effects?

    Why is it that medicine is only good when some company has found a way to patent and profit like bandits from it?

    Don’t start on the “because they’re tested” bull either – Vioxx was tested and APPROVED by the FDA. Ten years later its been withdrawn because it was killing people, and prozac has recently been re-tested and found to not be that much better than placebo. These companies have pillaged our heath systems, have driven prices through the roof, and in the end are not much better than the guy selling “colloidal silver”.

    Why aren’t you screaming “quack and charlatan” at them?

    Hypocrites.

    “FDA analysts estimated that Vioxx caused between 88,000 and 139,000 heart attacks, 30 to 40 percent of which were probably fatal, in the five years the drug was on the market.”

    On the low end, that is twenty six THOUSAND people DEAD in 5 years. 5,280 a year, or 14 people A DAY. And that is ONE of the myriad pharmaceuticals sold to us as “medicine”.

    Tp put this in perspective, Vioxx was used to treat inflamation and pain – it never saved a single life.

    If alternative medicines had a record as bad as that…

    By the way, have you Science-Based Medicine people figured out how the Placebo Effect works? Or has “medicine” not bothered to study that because it can’t really be profited from?

    “If you have something substantive to say, say it. If all you’re going to do is keep throwing insults and profanity around, particularly offensive ones like “retard” (several of our regular readers have children with autism and neurodevelopmental disorders), you will be gone.”

    Firstly, why is a word offensive? The word means “held back” and used the way I have been using it, means “held back mentally”. If that is not an accurate description of this article, then I understand the objection… but like I said I will take note of the delicate senisibilities and I’ll refrain from using words that some might find offensive.

    Now, can we talk about “quack” and “charlatan” and “woo woo” etc etc etc?

    “This is your only warning. You won’t get another.”

    Wow, so forceful! I mean, not asked.. WARNED… Warning recieved and understood… sir!

  14. “Ask her if she is one of the 60% of American doctors that have prescribed placebos. Ask her to explain what the difference is between that and “faith healing”.

    You can ask me directly and I can tell you that I never prescribed a placebo, and I can also tell you that most doctors do not prescribe placebos, either. To deliberately prescribe a placebo is to tell a lie and lying is unethical.

    “What if the “woo woo” that makes people believe that “remedies” work actually makes them work? Do you REALLY want to remove what could be one of the most powerful “remedies” we have, that have no bad side effects?”

    You seem to have a mistaken idea of the placebo effect. The placebo effect is not the sign that a treatment is working, it is what happens when the treatment is not accomplishing anything.

    “Why is it that medicine is only good when some company has found a way to patent and profit like bandits from it?”

    Nothing has a greater profit margin than “alternative” treatments. No money is spent on testing. No money is spent on getting FDA approval. No money is spent on identifying an active ingredient and making sure that each dose contains the same amount. No money is spent on making sure that there is ANY active ingredient in a dose.

    If you worry about profiteering, you should start with the “alternative” health industry. It is a multibillion dollar industry that is almost pure profit and offers no benefit.

  15. Karmakaze says:

    “You can ask me directly and I can tell you that I never prescribed a placebo, and I can also tell you that most doctors do not prescribe placebos, either. To deliberately prescribe a placebo is to tell a lie and lying is unethical.”

    http://www.bloomberg.com/apps/news?pid=20601124&sid=ahaD1J6VIA.o&refer=home

    I may have misquoted the numbers a bit because I missed that not all the doctors asked to respond, did. So you may be right that most don’t.

    However… read the article and tell me I am totally wrong, and that no doctors would ever engage in “faith healing”.

    “You seem to have a mistaken idea of the placebo effect. The placebo effect is not the sign that a treatment is working, it is what happens when the treatment is not accomplishing anything.”

    Wait. A person gets ill. They get a placebo, They get better. You saying that doesn’t happen? Really?

    http://www.wired.com/medtech/drugs/magazine/17-09/ff_placebo_effect?currentPage=all

    “Nothing has a greater profit margin than “alternative” treatments.”

    Are you kididng? How many alternative medicines cost THOUSANDS PER PILL? In my country some drugs are not available at our socialised hospitals because the companies that make them charge far more than they are worth.

    Read the Wired article about how in the 90′s pharmaceuticals were more profitable than OIL.

    I wonder… do you work for any pharmaceutical companies, or have investments in them? Perhaps disclosure is in order? Care to swear that you have no vested interest in protecting the pharmaceutical industry?

    “No money is spent on getting FDA approval. ”

    You mean no money is spent BUYING FDA approval – unless you think the process worked for Vioxx. This wasn’t some subtle effect that took years to show, Vioxx only lasted on the market for 5 years. and may be responsible for over 20 thousand deaths – for a drug that saved not one life.

    “No money is spent on identifying an active ingredient ”

    LOL and that is done to make the medicine work better? Or so the drug can be patented? Can’t patent a leaf, but you can patent the artificially produced extract of that leaf….

    “No money is spent on making sure that there is ANY active ingredient in a dose.”

    Placebo Effect. There doesn’t NEED to be an active ingredient – as long as everyone thinks there is.

    “If you worry about profiteering, you should start with the “alternative” health industry.”

    Why? Why not the mainstream industry? They have far more effect (and steal far more money).

    See: Vioxx!

    “It is a multibillion dollar industry that is almost pure profit and offers no benefit.”

    Vioxx, vioxx, vioxx.

    And that is only ONE RECENT drug scandal. Remember Thalidomide?

    What “herbal remedy” has done THAT? Care to name one?

  16. Karmakaze says:

    There seems to have been an error while posting, because this post hasn’t shown up but it tells me it’s a duplicate. I’ll try again:

    “You can ask me directly and I can tell you that I never prescribed a placebo, and I can also tell you that most doctors do not prescribe placebos, either. To deliberately prescribe a placebo is to tell a lie and lying is unethical.”

    http://www.bloomberg.com/apps/news?pid=20601124&sid=ahaD1J6VIA.o&refer=home

    I may have misquoted the numbers a bit because I missed that not all the doctors asked to respond, did. So you may be right that most don’t.

    However… read the article and tell me I am totally wrong, and that no doctors would ever engage in “faith healing”.

    “You seem to have a mistaken idea of the placebo effect. The placebo effect is not the sign that a treatment is working, it is what happens when the treatment is not accomplishing anything.”

    Wait. A person gets ill. They get a placebo, They get better. You saying that doesn’t happen? Really?

    http://www.wired.com/medtech/drugs/magazine/17-09/ff_placebo_effect?currentPage=all

    “Nothing has a greater profit margin than “alternative” treatments.”

    Are you kididng? How many alternative medicines cost THOUSANDS PER PILL? In my country some drugs are not available at our socialised hospitals because the companies that make them charge far more than they are worth.

    Read the Wired article about how in the 90′s pharmaceuticals were more profitable than OIL.

    I wonder… do you work for any pharmaceutical companies, or have investments in them? Perhaps disclosure is in order? Care to swear that you have no vested interest in protecting the pharmaceutical industry?

    “No money is spent on getting FDA approval. ”

    You mean no money is spent BUYING FDA approval – unless you think the process worked for Vioxx. This wasn’t some subtle effect that took years to show, Vioxx only lasted on the market for 5 years. and may be responsible for over 20 thousand deaths – for a drug that saved not one life.

    “No money is spent on identifying an active ingredient ”

    LOL and that is done to make the medicine work better? Or so the drug can be patented? Can’t patent a leaf, but you can patent the artificially produced extract of that leaf….

    “No money is spent on making sure that there is ANY active ingredient in a dose.”

    Placebo Effect. There doesn’t NEED to be an active ingredient – as long as everyone thinks there is.

    “If you worry about profiteering, you should start with the “alternative” health industry.”

    Why? Why not the mainstream industry? They have far more effect (and steal far more money).

    See: Vioxx!

    “It is a multibillion dollar industry that is almost pure profit and offers no benefit.”

    Vioxx, vioxx, vioxx.

    And that is only ONE RECENT drug scandal. Remember Thalidomide?

    What “herbal remedy” has done THAT? Care to name one?

  17. Karmakaze says:

    Maybe a little more information might be warranted:

    “The high cost of the health care system is considered to be a deficit, but seems to be tolerated under the assumption that better health results from more expensive care, despite evidence from a few studies indicating that as many as 20% to 30% of patients receive contraindicated care.1 In addition, with the release of the Institute of Medicine (IOM) report “To Err Is Human,”2 millions of Americans learned, for the first time, that an estimated 44,000 to 98,000 among them die each year as a result of medical errors.”

    http://jama.ama-assn.org/cgi/content/extract/284/4/483

    Care to tell me how many people die from alternative medical care each year?

  18. Karmakaze says:

    By the way, it turns out this MD doesn’t know what the Placebo Effect is either…

    “The placebo effect is the measurable, observable, or felt improvement in health or behavior not attributable to a medication or invasive treatment that has been administered.”

    http://www.skepdic.com/placebo.html

    ” * In recent decades reports have confirmed the efficacy of various sham treatments in nearly all areas of medicine. Placebos have helped alleviate pain, depression, anxiety, Parkinson’s disease, inflammatory disorders and even cancer.

    * Placebo effects can arise not only from a conscious belief in a drug but also from subconscious associations between recovery and the experience of being treated—from the pinch of a shot to a doctor’s white coat. Such subliminal conditioning can control bodily processes of which we are unaware, such as immune responses and the release of hormones.

    * Researchers have decoded some of the biology of placebo responses, demonstrating that they stem from active processes in the brain. ”

    http://www.scientificamerican.com/article.cfm?id=placebo-effect-a-cure-in-the-mind

  19. Karmakaze says:

    It seems to me that you (the people who have responded to me) seem to think I am some airy-fairy “my crystals protect me” spirtualist.

    Bet you regret making that assumption…

    Nothing I have said comes from the ‘alternative medicine’ people.

    You will note my links are to Wired, Scientific American, The Skeptic’s Dictionary, and the JAMA.

    Funny how this doctor seems so out of touch with modern medicine, isn’t it?

  20. Harriet Hall says:

    Karmakaze asked “how many people die from alternative medical care each year?”

    A few. Take a look at the What’s The Harm website. But first, how about you tell us how many lives are saved by alternative medical care each year.

    It is a fallacy to compare the risks of the two systems without putting them into perspective with the benefits of those systems. Alternative medicine is distinguished from scientific medicine by the fact that it hasn’t been proven to work. If it had, it would have been incorporated into mainstream medicine and would no longer be called alternative. Mainstream medicine saves lives and has a risk/benefit ratio; alternative medicine doesn’t.

    This has been discussed on this blog before. See http://www.sciencebasedmedicine.org/?p=136

  21. David Gorski says:

    And that is only ONE RECENT drug scandal. Remember Thalidomide?

    Of course, KK conveniently forgets to mention that thalidomide was never approved in the U.S. as a morning after pill. FDA reviewer Frances Oldham Kelsey refused approval for the applicatio to market thalidomide in the U.S. on the grounds that more study was needed. In the case of thalidomide, the FDA approval process worked fairly well. At least it worked better than the process did in several other countries.

