All posts by Brian Martin

Brian Martin is professor of social sciences at the University of Wollongong, Australia, and vice president of Whistleblowers Australia. He is the author of a dozen books and hundreds of articles on dissent, nonviolence, scientific controversies, democracy, information issues, education and other topics.

Pharmacrime and what to do about it

Is the pharmaceutical industry more dangerous than the mafia? Peter Gøtzsche thinks so.

PeterGotzschePeter Gøtzsche

Did you know that the third leading cause of death in western countries, after heart disease and cancer, is adverse reactions to prescription drugs? Did you know that large pharmaceutical companies usually control the trials of their new drugs, and sometimes manipulate the published results by misclassifying deaths, excluding some participants and not revealing studies that came up with null results? Did you know that some of people listed as authors of drug studies published in leading medical journals have had little or nothing to do with the research, have not written the papers, and are paid for their symbolic role? Did you know that several major pharmaceutical companies have paid fines of over one billion dollars for corrupt practice? Did you know that government drug regulators in several countries have become tools of the companies they are supposed to regulate? Did you know that hundreds of thousands of people have died from drugs when the company executives knew about and hid information about the hazards?

This information has been known to critics of large pharmaceutical companies — commonly called big pharma — for many years. There have been powerful critiques written by former editors of medical journals and as well as exposés by whistleblowers. Now there is a new book that puts together the case against big pharma in a more comprehensive and hard-hitting way than ever before: Peter C Gøtzsche’s Deadly Medicines and Organised Crime: How Big Pharma Has Corrupted Healthcare (London: Radcliffe, 2013).

DeadlyMedicines

The bulk of the book is a critical examination of research findings concerning pharmaceutical drugs, serving to illustrate general points. For example, chapter 4 is titled “Very few patients benefit from the drugs they take,” seemingly a startling claim. Gøtzsche gives some hypothetical examples of how results of drug testing might sound encouraging but actually disguise a very modest effect, and how double-blind trials that are not properly blinded can give misleading results. He then cites studies of antidepressants to show that the actual situation is probably worse than his hypothetical examples.

Different chapters in the book deal with conflicts of interest, pharmaceutical company payments to physicians, drug marketing operations, ghostwriting of articles for medical journals and the inadequacy of drug regulators, among other topics. Each of these chapters includes case studies of particular drugs or company operations. Then come chapters about particular drugs, abuses and companies, for example chapter 14 on “Fraudulent celecoxib trial and other lies.” Gøtzsche exposes corrupt practices, including the hiding of trials that did not show a benefit, disguising adverse drug reactions, promoting a new highly expensive drug that is no better than an existing one, making false statements about the benefits and risks of drugs, applying pressure on drug regulators, and suppressing information about dangerous drugs on the market.

Gøtzsche relies heavily on published studies (including his own) to back up his claims: the book is thoroughly referenced, with numerous citations to articles in medical journals. Deadly Medicines and Organised Crime is in the tradition of rigorous and knowledgeable exposé. Some previous books along the same line include Marcia Angell’s The Truth about the Drug Companies and Jerome Kassirer’s On the Take. Angell and Kassirer had been editors of the prestigious New England Journal of Medicine.

Gøtzsche has impeccable credentials to write a critique of big pharma. He started his career working for a drug company, and saw dubious operations from the inside. He qualified as a doctor and then worked as a medical researcher for many years. Most importantly, he is a key figure in the Cochrane Collaboration, a group of medical researchers who scrutinise the full complement of studies of particular drugs, drawing conclusions about benefits and risks.

Undertaking a meta-analysis of drug trials seems like an obvious thing to do. What makes the Cochrane Collaboration significant is that it is largely independent of the drug industry. The industry’s influence is so pervasive that many trials are fraudulent or misrepresented, many publications are ghostwritten by company staff, and evaluations by drug regulators are biased due to company pressure. Being relatively independent of this influence makes an enormous difference.

As well as obtaining insights from his involvement with the Cochrane Collaboration, Gøtzsche has had personal involvement in trying to influence drug policy. Being from Denmark, on various occasions he has provided information to the Danish drug regulator on crucial issues, such as that a new drug is far more expensive than an existing one, but no more effective. Yet the regulator on many occasions has served drug company agendas by approving drugs, costing the government large sums of money and providing no added benefit to patients.

Here is Gøtzsche’s summary of problems with drug regulation.

