The old corruption in medicine relied on envelopes of cash and luxury junkets. The new version builds careers, shapes institutions, and influences medicine from within.
Agree—they’re hugely influential. I think my focus here was really on doctors themselves—how the old-fashioned model of direct payments has evolved into funding the medical institutions that shape their careers, education and clinical practice.
Agree totally and I have seen it evolve from when I was in medical school in the late 1980s. You are correct in their early influence on the medical profession. But why stick with just medical professionals when you can talk directly to the people?
The advent of DTC (Direct to Consumer) advertising proved BigHarma could have an even greater influence. Their money bought all the talking heads everyone sees/reads and hears daily. And who was it that allowed DTC advertising for BigHarma? It was the Politicians, so maybe someone should see whether their $$ influenced the politicians to allow them the DTC which has not helped healthcare professionals one bit.
I was an eyewitness to the Pharma takeover of medicine. Full confession, I was a "key opinion leader (KOL)" for several Pharma companies early in my career and gave paid lectures. I wised up after seeing first hand how corrupt and antiscientific they were.
Back then, bribes were common but not hugely effective for the simple reason that most private physicians were financially independent and weren't easily bought. They were intellectually independent as well and could decide for themselves which drugs had merit. Over time, doctors lost financial control by acceding to direct third party payment and surrendering their ability to balance bill wealthier patients. Gradually, a free steak dinner gained more clout!
What really pushed the process along was the widespread acceptance of the pseudoscientific cult of "evidence-based medicine." Its arbitrary "hierarchy of evidence" promoted the randomized controlled trial (RCT) and trivialized other valid forms of scientific inquiry, basic medical science, and physicians' accumulated clinical experience. Pharma was handed a near-monopoly on production of RCTs, the dominant and now the only acceptable form of "evidence." They then pulled together panels of their KOLs to create "clinical practice guidelines" which then morphed into standardized care: One-size-fits-all, and drugs for everything! While there may be useful information in some guidelines, their main purpose is marketing. As the practice of medicine became more corporatized and centralized, guidelines became rigid standards that tyrannized doctors and patients, coercing them to give and take unneeded medicines and toxic shots.
I was an early foe of practice guidelines; I wrote articles and participated in many debates. Sadly, though I easily won all the debates, the guideline locomotive only gathered steam and completely took over clinical medicine, destroying in its path creative thinking, clinical reasoning, and personalized care. Medical students are no longer being taught scientific, individualized medicine. They are taught to follow guidelines.
You have correctly described our present-day dystopian medical-pharmaceutical complex. Any and all liberal or moderate proposals for change are literally useless. Only deep and transformational change will enable survival. Anything else will just feed the monster in the room.
Nice but you left out two even bigger and more Influential Industries BigHarma has captured.
1- Politicians via campaign financing contributions
2- Traditional media via advertising dollars
People hear more from those two than the medical establishment.
Agree—they’re hugely influential. I think my focus here was really on doctors themselves—how the old-fashioned model of direct payments has evolved into funding the medical institutions that shape their careers, education and clinical practice.
Agree totally and I have seen it evolve from when I was in medical school in the late 1980s. You are correct in their early influence on the medical profession. But why stick with just medical professionals when you can talk directly to the people?
The advent of DTC (Direct to Consumer) advertising proved BigHarma could have an even greater influence. Their money bought all the talking heads everyone sees/reads and hears daily. And who was it that allowed DTC advertising for BigHarma? It was the Politicians, so maybe someone should see whether their $$ influenced the politicians to allow them the DTC which has not helped healthcare professionals one bit.
Indeed, entire books have been written about how the system has been rorted.
And you saw it in spades during COVID.
ROTTEN - To The Core 🪱
I was an eyewitness to the Pharma takeover of medicine. Full confession, I was a "key opinion leader (KOL)" for several Pharma companies early in my career and gave paid lectures. I wised up after seeing first hand how corrupt and antiscientific they were.
Back then, bribes were common but not hugely effective for the simple reason that most private physicians were financially independent and weren't easily bought. They were intellectually independent as well and could decide for themselves which drugs had merit. Over time, doctors lost financial control by acceding to direct third party payment and surrendering their ability to balance bill wealthier patients. Gradually, a free steak dinner gained more clout!
What really pushed the process along was the widespread acceptance of the pseudoscientific cult of "evidence-based medicine." Its arbitrary "hierarchy of evidence" promoted the randomized controlled trial (RCT) and trivialized other valid forms of scientific inquiry, basic medical science, and physicians' accumulated clinical experience. Pharma was handed a near-monopoly on production of RCTs, the dominant and now the only acceptable form of "evidence." They then pulled together panels of their KOLs to create "clinical practice guidelines" which then morphed into standardized care: One-size-fits-all, and drugs for everything! While there may be useful information in some guidelines, their main purpose is marketing. As the practice of medicine became more corporatized and centralized, guidelines became rigid standards that tyrannized doctors and patients, coercing them to give and take unneeded medicines and toxic shots.
I was an early foe of practice guidelines; I wrote articles and participated in many debates. Sadly, though I easily won all the debates, the guideline locomotive only gathered steam and completely took over clinical medicine, destroying in its path creative thinking, clinical reasoning, and personalized care. Medical students are no longer being taught scientific, individualized medicine. They are taught to follow guidelines.
Here are two posts on the topic: https://richardamerlingmd437332.substack.com/p/guidelines-have-done-more-harm-than
https://richardamerlingmd437332.substack.com/p/the-destruction-of-american-medicine
Great insight
You have correctly described our present-day dystopian medical-pharmaceutical complex. Any and all liberal or moderate proposals for change are literally useless. Only deep and transformational change will enable survival. Anything else will just feed the monster in the room.