    Moreover, in recent years, thalidomide has been shown to be quite a useful drug in treating multiple myeloma.

    [Editor note: ERROR, brain fart. "Morning after" was supposed to read "morning sickness."]

  22. David Gorski says:

    It seems to me that you (the people who have responded to me) seem to think I am some airy-fairy “my crystals protect me” spirtualist.

    Bet you regret making that assumption…

    Actually, now you come across as your garden variety Mike Adams-style “critic” who’s simply hostile to and suspicious of scientific medicine in general and big pharma in particular. You may think your “critiques” are brilliant or novel, but your ilk is nothing we haven’t seen here many, many times before.

  23. David Gorski says:

    Firstly, why is a word offensive? The word means “held back” and used the way I have been using it, means “held back mentally”.

    Oh, give me a break with the disingenuous nonsense.

    If you don’t already understand why using the term “retard” the way you did as an insult is offensive, I doubt I can explain it to you. Simply don’t use it again. Whine about the warning all you want, but this discussion forum is not a democracy. We’re pretty lax in what we permit, but we do have limits, and, yes, as editor I get to decide in consultation with Steve Novella when a commenter has crossed the line. Don’t like it? You can go elsewhere.

  24. David Gorski says:

    See: Vioxx!
    “It is a multibillion dollar industry that is almost pure profit and offers no benefit.”

    Vioxx, vioxx, vioxx.

    Actually, it’s not true that Vioxx didn’t benefit many patients. Even Dr. Eric Topol, the strongest detractor of Merck and Vioxx, concedes that Vioxx was a useful drug and helped a lot of people. Indeed, in an interview in Michael Spector’s recent book Denialism, in what was otherwise a very harsh chapter about Merck and in essence a paean to Dr. Topol’s crusade against Merck, I was surprised to read Topol quoted as saying flatly that Vioxx should not have been taken off the market. In his opinion there should have been issued a black box warning regarding patients with diabetes or preexisting cardiovascular disease. In reality, Vioxx was a pretty good drug except for patients who fell into a couple of high risk categories. The idiocy of Merck’s leaders in trying to cover up these categories was an enormous self-inflicted wound from which Merck may never fully recover.

  25. “Of course, KK conveniently forgets to mention that thalidomide was never approved in the U.S. as a morning after pill.”

    Nor anywhere else either, as I understand it. Morning sickness, yes. And currently in the US for leprosy and multiple myeloma. (Doesn’t take away from anything you’ve said.)

  26. “They get better. You saying that doesn’t happen? Really?”

    No, that’s not what I am saying. Some people will get better if nothing is done for reasons we might or might not understand. Treatments are tested against placebo to judge the true effect of the treatment.

    Let’s say that after receiving Vioxx, for example, 50% of patients reported a decrease in pain. That makes it sound like 50% of the people who received Vioxx benefited. However, if we know that 35% of the people reported a decrease in pain after receiving placebo, we can see that the Vioxx benefited only 15%.

    In other words, the placebo effect is not a treatment; it gives us a better idea of who would have improved without real treatment.

    Deliberately invoking the placebo effect depends on a lie; the patient believes he is getting effective treatment when he is not. In the case of a randomized controlled double blind study, no one is deliberately lying to the patient, since the doctor doesn’t know what the patient is getting, either.

    However, deliberately invoking the placebo effect in the absence of blinding of the doctor means that the doctor is knowingly lying. I can’t imagine anything more likely to destroy the doctor-patient relationship than encouraging doctors to lie to patients “for their own good.”

    Moreover, you haven’t explained why quacks and charlatans should profit by deliberately lying to patients about the efficacy of their “treatments.” It is difficult for me to imagine a legitimate reason to reward entrepreneurs for lying.

  27. ” How many alternative medicines cost THOUSANDS PER PILL? ”

    I said profit margin, not profit.

    Consider those medications that cost thousands per pill. What is the profit margin? How much money went into research and development, testing and obtaining FDA approval? How much money goes into creating each pill, making sure that each pills has the exact same amount of active ingredient? How much money was lost developing treatments that never gained FDA approval? Millions? Tens of millions? Hundreds of millions?

    How much money goes into research and development of an alternative “treatment”? Zero dollars. How much money goes into testing and obtaining FDA approval? Zero dollars. How much money goes into making sure that each dose contains the same amount of active ingredient? Zero dollars. And how much money is lost developing treatments that don’t gain FDA approval? Zero dollars, since treatments are marketed whether they work or not.

    When it comes to alternative “treatments” only a minimal amount of money is invested and the returns are pure profit. If your real concern were profiteering, you’d be appalled by the “alternative” health industry.

  28. Amy, both profit and profit margin take expenses and investment into account and could be used interchangeably for the purposes of this discussion. Profit is expressed in absolute terms (the number of dollars); profit margin is expressed as a percentage of revenue.

    What our agitated KK is lathering on about is the revenue. As you correctly emphasize, revenue tells us nothing about the profit or profit margin.

  29. David Gorski says:

    Nor anywhere else either, as I understand it. Morning sickness, yes. And currently in the US for leprosy and multiple myeloma. (Doesn’t take away from anything you’ve said.)

    Nice bit of pedantry there, but mea culpa for a brain fart.

  30. Yes, sorry, I am sadly pedantic. I tried to keep it short, and I repeat that the brain fart doesn’t take away from your point that the FDA works.

  31. rosemary says:

    Just from a business perspective, when comparing a supplement business with a pharmaceutical business, one must also consider return on investment as well as the speculative nature of the investment for a drug company.

    Pharmaceutical companies must and do invest huge sums of money to develop drugs, yet there is no guarantee that any of the drugs they work on will be successful. If I remember correctly, the chances of that are actually quite slim, and if there is a return on investment, it usually takes years for it to come. Most investors will not invest in something speculative with any potential profits a long way off unless they hope that the return will be worth the risk and the wait.

    Supplement companies, on the other hand, start on a shoestring. (Hey, Joe, ya got some space in ya garage I can rent? I wanna mix up a bunch of weeds. My wife doesn’t like the smell in her kitchen.) My guess is that most of their investment goes into marketing, lobbying and packaging, but mostly marketing. Many make millions very quickly after opening. In other words their return on investment is excellent and the amount of time it takes to get it is very fast.

    Furthermore, given the present legal climate, their risks, unlike those of drug companies, are miniscule.

    Of course, none of that means that drug companies are loving, caring altruistic corporations. But neither are the supplement companies. Which is the reason that they all need to be regulated to a degree that will keep them as honest as possible in our imperfect world which is not the standard we have today when, for all practical purposes, supplement companies are unregulated and often get away with murder, and I don’t mean that figuratively speaking either.

  32. Zoe237 says:

    Dr. Gorski:

    “Actually, it’s not true that Vioxx didn’t benefit many patients. Even Dr. Eric Topol, the strongest detractor of Merck and Vioxx, concedes that Vioxx was a useful drug and helped a lot of people. Indeed, in an interview in Michael Spector’s recent book Denialism, in what was otherwise a very harsh chapter about Merck and in essence a paean to Dr. Topol’s crusade against Merck, I was surprised to read Topol quoted as saying flatly that Vioxx should not have been taken off the market. In his opinion there should have been issued a black box warning regarding patients with diabetes or preexisting cardiovascular disease. In reality, Vioxx was a pretty good drug except for patients who fell into a couple of high risk categories. The idiocy of Merck’s leaders in trying to cover up these categories was an enormous self-inflicted wound from which Merck may never fully recover…

    I thought it was a very interesting chapter, but my reading was that not only did Vioxx cause all these deaths (many more than any CAM I’ve ever heard of), but it was also shown not to be any more effective than aleve at reducing pain. (Where’s the benefit there?). However, that it DID reduce the risk of GI problems. I believe the studies showed a risk factor for more than just those with prior history of heart disease. So I didn’t follow his conclusion about why it should have been left on the market.

    He seemed to be saying that Vioxx is an isolated incident (along with the rest of the skeptics). While I’m not sure it’s common, I don’t for one minute think this is an isolated problem, or it wouldn’t have taken YEARS for it to be taken off. Topol wouldn’t have been fired. The FDA wouldn’t have been complicit. And Merck would have been forced to make some admissions of guilt. These are systemic problems. (not that I think the solution is to abandon modern medicine or trust quacks). Specter mentions than nothing substantial has changed either.

    All in all, though, I pretty much agreed with this review of the book. I liked Shermer’s “The Borderlands of Science” MUCH better in terms of bringing the message to a wider audience, not demonizing people, or engaging in a “nature vs. science” false dichotomy. “Science as a candle in the dark” to quote Sagan.

    http://www.amazon.com/review/R2PQ9XRJ5RY1JQ

    Dr. Tuteur:

    “You can ask me directly and I can tell you that I never prescribed a placebo, and I can also tell you that most doctors do not prescribe placebos, either. To deliberately prescribe a placebo is to tell a lie and lying is unethical…

    There was some discussion of using a surgical procedure as placebo here. Could the authors/commenters been joking? And actually, I’ve seen this [phrase] before on SBM. As long as you are honest about it, is there a harm? General question I’ve wondered. Do almost 50% of doctors really prescribe placebos 2-3x/month, as referenced above?

    Dr. Gorski, from vertebroplasty post:
    http://www.sciencebasedmedicine.org/?p=665

    “Dr. Weinstein, ironically enough, suggests what may well happen:

    In an interview, Dr. Weinstein, who does not perform vertebroplasty, suggested that rather than abandoning the procedure, doctors could let patients decide for themselves, by telling them, “This is a treatment option no better than a placebo, but if you want to consider a placebo because you might benefit from it, you might want to know that.”

    A $3,000 placebo? If given the choice between a pricey $3,000 placebo and a CAM placebo like acupuncture, which is likely to cost less than that and not have the potential for complications, I would pick the acupuncture, quite frankly, because the potential for harm is less than sticking needles into vertebrae and injecting cement. Really, if allegedly science-based practitioners make this sort of argument, then why not just offer CAM to patients as a placebo?…

    http://www.sciencebasedmedicine.org/?p=665

    Dr. Gorski:

    “You may think your “critiques” are brilliant or novel, but your ilk is nothing we haven’t seen here many, many times before….

    Criticisms of acupucture and chiro are a dime a dozen these days too. So what? Even though I don’t like the poster’s style, he brings up some good points (red herrings and strawmen though, some).

    “Nothing has a greater profit margin than “alternative” treatments…..

    (I think profit and profit margin are pretty much the same thing).

    Most of the money from drug companies goes to marketing, not research. Vioxx had a profit somewhere around 6 billion over the several years. I seriously doubt there has ever been a CAM drug that profitable, even if they didn’t have all of the costs.

    http://www.sciencedaily.com/releases/2008/01/080105140107.htm

  33. EricG says:

    @ zoe237

    a minor quibble

    “(I think profit and profit margin are pretty much the same thing).”

    i’m sure an accountant would disagree with you, hence the distinction in name. for good measure…

    Profit:

    The positive gain from an investment or business operation after subtracting for all expenses. opposite of loss.

    Profit Margin:

    Net profit after taxes divided by sales for a given 12-month period, expressed as a percentage.

    So…sorry, they are not pretty much the same thing.