We don’t have safe drugs. The drug industry more or less controls itself; our politicians have weakened the regulatory demands over the years, as they think more about money than patient safety; there are conflicts of interest at drug agencies; the system builds on trust although we know the industry lies to us; and when problems arise, the agencies use fake fixes although they know they won’t work. (p. 107)

In describing the unethical and damaging activities of the drug industry, with case after case of egregious behaviour, Gøtzsche sometimes expresses his exasperation. This comes across most strongly in the chapters on psychiatric drugs, many of which are useless or worse, cause addiction and massive damage, yet are widely prescribed due to massive marketing.

Gøtzsche’s book is filled with information and thoroughly referenced, yet perhaps its most striking feature is his claim that big pharma is organised crime, as indicated in the title. At first this may sound exaggerated, or just a metaphor, but Gøtzsche is quite serious. He looks at definitions of organised crime and finds that big pharma fits in all respects: the companies knowingly undertake illegal actions that bring them huge profits and kill people, and they persist in the same behaviour even after having been convicted of criminal activity.

At many points, Gøtzsche asks rhetorically what is the difference between the activities of big pharma in promoting addictive and destructive drugs and the activities of drug cartels producing and selling heroin.

organised-crime-cartoon

Calling big pharma organised crime is in a tradition of pointing to double standards in the way behaviour is labelled. The term “terrorism” is usually applied to violent acts by small non-state groups; some scholars have pointed out that many governments use violence to intimidate populations in way that fits the usual definitions of terrorism. They call this “state terrorism.”

If the operations of big pharma are a type of organised crime, except killing many more people than the mafia, what is to be done? Gøtzsche has a chapter spelling out ways to bring drug testing and regulation under control. One important step is for all drug testing to be done by independent scientists, rather than by the companies that manufacture the drugs. Another is to disallow payments from drug companies to physicians, researchers, medical journals, and regulators. Gøtzsche draws an analogy: what would people think if judges received payments from prosecutors or defendants? It would be seen as corrupt, of course. Company payments to physicians, journals and regulators should be seen as corrupt too.

doctorPayment176

Gøtzsche’s recommendations are sensible and, if implemented, would transform the way drugs are used in society. If this happened, company profits would plummet, which means that companies will do everything possible to maintain the current system. As well as saying what should be done, there is a need for a strategy for bringing about change, and the strategy has to involve citizen campaigners as well as concerned researchers and physicians. Just as the movement against smoking has involved a wide range of campaigners and methods of action, so too must a movement against corruption in healthcare. Deadly Medicines and Organised Crime is not a practical manual for such a movement, but it is essential reading for movement activists, especially so they will know what they are up against.

For readers thinking about their own health, and the health of their friends and family members, Gøtzsche provides important messages. He suggests not taking any drug unless it is absolutely necessary, because benefits are minimal and there are always potential harms. In this category would be included antidepressants and drugs to lower cholesterol and high blood pressure, for example. If you’re going to take a drug, then it’s usually better to take an old one, because newer ones are probably no better, cost vastly more, and are less well tested for harms.

olderisbetter

If you want to know more about the drugs you take, seek independent advice. That’s not easy, because so many researchers, medical journals, physicians and regulators are in the pay of the industry. Reviews by members of the Cochrane Collaboration are a good place to start. So is Deadly Medicines and Organised Crime. Gøtzsche provides enough references for even the most assiduous reader.

Brian Martin
bmartin@uow.edu.au

 

I thank Melissa Raven for useful comments on a draft of this comment.

Learning from Snowden

A review and commentary on Luke Harding’s book The Snowden Files, with special attention to implications for leaking and whistleblowing

Snowden I want you cropped
In June 2013, spectacular revelations were reported in the news. A secretive US organisation, the National Security Agency, was carrying out extensive spying on people’s electronic communications. This spying was massive. The NSA, according to reports, was collecting just about everything imaginable: emails, phone calls, texts, you name it – from everyone around the world.

The revelations continued for weeks and months. The NSA was spying on US citizens in the US, apparently in violation of the law. It was also spying on foreign leaders. For example, there were reports that the NSA had monitored the personal mobile phone of Germany’s chancellor Angela Merkel, and the phones of many other political leaders.

The stories were broken by the Guardian, a well-known British newspaper and media group. The Guardian‘sinformation came from an NSA insider who had leaked vast amounts of NSA top-secret material. This was unheard of. The NSA did not have leaks.

Several days later, the leaker went public. He was Edward Snowden, a 29-year old NSA contractor who looked even younger than his age, and he was in Hong Kong.

Snowden said he had released the material because it showed the US government was carrying out massive surveillance, and that this needed to be exposed. He seemed to be sincere.