  34. Zoe237 says:

    Thanks Eric. I’m still not sure it makes any difference to a discussion of whether Big pharma companies or Big Alties make more money. Both profit and profit margin take into account expenses and sales of either business.

  35. Scott says:

    It really does make a significant difference, because one of them (profit) is a function of scale and the other (profit margin) is not. Depending on the precise question at hand, either one might be the more relevant measure.

    For example, you cite Vioxx making a profit of $6B, and I’ll accept that figure for the sake of discussion. It makes a huge difference whether that’s $6B after costs of $600B, or after costs of $1B (numbers selected to make a point, with no claims of accuracy or even reasonability).

    In the former case, the profit margin is 1%. The conclusion would be that the $600B could have been far better employed elsewhere (just sticking it in the bank would typically do better), and that the drug was actually a flop.

    In the latter case, a profit margin of 500% is truly massive, and will attract a great deal of interest in matching it. People would pile into that business, even if they have to be dishonest to do so.

    Profit is greatly affected by how much money is available to be sunk into the business. But profit MARGIN determines how much money a particular venture (with a particular amount of funding available) might be able to make, and hence is far more relevant to the question of how much incentive there is for mendacity.

    If you wanted to address simply “which industry is bigger”, profit would be a not unreasonable measure. But for the question “who has more incentive to peddle snake oil”, profit MARGIN is the proper thing to look at.

  36. Zoe237 says:

    Scott, you’ve described me a good reason to use profit margin ( as a percentage return on an investment) as a good comparison to that of a bank. It’s certainly valuable for investors and producers. But comparing companies or industries to each other seems iffy. Health insurance companies have traditionally low profit margins (2-3%) but so what? BCBS is still yanking my chain about paying for my knee surgery, six months later, for no other reason other than they screwed up on the year of my birth. 3% profit margin on 20 billion dollars is a lot different than a profit margin of 3% on $100,000. Basically you claim to be saying that because the investors are putting less into the product that they are more likely to lie about it. You could make the opposite argument too. That doesn’t make any sense. But maybe I’m missing something.

    Moreover, this article mentions that pharmaceutical companies have profit margins of 17%. Other sources I’ve read put it as high as 19%, and that pharmaceuticals are the most profitable industry on the planet, more profitable than oil (where PM are somewhere around 9%). Does CAM really have as high a profit margins as this?

    http://www.time.com/time/magazine/article/0,9171,993223-2,00.html

    I can see why some people would believe that profit margin is more relevant and I admit my mistake. Still seems like splitting hairs to me though.

    Can I just say I hate economics about as much as I love science? :P

  37. EricG says:

    @ Zoe237

    “Can I just say I hate economics about as much as I love science? ”

    absolutely, I would say most on this blog are of similar sentiment

    “I can see why some people would believe that profit margin is more relevant and I admit my mistake. Still seems like splitting hairs to me though.”

    true, it teeters on splitting hairs, but it is important. your point seems to be that profit margin is irrelevant because of scale, in that a margin of 10% in a billion dollar industry is of greater concern than a margin of 20% in a million dollar industry (as an example only).

    I could, if I wanted, go to the store (or heck, the woods), assemble a random concoction of herbs and vitamins, throw up a website and be in business. I could post a variety of sham testimonials and never even call the FDA. I could charge 40x what it took me to make the “formula” and tie it up nice with a bow promising all sorts of miracles. Kevin Trudeau basically did this but, he is even more clever – he never even delivers the goods, just leads you on a fool’s errand to find them yourself…by paying him first. As mentioned earilier, his only expense is cranking out his infomercials with the hope (and success) that enough will buy his useless book and perhaps even subscribe to his website. I would imagine his margin is pretty insane, as the infomercials are still running.

    What we are talking about here is essentially barriers to entry. It would be much harder for me to develop a drug…for 1000 different reasons, one of which is notably capital.

    so in discussion of margins, it is a useful tool. In this scenario it sheds light on barriers to entry and the potential for any old schmoe to make dishonest money hand over fist with little investment while simultaneously making a pittance compared to competing treatment options from an industry leader/competitor such as a large pharma org.

  38. Scott says:

    Basically you claim to be saying that because the investors are putting less into the product that they are more likely to lie about it. You could make the opposite argument too. That doesn’t make any sense. But maybe I’m missing something.

    Let me try to clarify with an example. Suppose Joe has some money to invest in something, and he’s trying to decide what. One opportunity will provide him with a profit margin of 5% honestly. Another will provide him with a profit margin of 5.5% dishonestly. Unless he’s really unscrupulous, he’ll probably go with the former.

    But if there’s a third option with a profit margin of 200%, which is dishonest, there’s a quite good chance that he’ll go for that one.

    The point I’m trying to make is that the incentives to do something dishonest are a greater if the gains which will be obtained are larger. And for a given individual making a decision how to invest a given amount of money (the usual real-world situation), the profit margin available in an industry is a much better measure of the gains the individual can expect than the profits of a particular company (or even the whole industry) of unknown scale.

    Put yet another way, what’s important to Joe is how much profit Joe can make given the amount of money Joe has to invest. Whether Merck makes profits of $6B or $5B is irrelevant to him, but Merck’s profit margins are relevant because they suggest how much he might be able to make with his money if he invests in pharmaceuticals.

    And for the pedantic, yes, I’m completely and deliberately ignoring the fact that profits most definitively do NOT scale linearly with investment; the key points are clearer that way.

    Or to more directly address your comment, the key point is not that they’re spending less; it’s that they’re making more profit for a given investment. If you fix profit at a constant level, then yes, higher profit margin implies lower investment, but that’s never the real-world situation.

    Moreover, this article mentions that pharmaceutical companies have profit margins of 17%. Other sources I’ve read put it as high as 19%, and that pharmaceuticals are the most profitable industry on the planet, more profitable than oil (where PM are somewhere around 9%). Does CAM really have as high a profit margins as this?

    I wouldn’t be at all surprised if they were 100% or even higher, though I’m not aware of any specific figures. Any statement along the lines of “most profitable industry on the planet” can be pretty much completely discounted. What it really means is “most profitable of the industries I have numbers for, with industries defined in the way used for calculating those numbers.” In most such statistics, CAM would either not be counted at all or would be counted as part of the larger pharmaceutical/health industries. It would be quite unlikely that it was considered separately unless that was the point of the calculation.

  39. Fifi says:

    I think it’s unfortunate that the author put this in such black and white terms and there seems to be some confusion regarding new agey detox diets and the very well documented (by science, thank you very much) pollution of the planet and the effects on the health of all of us animals. It’s, of course, just this conflating of two unrelated things that makes it easy for woo-meisters to sell detox diets to relatively intelligent (if not scientifically literate) people. Most of the more mainstream woo is sold in this way.

    These kinds of false dichotomies help no one nor to they get to the truth or actually support good science. It’s like the fake Big Pharma vs Big sCAM gambit – both Big Pharma and Big sCAM are primarily in business to make money for their owners or shareholders (at an ever increasing percentage), both use corrupted/pseudo-science and lobby the government to avoid consumer safety regulations, neither actually cares about the people they’re selling things to. Industry uses science, it isn’t actually science itself.

    While detox diets are total rubbish and are part of a rather narcissistic and obsessive need to be “pure” (which is as prevalent amongst right wing Protestant Christians as it is amongst bourgeois boomers and new agers, both are equally into woo), pretending all environmental toxins/poisons are “natural” just seems silly. (And, to be realistic, if someone is living off of fast and packaged food and driving everywhere then switching to a healthy diet and getting some exercise will make a big difference to their health and consequently to brain function and mental state.) To make out that anyone concerned about the environment and industry is just anti-industry or anti-science is living in another type of fantasy land (which presumes industrialists aren’t motivated by increasing their bottom line, talk about a naive take on the world!).

    What I’ve noticed with some people into extreme diets (who aren’t genuinely allergic or intolerant to something) is that it’s really a means to control people around them. I’m not talking about vegans or people into special diets who just pack their own lunch – there are plenty of vegans who are just quietly doing their own thing as a personal choice that they don’t impose upon others – I’m talking about people who get mad that others and society don’t bend and conform to their desires and needs. It’s pure narcissism really, as is the desire to be “pure”. To me it seems totally linked into the general weird American obsession with killing germs and sanitary insanity that equates being “good” and “safe” with being clean. The “dangerous world” meme in the US is spread throughout society, the “detox diet” is only one manifestation of it. An even more prevalent one is the total paranoid fear of terrorism and the Other who is out to get America. Germs, terrorists, toxins….all the unseen bad just waiting out there to pounce on Americans to steal away the American way of life and defile the purity of American children!!!!! Oh nooooooooo….it’s really just a fear of death, and life for that matter.

    Of course environmental toxins exist and, in general, industry has proven itself over and over again to wildly disregard public health if there’s a buck to be made. It’s why we have environmental protection laws, to try to force industries to minimize the toxicity of what they emit as by-products of industrial processes. Of course, everyone who drives a car contributes as well, and the vast majority of us by the products made by industry, so we’re all responsible. (Since we’re all on computers, we’re all contributing in one way or the other to both pollution from mining and exploitation of other people.)

  40. Zoe237 says:

    “Or to more directly address your comment, the key point is not that they’re spending less; it’s that they’re making more profit for a given investment. If you fix profit at a constant level, then yes, higher profit margin implies lower investment, but that’s never the real-world situation.”

    Ah, yes, that makes more sense to me. I’m still not sure I agree that it is more relevant than actual profit, but I’ll have to let it go for sake of time. But I do understand the original comment much better.

    Fifi, I do believe I agree with every word you just wrote. I’m not trying to defend CAM at all. I just think the debate is oversimplified by some on both sides.

  41. wales says:

    “Poisons exist, of course, but their existence is hardly a secret, and their actions are well known.” Au contraire, as pointed out in this January 3 Washington Post article.

    http://www.washingtonpost.com/wp-dyn/content/article/2010/01/03/AR2010010302110.html

    “Of the 84,000 chemicals in commercial use in the United States — from flame retardants in furniture to household cleaners — nearly 20 percent are secret, according to the Environmental Protection Agency, their names and physical properties guarded from consumers and virtually all public officials under a little-known federal provision.”

    “Although a number of the roughly 17,000 secret chemicals may be harmless, manufacturers have reported in mandatory notices to the government that many pose a “substantial risk” to public health or the environment. In March, for example, more than half of the 65 “substantial risk” reports filed with the Environmental Protection Agency involved secret chemicals.”

    “Of the secret chemicals, 151 are made in quantities of more than 1 million tons a year and 10 are used specifically in children’s products, according to the EPA. The identities of the chemicals are known to a handful of EPA employees who are legally barred from sharing that information with other federal officials, state health and environmental regulators, foreign governments, emergency responders and the public.”

    “The handful of EPA officials privy to the identity of the chemicals do not have other information that could help them assess the risk, said Lynn Goldman, a former EPA official and a pediatrician and epidemiologist at the Johns Hopkins Bloomberg School of Public Health.”

  42. Eric and Scott,

    Your discussions of the different uses of absolute profit and profit margins are well taken.

    The reason I said that they could be used interchangeably for the purposes of this discussion was that it came up in repsonse to a barely coherent troll by KK commenting on Amy’s statement that “Nothing has a greater profit margin than ‘alternative’ treatments.”

    “Are you kididng? How many alternative medicines cost THOUSANDS PER PILL?”

    Amy is completely correct and KK’s response is a non-sequiteur. If the price of a chemotherapy drug is a thousand dollars and it costs a thousand dollars to deliver it, profit (both margin and absolute) would be low. All the price of an expensive drug tells you is that revenue per dose for that drug is high. For all we know that drug is being sold at a loss. It’s also possible that they have us by the short hairs and we are being charged thousands for a life-saving drug that costs very little to deliver. We would need an understanding of both margin and absolute profit to understand what was really happening. (5% margin with high volume and fast turnover is better than 50% margin with low volume and slow turnover. If I can sell something that costs me $100 for $105, that’s an annual rate of return of 5% on a $100 investment if I sell one a year. If I sell one a week, it’s an annual rate of return of 260%.)

    Correcting KK by emphasising margin over absolute profit is not wrong, but since KK was talking about revenue, not profit, his error was at a more fundamental level.

  43. EricG says:

    fifi – *clap* *clap*

    yea, im on board with that.

    Allison Cummins and Zoe237

    to be completely honest, I lost where the “purpose” of the distinction came in. I merely saw an opportunity to interject that they are in fact different and that distinction could be usefully applied to what we are discussing atm. i ‘spose that gets a bit pedantic at some point.

    what you get into, Allison, I fully concede as important to acknowledge.

  44. windriven says:

    @Zoe

    “Moreover, this article mentions that pharmaceutical companies have profit margins of 17%. Other sources I’ve read put it as high as 19%, and that pharmaceuticals are the most profitable industry on the planet, more profitable than oil (where PM are somewhere around 9%). Does CAM really have as high a profit margins as this?”

    I don’t know where that information came from. I’m a regular investor, always looking for attractive equities – and I don’t own a single pharmaceutical stock right now. It is a very tough business. Later I’ll pull some charts and tell you what the real numbers are.

  45. wales says:

    Here’s some Forbes data on Merck: pre-tax profit margin of 30.6%; after tax profit margin of 22.5%

    http://finapps.forbes.com/finapps/jsp/finance/compinfo/Ratios.jsp?tkr=mrk

    Pfizer after tax profit margin 18.8%….Glaxo 21.8%….

  46. “Here’s some Forbes data on Merck: pre-tax profit margin of 30.6%; after tax profit margin of 22.5%”

    You do realize that Merck is a major purveyor of “alternative” remedies as well as pharmaceuticals, right?

  47. Fifi says:

    “You do realize that Merck is a major purveyor of “alternative” remedies as well as pharmaceuticals, right?”

    Of course they are, which is why Big Pharma vs Big sCAM is about marketing and ideology and not actually about science or medicine. It’s also why it’s so important to have scientific research that isn’t tethered to profit or industry but, instead, is done in the public interest.

    Here in Canada, our disgustingly pro-industry NeoCon PM (not that NeoLiberals are any better really) appointed a chiropractor to be Minister of Science and Technology and appointed a Pfizer exec (who still works for Pfizer) to a body that oversees health research funding. The only ideology at work is political corporatism and finding ways to channel public funds into private pockets. The whole Big Pharma vs Big sCAM thing is merely to distract us plebians – it’s the dog and pony show to distract us while science and any other reality based practice that may interfere with corporate profit is dismantled or co-opted.

  48. wales says:

    Amy, care to break out the profit margins for the various divisions of Merck, Pfizer, Glaxo, etc. (by vaccines, pharmaceuticals, etc.?) Your comment is meaningless if not documented quantitatively.

    Also gotta love the % of sales spent on SG&A v. R&D…

    SG&A R&D

    Merck 32.5% 19.3%
    Pfizer 32.0% 15.6%
    Glaxo 32.1% 14.5%

    Remember that the next time you hear pharma execs whining about how much they spend on R&D.

  49. “care to break out the profit margins for the various divisions of Merck”

    No, that’s YOUR job if you wish to claim that profits come largely from the pharmaceutical division.

  50. wales says:

    Amy, it’s not my “job”. However it is your job to substantiate your claims to maintain credibility. But in the interest of education (always a good cause) I will take the bait. Page 66 of Merck’s 2008 10-K filing with the SEC breaks out profits by division thus for 2008, 2007 and 2006 respectively:

    Pharmaceutical segment profits $12.4 billion, $13.4 billion and $12.5 billion

    Vaccine segment profits $2.8 billion, $2.6 billion and $1.3 billion

    Other segment profits $419 million, $453 million and $381 million

    Pharmaceuticals and vaccines account for 97.4% of profits. Yes those billions are profits, not gross revenues. So it is true that “profits come largely from the pharmaceutical division” as you put it.

  51. wales says:

    My comment (brief, no links) from 5 hours ago appears to be held up for some reason. One point I made was that according to public SEC documents (Merck’s 2008 10-K) the company’s pharmaceutical and vaccines segments accounted for over 95% of revenues and profits. The point is that Merck enjoys both high profit margins and high absolute profits, the overwhelming majority of which are generated by pharmaceuticals and vaccines, regardless of the company’s status as a “purveyor” of alternative health products. Thus, it is correct that “profits come largely from the pharmaceutical division” as Amy phrased it.

  52. Scott says:

    That doesn’t necessarily answer the question, though. Does that filing make clear whether Merck’s sCAM offerings fall under the pharmaceutical division, or are they counted as their own?

    If the latter is demonstrably the case, you’ve proven your point. If not, it’s still open to some question.

  53. rosemary says:

    I assumed that the readers and commenters on this site had actually waded through the muck produced by the supplement industry, the engine that fuels the billion $$$ alt. med industry, However, reading these comments, I suspect that I was wrong.

    Based on my attempts to investigate supplements, I have come to suspect that the industry developed when some very savvy marketers realized that by making health claims they could sell all kinds of garbage at terrific markups. They found products used by what was and may still be called “the lunatic fringe”, things like “natural and homeopathic remedies”. Initially, the marketers used outrageous, insane claims, testimonials and characters to get the attention of a large portion of the public who effectively lobbied the government to give them “freedom of choice” by creating an entire legal category of virtually unregulated products promoted for human consumption.

    Then they started to clean up and water down the outrageous claims to make them sound plausible to the general public, the mass market. Homeopathic remedies were sold next to OTCs in pharmacies giving the erroneous impression that they too were regulated OTCs rather than well shaken water. A supplement like silver was sold in health fraud stores by clerks claiming that it was the “natural” antibiotic granny took to prevent and cure colds and the flu. (A very uneducated public didn’t notice that colds and flu are caused by viruses which antibiotics don’t work against or that granny actually suffered from lots of colds and flu because she didn’t have a remedy that worked against them.)

    In the beginning while demonstrating outside my local health fraud store one of the normally ever so pleasant saleswomen came out to speak with me leaving her “retail smile” behind in the store. I distinctly remember her disgruntled look as she walked back into the establishment in a huff after I told her what damn fools they were, how they were being used by the supplement industry explaining that while they were opening up the market and taking all the hits on the front lines, they were not going to be the ones who made the big bucks. The profits would be made by a few of the little guys, the very few who had the skill to actually develop large profitable businesses, by the drug companies who were probably salivating in the wings at the thought of all they could earn in the unregulated supplement industry, and by other large industries such as those who supply the supplement industry with its raw materials as well as those who produce its “educational” material like books and magazines promoting the stuff.

    As Fifi has pointed out, that has happened.

    I’m really sorry. I just don’t have time to cover this in a comment, but I would strongly suggest that those of you who have not waded through the supplement muck start doing so to educate yourselves. I think if you do, you will stop thinking in terms of drug companies vs. supplement companies and start thinking of regulated vs. unregulated. You will also see the way supplement salesmen use the term “toxin” and how they promote chemo-phobia to sell their “natural” products.

    To give you a general idea of what I’m talking about, I will include a few links on the silver fraud, the one I know best, starting with my own webpage, followed by just a few comments.
    http://rosemaryjacobs.com
    http://www.quackwatch.org/14Legal/hinkson.html
    http://www.justice.gov/opa/pr/2005/January/05_crm_039.htm

    There are several unconfirmed reports of Oz Water causing argyria. This is the site with the claims for its silver supplement as it appears today, after the founder went to jail.
    http://wateroz.jeffotto.com/products/silver.htm

    While Oz may sound extreme, IMO, the only part that really is is the effort by the owner to have 3 federal officers killed. I myself have been threatened and am absolutely certain that at least one of the major silver quacks suffers from a very serious, untreated mental illness. Yet I also know how with his sites, now down, and books, he has fooled a good many intelligent people.

    Regarding supplement profits. From PR Newswire, Dec. 8, 1998, “Clifton Mining Company (OTC-Bulletin Board: CFTN; Alberta: CFB) is pleased to announce that the company obtained the majority interest in American Silver LLC, in a cash transaction, which is a new private company that manufactures and distributes health supplement – colloidal silver products…a perfect fit, multiplying silver values at least 50 fold, and at the same time making a product that many significantly benefit mankind.” It really says 50 fold, not 50%.

    I’m sorry. I don’t have the time to even tell you about American Silver although I do mention it in an FAQ in which I have posted comments from the head of microbiology at BYU.

  54. Calli Arcale says:

    I’m not clear why alt-med offerings by Merck would *not* be counted under the pharmaceutical division. It’s the most logical place, from a business perspective, to put them. It’s not like there’s anything fundamentally different from a manufacturing or business perspective.

  55. Fifi says:

    I think it’s funny that you’re arguing about where Merck’s biggest profits come from when Merck doesn’t care, they just want to profit from selling people things (if they can get the government to mandate their product all the better). Both Big Pharma and Big sCAM lobby governments to try to avoid consumer protection and/or get government money – not based on evidence – both are profit driven and could care less as long as they’re making cash. A drug/treatment has deadly side effects and is recalled? Neither Merck or Guru’s Miracle Tonic care if they lose in court as long as they’ve made more in profit than they paid (or avoided paying) in fines. Really, all these ideological battles are just diversions and a means to suck people into consuming one brand or the other. Or, better yet, to consume both. Ideologues on both sides seem totally blind to the fact that both Big Pharma and Big sCAM are about integration and getting consumers to use both. They BOTH want to get rid of pesky science that’s done in the public interest and get the public to fund their research (which they’ll own the results of, of course, and then sell back to us). It really is entirely irrelevant whether Merck currently makes more selling one product or the other – but keep up the dog and pony show so that no one notices what’s really going on!
    I find it interesting that the focus here is always on Big Pharma and there’s rarely any discussion of generic drugs and their manufacturers (whose interests are often in conflict with Big Pharma’s, they’re not part of the Big Pharma lobbying consortium). It’s not like a drug is better or more appropriate simply because it’s newer and still under patent. Certainly in the case of medications for depression, this is becoming glaringly obvious.