US government officials were furious. Snowden became a wanted man, and the full power of the US government was deployed in an attempt to arrest him.

If you’ve read Robert Ludlum’s novels about Jason Bourne, or seen the films based on them, starting with The Bourne Identity, you’ll have an idea of how surveillance capacities might be used to track down a rogue agent. Something similar happened in Snowden’s case, but this time in reality rather than fiction. The US government pulled out all stops, not to assassinate Snowden, but to arrest him.

The Snowden files

If you followed the Snowden revelations via news reports, like me, some of the basic points will be clear but how it all hangs together may not be so obvious. For a broader perspective, I recommend Luke Harding’s new book The Snowden Files: The Inside Story of the World’s Most Wanted Man (London: Guardian Books, 2014). Harding is a journalist for the Guardian and has obtained first-hand information on key events. Just as importantly, Harding writes in an engaging fashion. Parts of the book read like a thriller.

Snowden Files

The Snowden Files covers Snowden’s early online presence, his patriotism, his work for the NSA, his gradual disillusionment due to observing dubious activities carried out in secret, his collection of NSA files and leaking of them to the Guardian, and his experiences as a fugitive. In between the Snowden narrative, Harding tells about the massive spying operations carried out by the NSA and its partners, especially its British equivalent GCHQ. He also tells how the media – especially the Guardian – handled the biggest leak in history in the face of implacable hostility from intelligence agencies and top politicians. Snowden was incredibly brave and shrewd, but so were quite a few others in the story.

Lessons for whistleblowers

Here I offer a few lessons for whistleblowers based on Snowden’s experiences. Although few whistleblowers reveal information warranting international headlines, every effort at speaking out in the public interest is important and hence worth doing as well as possible.

Leaking is revealing inside information, typically to media or sometimes to interested groups. A lot of leaks are from top politicians and bureaucrats. These leaks are everyday operations intended to manipulate public opinion for political or personal purposes.

However, when someone leaks information in the public interest, for example exposing corruption or dangers to the public, top managers typically treat this as a serious breach of trust. Leakers are often called traitors. The double standard is stark: it’s okay for bosses to leak but not for employees.

Whistleblowers are people, typically employees, who speak out in the public interest, and most of the time they reveal their identity immediately, such as when they report a problem to the boss or some internal body. Unfortunately, this is disastrous much of the time: the whistleblowers are attacked – for example ostracised, denigrated, reprimanded, sometimes dismissed – and furthermore their access to information is blocked. As soon as their identity becomes known, they have limited opportunities to collect more information about wrongdoing.

For these reasons, it is often advantageous for whistleblowers to remain anonymous, and to leak information to outside groups, especially to journalists or action groups. The leaking option reduces the risk of reprisals and enables the leaker to remain in the job, gathering information and potentially leaking again. Furthermore, stories based on leaks are more likely to focus on the information, not the leaker.

snowden wbs are heroes

Lesson 1: be incredibly careful

Snowden leaked the most top-secret information of anyone in history, but it wasn’t easy. The lesson from his experiences is that to be a successful leaker, you must be both knowledgeable and incredibly careful. Snowden had developed exceptional computer skills. He was leaking information about state surveillance, and he knew the potential for monitoring conversations and communication. He took extraordinary care in gathering NSA documents and in releasing them. When he contacted journalists, he used secure email. When meeting them, he went to extreme lengths to screen their equipment for surveillance devices. For example, before speaking to journalists, he had them put their phones in a freezer, because the phones might contain monitoring devices.

Few whistleblowers need to take precautions to the level that Snowden did: his enemies were far more determined and technically sophisticated than a typical whistleblower’s employer. Nevertheless, it is worth learning from Snowden’s caution: be incredibly careful.

Lesson 2: choose recipients carefully

Snowden considered potential recipients for his leaks very carefully. He wanted journalists and editors who would treat his disclosures seriously and have the determination to publish them in the face of displeasure by the US government. He decided not to approach US media, which usually are too acquiescent to the government. US media have broken some big stories, but sometimes only after fear of losing a scoop. The story of the My Lai massacre, when US troops killed hundreds of Vietnamese civilians during the Indochina war, was offered to major newspapers and television networks, but they were not interested. In 2004, US television channel CBS initially held back the story about abuse and torture of Iraqi prisoners by US prison guards at Abu Ghraib prison, at the request of the Pentagon, finally going to air because the story was about to be broken in print.

new-york-times-building-380x285Snowden didn’t approach the New York Times

Snowden decided instead to approach the Guardian, a British media group with a history of publishing stories in the public interest, despite government displeasure. It was a wise choice.