  56. wales says:

    Scott, in the Merck 10-K all $23.5 billion in pharma and vaccine sales are itemized by product name. The remaining “other” revenues are about $400 million. BTW,10-Ks and proxy statements (interesting for executive compensation information) are available for all to read on Merck’s website.

    Calli, never underestimate the amount of obfuscation that occurs (intentional or not) in financial statements. As disclosure documents they often leave much to be desired. Merck lists “other” as “nonreportable human and animal products”. Generally that means they are not a primary source of revenue.

    Fifi, who’s arguing? I am merely stating fact.

  57. Scott says:

    I’m not clear why alt-med offerings by Merck would *not* be counted under the pharmaceutical division. It’s the most logical place, from a business perspective, to put them. It’s not like there’s anything fundamentally different from a manufacturing or business perspective.

    The different regulatory environment, and the different way the products are developed (research & science vs. make it up) would be plausible reasons to separate them. I could honestly see it going either way – and even if I were sufficiently motivated to try and find out, I wouldn’t know where to start.

  58. wales says:

    Calli you said “It’s not like there’s anything fundamentally different from a manufacturing or business perspective.” Really? No difference in manufacturing process for pharmaceutical and herbal products? Not knowing exactly what “alt-med” products are being referred to, I cannot say. The business perspective is also very different. For pharmaceuticals and vaccines Merck has an army of drug reps selling to doctors. For “alt-med” I would assume those are products that just appear on store shelves….what exactly are these alt-med products anyway, by name?

  59. Scott says:

    Scott, in the Merck 10-K all $23.5 billion in pharma and vaccine sales are itemized by product name. The remaining “other” revenues are about $400 million. BTW,10-Ks and proxy statements (interesting for executive compensation information) are available for all to read on Merck’s website.

    We cross-posted, I see, but that does indeed answer the question. I appreciate the information.

  60. Fifi says:

    Wales – “Fifi, who’s arguing? I am merely stating fact.”

    Oh, so the “fact” that you claim you’re stating isn’t to make a point? You’re trying to promote the idea that there’s some kind of big difference between Big Pharma and Big sCAM and only Big Pharma is motivated by greed and only Big Pharma is really making a profit and engages in nefarious business practices. That’s rubbish and the usual gambit of those who pretend that there’s really some huge ethical and practical difference between the two overlapping industries.

    The whole Big sCAM pretense about being oppressed by Big Pharma (and is just some wholesome mom and pop operation, not just more pills/potions being churned out in China) is purely a marketing ploy and aimed at creating astroturf activism as a means to avoid basic consumer protection regulation. You’re trying to propose this is an ideological battle to obscure the fact that Big sCAM is just as nefarious as Big Pharma, lobbies government just as intensely as Big Pharma and ultimately cares as little about peoples’ health and as much about profit as Big Pharma. You’re focusing in on one rather irrelevant detail as a means to distract from the big picture.

  61. Fifi says:

    Wales – “The business perspective is also very different. For pharmaceuticals and vaccines Merck has an army of drug reps selling to doctors. For “alt-med” I would assume those are products that just appear on store shelves….”

    Nice, you “assume” what you want after claiming to be stating “facts”. No, alt med potions and pills don’t just sit on shelves. In the case of alt med there’s just no person between the salesperson and the patient. In the case of medicine, doctors aren’t allowed to sell what they prescribe so they don’t profit from writing a prescription. However alt med practitioners often make a large percentage of their profit from selling the products they’re telling their patients to take. In the case of alt med, the practitioner and the salesperson are often one and the same. All one has to do is look into the incredibly sketchy and misleading practices of a hugely profitable Big sCAM company like Juice+ to see how corrupt and unethical – consciously and calculatedly so – Big sCAM is on a hundred and one levels. Big sCAM uses MLM techniques, practitioners to prescribe and sell their products and astroturf activism so any claims that alt med products “just sit on shelves” is dishonest. For someone who’s claiming to know what they’re talking about you’re either woefully uninformed or pretending to be naive to the reality of how Big sCAM functions.

  62. Fifi says:

    The other big alt med scam is getting people to pay for expensive and useless tests BEFORE they prescribe expensive products or cargo cult treatments. You know, wacky stuff like “chelation” (outside of the true medical usage) to remove “toxins”. It’s no small irony that alt med practitioners in the US and Canada have aggressively lobbied for the right to prescribe pharmaceutical medicines. It really is all about money and getting rid of science in the public interest and universal healthcare (because universal healthcare systems engage in science in the public interest and are naturally not into pseudomedicine, pseudomedicine being much more profitable than real ethical medical care and basic evidence-based preventative medicine that generally comes down to eat well and exercise, not buying and taking the supplements or pills of either Big Pharma or Big sCAM).

  63. Fifi says:

    On a lighter note, I wonder how many people get Botox injections while on detoxification diets (and who drive their SUV to Wholefoods to buy organic supplements). I’m sure the crossover is huge amongst aging Boomers. So much for it really about being about a fear of toxins. It’s really much more about narcissistic “purity” and fear of aging/death for a lot of people into this kind of thing, especially the majority in the mainstream.

  64. wales says:

    Fifi seems to have a habit of attibuting ideas and arguments to others, perhaps she can read minds? I have no axe to grind about “pharma” profits v. “alt-med” profits, my point simply was, if you go back to my original comment, that pharma companies enjoy substantial profit margins and profits. This was in response to earlier commentators who had questioned whether or not the large pharma profit margins they had “heard of” in the 17-19% range were accurate. I posted information showing they are accurate. Then Amy pointed out that Merck was a “major purveyor” of alt-med products (still no named products, what are they?) as if to suggest that segment of the business was a major source of Merck’s profits (actually Amy did not explain the reason for her comment, so I can only guess about the intention). I pointed out that is not true. Fifi seems to be generalizing about “alt-med” products, while the topic was Merck’s “alt-med” products in particular. Not knowing what those products are for Merck, I have no clue about what the selling arrangements are via “alt-med” practitioners v. health food stores v. Walmart.

  65. Calli Arcale says:

    wales:

    It’s not that I don’t think numbers can be obfuscated; I just don’t know why Merck would have any reason to do so.

    Calli you said “It’s not like there’s anything fundamentally different from a manufacturing or business perspective.” Really? No difference in manufacturing process for pharmaceutical and herbal products?

    Apart from the approval process that happens at the beginning for something legally defined as a drug, no, there’s no real difference. Oh, the specifics are different, like how the particular substance is purified and what binding agents are used, etc, but the equipment is all pretty much the same. Claritin (which I use, though I prefer the generics for obvious cost reasons) is one of their products. It’s sold as a small tablet. The same basic technology can be used to make a vitamin tablet. The FDA does actually inspect facilities for non-drug products such as vitamins and herbal remedies, but there it’s more a question of assuring safe manufacturing practices than anything else, and they do that same sort of inspection for facilities making drugs as well. (Note: the FDA has been criticized for not doing a good enough job of this, which is mainly a funding problem.)

    And the business side is pretty much the same too, though for non-drug items, they don’t have to go through quite as many regulatory hoops. Once development is over and it goes into production, it’s basically the same, though there are different restrictions for the marketing side.

    You were curious about what they make. I did find a list on their website, but haven’t yet read through it. (Skimmed it briefly.) It doesn’t appear to say which business unit is responsible for which product, though. That information may be available elsewhere, though they may obfuscate their internal organization for the purposes of frustrating information thieves. (The target of such thieves would mostly be pricing information and marketing strategies, which would be useful to competitors.) A few random examples:

    Claritin (pharmaceutical)
    Dr Scholl’s (non-drug, non-medical device, AFAIK)
    MMR II (vaccination)
    Coppertone (probably classed as a cosmetic)

    The vast majority of their business is straight-up pharmaceuticals, though.

    I was a bit surprised to see that they have a product called ANTIVENIN (it’s black widow antivenin) which is a registered trademark. They’ve seriously registered “antivenin” as a trademark. *shakes head* That’s silly.

    Looks like most of the supplements they manufacture are not for human consumption, but for animals; they have a line of various supplements for livestock, some injected but most intended to be added to feed. Most “alternative” product I saw in a casual perusal was the Dr Scholl’s line. It’s not a drug, nor a medical device — just a line of shoe inserts. If you believe the advertising, they’re better than Valium. :-D

  66. Fifi says:

    No Wales, you’re focusing in on the detail of where Merck makes the most profit to distract from the fact that both Big Pharma and Big sCAM make huge profits. You want to focus on and argue a largely irrelevant detail to distract from and avoid discussing the big picture. Plus you’re making assumptions and assertions about alt med products – which certainly aren’t just herbs like you naively/dishonestly make out – while claiming to be presenting “just presenting facts”.

  67. Calli Arcale says:

    Oh, forgot the link:
    http://www.merck.com/product/home.html

    When I get time later, I’m going to look at the product lines of some other big pharmaceutical companies, because I’m curious which ones are players in the supplement business. Bayer’s gotta be up on the list; they’re the ones who make the highly successful “One-A-Day” series. (Of course, working out Bayer’s profit margin from that may be difficult. They aren’t so heavily focused on pharmaceuticals, having been a fairly diversified chemicals manufacturing company from the get-go.)

  68. wales says:

    Fifi, since you make several inaccurate assumptions about my “dishonest” intentions to “distract” (distract from what I have no idea, the topic of this thread for considerable length of time was profit margins and absolute profits). If you are convinced of my dubious motives, why respond to my comments? Best to leave it to the intelligent reader to extract valuable information, rather than assign unknown motives to others. What your motives are I can only guess, therefore I will not express my intuitions here as my opinions about your motives are worthless to others. Digressions based upon personal feelings (yours included) are not very educational.

  69. wales says:

    Calli, thanks. I don’t know what the rationale would be for intentional obfuscation, either, and I didn’t claim that’s what Merck was doing. I too have perused the Merck site for “alt-med” products and could not find any. I am well aware of Merck’s pharma and vaccine product lines from reading the financials. I agree with you that the closest thing to “alt-med” is the Dr. Sholl’s foot pads. Funny to think of that (or sunscreen) as “alt-med”. You make a comment on Bayer’s “One-a’day” vitamins I believe? Are you including vitamin supplements in the “alt-med” category? If so, I had better reprimand my physician for recommending vitamine supplements to me.

  70. wales says:

    Fifi, you make several inaccurate and disparaging assumptions about my “dishonest” intentions to “distract” (distract from what I have no idea, the topic of this thread for a considerable length of time was profit margins and absolute profits). If you are convinced of my dubious motives, why respond to my comments? Best to leave it to the intelligent reader to extract valuable information, rather than assign unknown motives to others. What your motives are I can only guess, therefore I will not express my intuitions here as my opinions about your motives are worthless to others. Digressions based upon personal feelings (yours included) are not very educational.

  71. Zoe237 says:

    I am also curious to what alternative medicine Merck engages in. I wouldn’t count Dr. Scholl’s. I have heard this claim several places, but never any examples.

    My 17-19% profit margin came from the Time magazine article I linked to. I could have looked at Forbes or Fortune 500, but ran out of time. The point is that it was consistent with what I’d read in the past. Thanks Wales, for more recent numbers. I still haven’t seen any profit margins for alt med, even though people keep claiming how insidious they are. I’m guessing that the numbers aren’t readily available.

    There was also an AP article today stating the Americans had spent 2.2 trillion on healthcare in 2008, or $7000 something /person. I also would be curious to know if this includes alternative health care.

    The number of people engaging in alt medicine, and the amount of money being wasted, is highly relevant because it dictates how much attention skeptics should devote to the topic. If one person spent one dollar on a supplement in 2009, nobody should care. I realize that it’s lots more, but I suspect that people who go to chiros are just a lot easier to scorn than people taking lipitor or whatever. That’s the whole point of many skeptics- drawing the line between science and pseudoscience. Obviously there is a false dichotomy there, Michael Shermer (editor of Skeptic mag) in his book “The Borderlands of SCience” puts chiro and acupuncture in the “bordelands” rather than outright pseudoscience category (with astrology and creationism).

    And are things like prenatal vitamins considered supplements and alternative medicine? It would be interesting what is altie, what is conventional, and what is integrative (and why some are so opposed to the latter).

  72. Scott says:

    Are you including vitamin supplements in the “alt-med” category? If so, I had better reprimand my physician for recommending vitamine supplements to me.

    Depends on the purpose, I’d say. Taking supplements for an established deficiency (e.g. iron for anemia) definitely isn’t CAM. Supplements for known important nutrients, for which deficiency is common, in amounts similar to the RDA, I’d also put on the side of science-based. (Though inferior in both cases to improved diet, presuming that is feasible.)

    Massive doses of vitamin C to cure cancer, or anything along those lines, absolutely CAM.

  73. Karmakaze says:

    @Harriet Hall

    “But first, how about you tell us how many lives are saved by alternative medical care each year.”

    Why? I am not defending alternative medical care. I am simply saying this is a case of the pot calling the kettle black. For every case of a ‘quack’ or ‘charlatan’ selling ‘snake oil’, I can come up with a ‘doctor’ selling ‘medicine’ that is every bit as fraudulent (anti-shyness drugs anyone?) or dangerous, and often a hell of a lot more expensive.

    It’s not ME saying that 40 to 90 thousand people are killed by their doctors or medicines each year in the US. I’m just pointing that out and saying THIS MD is not only totally wrong about her “toxins are imaginary’ claim, but that she belongs to a profession that seems far worse than any ‘snake-oil’ salesman.

    “Alternative medicine is distinguished from scientific medicine by the fact that it hasn’t been proven to work.”

    Was Vioxx proven to work? A pain and anti-inflamatory drug, that never saved a single life, killed possibly 20 thousand people in 5 years according to the FDA.

    “Mainstream medicine saves lives and has a risk/benefit ratio; alternative medicine doesn’t.”

    Oh? How sure are you of this? Did you carry out your own studies, or did you rely on the drug companies to tell you? Remember, the FDA is there to protect the pharmaceutical industry, not you, otherwise Vioxx would never have been approved.

    -

    @David Gorski

    “Of course, KK conveniently forgets to mention that thalidomide was never approved in the U.S. as a morning after pill.”

    Decided not to talk to me any more?

    “In the case of thalidomide, the FDA approval process worked fairly well. At least it worked better than the process did in several other countries.”

    You mean drug companies might sell their killer medicines to people not protected by a first world legal system in order to profit, regardless of human misery? Funny that.

    -

    “Actually, now you come across as your garden variety Mike Adams-style “critic” who’s simply hostile to and suspicious of scientific medicine in general and big pharma in particular.”

    Oops. Wrong again. I have been DEFENDING science based medicine – what YOU call ‘science-based medicine’ is actually corporate-profit-based medicine. There is a big difference.

    “You may think your “critiques” are brilliant or novel, but your ilk is nothing we haven’t seen here many, many times before.”

    My “ilk”?

    Funny that the ONLY answer you have for my arguments is “well the FDA didn’t approve Thalidomide” while forgetting they did nothing to stop its sale, and vague ad hominem arguments that my “ilk” somehow makes me ‘bad’.

    -

    “If you don’t already understand why using the term “retard” the way you did as an insult is offensive,”

    Do you often have trouble following simple concepts? What I was saying is that *I* don’t find the word offensive, but what *I* think about it is not important. Likewise the fact YOU don’t find “charlatan” or “quack” or “woo woo” offensive is meaningless.

    I was simply doing what YOU do.

    “Simply don’t use it again.”

    I didn’t, YOU did.

    “Whine about the warning all you want”

    I wasn’t whining, I was simply pointing out that the word provoked a strong reaction – sort of like being called a “charlatan” provokes strong reactions. Now you’re getting upset about me pointing out that you leaped straight to the threats rather than even trying to ask me not to do it.

    “We’re pretty lax in what we permit, but we do have limits, and, yes, as editor I get to decide in consultation with Steve Novella when a commenter has crossed the line.”

    Well, except for swearing and certain offensive words… and well any disagreement with YOUR idea of “science-based” medicine.

    “Don’t like it? You can go elsewhere.”

    I believe I already agreed not to do it… why the need to threaten me again?

    “Actually, it’s not true that Vioxx didn’t benefit many patients. Even Dr. Eric Topol, the strongest detractor of Merck and Vioxx, concedes that Vioxx was a useful drug and helped a lot of people.”

    Oh yeah, it reduced their inflamation and pain… it just KILLED THEM.

    “I was surprised to read Topol quoted as saying flatly that Vioxx should not have been taken off the market. In his opinion there should have been issued a black box warning regarding patients with diabetes or preexisting cardiovascular disease.”

    Well, he may have had a problem with the drug, but he was still part of the club…

    Let’s put it this way – was there no other way to reduce pain and inflamation WITHOUT kiling patients? Or was this just the most profitable way?

    “In reality, Vioxx was a pretty good drug except for patients who fell into a couple of high risk categories.”

    Which it killed.

    “The idiocy of Merck’s leaders in trying to cover up these categories was an enormous self-inflicted wound from which Merck may never fully recover.”

    The same idiocy that seems to be repeated every few years, and is not prevented in the slightest by “science-based medicine” or the FDA (and other govt. organisations around the world).

    As I said, Vioxx is a recent, but it is a LONG way from being the ONLY such scandal.

    @Amy Tuteur, MD

    “No, that’s not what I am saying. Some people will get better if nothing is done for reasons we might or might not understand. Treatments are tested against placebo to judge the true effect of the treatment.”

    Did you even bother to read any of the links I sent?

    “In a study last year, Harvard Medical School researcher Ted Kaptchuk devised a clever strategy for testing his volunteers’ response to varying levels of therapeutic ritual. The study focused on irritable bowel syndrome, a painful disorder that costs more than $40 billion a year worldwide to treat. First the volunteers were placed randomly in one of three groups. One group was simply put on a waiting list; researchers know that some patients get better just because they sign up for a trial. Another group received placebo treatment from a clinician who declined to engage in small talk. Volunteers in the third group got the same sham treatment from a clinician who asked them questions about symptoms, outlined the causes of IBS, and displayed optimism about their condition.

    Not surprisingly, the health of those in the third group improved most. In fact, just by participating in the trial, volunteers in this high-interaction group got as much relief as did people taking the two leading prescription drugs for IBS. And the benefits of their bogus treatment persisted for weeks afterward, contrary to the belief—widespread in the pharmaceutical industry—that the placebo response is short-lived.”

    http://www.wired.com/medtech/drugs/magazine/17-09/ff_placebo_effect?currentPage=all

    Tell me, how did THAT happen if the placebo effect wasn’t a REAL effect? Surely all three groups should have shown the same (lack of) response?

    Did you also notice that a placebo plus some encouraging words did better than the TWO leading prescription medicines? How did THEY pass FDA approval?

    “In the case of a randomized controlled double blind study, no one is deliberately lying to the patient, since the doctor doesn’t know what the patient is getting, either.”

    Ah, I see. Your objection is the “lie”. Of course Vioxx came with a lie too – that it was safe. And it ISN’T a lie to give a sugar pill and say “this may help ease your pain” when we know that it MAY. Think of it this way: if you are harnessing the body’s natural ability to ‘heal’, whether it is with a chemical, or a ‘lie’, you are still providing health care… are you not?

    “I can’t imagine anything more likely to destroy the doctor-patient relationship than encouraging doctors to lie to patients “for their own good.””

    You mean like when a doctor doesn’t tell an accident patient that they are likely to die? Is that kind of lie ok?

    But let’s say I agree with you. I was not talking about the placebo effect as an alternative to other pharmaceuticals. I was saying the placebo effect is ALREADY a part of pharmaceuticals. Most of the world has come to believe that a doctor with a drug can cure them (even if it turns out the drug did nothing more than placebo, as in the quote above).

    So many if not most of them WILL be cured, even if the drug does NOTHING. The belief of the patient is what is key. If I don’t believe you can help me, it will be far harder for you to help me, even with all the drugs in the world. On the flip side, if I think some herbal remedy will help me, it is likely that it will.

    “Moreover, you haven’t explained why quacks and charlatans should profit by deliberately lying to patients about the efficacy of their “treatments.””

    Vioxx: tell me that there were no deliberate lies told simply to protect the profits of Merck…

    And don’t even get me started on the fake diseases that have been invented just so that another drug can be sold for extortionate prices…

    The pharmaceutical industry is telling us that we are sick, even if we aren’t, and then saying they have the remedy to make us better…

    And you say they are better than “snake oil” salesmen?

    “It is difficult for me to imagine a legitimate reason to reward entrepreneurs for lying.”

    OK seriously. Have you paid ANY attention to the pharmaceutical industry lately?

    Drugs to cure shyness for ****’s sake! Need I say more? By the way, there is a natural remedy for that… it’s called “beer”. And its a lot cheaper I bet! Probably safer too…

    “I said profit margin, not profit.”

    Oh? I see. As long as they spend billions bribing the FDA… err I mean getting approval from the FDA, then their profits are ok… even if the end result is the patient pays a lot more for treatment that is often no better or even worse than doing nothing?

    Makes sense!

    “How much money goes into research and development of an alternative “treatment”? Zero dollars.”

    How do you know? Seriosuly, you think these poeple just grab some random ingredient and say “oh a new cancer drug”? Bull.

    “Zero dollars, since treatments are marketed whether they work or not.”

    Anti-shyness drugs… Oh and those prescription medicines that did no better than the placebo in the quote above, that was in the link I gave, and that you seem to have not read.

    “When it comes to alternative “treatments” only a minimal amount of money is invested and the returns are pure profit.”

    Once again, it’s all well and good to make that CLAIM, but when you put it up against say Vioxx, then all I see is a company that paid billions to bribe the FDA, and then made billions killing people… until enough people had died to FORCE the FDA to act… but oh wait, they didn’t – Vioxx was withdrawn voluntarily by the company – so if they hadn’t been confronted by people like me, they would STILL be killing people.

    Remember how the FDA refused thalidomide because it was worried about how safe it was – half a century later, now the FDA doesn’t even force a drug off the market that even the manufacturer recognises is dangerous. Funny that.

    -

    @Alison Cummins

    I was going to let that pass, because the MD doesn’t claim to be a businessman – but yes, profit and profit margin are the same thing – except one refers to the difference between the cost of a product and the expected proft… and the other is the profit.