Lesson 3: be persistent

Snowden decided to approach the Guardian, and not just anyone: in late 2012 he contacted the Guardian‘s freelance columnist Glenn Greenwald, noted for his outspoken stands critical of US government abuses, especially surveillance. Snowden sent Greenwald an anonymous email, offering disclosures and asking Greenwald to install encryption software. However, Greenwald – resident in Brazil – was busy with other projects and didn’t get around to it. So Snowden created a video primer for installing the software just to encourage Greenwald to use it. However, even this wasn’t enough to prod the busy Greenwald to act.

Snowden didn’t give up. In January 2013, he next contacted Greenwald’s friend and collaborator Laura Poitras – a fierce critic of the US security state, and a victim of it – who he thought would be interested herself and who would get Greenwald involved. It worked.

Snowden+Guardian

The lesson is to be persistent in seeking the right outlet for leaks – and to be careful and patient along the way.

Lesson 4: improve communication skills

Snowden is a quiet, unassuming sort of person. He might be called a nerd. Contrary to some of his detractors, it was not his desire to become a public figure. Despite his retiring nature, Snowden knew what he wanted to say. He refined his key ideas so he could be quite clear when speaking and writing, and he stuck to his message.

Most whistleblowers need good communication skills to be able to get their message across. (In a few cases, leaking documents without commentary might be sufficient.) My usual advice is to write a short summary of the issues, but this isn’t easy, especially when you are very close to the events. Being able to speak well can be just as important, if you have telephone or face-to-face contact with journalists or allies. Many people will judge your credibility by how convincing you sound in speech and writing. Practice is vital, as is feedback on how to improve.

Lesson 5: make contingency plans

Snowden thought carefully what he wanted to achieve and how he was going to go about it. Initially he leaked selected NSA files to journalists to pique their interest and demonstrate his bona fides. After all, who’s going to believe someone sending an email saying they can show the NSA is carrying out massive covert surveillance of citizens and political leaders? After establishing credibility, Snowden then arranged a face-to-face meeting, to hand over the NSA files and help explain them: many of the files were highly technical and not easy for non-specialists to understand.

After the initial stories in the Guardian and the ensuing media storm, Snowden knew that it would be impossible for him to remain in hiding. The US government would do everything possible, technically and politically, to find and arrest him. So Snowden decided to go public, namely to reveal his identity. This would help to add credibility to the revelations by attaching them to a human face.

He did not anticipate every subsequent development: it was not part of a plan to flee Hong Kong and end up in Russia. Even so, Snowden anticipated more of what happened than most whistleblowers, who are often caught unawares by reprisals and stunned by the failure of bosses to address their concerns and of watchdog agencies to be able to protect them.

The lesson from Snowden is to think through likely options, including worst case scenarios, and make plans accordingly.

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Is this your escape plan?

Lesson 6: be prepared for the consequences

Snowden knew that leaking NSA documents would make him a wanted man. He was prepared for the worst scenario, arrest and lengthy imprisonment. He knew what he was sacrificing. Indeed, he had left his long-time girlfriend in Hawaii, knowing he might never see her again. He made his decision and followed it through.

So far, Snowden has avoided the worst outcomes, from his point of view. He might have ended up in prison, without access to computers (his greatest fear), perhaps even tortured like military whistleblower Chelsea Manning. Still, living in Russia – an authoritarian state, where free speech is precarious – is hardly paradise. Snowden is paying a huge price for his courageous actions. He knew he would, and he remains committed to his beliefs.

Whistleblowers seldom appreciate the venom with which their disclosures will be received. It is hard to grasp that your career might be destroyed, and perhaps also your finances, health and relationships. It is best to be prepared for the worst, just in case. Being prepared often makes the difference between collapsing under the strain and surviving or even thriving in new circumstances.

***

Reprisals are only partly directed at the whistleblower. The more important audience is other employees, who receive the message that speaking out leads to disastrous consequences.

Snowden has provided a different, somewhat more optimistic message. He has shown that the NSA is not invincible: its crimes can be exposed. He has shown that careful preparation and wise choices can maximise the impact of disclosures. He has stood up in the face of the US government, and continued unbowed. Although few whistleblowers will ever have an opportunity like Snowden, or take risks like he has, there is much to learn from his experiences.

Brian Martin, bmartin@uow.edu.au

This post is reproduced from the July issue of The Whistle.