    “What our agitated KK is lathering on about is the revenue.”

    No, no, no. I am not a … oops almost… I know the difference between profit and revenue. In the 90′s, the pharmacuetical industy was MORE PROFITABLE than the Oil industry – its revenue was nowhere near though. As an example, this article claims that pharmaceuticals have an estimated 157 billion in sales:

    http://www.pharmaceutical-technology.com/features/feature2086/

    While this report to congress estimates ExxonMobil alone as having a revenue of 400 billion…

    http://docs.google.com/viewer?a=v&q=cache:8dTm1QB90esJ:fpc.state.gov/documents/organization/103679.pdf+oil+industry+revenue+90%27s&hl=en&gl=nz&pid=bl&srcid=ADGEESgh3_qgZ4i4GsUujrD0bTPBnNp2fpaig87vuLnQ0SrONMRe0hs2UWwIeVxqYbNZytJ_s7YlbLXzOwvo00LMK1VvUtEP-fmIlEI-UhJ8aeLa6Sr-AB5XjocwuN_grvKRFbDzJPww&sig=AHIEtbQcZ6oF4nwxkKYPNhNP8fcDpZpCTQ

    The difference in revenue is truly vast – but the profit margins were such that drug companies made more per dollar spent than even the oil companies…

    But thanks for trying to correct an error you THOUGHT I made (and trying to turn it into an insult…)

    -

    @David Gorski

    “Nice bit of pedantry there, but mea culpa for a brain fart.”

    Wow. You really don’t like even a HINT of criticism, do you? Alison Cummins was trying to protect you from me having a go at your error, and you attack her?

    -

    @Alison Cummins

    “I repeat that the brain fart doesn’t take away from your point that the FDA works.”

    Oh really? Merck thought Vioxx was bad enough for them to throw away all their R&D (or they had already profited enough) that THEY took Vioxx off the market… but the FDA did nothing. Except a few studies to estimate how many people died from their lack of oversight…

    -

    @rosemary

    “Most investors will not invest in something speculative with any potential profits a long way off unless they hope that the return will be worth the risk and the wait.”

    In the 90′s at least Pharmaceuticals were more profitable (not higher revenue by a long margin) than oil according to the Wired article I linked. For example, Vioxx was on the market for only 5 years and is expected to end up costing the company billions, yet the CEO saw it as nothing more than a severe blip rather than a company threatening liability.

    Now, to highlight just how iffy this ‘business’ is, here are some quotes from a recent WSJ article:

    “Both companies reported a decline in sales for their cholesterol-drug joint venture, which continues to be under pressure because of clinical studies last year that raised questions about the safety and effectiveness of Vytorin and Zetia.”

    “Merck’s biggest product, allergy and asthma medication Singulair, posted sales growth of 5% to $1.09 billion, continuing a rebound that picked up in the second quarter. Last year, sales were under pressure partly from safety concerns prompted by U.S. regulatory alerts.”

    http://online.wsj.com/article/SB10001424052748704224004574488881670601574.html

    Notice how this company alone has at least two questionable medicines on the market that it is still profitting from.

    Further to my claim about profit, I found this post:

    http://everydayecon.wordpress.com/2006/04/26/oil-profit-margins-vs-other-industries/

    where you can see a graph attributed to Business Week and Oil Daily. In that graph pharmaceuticals and biotech are listed with a >19% profit margin (19 cents profit per dollar of sales). To put that in perspective Oil & Gas is just over 8% and even banking only hits 18%!

    More profitable than banking – the industry that actually DOES have a ‘license to print money’? Really?

    “(Hey, Joe, ya got some space in ya garage I can rent? I wanna mix up a bunch of weeds. My wife doesn’t like the smell in her kitchen.)”

    There is a company in my town that manufactures alternative medicines like homeopathic remedies. I have been into that factory (in a previous life I was a commercial cleaner specialising in special jobs – such as disinfecting surgical theatres etc) and I can tell you that company was every bit as high tech and sanitary as any pharmaceutical factory.

    You lot always have to add a lie to put your point across, don’t you?

    “My guess is that most of their investment goes into marketing, lobbying and packaging, but mostly marketing.”

    LOL, you want to talk about marketing and lobbying? I’ve seen docotrs that are offered free tropical holidays for prescribing a certain amount of a company’s drug (I actually read the brochure in my doctors office) – the interesting part, is they were trying to push OFF LABEL prescriptions of this drug for ailments for which the drug wasn’t specifically approved. It was clear from the wording that the only thing the company cared about was volume, not effectiveness.

    “Furthermore, given the present legal climate, their risks, unlike those of drug companies, are miniscule.”

    Oh, you can’t sue alternative medical companies? I mean you can’t be talking about the lap-dog FDA, so you must be refering to the potential for lawsuits…

    “supplement companies are unregulated and often get away with murder, and I don’t mean that figuratively speaking either.”

    Ok. Give us ONE example of an alternative medicine that killed 14 people a day in the FDA’s estimation, that didn’t result in criminal charges.

    I’ve given Vioxx. What do you have that comes even CLOSE, to that?

    -

    @Zoe237

    “I believe the studies showed a risk factor for more than just those with prior history of heart disease.”

    It is my understanding that the risk factor that caused the removal of the drug was the greatly enhanced risk of heart attack in long term users (18 months or more) – the kind of users drug companies love…

    Notice, that it was only studies done AFTER the approval that showed this, seeming to imply that it was never even tested as a long-term medication!

    “(not that I think the solution is to abandon modern medicine or trust quacks)”

    I never said, or intended to imply that. All I am saying is that these claims about how dangerous alternative medicines are have to be put up against how dangerous ‘normal’ medicince can be, that the mechanisims people like this MD say protect us in the ‘normal; health industry don’t, that pharmaceuticals are HIGHLY profitable, and it is seeming more and more that drugs we thought were actually doing something turn out to be no better than placebo – an effect that works whether you’re talking about Vioxx or ‘snake oil’.

    “And actually, I’ve seen this [phrase] before on SBM. As long as you are honest about it, is there a harm?”

    The question is, are you being DISHONEST when you say a placebo will help a patient. Do doctors tell patients what the active ingredient of Vioxx is and how it works? No. They say “Here, take this Vioxx, it will help you.” How is that any different from saying “Here take this hensbane, it will help you.”? Of course the MD will jump in and say that the FDA made sure there was an active ingredient – but what if the active ingredient is the patients own brain chemistry and the influence the patients state of mind has on it?

    -

    @Scott

    You of course made up the ‘costs’ to illustrate your point. Do you REALLY think it cost OVER HALF A TRILLION DOLLARS to develop Vioxx? Seriously?

    I showed a source for my claim, and it suggests that Vioxx would have cost around 5 billion dollars to develop (if its profit margin was the industry standard).

    I quantified my claim (and supported it with a source) that pharmaceuticals are highly profitable (>19%, better than banking!) does anyone care to show the profit margins for any alternative medicines?

    After all you (not you specifically, in general) have made a positive claim that alternative medicines are FAR more profitable. Where are the figures? Or are you just making that claim up?

    “If you wanted to address simply “which industry is bigger”, profit would be a not unreasonable measure. But for the question “who has more incentive to peddle snake oil”, profit MARGIN is the proper thing to look at.”

    Yes. So why haven’t you? You simply claim alternative medicines are more profitable, without even a scintilla of evidence…

    -

    “The point I’m trying to make is that the incentives to do something dishonest are a greater if the gains which will be obtained are larger.”

    Yes, I get your point. You have a valid argument… but is it TRUE? Have you ANY evidence AT ALL, that alternative medicines are more profitable (higher profit margin)?

    “Any statement along the lines of “most profitable industry on the planet” can be pretty much completely discounted. ”

    Are you kidding?????

    You make a claim without any evidence, then simply “discount” a claim that is SUPPORTED BY EVIDENCE?

    How skeptical of you…

    “It would be quite unlikely that it was considered separately unless that was the point of the calculation.”

    So you won’t even bother trying to support your claim with evidence?

    -

    @Alison Cummins

    “The reason I said that they could be used interchangeably for the purposes of this discussion was that it came up in repsonse to a barely coherent troll by KK commenting on Amy’s statement that “Nothing has a greater profit margin than ‘alternative’ treatments.””

    Troll? Barely coherent? So far, I am the ONLY person to provide ANY evidence for his/her claims. *I* am a troll? Man you lot make me laugh! (I notice that a couple of newer posts include evidence… all supporting my claims.)

    >19% is the profit margin for pharmaceuticals and biotech – care to support your (or the MD’s) claim with ANY EVIDENCE???

    “Amy is completely correct and KK’s response is a non-sequiteur. If the price of a chemotherapy drug is a thousand dollars and it costs a thousand dollars to deliver it, profit (both margin and absolute) would be low.”

    No, Amy’s point is NOT correct. She made an unsupported claim (that the profit margin was higher for alternative medicines) in response to my question. I did not make myself perfectly clear that I was talking about the cost to the consumer. However, I have since checked her claim and found that pharmaceuticals are more profitable than oil and even banking. Where is her (or your) evidence that alternative medicines are more profitable?

    I can make claims all day, and you won’t accept them unless I can provide evidence – so why should I accept hers (yours) without evidence?

    “All the price of an expensive drug tells you is that revenue per dose for that drug is high.”

    Unless we know the profit margin, which I have shown is said to be higher than banking at around 19%.

    So, to support your argument, care to show what the profit margin on alternative medicines is? Or do you not want to quantify your claim so we can actually compare and contrast and see if your claim has any merit?

    “Correcting KK by emphasising margin over absolute profit is not wrong, but since KK was talking about revenue, not profit, his error was at a more fundamental level.”

    True, emphasising margin isn’t wrong… now I’ve shown my figures… where’s yours?

    I am not the one making the positive claim (that one is more profitable than the other), I am being SKEPTICAL of the claim, and asking for evidence. ANY evidence. So far not one of you has done it. All you do is keep repeating the same claim that as far as I can see is total bull.

    Also, consider this – profit margin doesn’t actually take account of the true costs. The profit margin may have been 100% or 1% on Vioxx.. but over 20 thousand people died according to the FDA. Can you put a price on the deaths of 20 thousand people? Sure we can include the legal costs, but even that doesn’t represent a TRUE picture of the cost to humanity in general and the patients in particular.

    Those 20 thousand people will never get a dime of any legal pay out – they are dead – and all because a drug that was unecessary and was rushed through FDA approval (no studies of long term use?) and was highly profitable. The CEO of Merck was particualrly galling when he answered questions about the damage it would cause to Merck’s share prices – basically that it was a blip and that the company would not suffer in the long term… and TWENTY THOUSAND DEAD PEOPLE rolled in their graves…

    -

    @Amy Tuteur, MD

    “You do realize that Merck is a major purveyor of “alternative” remedies as well as pharmaceuticals, right?”

    WTF? Now YOU are criticising the pharmaceutical companies? And wait! I thought alternative medicines were cooked up in people’s garages from weeds?

    Will you lot stick to one story?

    -

    “No, that’s YOUR job if you wish to claim that profits come largely from the pharmaceutical division.”

    Ok, so why not support YOUR claim that alternative medicines are more profitable? YOU made it, support it! I and others have given figures WE found. But you have not even TRIED. Why is that?

    (nice one wales, by the way!)

    -

    @Calli Arcale

    “It’s not like there’s anything fundamentally different from a manufacturing or business perspective.”

    Hang on! We’ve been told that there IS a significant business difference – that alternative medicines COST more to manufacture and are thus LESS PROFITABLE. Surely, if that was the case, Merck would shut down its pharmaceutical manufacturing and stick to alternative remedies? After all they are trying to maximise profit, aren’t they?

    -

    @Fifi

    “In the case of medicine, doctors aren’t allowed to sell what they prescribe so they don’t profit from writing a prescription.”

    Not true at all. Have you never seen any of the ‘incentive’ programs the pharmaceutical comapnies offer doctors? Like free holidays etc…

    -

    One last thing: I noticed the MD did not TOUCH my question regarding her interest in pharmaceuticals.

    I’ll ask again – does she care to declare that she has NO FINANCIAL INTEREST in the industry she is trying to defend? It seems to me that this would be an important piece of information (after all SHE claims the profit motive is strong enough to overcome humanity in the alternative medical industry…), of course as a doctor she does have a financial interest in medicine in general… but what about pharmaceuticals in particular?

    I will declare right now that I have no financial interest in either industry.

  74. wales says:

    Zoe makes some good points. Interesting what Shermer’s take is on chiro and acupuncture. As a political libertarian perhaps he would agree that the consumer’s freedom of informed choice is important in a “free” society.

  75. wales says:

    Still waiting for Fifi and Amy, who are both certain that Merck is a “major purveyor of altenative remedies” to enlighten us with specific product information…….

  76. Calli Arcale says:

    wales:

    Calli, thanks. I don’t know what the rationale would be for intentional obfuscation, either, and I didn’t claim that’s what Merck was doing. I too have perused the Merck site for “alt-med” products and could not find any. I am well aware of Merck’s pharma and vaccine product lines from reading the financials. I agree with you that the closest thing to “alt-med” is the Dr. Sholl’s foot pads. Funny to think of that (or sunscreen) as “alt-med”. You make a comment on Bayer’s “One-a’day” vitamins I believe? Are you including vitamin supplements in the “alt-med” category? If so, I had better reprimand my physician for recommending vitamine supplements to me.

    Well, that’s just it — define “alt-med”. I dislike the term largely because it’s too vague. When we’re talking the distinction between drugs and non-drugs, I prefer to use the legal distinction between the two, which is basically how the FDA decides to regulate them. If a medical claim is made, it is considered a drug (or a medical device, if it’s a thing rather than a substance). If not, it’s not a drug (by the legal definition).

    One-A-Day falls in the “non-drug” category. It is regulated as a dietary supplement. (Also, quite a few questionable* claims are made for it, though Bayer is careful to keep them “structure function” claims. For instance, I’ve seen them push Men’s One-a-Day for “prostate health”.) Truthfully, that’s the logical place for it — but that’s also the category for stuff like St John’s Wort, and it allows them certain liberties in the marketing department.

    Of course, just because something’s a drug doesn’t mean it’s not “alternative medicine” (or at least not science-based medicine). Bayer, and other aspirin makers, has also been known to make questionable claims about aspirin, which *is* regulated as a drug. And we’ve discussed elsewhere the propensity of big pharma companies to encourage doctors to prescribe offlabel, which is often not science-based either. So it’s probably impossible to say how much these companies profit from alternative medicine, in large part because the term is so nebulous.

    *I say “questionable” because it raises the question of whether these claims have been proven, since there’s little evidence provided. They *might* work, but the manufacturers haven’t attempted to prove it adequately to allow them to make the claim directly (so instead they hint at it).

  77. Calli Arcale says:

    Karmakaze:

    “It’s not like there’s anything fundamentally different from a manufacturing or business perspective.”

    Hang on! We’ve been told that there IS a significant business difference – that alternative medicines COST more to manufacture and are thus LESS PROFITABLE. Surely, if that was the case, Merck would shut down its pharmaceutical manufacturing and stick to alternative remedies? After all they are trying to maximise profit, aren’t they?

    It’s not as simple as that. For most remedies, the manufacturing methods are basically the same, not counting isolation of the active ingredient(s). And for herbal remedies, that latter has a fair bit in common with food processing, so it’s not really exotic technology.

    The real differences are in marketing. Getting FDA approval opens up huge new areas. You can really say “this product treats this condition” and not get busted. Insurers are more likely to pay for it, especially if it’s prescription-only. Patients are more likely to think they actually need it, rather than just want it. And so on. With supplements, you have to restrict yourself to wishy-washy “structure function” claims and suggestively waggling eyebrows. Doctors will be more skeptical. Insurers will likely refuse to pay, since it’s OTC, or at least make a big stink about it. What’s more, the public generally tends to regard them as less potent (rightly or wrongly) than “real” medicine.

    Pharmaceuticals represent a big risk for a big payoff. The development costs are huge, though the production costs usually are not. Supplements don’t usually have as much of a payoff, but they also have less risk. A lot of companies will specialize in one or the other, optimizing their business model for high or low risk, and others will dilute the risk by doing a bit of each. Of course, be wary of generalizations — it is certainly possible to get very large profit margins from a dietary supplement while someone else gets very low profit margins from a pharmaceutical.

  78. Fifi says:

    Wales – You’ll get no argument from me that Big Pharma is corrupt and out to make money, I’ve been saying that all along. My argument with you is your slippery and faux naive assertions (alt med = herbs…wrong, you “assume” that there’s no marketing of vitamins and supplements…wrong, etc) and dishonest claim to be just reporting “facts” (when you’re “assuming” and so on).

    I’m saying it’s the nature of industry to put profit first, you’re trying to make out that it’s only the industry you have a bias against that does this and that Big sCAM is all herbs, no marketing and innocence and light. Merck is only one of many pharmaceutical companies, it’s very common for companies that make pharmaceuticals to also make vitamins and supplements, as well as other industrial ingredients.

    Merck buys French vitamin producer
    http://www.nutraingredients.com/Industry/Merck-buys-French-vitamin-producer

    http://www.merck.co.in/en/company/merck_in_india/merck_ltd_india/merck_ltd_india.html
    Major products – Pharmaceuticals Vitamins, Nutritional supplements, Cardiovascular Diseases, Respiratory, Hematinics, Cough & Cold, Anti-malarial, Non-Steroidal Anti-inflammatory Drugs (NSAID), Antibiotics, Oral Rehydration Salts and Encephalotropics

    And then there was that big legal fuss back in 2001 for price fixing on vitamins by pharmaceutical companies…

    http://findarticles.com/p/articles/mi_m0999/is_7324_323/ai_n27572491/
    http://www.quackwatch.org/02ConsumerProtection/rochefine.html

  79. wales says:

    Fifi this is the last comment I have for you. When I am stating facts I state them and supply supporting documentation. When I am assuming or guessing about something I announce that fact too. Read through my comments, they are consistent in that regard. That is not dishonest.

    You however assume far too much about the accuracy of your pseudo-psychological analyses and mistakenly state your assumptions and personal prejudices as fact. Is that honest? A bit of parting advice: your credibility would be enhanced greatly by omitting the colorful adjectives like “slippery” and “faux naive”. Good luck.

  80. Karmakaze says:

    @Calli Arcale

    Thanks for the reasonable post. :)

    “it is certainly possible to get very large profit margins from a dietary supplement while someone else gets very low profit margins from a pharmaceutical.”

    Oh yes indeed!, It is ALSO possible that the profit margins from pharmaceuticals are higher than supplements (people will pay more for a ‘real’ drug, so greater margins could be built in). So the question is, which of the two possibilities is correct (at least in general).

    I and others have given figures we found to support our contention that pharmceuticals have phenomenal margins (better than banking), but all we get from the other camp is the same unsupported assertion repeated over and over again, and then one of them even told one of us that WE had to go find HER evidence.

    Seriously? Is that what passes for ‘science-based’ debate around here?

    I am still waiting fo the MD to support that contention, and to declare she has no financial interest in pharmaceuticals.

    I have a feeling I’ll be waiting a LONG time.

  81. BillyJoe says:

    Kamakaze,

    “WTF? Now YOU are criticising the pharmaceutical companies?”

    Why not?
    Why does a criticism of Alternative medicine automatically mean that you will not criticise the pharmaceutical industry? Or that you unquestioningly support the pharmaceutical industry?

    I don’t know this particular MD, but the well known Ben Goldacre, often gets accused of being in league with Big Pharma, despite the fact that his book “Bad Science” gives equal space to the evil practices of the pharmaceutical industry and makes the point also made by this MD that the big drug companies are busy taking over the profitable alternative medical companies.

    Hell, there is even an alternative medical apologist who works for an alternative medical company who has accused Ben Goldacre of being in cohoots with Big Pharma whose own company is 30% owned by a large pharmaceutical company!

  82. Fifi says:

    BillyJoe – “Why not? Why does a criticism of Alternative medicine automatically mean that you will not criticise the pharmaceutical industry? Or that you unquestioningly support the pharmaceutical industry?”

    Funny how some people can only see things in black and white, it’s a hallmark of being an ideologue and close minded. Apparently a lot of people don’t actually understand that medicine and science are used and often abused by various industries – from Big Pharma to Big sCAM – but aren’t actually those industries. And many people don’t understand that by promoting ideology over actual science they’re merely being industry propagandists. It’s a great way for both industries (which are often the same industry, as you so accurately point out) to pretend that they’re not both out to destroy science done in the public good because it gets in the way of them selling their products. The irony of astroturf activists screaming about the evils of industry while promoting Big sCAM or pseudoskeptics pretending they’re promoting science when they’re defending Big Pharma seems to be lost on many. I suspect a lot of people believe critical thinking or being skeptical is about being against something and not actually trying to figure out the reality of what is. Both Big sCAM and Big Pharma have been waging an all out war on reality-based thinking and have been actively promoting pseudoscience, one of their most effective tactics has been pretending they’re at war with each other and not both trying to destroy good science because it is what allows people to actually make a choice based on the best evidence available. True freedom of choice regarding healthcare requires good science so we can all make choices based on reality and not marketing propaganda.

  83. Fifi says:

    Taken in the context of Dr Tuteur’s recent intentionally inflammatory post on circumcision and her obviously ideological and not SBM approach in that matter, her apologist approach to industry and conflating of Big sCAM “toxins” with the very real and well documented dumping of toxic waste by industry in this post indicates that Dr Tuteur is not actually a defender of good science or reality-based thinking.

    This is a very good little video about industry promoted pseudoscience and how it relates to global warming (which may seem off topic but many of the same people involved in global warming denialism were also involved in promoting Big Tobacco’s interests against the public interest, and global warming is also a public health issue).

    http://www.youtube.com/watch?v=Py2XVILHUjQ

    Dr Tuteur really is doing damage to the credibility of SBM (both this blogging collective and in terms of being an obvious ideologue who abuses science rather than defending SBM). Really, she’s part of the problem and not part of the solution!

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